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Kidney transplant rejection for SLE patient - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Kidney Conditions
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3366 Questions
User :   Hi! what is the next option after hyperacute rejection of a kidney transplant
User :   hi
Doctor :   can u give me a few more details about ur condition and the current treatment u are undergoing ?
Doctor :   the first step - is treatment with immunosuppresives,
Doctor :   then to diagnose by taking a biopsy of the affected transplant
User :   got a transplant done here on the 1st of november n aftr biopsy report which was done on the tenth day we were told that its a rejection
User :   the donor was the mother n the recepient was the daughter
Doctor :   was the transplant checked for HLA typing ?
User :   yap
Doctor :   what % of similarity was found in HLA typing ?
Doctor :   i mean compatibility ?
User :   50percent
Doctor :   ok
Doctor :   have they taken a biopsy ?
User :   according to the hla crossmatch
User :   the doctors were more then happy with the reports
User :   the biopsy was done twice
User :   once on the third day n another was done on the tenth day
Doctor :   ok
Doctor :   can u tell me the results?
User :   according to the first biopsy ,we were told its Atn
User :   n after the second biopsy we were told that its a hyper acute rejection
Doctor :   ok
User :   due to the formation of lot of antibodies n antigens
Doctor :   let me explain some facts about hyperacute rejection
Doctor :   hyperacute rejection - is due to preformed antibodies to the donor cells and complment injury to the transplant
User :   n the patient is a sle
Doctor :   oh ok
User :   but is it not possible to find out abt the presence of these anti bodies in one's body before the transplant
User :   or rather get to know from the HLA cross match
Doctor :   its difficult to detect them before hand
Doctor :   but it is possible
User :   are they not suppose to find out from the cytotoxic crossmatch
Doctor :   yes they should have done that
Doctor :   may i know where the transplant was done ? which place ?
User :   So what is the next option left with us now
Doctor :   ok
Doctor :   Immunosuppressive therapy protocols are used now
Doctor :   Standard immunosuppressive therapy in renal
transplant recipient consists of
User :   by the team of nephrologist n urologist
Doctor :   1) baseline therapy to prevent rejection, and ..
Doctor :   2) short courses of
antirejection therapy using high-dose methylprednisolone, monoclonal antibodies or polyclonal antisera such as antilymphocyte globulin (ALG) and antithymocyte globulin (ATG).
User :   what is the next option left with us now
User :   the patient has never been on a dialysis before the transplant
Doctor :   Immunosuppression therapy with IV medicines are the first step
Doctor :   thats fine,
Doctor :   Does she have any symptoms right now ?
User :   n now after the OT she has been on dialysis thrice
Doctor :   thrice a week
User :   thrice in abt twelve days time
Doctor :   the next course of action - is to stabilise the patient and allow the transplanted kidney to recover its function
Doctor :   this will take some time ,
User :   the new kidney has already been taken out
Doctor :   but since the patient has SLE,. there are chances that she can produce more antibodies that can complicate the things more
Doctor :   Sorry to hear that ,
User :   so stabilising it does not seem to make any sense
Doctor :   In that case, maintainance dialysis will be needed once or twice a week
User :   we saw the kidey n 80% of it had becomr dark red in colour
Doctor :   this means that the blood flow to the transplanted kidney was bloced by the formation of plaques of clots
User :   can we go for a second transplant
Doctor :   and hence the kidney failed
Doctor :   the chances of a transplant suceeding now is very difficult
User :   they said its due to anti bodies
Doctor :   since the patient has already been exposed to other antibodies
Doctor :   Yes
User :   maybe in a period of six months time
Doctor :   its similar to a mismatched blood transfusion
User :   n if yes! then where in india will u suggest
Doctor :   if a A+ GROUP person is given B + blood a similar reaction will occur and the pateint will die due to anaphylaxis reaction
Doctor :   I will not advice a repeat of transplant for at least a year
Doctor :   instead u can opt for home dialysis, by buying a dialysis machine it self
User :   any side effect of this home dialysis
Doctor :   since the patient has SLE,. there are chances that she can produce more antibodies that can complicate the things more.
Doctor :   home dialysis - has not much side effects
User :   n what will be the approximated cost of it
Doctor :   with this the patient can resume her daily activities much earlier
Doctor :   it will not be more than 50-75000INR
Doctor :   i am not completely sure of the cost, but its much better than going for a transplant with chances of failure
User :   how does this home dialysis work
Doctor :   its similar to dialysis in a hospital
User :   do we need to fit in some kind of a machine in our body
Doctor :   but its can be done at home
Doctor :   no a artificial opening called fistula is made and the vein is connected with the machine
Doctor :   and the dialysis is done
User :   where will be this fistulla gonna be
Doctor :   it will be in the forearm
User :   on the wrist or some where else
Doctor :   yes , just above the wrist
User :   so u mean those with Sle should not go for a second transplant in a years time
Doctor :   yes
Doctor :   i will suggest you some forums where u can find patients undergoing home dialysis
User :   so llife long dialysis is the only option
User :   thanks a lot for that
Doctor :   thats a better option than going for transplantation
Doctor :   and thenhave to take medicines to prevent rejection
User :   but I was told that life long dialysis is not at all a good option
User :   in terms of life
Doctor :   its diffe rentfor diff patients
User :   duration
Doctor :   since a patient with SLE, will have lower chances of transplant acceptance , and since u have already have had a rejcetion, its not good to go for a second transplant so soon
User :   where do u think will be the best hospital for a renal related problems
Doctor :   thanks for consulting me here
Doctor :   i hope i have answered ur queries
Doctor :   bye fo rnow
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