Nephrology

412 Recipient management for live donor transplant

  • Recipient management for live donor transplant

    Assessment process

     

    • Transplant education of patient and family (Kidney transplant coordinator) - discuss options for transplantation
    • Social Work assessment
    • Blood Group (confirm compatibility with potential donor/s)
    • Tissue typing and Crossmatch (x2 at least 2 weeks apart)
    • Send 'Patients Accepted for Renal Transplatation' (Front sheet) to VTIS with recipient and donor blood groups.
    • Viral Serology (Hep B, Hep C, Hep A, HIV, Varicella, CMV, EBV, measles, mumps,rubella, TB quantiferon)
    • Assessment by SaefVic clinic (Tuesday mornings)
    • Cardiology Assessment (including Echo,ECG)
    • Dental Assessment
    • Audiology if requested
    • Dietician Assessment
    • Opthalmology Assessment if required
    • Paediatric urology assessment if required (discuss patient with Urologist - Mr Mike OBrien or Prof Yves Heloury)
    • Assessment by transplant surgeons (Austin and RCH) 
    • Patients who have involvement with other department to be 'cleared' for transplantation. ie other assessments, treatments, surgery may need to be completed prior eg gastroenterology, orthopaedics.

    12  Weeks Prior to Planned Operation

    • Ensure all assessments/ treatments (above) have been completed (including live vaccines - MMR, Varicella) 
    • Consultant interview completed
    • Transplant date selected after approval at Transplant planning meeting.
    • Preadmission day organised by Transplant Coordinator and the family notified (see below for assessments). 
    • Book final x-match
    • Organise Admission:
      • Send booking form
      • Book imaging
      • Organise blood slips
      • Notify Pharmacy, ICU liason, Koala ward

    4-6 Weeks Prior to Operation

    • Consultant checks with Renal Transplant Coordinator that all arrangements are complete (including preadmission and admission for transplant operation).
    • Consultant and Coordinator generate Transplant plan document and send out to all appropriate parties. 

    Preadmission (7-10 Days Prior) 

    The patient is admitted for a few hours for the following procedures.(Transplant Coordinator to organise)

    • The "final crossmatch" - >30kg:30 mls ACD blood from donor and 30 mls ACD blood and 10 mls clotted blood from recipient, <30kg: 10 mls ACD blood and 5 mls clotted blood. This is usually carried out 7 days and no more than 10 days before operation is scheduled and must be at least 3 weeks, following latest blood transfusion.
    • Pre-Tx Medical Assessment for recipient including Ht, Wt, FBE, U+E, Cr, Ca, P, Proteins, LFT, MSU , PT, PTT, Gluc.  Pregnancy test for females of child bearing potential
    • Repeat CMV/EBV serology if previously negative for both donor and recipient
    • MRSA screen - nose / throat / groin / axilla
    • Swab Tenchkhoff catheter exit site or permcath exit site if present
    • Introduce to pain nurse consultant
    • Introduce to physiotherapist
    • Anaesthetic review
    • Dispense Tacrolimus, Mycophenolate Mofetil and give instructions to commence 3 days before surgery
    • Medical assessment (Nephrology Fellow)
    • Education regarding admission

    3 Days Pre-Op (Monday)

    Recipient to commence oral immunosuppression with Tacrolimus, and Mycophenolate Mofetil.

    Suggested Doses

    Mycophenolate Mofetil

    400mg/m2 bd

    Tacrolimus

    0.1 mg/kg/d