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Pre Transplant in Pune

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Before going ahead with kidney transplant treatment in Pune, a comprehensive evaluation is necessary to assess the patient's fitness and the technical feasibility of the procedure. This evaluation aims to discern the presence of any active infections or comorbidities, such as advanced age, cardiac disease, or liver disease, which might impact long-term survival post-transplant. Corrections may be necessary before the transplant, and in some cases, a combined organ transplant may be considered.

Detailed assessments include a comprehensive medical history, physical examination, and scrutiny of the native kidney disease to gauge the likelihood of recurrence in the transplanted kidney. At our kidney transplant hospital in Pune, cardiologists assess the heart for any pre-existing conditions that may need to be addressed before transplantation. Additionally our pulmonologists evaluate lung function to ensure suitability for anesthesia and to rule out active lung diseases.

Urologists play a pivotal role in evaluating bladder capacity, checking for urinary flow obstruction, assessing the presence of kidney stones, and ensuring the adequacy of blood vessels for successful anastomosis. Additionally, gynecologists conduct cervical cancer screenings for female recipients aged 21 to 65, with mammography recommended for women over 40 to screen for breast cancer.

Psychological assessments by psychiatrists aim to identify social, financial, and behavioral factors that may influence adherence post-transplant, ensuring the patient's fitness to provide informed consent. Evaluations by dental, dermatology, and ENT specialists are conducted to rule out septic foci, with any identified issues addressed before transplantation.

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Laboratory Evaluation

  • Blood group (ABO): To determine blood group for compatibility with a suitable donor.
  • CBC: To assess the degree of anemia and plan treatment before the transplant.
  • Urine routine and culture: To rule out urinary tract infection and evaluate the extent of proteinuria pre-transplant.
  • Liver function: To detect any impairment in liver function.
  • Blood glucose: To rule out diabetes and assess sugar control in diabetic patients.
  • Lipid profile: To detect abnormalities in lipid levels and initiate appropriate treatment.
  • Renal function tests: To evaluate preoperative electrolyte levels for overall fitness.
  • PT/PTT/BT: To rule out bleeding tendencies and coagulation abnormalities.
  • HbsAg/HCV/HIV/EBV/CMV IgG: To detect viral diseases and implement necessary treatment; prophylaxis may be required post-transplant for certain viruses.
  • Tissue typing/HLA: To determine compatibility between donor and recipient for a successful transplant.
  • Lymphocyte cross-match: To identify antibodies against donor T cell and B cell in the recipient's blood, assessing compatibility and potential rejection risks.
  • Uroflowmetry post-void residue: To assess for obstruction and determine bladder status before transplant.
  • CT scan plain/iliofemoral vessel doppler: To detect kidney stones or calcification in iliac blood vessels, crucial for successful anastomosis of donor kidney vessels.
  • Gastrointestinal endoscopy: To conduct in selected patients with positive stool occult blood or a history of peptic ulcer to address potential gastrointestinal issues before transplant.

Donor Evaluation

If a donor is available, a preemptive transplant is preferably considered for individuals aged 18 to 65 before resorting to long-term dialysis. A preemptive transplant is not only cost-saving but also yields better outcomes. As a potential donor, you will undergo a thorough evaluation, during which short and long-term risks will be discussed based on your health profile.

ABO compatibility testing is now standard owing to technological advances, enabling transplants across the ABO barrier with immunosuppression medication. While this option may incur higher costs and risks, it offers an effective alternative. Additionally, a paired or swap kidney transplant is another available choice. Compatibility and cross-match testing are mandatory under the Human Organ and Tissue Transplant Act (HOTA) to assess immunological risks.

Medical Evaluation

The purpose of medically evaluating a donor is to confirm your good health, and ensure absence of issues like renal problems, diabetes, hypertension, psychological well-being, and ensuring that you have no diseases transmittable to the recipient. It will be verified that there are no long-term or short-term risks associated with the removal of one kidney. The following investigations will be conducted as part of the donor evaluation:

  • Cardiac Evaluation: Includes ECG, 2D echocardiography, and a cardiac stress test.
  • Pulmonary Evaluation: Comprises chest X-ray, arterial blood gases (ABG), and lung function tests.
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