Junior doctors preoperative responsibilities for recipients of renal transplants

History and examination

In particular enquire / examine:

Evidence of recent or ongoing infection

• History of night sweats, fevers, chills on dialysis etc.
• Be particularly vigilant in patients with indwelling lines
• Check line and CAPD exit sites
• Patients on CAPD should have PD fluid sent for culture
• Note history of diverticular disease and examine dentition

 Evidence of malignancy

• Recent weight loss, haemoptysis, change in bowel habit etc
• Up to date with cervical smears / breast exams etc
• Symptoms of bladder outlet obstruction in men prior to dialysis dependence

 Evidence of ischaemic heart disease

• Symptoms / risk factors for IHD
• Ensure recent exercise test / angiogr4am if symptomatic or diabetic

Document dry weight and native urine output

Preoperative investigations

U&E’s, glucose, liver and bone profiles, FBC, clotting screen
Viral antibodies: HBV, HCV, HIV, VDRL, CMV, EBV, CRP.
Group and Xmatch for 2 units
Direct Cross match (1 red top and 4 purple top tubes).

ECG and CXR
Send PD fluid for cell count and culture

Drugs

• Most pre-dialysis medication will be discontinued
• Discuss immunosuppressive medications with consultant on call
• Hold ACEI and ARB
• Ensure patient not on agents that enhance metabolism of steroids and CNI such as phenytoin, rifampicin
• Insulin sliding scale for diabetics

Discuss all care with consultant nephrologist on call.