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SW Transplant

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.


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