IMMUNOSUPPRESSION AND REJECTION

• One of the two immunosuppressive protocols is utilized to control the immune response to the foreign renal graft. These include:
• Cyclosporin (Neoral), prednisone, mycophenolate mofetil (Cell Cept)
• FK506 (Prograf, Tacrolimus) and prednisone

COMPLICATIONS

• In the first few hours or days after renal transplantation, complications are commonly related to technical problems in establishing vascular and urinary tract continuity or the damage which occurs during donor nephrectomy or preservation.
• Arterial thrombosis occurs in less than I percent and venous thrombosis is even less common.
• Other causes of early arterial thrombosis include hyperacute or accelerated rejection, postoperative hypotension, hypercoagulable state, atherosclerosis of the donor or recipient vessels, trauma to the donor artery during recovery or subsequent preservation, disparity in vessels size during anastomosis, or dissection of a distal intimal flap.
• Acute anuria is suggestive of diagnosis and emergency exploration and thrombectomy are the only chance for salvage of the renal allograft.

Urinary Tract Complications
Diagnosis

• Analyses of fluid obtained from wound drains or needle aspirations, ultrasound, nuclear scans, cystograms, and antegrade pyelography are other helpful studies to confirm the anatomic diagnosis

Treatment

• Revision of the ureteroneocystostomy or ureteropyelostomy using the patient's own ureter

Acute Tubular Necrosis
Treatment

• Oliguria in the early transplant period should be treated with boluses of fluid for exclusion of hypovolemia. Although mild ATN per se does not significantly worsen the prognosis for eventual transplant success, the overall impact of ATN is an adverse one, primarily because it may interfere with the early diagnosis of rejection and delay antirejection therapy.

Infectious Complications
Treatment

• Prompt antibiotic therapy
• It is important to exclude the possibility of infection before antirejection therapy

References

Calligaro P, Modern Management of Renovascular Hypertension and Renal Salvage, Williams & Wilkins, 1996.

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Galanski M, Prokop M, Chavan A, et al: Renal artery stenosis: Sprial CT angiography. Radiology 189:185-192, 1993.

Martin LG, Price RB, Casarella WJ, et al: Percutaneous angioplasty in the clinical management of renovascular hypertension: Initial and long term results. Radiology 155:629, 1985.

Meier GH, Sumpio B, Black HR, Gusberg RJ; Captopril renal scintography. An advance in the detection and treatment of renovascular hypertension. J Vasc Surg 11:770-777, 1990.

Prince MR, Narasimham DL, Stanley JC, et al: Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 197:785, 1995.

Raynaud AC, Beyssen BM, Turmel-Rodrigues LE, et al. Renal artery stent placement: Immediate and midterm technical and clinical results. JVIR 5:849, 1994.

Strandnesss DE. Duplex scanning in diagnosis of renovascular hypertension. Surg Clin North Am 70:109-117, 1990.

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