Transplantation
HLA typing
Patients may become sensitised to HLA antigens by:
- Pregnancy
- Previous transplant
- Blood transfusion
Statistics
Demand in UK is >80 per million population. Transplant activity is 28 per million population.
Kidney graft survival t½:
- Cadaveric 9 years
- Living identical 23 years
- Living haploidentical 12 years
- Living unrelated 12 years
- Living spousal 14 years
Living Donor kidney transplantation
Advantages:
- Better outcome for recipient
- Lack of cadaveric donor organs
- optimal timing
Disadvantages:
- Mortality (0.03%)
- Morbidity (wound pain, hypertension, proteinuria)
- Inconvenience (>6/52 recovery period)
- Coercion (living unrelated needs to be approved by ULTRA)
- Untreatable condition found
Work-up (takes 3–6 months):
- ABO compatibility
- history & examination
- cross-match blood
- FBC, U&E, LFT
- urinalysis
- virology (EBV, CMV)
- radionucleotide scan
- renal angiography