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Home » Surgical Notes » Clinical » The Trunk » Abdominal Examination

Transplanted Kidney

Approach

  • As for abdominal examination

 

  • Signs of anaemia (pale palmar creases, pale conjunctivae)

  • Scar over wrist (site of Bresica-Cimino AV fistula)
  • Signs of steroid use - bruising, thin skin
  • Swelling in RIF or LIF if combined kidney-pancreas transplant
  • Specific scar over RIF (curved inguinal incision used to perform transplant - Rutherford-Morrison)

  • Presence of previous nephrectomy scars and points of access of old dialysis catheters
  • Perma-cath / porta-cath / tunnelled-lines

  • Collar incision (for parathyroidectomy; hyperparathyroidism is a common complication of chronic kidney disease, vitamin D deficiency from failure of 1-OH-lation)

 

 

  • Mass in iliac fossa - superficial, well defined as transplanted kidney placed outside peritoneum (covered only by external and internal oblique and transversus abdominis muscles
  • Should only be palpated very lightly

 

 

 

 

Renal transplantation

Indication = End stage renal failure

  • DM
  • Hypertensive renal disease
  • Glomerulonephritis
  • Polycystic kidney disease
  • Congenitally small kidneys

 

Matching of kidneys

  • ABO compatability
  • HLA compatability - HLA DR has greatest importance, hen HLA-B

 

Anastamoses performed in renal transplantation

  • Renal artery (with Carrel patch from aorta) anastamosed to either internal or external iliac artery
  • Renal vein to external iliac vein
  • Ureter attached to bladder

 

 

Post-operative problems

  • Potential malignancies associated with immunosuppression (1) post-transplant lymphoproliferative disease (2) Skin cancer
  • Infections - CMV

Transplant rejection

  • Hyperacute: within hours of surgeyr: due to pre-formed antibodies in a sensitized patient
  • Accelerated acute: 1-4 days postoperatively due to a "secondary immune reposne" as a consequence of activation of T-memory cells
  • Acute: 5 days - 2 weeks: cell-mediated
  • Chronic: Humoural mechanisms more important

 

 

Features of transplant rejection

  • Tenderness over graft
  • Reduction in urine output
  • Rising Creatinine
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