30 M POST RENAL TRANSPLANT

 Here is the story of our 30 M ,who was suffering with ESRD for about 2 years and was intubated and extubated twice . He was planned for  live renal transplantation  with donor being his mother . He underwent renal transplantation on 16/4/21 .

 

PRE-REQUISITES FOR RECIEPIENT EVALUATION :

Lymphocyte cross match 4%​

CT renal angiogram ​

Psychiatry opinion

Upper GI endoscopy​

Cardiology opinion​

Pulmonology opinion (previous Koch)​

HRCT​

RT-PCR for COVID 19​

Blood grouping ​

Booster dose of Hep B vaccine​

Flu vaccine & pneumococcal vaccine ​

CMV – IgG & IgM​

Throat & nasal swab cultures ​

ESR , Sr.amylase & lipase​

COVID vaccine​

 Blood & urine culture and sensitivity ​

MCUG​

DOPPLER for pelvic vessels​

Blood reserve​ and cross matching

INITIAL CROSS MATCH REPORT : ON 16/2/21 - negative. 

              DONOR PRE REQUISITES :

All routine investigations             

Cardiac fitness 

DTPA scan .

Covid vaccination - 2 doses .

Pt is on regular hemodialysis three times weekly with strict hypertension control and on INJ ERYTHROPOIETIN 4000 S/C weekly once.

Lymphocyte cross match was repeated on 12/4/21 which was negative. 

Mycophenolate moefitil (MMF) 500 mg was started at 8 pm 

On 15/4/21 : 

Pt was taken for one session of hemodialysis .

Post dialysis all routine investigation were repeated.

Inj Taxim 1 g IV BD was given

Tab MMF 500 mg BD continued.

Cross matching was sent to blood bank .

Antihypertensives were continued. 

On 16/4/22 : Day of surgery 

@ 3am - ATG 25 mg infusion slowly over one hour ,was given 4 hours prior to surgery      

-Inj Hydrocortisone 100 mg IV STAT 

INJ AVIL IV STAT 

INJ PCM  1gm IV STAT given 

Surgery was continued for upto 7 hours , after starting at 8 :30 Am .

Inj methyl prednisolone 1g was given during surgery ,just prior to release of clamp of recipient renal artery .

After surgery planned to give :

1) Tab MMF 750 MG BD 

2) IV FLUIDS -NS/RL - OUTPUT PLUS 50 ML/HR

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