Nephrology

411 Work-Up Live and Deceased Donor

  • Work-Up (Live and Deceased Donor)

    Preliminary Management All Patients On Transplant List

    The following procedures/tests are necessary prior to placing a patient on the Deceased donor list or confirming a date for Live donor transplant.

    Blood group

    Blood group must be confirmed for all recipients and donors. 

    A copy of the recipient and donor's blood group report must go to VTIS.  Report must have visible NATA accreditation (ie: not a print out from clara, can be obtained from blood bank). 

    If a recipient is blood group incompatible ABO titres may be requested.  This test is sent to The Royal Melbourne Hospital where they will complete a Diamed and Ortho test.  The minimum volume required is 2-3 ml Neutral (plain) tube and 7ml (large tube) EDTA.  If this test is against a specific donor the donor will also need to provide samples. For information call RMH haematology laboratory. 

    VTIS (Victorian Transplantation and Immunogenetics Service)

    Tissue typing

    The tests need to be booked with VTIS (Red Cross - phone 9694 0354).  VTIS request form to accompany all blood samples sent to VTIS. 

    Blood is to be sent to VTIS via RCH Hospital courier and needs to be received by RCH laboratory before 10.00am if tests are to be carried out on the same day.  If blood is collected later in the day, it can be stored overnight at room temperature and should be booked for the following day.  The initial tests need to be repeated by confirming tests at least 2 weeks later.

    Deceased Donor Transplantation

     Initial crossmatch & Tissue type 30ml ACD & 10ml clotted blood
    (Paediatric - 5ml ACD and 5ml clotted)
     
    Initial tests

    Class I typing

    Class II typing
    Autoantibody Crossmatch

    Confirmatory Tests  

    Class I typing

    Class II typing

    Cytotoxic antibodies

    Monthly sample to VTIS (10 ml serum gel tube)

    Living Related Transplantation

    It is preferable to receive patient and donor samples on the same day.  

    • Patient 30 ml ACD & 10 ml clotted blood
    • Paediatric  10 ml ACD & 5 ml clotted
    • Infants 5ml ACD 1ml clotted
    • Donor 30 ml ACD blood (4 tubes)
     Initial test Class I typings by serology (patient & donor)
    Class II typings by serology (patient & donor)
    Autoantibody crossmatch (T & B cells)
    Alloantibody crossmatch (T & B cells)
    Extract DNA (patient & donor)
    DR typings by DNA method

    Confirmatory Tests

    Repeat Class I typing by serology (patient)
    Repeat Class I typing by serology (donor, if previous result as unsatisfactory)
    Repeat Autoantibody crossmatch (T & B cells)
    Repeat Alloantibody crossmatch (T & B cells)
    Repeat Extract DNA (patient & donor)

    If a flow crossmatch is required it must also be mentioned at time of booking and an extra 10mls (ACD) from the donor.

     

    Final Crossmatch Test

    The final crossmatch is carried out 6 to 10 days prior to transplantation

    Autoantibody crossmatch (T & B cells)
    Alloantibody crossmatch (T & B cells)

    It is essential to repeat the crossmatch at least one month after any blood transfusion.  All crossmatches need to be booked with VTIS  by phoning: 9694 0354.

     

    Viral Serology

    Serology screening

    • Hep Bs Ag
    • Hep B antibody
    • Hep A antibody
    • Hep C antibody
    • HIV antibody
    • CMV Antibody
    • EBV Antibody
    • Varicella antibody
    • TB quantiferon gold
    • Measles Antibody
    • Mumps Antibody
    • Rubella Antibody

    All Serology to be repeated annually.  CMV serology and EBV serology to be repeated every 6 months for patients active on the deceased donor list.  These results are recorded on the RCH Kidney Transplant Checklist.  Renal Transplant Coordinator to organise. 

    Immunisation

    • All patients to attend Saefvic Immunisation clinic (Tuesday mornings) for advice re pre transplant vaccinations.
    • Patients should be referred by the Renal Transplant Coordinator when the patient is at CKD stage 4.
    • All live vaccines are to be completed prior to transplantation.

    Dental assessment

    • All patients are required to undergo a dental assessment.
    • +\- treatment prior to transplantation.
    • Renal Transplant Coordinator to organise.

    Cardiology

    • All patients are required to undergo a Cardiology assessment.
    • Ongoing review if required. 
    • Renal Transplant Coordinator to organise. 

    Psycho-Social 

    • Introduce to Renal Transplant Coordinator. 
    • Provide transplant parent education booklet.
    • Arrange Social Work referral

    Audiology

    • As requested by Consultant Nephrologist.

    Urological Assessment

    • All patients will be discussed with the RCH urologists who will advise re urological assessment requirements.
    • Cystoscopy +/- CMG if requested.

    Surgical Assessment

    • All recipients are required to attend the Transplant Planning Clinic (surgical assessment) with the Austin and RCH transplant surgeons. 
    • This clinic is held once per month on a Monday afternoon. 
    • Each patient will be reviewed annually if not transplanted within that timeframe. 

    Other

    Patients that have involvement with other specialties should have clearance for transplant by that department, ie: orthopaedics, gastroenterology, respiratory etc.

    Consultant Interview

    All patients are required to attend a Consultant Nephrologist interview.  This is a comprehensive discussion which identifies that the transplant education is complete and patients/parents understand the procedure, risks and benefits and ongoing care requirements (including medications, clinics etc) for renal transplantation. 

    Allocation of living donor transplantation dates

    Transplant dates will be allocated once all assessment requirements are complete. 

    Transplant dates are selected for patients at the Transplant planning meeting which is held on the fourth Monday of each month.

    Deceased Donor List Activation

    Patients will be made active on the Deceased Donor list once:

    All the assessment requirements are complete

    Confirmed for listing by the Renal Transplant Team

    A transplant plan must be sent out to all the appropriate parties

    CYT samples available at VTIS - please note that for a patient to be made active in particular month they must be on the 'trays' for that month.  In order to do this VTIS must be notified by the last week of the month that the patient is to be added to the trays and a sample must be available.  The patient will then be active once the trays are complete ( usually within the first week of the month).