x
Dartmouth-Hitchcock logo
Residents In This Section

Transplantation

General objective: To become familiar with the biology of histocompatibility, the process of donor and recipient selection, renal perfusion and preservation and the procedure of transplantation. In addition the resident should be competent in the techniques of donor nephrectomy.

Evaluation

Donor evaluation: Discuss criteria of selection and management

  • Living related donors
    • The significance of histocompatibility testing
    • Methods of assessment; history, physical, laboratory tests, radiographic studies
  • Cadaver donors
    • The role of histocompatibility testing
    • Diseases precluding kidney donation
    • Methods used to optimize renal function prior to nephrectomy
    • Determination of brain death

Recipient evaluation

  • Risk factors
  • Alternate forms of treatment
  • Indications for pre-transplant nephrectomy
  • Evaluation of the lower urinary tract

Surgical techniques

Renal perfusion and preservation: Should understand the following:

  • The reason for flushing and cooling
  • The major techniques of renal perfusion and preservation
  • The composition of a satisfactory perfusate
  • Approaches for improving renal viability

Surgery

  • Acquire competence in the proper technique of live and cadaver donor nephrectomy.
  • Acquire competence in the technique of vascular anastomosis in transplantation including:
    • Uncomplicated adult transplant
  • Acquire competence in methods of urinary tract restoration including ureteroneocystostomy and ureteropyelostomy.

Complications

Surgical complications

  • Acquire competence in the management of post-operative surgical complications including ureteric obstruction, necrosis, fistula, and lymphocele.

Rejection

  • Understand the mechanism of rejection, its clinical manifestations and diagnosis.
  • Understand the methods (including their complications) used for the prevention and treatment of rejection.
Contact Us

0