"Kidney Disease - Transplant Surgeon's Perspectives": World Kidney Day Celebration (14/03/2024)

Abstract

The aim is to promote awareness of kidney disease, its prevention, early detection and treatment to prevent complications including premature death by educating people about their role in maintaining health.

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Time Presentation Speaker
6:00PM
Welcome & Introduction
General Renal Update
Dr Jiehan Chong
6:05PM
‘Kidney Health & Blood Pressure
–
Know Your Numbers’.
Dr Syazrah Salam
6:15PM
Information from Renal Dietician
Amy
Nuttall-Allsop
6:25PM
Home Haemodialysis & Transplant
Patient Story
Dana Holmes
6:35PM
Meeting a Kidney Transplant Surgeon
Dr Badri Shrestha
6:45PM
Caring for kidney patients in the South
Rift region of Kenya
Dr Helen Nye
6:55PM
Q&A
ALL
7:00PM
Closing Remarks
Dr Jiehan Chong
PROGRAMME

Kidney Disease: Transplant Surgeon’s Perspectives
World Kidney day
14 March 2024
Badri Man Shrestha MS MPhil MD FRCS FEBS FACS FICS
Consultant Transplant Surgeon
Sheffield Kidney Institute

World Kidney Day - Aims
To promote awareness of kidney disease, its prevention,
early detection and treatment to prevent complications
including premature death by educating people about
their role in maintaining health.

Any one of us , irrespective of age, sex
and
family history, can have kidney disease.

Kidney diseases can be prevented.
“Self-care”
Control 3 Ss
Salt
Sugar
Saturated fat

Early diagnosis of kidney disease is important.

Once diagnosed, make every effort to slow down the
progression of CKD
•Hypertension, Diabetes, Obesity, Hyperlipidaemia
•Regular follow-up by dedicated teams
•Regular medicines
•Healthy life-style

Established CKD 4
•Start transplant work-up (eGFR 20)
•Early referral to transplant surgeon for assessment of suitability for
kidney transplant
•eGFR 10-15
•Pre-emptive living donor kidney transplantation – the best option
•Don’t wait for dialysis, if possible.

Advantages of Pre-emptive Transplantation (eGFR <15)
•Avoids need for dialysis access surgery
•Avoids complications of dialysis
•Living donor transplant – Planned surgery
•Better graft survival
•Better Patient survival
•Better QOL
•Higher return-to-work rates
•Cost-saving
Shrestha BM: Pre-emptive renal transplantation: optimum treatment for end-stage renal disease ? JNMA 2019:47(169:44-46.

Why Transplantation?
•Improves quality of life
•Improves survival
•Cost-effective

Improved QOL
Nutrition
Fertility
Lucy Claire Davis
(Dawn Tinsley in
Office)
1997- Hazel
Amy Purdy: Athlete and
Actress
Motivational speaker
Mr KP Oli, Prime Minister of Nepal
British Transplant Games

Disadvantages of Dialysis
• Peritoneal dialysis and Haemodialysis
– Surgery
– Complications
• Related to surgery
• General
–QOL
– Costly
– Consumption of health resources

ADVANTAGES OF LIVE DONOR KIDNEY TRANSPLANTATION
• Planned procedure
• Shortened waiting time
• National LD Kidney Sharing Scheme for ABO incompatible and Positive X-match pairs
•Pre-emptive Tx is possible avoiding need for dialysis
• Low rejection rate
• Less intense immunosuppressive regimen
• Better graft and patient survivals
• 1/3 of Total Tx in UK : LD Tx

Kidney Transplantation in UK: 2022-2023
The average waiting time is 2-3 years for deceased donor kidney
transplantation and 3-6 months for living donor kidney transplantation

First Successful Living Donor Kidney Transplantation
23 December 1954
Ronald Herrck
29/12/2010
79 years old
56 years post-donation
Complication of heart surgery
Richard and Ronald Herrick – aged 23
Oldest LD in Sheffield: aged 73, ladies, now 86 and 78, well.
Oldest UK NDA LD: 83 (in 2012) celebrated his 95th birthday last year. Transplanted in Sheffield

Laparoscopic Living Donor Nephrectomy
•Advantages of laparoscopic LDNx
•Sheffield experience: 332/1082 (31%) since 2005
Present –Laparoscopic Past -Open

Renal Transplantation

Gift of life…… Look after the transplant well
•Don’t forget to take anti-rejection drugs regularly
•Adopt healthy life style
•Manage risk factors

Non-adherence to therapy
• Rejection
• Suboptimal organ function
• Disease recurrence
• Premature graft loss
• Death
• Address specific reasons for non-adherence and prevent above
complications

How old is old for a kidney transplant?
Sheffield: DD: 85 - 92
LD: 77- 87
Oldest DD Tx: 87 year 262 days old – Canada (June 2023)
Longest kidney survivor (Mayo Clinic, USA)
Transplanted 57 years ago now 81
Sunderland, UK
58-year old LD to 25-year old recipient in 1973
(50 year ago) (75 now)= 108-year old kidney
Age: Biological age is more important than chronological age.
Outcomes of assessment and co-morbidities are important factors.

KEY MESSAGES
•Prevention is better than cure.
•Early diagnosis
•Multidisciplinary approach to slow the progression of CKD
•For CKD 5: Pre-emptive living donor kidney transplantation is the best
option.
•Age is just a number.
•Kidney transplant –Gift of life….. must be looked after well.

Thank you