Kidney transplantation, forms, recipient and living donor suitability, immunosuppression

1. Big picture

Kidney transplantation is the best renal replacement therapy for suitable patients with end-stage kidney disease (ESKD) because it usually gives better survival, quality of life, fertility, rehabilitation, and freedom from dialysis than chronic haemodialysis or peritoneal dialysis. The attached exam question file also states that kidney transplantation provides the best survival and quality of life among renal replacement modalities, while haemodialysis and peritoneal dialysis have comparable efficacy.

Think of transplantation in one clinical chain:

End-stage kidney disease
   ↓
Is the patient suitable for transplant?
   ↓
Is there a living donor or deceased donor kidney?
   ↓
ABO/HLA/crossmatch compatibility
   ↓
Surgery + induction immunosuppression
   ↓
Lifelong maintenance immunosuppression
   ↓
Monitor graft function, rejection, infection, malignancy, drug toxicity

The examiner usually wants you to explain: forms of kidney transplant, recipient evaluation, living donor evaluation, immunological matching, immunosuppression, rejection, and complications.

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