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Kidney Transplantation - Coggle Diagram

- - - - Wait time apprx 3 yr
      - Average kidney survival 14 yrs
      - Proscpecctive precipient evaluated and listed for transplant
    - - DCD - Deceased cardiac death
      - DBD - Deceased brain dead
  - - - Potential donors evaluated for suitability
      - If suitable donor - tranplant performed at suitable time
      - Average kidney survival 20 yrs
      - Proscpective recipient evaluated and listed for transplant
    - - LRD - Living Related Donor
      - LURD - Living Unrelated Donor
        
        Spouse
        Friend
        Altruistic
        Matching programs
- - - - eople who have given birth to children from more than one partner
      - Blood transfusion
- - - - Avoid sun
        Factor 50
        Hats long sleeves
- - - - PET
      - Rejection / allograft loss
      - HTN
    - - Tacrolimus
        
        Tolerated by featus
        
        Increased dose to maintain availability with increased binding proteins in pregnancy
      - Mycophenolate teratogenic 🕷️ → Switch to azathioprine
  - - - Epidmeiology
        
        21-73% of TxP have HTN during pregnancy vs 1-5% normal population
      - Target
        
        . <130/80
      - Acceptal Medication
        
        Methyldopa often 1️⃣Line
        
        Labetalol
        
        Nifedipine
        
        Hydralazine and thiazide diuretics used as adjuntiv agents
    - - Epidemiology
        
        High incidence
        
        Hard to diagnosis -proteinuria in this group
        
        Calcineurin inhibitors may cause high uric acid → False positive
      - Newer biomarkers
        
        Uric acid
        
        sFLT
        
        Soluble endoglin
        
        Yet to be evaluated
  - - - Parameters
        
        Normal BP
        
        Creatinine <125μmol/L
      - Epidemiology
        
        . >95% live births
        
        . > 75% appropriate gestational age
        
        Consistently improving outcomes
    - - Parameters
        
        Creatinine 125-250μmol/L
      - Epidemiology
        
        Poorer outcomes
        
        ~90% live births
        
        Incidence >50% PT, IUGR, Preterm delivery
        
        30% mothers experience deterioration of renal fx +/- accelerated HTN
    - - Parameters
        
        Creatinine >250 μmol/L
      - Epidemiology
        
        Maternal complcations more frequent
        
        Pregnancy success rates much poorer
        
        Number of pregnancies reported in pt with severe renal failure are few due to low fertility rates in this group
  - - - PET
      - Proteinuria (second half of pregnancy
  - - - No rejection episodes
      - Well controlled BP
      - Minimal / no proteinuria
      - Adequate allograf fx (Cr < 132μmol/L)
  - - - HTN
      - DM
      - Neurological abnormalities
      - Developmental delays
    - - Structural abnormalities - in utero mycophenolate exposure
      - Immunological anbd neurocognitive deficits
  - - - Detected at low levels in foetus
      - Metabolised effeciently by placenta
    - - Inosinate pyrophosphorylase probably lackingin foetal lover
    - - Detected in amniotic fluid, placenta, foetal tissure
      - Immunosuppressive properties in foetal blood
      - Deemed safe
    - - Most common antiprolifeative drug in immunosuppression regimens
      - Evidence of in utero malformation
      - C/i in pregnancy
    - - Avoided in pregnancy - little experience