Work up for Transplant

Cardiovascular Investigation - vessels and heart ar the Achilles heel in the transplanted patient

Evaluation of iliac and lower extremity vessels prior to transplantation

• Approapirate procedure a stenotic lesions in these areas are doppler/duplex sonography or angiography. These examinations are particularly indicated in patients with signs of peripheral vascular occulsive disease.

Evaluation of cardiac performance

• Mainly two diseases must be excluded which are common in dialysis patients: 1) coronary artery stenosis ( present in 40 % of patients at the start of dialysis ), 2) Aortic valve calcification and stenosis.
• Stress echocardiogram are useful.
• If the stress echocardiogram reveals signs indicating previous MI, coronary angiogram is strongly recommended.
• Coronary angioplasty or bypass procedure are necessary, if required, before putting patient on the waiting list.
  

Evaluation of carotid arteries

• Carotid duplex/doppler is useful as coronary artery disease is an indicator of coronary artery disease.
• In polycystic kidney disease, cerebral aneurysm should be excluded by MRI.

Respiratory examination

• CXR
• Respiratory Function Test

Oncology

• Skin cancer - need dermatological review
  
• for women - need mammogram and pap smear
• for men over 50 yrs - need PSA and PRDE of prostrate gld
• for analgesic nephropathy patient - urothelial cancer need to be checked.
• There is a consensus that a waiting period of 5 yrs should be respected before the patient is put on the waiting list.
  

Exculsion of chronic bacterial or viral infection

Chronic Bacterial Infection:

• Tuberculosis
• Dental Check up for dental root abscess
• Cholecystolithiasis and diverticulosis need to be treated before transplantation

Chronic Viral Infection:

• Hepatitis B and C
• HIV
• CMV carrier status is important as well

Immunological Investigation

• HLA types
• Blood groups