|Year : 2018 | Volume
| Issue : 6 | Page : 1452-1469
|The National Guard Health Affairs guidelines for the medical management of renal transplant patients
Ziad Arabi1, Abdulrahman Theaby1, Mahfooz Farooqui2, Mubarak Abdalla2, Ali Hajeer3, Khalid Abdullah4
1 Consultant in Renal Transplantation, Adult Transplant Nephrology, Organ Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
2 Consultant in Nephrology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
3 Professor of Laboratory Medicine and Immunology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
4 Chairman, Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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|Date of Submission||09-Dec-2017|
|Date of Acceptance||09-Dec-2017|
|Date of Web Publication||27-Dec-2018|
|How to cite this article:|
Arabi Z, Theaby A, Farooqui M, Abdalla M, Hajeer A, Abdullah K. The National Guard Health Affairs guidelines for the medical management of renal transplant patients. Saudi J Kidney Dis Transpl 2018;29:1452-69
|How to cite this URL:|
Arabi Z, Theaby A, Farooqui M, Abdalla M, Hajeer A, Abdullah K. The National Guard Health Affairs guidelines for the medical management of renal transplant patients. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2019 Mar 21];29:1452-69. Available from: http://www.sjkdt.org/text.asp?2018/29/6/1452/248311
| Introduction|| |
There are only few published international guidelines for renal transplant immunosuppression. International guidelines are generally specific to their population and there are no published guidelines in this area in Saudi Arabia. Here, we present the first guidelines for the medical management of renal transplant patients in KSA.
These guidelines were subject to an extensive review according to the most up-to-date international guidelines tighter with experience and literature in Saudi transplant patients.
These guidelines establish the standards for the management of kidney transplants including immunosuppression, infection prophylaxis, surveillance testing, treatment of rejection, ABO incompatible transplantation and desensitization.
The desensitization protocols detailed here for transplantation across incompatible HLA and ABO are presented in a very clear and stepwise approach for desensitization according to the estimated risk.
These guidelines also address several complex and commonly encountered issues such as the management of recipient with gallbladder disease, catheter-induced thrombosis, or supra vena cava obstruction. Antibiotic prophylaxis before dental procedures, intravenous fluid management post renal transplant and the timing of urinary stent removal are also reviewed.
These practical guidelines are designed to be easy to be read, follow, and adopt in the transplant centers.
These guidelines, like any other international guidelines, are based mostly on expert opinion and centers practices and not necessarily supported by well-established evidence from randomized controlled studies.
While these guidelines present personal recommendations from the authors and not endorsed by any formal society or institution, these guidelines present the first step to unify the practices among the transplant centers in KSA. This step is very essential for any future research to evaluate current practices in KSA.
In summary, these guidelines are one of the few internationally published guidelines of renal transplant immunosuppression with specific emphasis for transplant patients managed in KSA.
| Table of Contents|| |
List of abbreviations.........1453
Renal transplant immunosuppression.........1454
Kidney transplant prophylaxis.........1455
At-risk recipients for HBV.........1456
At-risk recipient for TB.........1456
At-risk for Schistosoma.........1456
At-risk for recurrent aHUS.........1457
Treatment of BK viremia.........1458
Treatment of CMV disease.........1458
Treatment of acute rejection.........1459
Cellular mediated rejection (ACR).........1459
Antibody-mediated rejection (AMR).........1459
Intravenous immune globulin administration guideline.........1461
Rituximab administration guideline.........1461
Bortezomib subcutaneous administration guideline.........1462
HLA incompatible kidney transplants.........1462
Risk stratification and desensitization protocol.........1462
Desensitization while on the waiting list of DDKT.........1463
ABO incompatible kidney transplant.........1463
Risk stratification of ABO-incompatible renal transplant.........1463
Desensitization protocol of ABO incompatible renal transplant.........1464
Urinary stent removal.........1466
PD catheter removal.........1466
SVC obstruction (symptomatic or asymptomatic).........1466
Antibiotic prophylaxis before dental procedures.........1466
IVF management post renal transplant.........1466
| List of Abbreviations|| |
AMR: Antibody-mediated rejection
CNI: Calcineurin inhibitors
DDKT: Deceased donor kidney transplant
DGF: Delayed graft function
DSA: Donor-specific antibodies
EBV: Epstein–Barr virus
FFP: Fresh frozen plasma
IVIG: Intravenous immunoglobulin
LATB: Latent tuberculosis infection
LKT: Living donor kidney transplant
MMF: Mycophenolate mofetil
PCR: Polymerase chain reaction
TB: Tuberculosis infection
BKV: BK virus
ACMR: Acute cell-mediated rejection
MFI: Mean fluorescence intensity
PRA: Panel reactive antibody
ACR: Acute cellular rejection
|Figure 1: Management of refractory antibody-mediated rejection.|
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|Table 2: Recipient antibody titer and number of required sessions of plasmapheresis.|
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|Figure 2: ABO desensitization protocol: Example: Initial Anti A/B IgG isoagglutinin titer 1:32.|
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Many thanks to Almarastani, Mohamad; Al Tamimi, Abdulrahman; Kashkoush, Samy, Ohali, Wael Abdulazi; Faisal, Nabiha; Sibai, Abdul Razak; Al Khairy, Omar; Hajeer, Ali; Aloudah, Noura, Al Marshdi Al Otaibi, Nouf; Moaquel, Mohammed.
Conflict of interest: None declared.
This document was designed to aid the qualified health-care team in making clinical decisions about patient care, but it should not be construed as dictating exclusive courses of treatment and/or procedures. No health-care team member should view these documents and their bibliographic references as a final authority on patient care. Variations from these guidelines may be warranted in actual practice based on individual patient characteristics and clinical judgment in unique care circumstances.
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] [Full text]
Division of Adult Transplant Nephrology, Department of Organ Transplant Center, King Abdulaziz Medical City, Riyadh
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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