
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.