| Theme | Working in Cooperation with Other Departments for Dialysis Treatment -- Centered Mainly on Easily Overlooked Conditions | |
|---|---|---|
| Title | Management of post kidney transplant end stage patients | |
| Publish Date | 2011/02 | |
| Author | Ken Morita | Blood Purification Center, Hokkaido University Hospital |
| [ Summary ] | Even though the number of patients who lose allograft functions in the early post-transplant period has decreased, the initiation of renal replacement therapy (RRT) should be carefully considered. We evaluated safe clinical strategies for patients who underwent RRT after kidney transplantation due to renal allograft dysfunction. The reasons for graft loss were chronic allograft nephropathy primarily, followed by acute cellular rejection, recurrent renal disease and other conditions. RRT in patients who have experienced graft loss should be treated in consideration of dialysis access site preparation and modulation of immunosuppressive therapy to avoid complications related to renal dysfunction. Serum creatinine levels observed in patients with graft loss were approximately the same as those observed in non-transplanted end-stage renal disease patients. It is important for patients who have lost allograft function to have reduced immunosuppressive therapy, psychological care, and socio-economic support and sparing of renal allograft for the possibility of retransplantation in the future. At graft loss complications was found in 60 % of the cases. There were viral and bacterial infections in many cases. In order to avoid these infections, we must reduce and withdraw immunosuppressive agents properly. Cardiovascular complications were found in a small number of patients, and sometimes became life threatening. Comprehensive care for these patients including RRT induction and patient education, should be performed with diverse medical staff efforts in order to avoid the delay of RRT execution and exessive immunosuppression in association with graft loss. |
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