Kidney Transplantation

BTS President, Lorna Marson, and the Chair of EKITA, Robert Langer: May 2018

Kidney Tranplantation General

0 CME Credits 

  • Role of Transplant Recipient Co-ordinator
  • Involvement of Recipient Transplant Coordinators in Transplant Outpatient Clinics in Japan: Current Status and Transplant Physician’s Thoughts on Follow-Up Clinics
  • Clinical Practice Guidelines
  • The effect of anastomosis time on outcome in recipients of kidneys donated after brain death
  • Osband et al 2015 American Journal of Transplantation
  • Center level variation in the development of DGF after deceased donor kidney transplantation
  • Preimplant histologic acute tubular necrosis and allograft outcome
  • A new quantitative index for baseline renal transplant scintigraphy in evaluation of DGF and prediction of 1 year function
  • Patel et al 2017 American Journal of Transplantation
  • Intrarenal Resistive Index after Transplantation
  • Abdominal Organ Retrieval and Transplantation Bench Surgery
  • Operative Techniques in Transplantation Surgery
  • Kidney Transplantation - Principles and Practice 7th Edition
  • Atlas of Organ Transplantation
  • Effectiveness and Harms of Using Kidneys with Small Renal Tumors from Deceased or Living Donors as a Source of Renal Transplantation: A Systematic Review
  • Tailored desensitization strategies in ABO blood group antibody incompatible renal transplantation
  • Annual report on living donor kidney transplantation
  • Difference in outcomes after antibody-mediated rejection between abo-incompatible and positive cross-match transplantations
  • Kidney exchange match rates in a large multicenter clearinghouse
  • Transplanting the highly sensitized patient: trials and tribulations
  • Post-listing survival for highly sensitised patients on the UK kidney transplant waiting list: a matched cohort analysis
  • Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors
  • Successful Expansion of the Living Donor Pool by Alternative Living Donation Programs
  • The use of eculizumab in renal transplantation
  • Three-Year Outcomes Following 1420 ABO-Incompatible Living-Donor Kidney Transplants Performed After ABO Antibody Reduction: Results From 101 Centers

Module 1: Pre-transplant Management

3 CME Credits 

Options for management of the patient with end stage renal failure (Rainer Oberbauer)
  • Options for Management of the Patient with End Stage Renal Failure
Assessment of the potential renal transplant recipient (Christophe Legendre)
  • Indications of kidney transplantation
  • Preparation for the potential and future recipient: information
  • Preparation for the potential and future recipient: medical interviews
  • Tests to be performed
  • Strategy and prognosis definition
Decision making in the high risk recipient (Christophe Legendre)
  • The high immunological risk patient
  • The patient at high risk of kidney disease recurrence
  • The patient a past history of cancer
The role of the renal recipient coordinator (Alison Glover)
  • Who is the renal recipient transplant coordinator?
  • The role of the renal recipient transplant coordinator
  • Transplant referral
  • Transplant assessment
  • Listing for transplant
  • Waiting list management
  • Role development for the renal recipient transplant coordinator
Communicating risk and consent (Lorna Marson)
  • Current challenges in communication
  • Understanding risk
  • Principles of informed consent
What happens in the H&I laboratory? (Frans Claas)
  • General introduction
  • HLA typing of donor and recipient
  • Serological crossmatching
  • Antibody screening and virtual crossmatch
  • Towards epitope matching

Module 2: Peri-transplant Management

3 CME Credits 

Assessment of potential deceased donor offer (Robert Langer)
  • General introduction of deceased donor transplantation
  • Understanding the definition of brain death
  • DCD donation & organ perfusion
  • Organisational aspects of deceased donor transplantation
Optimizing organ utilization (Chris Callaghan)
  • Soon available
Peri-operative care of the renal transplant recipient (Dr Mortimer Kelleher)
  • Patient Assessment prior to listing for transplant
  • Pre-operative evaluation
  • Intra-operative care: Physiological goals during renal transplantation
  • Post-operative care
Immunosuppression in the renal transplant recipient (Nick Torpey)
  • Introduction to immunosuppression
  • Immunosuppressive protocols
  • Individualised immunosuppression - immunologic risk
  • Challenges in immunosuppression
Management of the patient in the first week (Lucrezia Furian)
  • Failing urine output
  • Delayed graft function
  • Ureteral complications
  • Vascular complications
Early complications in the renal transplant recipient (Bruno Watschinger)
  • Delayed allograft function
  • Allograft dysfunction
  • Differential diagnosis of acute allograft rejection
  • Classifications of allograft rejections

Module 3: Surgical Techniques and Challenges

2 CME Credits 

Standard surgical techniques in renal transplantation (Ina Jochmans)
  • Back table procedure
  • Positioning & entering retroperitoneal space
  • Exposure vessels & venous anastomosis
  • Bladder anastomosis
  • Closure
Surgical vascular challenges during renal transplantation (Ina Jochmans)
  • No patch & atherosclerosis
  • Multiple arteries
  • Cuts & transsections
  • Dissections & tears
  • Short vein & multiple veins
  • Recipient issues
The urological challenges of surgical techniques in renal transplantation (Jonny Olsburgh)
  • Introduction & Work Up for Transplant
  • Benchwork and Transplant scenarios
  • Abnormal urinary tract
  • Complication: urine leak
  • Complication: ureteric obstruction
  • Small renal mass

Module 4: Post Transplant Management

2 CME Credits 

Long-term management of the renal transplant recipient (Josep Grinyo)
  • General introduction
  • Cardiovascular complications
  • Recurrent diseases
  • Maintenance immunosuppression and immune surveillance
  • Malignancies
  • Recurrent urinary tract infections
Managing the failing transplant (Gareth Jones)
  • Epidemiology and patient survival
  • Reducing cardiovascular risk
  • Achieving Chronic Kidney Disease (CKD) targets
  • The failed kidney and immunosuppression withdrawal
  • Renal replacement options

Module 5: Special Considerations

3 CME Credits 

Transplanting the recipient with antibodies (Nizam Mamode)
  • The definition of Antibody Incompatible Transplantation and Kidney Sharing Schemes
  • How do Kidney Sharing Schemes (KSS) work?
  • Who should have AIT and how do we do it?
  • Outcomes of Antibody Incompatible Transplantation?
Managing pregnancy post kidney transplantation (Kate Bramham)
  • Introduction and fertility in renal transplant recipients
  • Timing of pregnancy
  • Ante-natal care and vaccinations
  • Peri-natal and post-natal care
  • Long term consequences
Infectious considerations post-transplant (Dr Adnan Sharif)
  • Pathophysiology of post-transplant infections
  • Epidemiology and outcomes of post-transplant infections
  • Preventive measures against post-transplant infections
  • General principles for management of post-transplant infections
  • Specific considerations of post-transplant infections
Management of the transplant patient with cancer (Nick Torpey)
  • Organ donors with a history of cancer
  • Cancer developing after transplantation
  • Risk factors of new cancers after transplantation
  • Important post-transplant cancers
  • Prevention, surveillance and screening of cancers

Module 6: Cases

1 CME Credit 

Multi-disciplinary team discussion – decision making (Lorna Marson)
  • To list or not to list - Case 1
  • To list or not to list - Case 2
  • To list or not to list - Case 3
Challenging organ offer (Lorna Marson)
  • Challenging organ offer - Case 1
  • Challenging organ offer - Case 2
Surgical tricks and tips in renal transplantation from a panel of experts (Jeff Lafranca)
  • How to tell a procurement surgeon he/she has done a poor job?
  • What to do if renal parameters are bad on a good kidney?
  • What if arterial flow is poor after reperfusion?
  • Separate anastomosis or bench reconstruction in case of vascular multiplicity?