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Comprehensive Guide to Kidney Transplantation Procedures and Treatment Options

Explore the best treatment options for chronic renal failure, including hemodialysis, peritoneal dialysis, and renal transplantation. Learn about the importance of donor kidneys and the HLA typing process for successful transplants. Discover the major histocompatibility complex and immunosuppressive agents used post-transplant to prevent rejection. Dive into the various medications and their side effects, as well as biologic immunosuppression methods. Follow the inspiring kidney transplantation journey of Meryem and gain valuable insights into post-transplant care and success stories.

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Comprehensive Guide to Kidney Transplantation Procedures and Treatment Options

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  1. Kidney Transplantation

  2. Best treatment of chronic renal failure

  3. HEMODIALYSIS

  4. PERITONEAL DIALYSIS

  5. Renal transplantation needs donor kidney

  6. Organ Source • Cadaver • Living donor

  7. Yalnız kalp atacak

  8. HLA TYPING • HLA ANTIGENS • A • B • C • DR LOCUS HLA A21,A24,B7,B9,DR22

  9. MAJOR HISTOCOMPATABILITY COMPLEX • Class I - present on almost all nucleated cells (interesting exceptions include sperm and the cells of the trophoblast). • Class II- present on Antigen Presenting Cells (macrophages, B cells, and dendritic cells). • Class III- are not surface molecules, but instead are various proteins typically which have some immunological role (C2,C4,Tumor necrosis factor alpha and beta, various HSPs) Human HLA region [Highly Simplified version !] ---DP--DQ--DR------------C4--C2--Bf---------------B--C--A--- Protein Products: DPa and DPb Complement HLA-B (a) DQa and DQb TNF a & b HLA-C (a) DRa and DRb HSP proteins HLA-A (a)

  10. Human MHC genes are highly polymorphic

  11. HLA TYPING • A-MATCH…FULL • B-MATCH..ONE ANTIGEN DIFFERENT • C-MATCH..TWO ANTIGENS DIFFERENT • …..SO ON • THE MORE CLOSER TO A-MATCH, THE MORE SUCCESSFULL KIDNEY TRANSPLANTATION

  12. RECIPIENT SHOULD NOT HAVE ANY INFECTION

  13. IMMUNUSUPRESSION

  14. The TcR-CD3 complex on helper (CD4+) or cytotoxic/suppressor (CD8+) T cells

  15. IMMUNOSUPRESSIVE AGENTS • T-CELL BLOCKERS • GLUCOCORTICOIDS • SITOTOXIC AGENTS • MONOCLONAL ANTIBODIES

  16. T-CELL BOCKERS • CYCLOSPORINE-A • TACROLIMUS • SIROLIMUS CYCLOSPORINE AND TACROLIMUS ARE SELECTIVE CALCINEURIN INHIBITORS INHIBITION OF Th INDUCTION WHICH IS ACTIVATED BY IL-2

  17. NFAT :Nuclear factor of activated T-cells FKBP: FK Binding protein

  18. TOXIC EFFECTS OF TACROLIMUS AND CYCLOSPORINE . NEPHROTOXICITY (C>T) . NEUROTOXICITY (T>C) . GASTROINTESTINAL PROBLEMS(T) . HYPERTENSION(C>>T) . HYPERKALEMIA(T) . HPERGLICEMIA AND DIABETES(T>C) . INFECTION AND MALIGN TUMORS(BOTH)

  19. SIROLIMUS(RAPAMYCINE) • Blockage of mTOR kinase • Side Effects: • Hyperlipidemia • Anemia • Leucopenia, trombositopenia • Fever • GI effects, • Hypo and hyperkalemia

  20. IMMUNOSUPRESSIVE EFFECTS OF GLUCOCORTICOIDS -Inhibition of release of cytokines in T-Cells -Inhibition of antibody production in B-Cells -Inhibition of macrophages,monocytes,PMNL’s -Blockage of complement system

  21. SIDE EFFECS OF STEROIDS -Cushing Syndrome -Glucose intolerance -Infections -Osteoporosis -Muscle weakness

  22. Antineoplastic drugs as immunosupressive agents -Mycophenolat Mofetil (Inhibition of IMP dehydrogenase) -Azathioprine (Inhibition of nucleotid synthesis) -Cyclophosphamide (Alkylating agents) -Methotrexate(Inhibitor of dihydrofolate reductase)

  23. BIOLOGIC IMMUNOSUPPRESSION -Antilymphosite globulines(Polyclonal antibodies) (Atgam, timoglobulin) -Anti-CD3 monoclonal antibodies (OKT3, muromonab-CD3) all -mab, -imab and -umab suffixes -Anti-Tac, Anti-CD25 monoclonal antibodies (Basiliximab, daclizumab) Anti-CD25 Monoclonal Antibodies (Basiliximab and Daclizumab) Anti-CD52 Monoclonal Antibody Alemtuzumab (Campath-1h) Anti-CD20 (Rituximab) Monoclonal Antibodies to Adhesion Molecules anti–LFA-1 mAb (efalizumab) anti-CD4 mAb (priliximab)

  24. PROF. DR. MEHMET A. HABERAL

  25. 16 DECEMBER 2006

  26. Meryem (28 years old) Kidney transplantation: 7 June 1997 Marriage : 2001 Baby : 2002

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