thank you so much for the great new informative lecture
Esraa Mohammed
2 years ago
Thank you
Eusha Ansary
2 years ago
Thanks a lot
Hussam Juda
2 years ago
Thank you professor.
Mohammed Sobair
2 years ago
Thanks prof.Halawa. for informative lecture. And it’s an art really to transplant damage kidney. As it’s better in old than waiting in transplant or dialysis but worse if it fails fast in young.
Mahmoud Hamada
2 years ago
Thanks a lot Prof Ahmed for This lecture
Yashu Saini
2 years ago
Thank Prof for this informative lecture.
Many new concepts learnt.
saja Mohammed
2 years ago
Dear prof Ahmed and colleagues as we understand from this challenging week 8 review including the JC articles in the particular DKT article, that expertise preferred to move from the histological scoring as part of selection criteria and more depend on clinical donor criteria including estimation of GFR. mu question to all is the e GFR by Cockcroft and guilt criteria inaccurate enough to help us in making our decision we know very well the limitation of estimated GFR. especially in the presence of AKI?
thanks
Thanks, Saja We should not use Cockcroft-Gault at all in the assessment of kidney function. This measures creatinine clearance rather the eGFR. In Sheffield we use CKD-EPI. All these formulas are associated with lack of evidence and not validated in many situations
I’m just referring to this study by Snanoudj and his group
Snanoudj R, Rabant M, Timsit MO, et al. Donor-estimated GFR as an appropriate criterion for allocation of ECD kidneys into single or dual kidney transplantation. Am J Transplant. 2009;9(11):2542-2551.
Last edited 2 years ago by saja Mohammed
MOHAMMED GAFAR medi913911@gmail.com
2 years ago
thanks for the great lecture
Ahmed Omran
2 years ago
Thanks for the practical informative lecture
How biopsy procedure itself can affect the result of interpretation with easier approach compared to live donor biopsy?
Thanks, Ahmed Biopsy plays a role in cases of uncertainty regarding kidney function. There is no guideline on eath would advise you strongly to perform a biopsy
Mohammed Abdallah
2 years ago
Dear Professor
Yes, there is no consensus guidelines for DKT and limited centers have experience.
My question
When to do pretransplant kidney biobsy?
For example in case 1 (wak 8), 71 years old with diabetes and HTN but normal kidney function. Is it indicated here or not?
Thanks prof for the elegant lecture.
Putting 2 kidneys in one side is technically challenging as you mentioned, what about very small paediatric kidneys in adult recipient?..as nephrologist i know it grows with time to adult size, but am asking about the surgical challenges. Currently am following 2 adult recipients ( sisters) who received kidneys from 4years child more than 10years back and both are working perfectly well.
Thanks, Montasir It is always challenging especially pediatric kidneys into a pediatric patient which is the worst combination. The best combination is a child’s kidney into an adult recipient.
Huda Saadeddin
2 years ago
Thank you prof
Hussein Bagha baghahussein@yahoo.com
2 years ago
Thank you Professor Halawa for an excellent lecture
My question is for the dual kidney transplant. We transplant both the kidneys in the right iliac fossa. Do you experience challenges of closing the surgical site? What are the risks of kinking the blood vessels of the graft?
It is always a challenge to close the wound after DKT. Therefore, the recipient should not be a very small patient. In case you have to transplant DKT into a small patient, we do bilateral transplantation, I did this once when the recipient was 61 kg and her age was 67 years old.
Hamdy Hegazy
2 years ago
Thanks professor Halawa for this lecture.
what is your center protocol for ECD regarding suitability for donation, do you use Remuzzi score or KDRI or both?
Do you apply these scores on SCD as well?
Mohamed Essmat
2 years ago
Thank you Professor for the informative lecture
Indeed Tx ECD kidneys, especially the kidneys with Acute injury will benefit from minimizing CNI’s exposure
Thank you, Mohamed Definitely, even use of aggressive induction such as Alemtuzumab or ATG to reduce the CNI dose.
Ramy Elshahat
2 years ago
Thanks, professor Halawa for the illustrative presentation
my question is about the kidney donor risk index what is the cutoff number after which I should be worried about accepting it and I will be more confident to discard the graft
and 2nd question regarding perfusion machines
which one is preferred supposing we have access for all of the them
Thank you Ramy I will leave you to search and find an answer for us. These are excellent questions. Text me when you put your answer (please put it in blue colour).
thanks professor Halawa for great discussion i found that in change from year to another and in general Maximum of the range of KDRI rounded to 2 decimal places and in the attachment the KDRI of 2018
My question as a nephrologist regarding the surgical aspect:
In dual kidney transplant, both the kidneys are implanted on the same side always ?
Is Dual kidney Transplantation is technically different from enbloc implantation ?
Thank you It could also be transplanted bilaterally (one kidney on each side). Technically is different and difficult compared to an en-bloc transplant. En bloc transplantation involves transplanting the kidneys while both attached to the IVC and aorta. Dual involves transplanting both kidneys one on top of the other (separate anastomosis for each kidney).
Last edited 2 years ago by Professor Ahmed Halawa
Nahla Allam
2 years ago
thank you for this lecture
Doaa Elwasly
2 years ago
Many thanks Professor Halawa for this to the point lecture
Hadeel Badawi
2 years ago
Thank you, prof. Halawa for the nice informative lecture
Batool Butt
2 years ago
Thank you for the informative lecture
Abdullah hindawy
2 years ago
thanks prof for this informative lecture.
I have a question
Is there any work up or cocerns about cancer and infections
Manal Malik
2 years ago
Thank you professor Ahmed Halwa
Mohammed Abdallah
2 years ago
Thank you Professor Halawa
Sahar elkharraz
2 years ago
Thank you for this nice presentation
Mohamed Ghanem
2 years ago
Many thanks , prof for this amazing lecture
Huda Mazloum
2 years ago
Many thanks prof Ahmad for this nice lecture
KAMAL ELGORASHI
2 years ago
thank you, Prof. Ahmad H., for this valuable pointed lecture, and the simplicity way to reflect this topic to us
thanks
saja Mohammed
2 years ago
Thank you prof Halawa for the excellent presentation, as usual, I like the style of presenting real work, and compared with the evidence, my question is regarding the induction IS for the senior ECD program is it always ATG vs alemtuzumab irrespective of the immunological risk? and what the tacrolimus trough level target in the first 6 months and in the long term
Thank you Saja We moved away from ATG now. We prefer Alemtuzumab as one dose given subcutaneously; therefore low dose tacrolimus to achieve a trough level of 6 ng/ml.
in that case, the use of alemtuzumab will allow you to easily withdraw steroids as well and continue on tacrolimus with everolimus or alternative MMF without steroids on the long run
Mohammad Alshaikh
2 years ago
Thank you Prof. Ahmad for this nice lecture
Mohamed Saad
2 years ago
Thanks a lot professor Halwa, comprehensive talk
Riham Marzouk
2 years ago
thanks a lot our prof for great and very informative lecture
Ben Lomatayo
2 years ago
Thank you prof, nice lecture, my questions ;
1. Why ECD to given to small or female recipients ?
2. What are the difference between graft survival and death censored graft survival, are they the same concept, when are you allowed to say only graft survival or instead to say death censored graft survival ?
3.Correct me here, ECD is contraindicated in a recipient < 40 years ?
Thank you No, nearly the same risk and subject to other factors such as DSA, HLA profile, etc
Mahmoud Wadi
2 years ago
Thanks alot Prof.Halawa for important and informative about ECD.
My question about this criteria only in kidney donor or used different type of ECD in liver transplant .
thanks you very much .
Thank you Liver transplant has different criteria. The talk is about the kidney
Isaac Abiola
2 years ago
Thanks a lot Prof Halawa for this lecture.
My question is, for dual kidney transplantation in a recipient with ADPK that is massive, do we still leave the native kidney if not in the pelvis
Thank you Isaac We have to remove at least one of the native kidneys in case of APKD especially if big to creat space. Generally, APKD are not suitable for DKT,
Excellent lecture professor.
Thanks Peof
Thank you dear prof for clear useful presentation
Thank you 😊
thank you so much for the great new informative lecture
Thank you
Thanks a lot
Thank you professor.
Thanks prof.Halawa. for informative lecture. And it’s an art really to transplant damage kidney. As it’s better in old than waiting in transplant or dialysis but worse if it fails fast in young.
Thanks a lot Prof Ahmed for This lecture
Thank Prof for this informative lecture.
Many new concepts learnt.
Dear prof Ahmed and colleagues as we understand from this challenging week 8 review including the JC articles in the particular DKT article, that expertise preferred to move from the histological scoring as part of selection criteria and more depend on clinical donor criteria including estimation of GFR. mu question to all is the e GFR by Cockcroft and guilt criteria inaccurate enough to help us in making our decision we know very well the limitation of estimated GFR. especially in the presence of AKI?
thanks
Thanks, Saja
We should not use Cockcroft-Gault at all in the assessment of kidney function. This measures creatinine clearance rather the eGFR. In Sheffield we use CKD-EPI. All these formulas are associated with lack of evidence and not validated in many situations
I’m just referring to this study by Snanoudj and his group
Snanoudj R, Rabant M, Timsit MO, et al. Donor-estimated GFR as an appropriate criterion for allocation of ECD kidneys into single or dual kidney transplantation. Am J Transplant. 2009;9(11):2542-2551.
thanks for the great lecture
Thanks for the practical informative lecture
How biopsy procedure itself can affect the result of interpretation with easier approach compared to live donor biopsy?
Thanks, Ahmed
Biopsy plays a role in cases of uncertainty regarding kidney function. There is no guideline on eath would advise you strongly to perform a biopsy
Dear Professor
Yes, there is no consensus guidelines for DKT and limited centers have experience.
My question
When to do pretransplant kidney biobsy?
For example in case 1 (wak 8), 71 years old with diabetes and HTN but normal kidney function. Is it indicated here or not?
Thanks, Mohamed
It is not an absolute indication if you are going to do DKT. I transplanted these kidneys as DKT
Thank you, sir, for this enlightening lecture.
Sir can we have video of dual kidney transplant highlighting each step?
Thanks, I find a video
Thank you Professor for the detailed lecture.
Thank you prof Halawa for the informative lecture
Thanks prof for the elegant lecture.
Putting 2 kidneys in one side is technically challenging as you mentioned, what about very small paediatric kidneys in adult recipient?..as nephrologist i know it grows with time to adult size, but am asking about the surgical challenges. Currently am following 2 adult recipients ( sisters) who received kidneys from 4years child more than 10years back and both are working perfectly well.
Thanks, Montasir
It is always challenging especially pediatric kidneys into a pediatric patient which is the worst combination. The best combination is a child’s kidney into an adult recipient.
Thank you prof
Thank you Professor Halawa for an excellent lecture
My question is for the dual kidney transplant. We transplant both the kidneys in the right iliac fossa. Do you experience challenges of closing the surgical site? What are the risks of kinking the blood vessels of the graft?
It is always a challenge to close the wound after DKT. Therefore, the recipient should not be a very small patient. In case you have to transplant DKT into a small patient, we do bilateral transplantation, I did this once when the recipient was 61 kg and her age was 67 years old.
Thanks professor Halawa for this lecture.
what is your center protocol for ECD regarding suitability for donation, do you use Remuzzi score or KDRI or both?
Do you apply these scores on SCD as well?
Thank you Professor for the informative lecture
Indeed Tx ECD kidneys, especially the kidneys with Acute injury will benefit from minimizing CNI’s exposure
Thank you, Mohamed
Definitely, even use of aggressive induction such as Alemtuzumab or ATG to reduce the CNI dose.
Thanks, professor Halawa for the illustrative presentation
my question is about the kidney donor risk index what is the cutoff number after which I should be worried about accepting it and I will be more confident to discard the graft
and 2nd question regarding perfusion machines
which one is preferred supposing we have access for all of the them
Thank you Ramy
I will leave you to search and find an answer for us. These are excellent questions. Text me when you put your answer (please put it in blue colour).
thanks professor Halawa for great discussion i found that in change from year to another and in general Maximum of the range of KDRI rounded to 2 decimal places and in the attachment the KDRI of 2018
Thank you Ramy
Thanks dear Professor,
Well discussed and is lucid in nature.
My question as a nephrologist regarding the surgical aspect:
In dual kidney transplant, both the kidneys are implanted on the same side always ?
Is Dual kidney Transplantation is technically different from enbloc implantation ?
Thank you
It could also be transplanted bilaterally (one kidney on each side).
Technically is different and difficult compared to an en-bloc transplant. En bloc transplantation involves transplanting the kidneys while both attached to the IVC and aorta. Dual involves transplanting both kidneys one on top of the other (separate anastomosis for each kidney).
thank you for this lecture
Many thanks Professor Halawa for this to the point lecture
Thank you, prof. Halawa for the nice informative lecture
Thank you for the informative lecture
thanks prof for this informative lecture.
I have a question
Is there any work up or cocerns about cancer and infections
Thank you professor Ahmed Halwa
Thank you Professor Halawa
Thank you for this nice presentation
Many thanks , prof for this amazing lecture
Many thanks prof Ahmad for this nice lecture
thank you, Prof. Ahmad H., for this valuable pointed lecture, and the simplicity way to reflect this topic to us
thanks
Thank you prof Halawa for the excellent presentation, as usual, I like the style of presenting real work, and compared with the evidence, my question is regarding the induction IS for the senior ECD program is it always ATG vs alemtuzumab irrespective of the immunological risk? and what the tacrolimus trough level target in the first 6 months and in the long term
Thank you Saja
We moved away from ATG now. We prefer Alemtuzumab as one dose given subcutaneously; therefore low dose tacrolimus to achieve a trough level of 6 ng/ml.
in that case, the use of alemtuzumab will allow you to easily withdraw steroids as well and continue on tacrolimus with everolimus or alternative MMF without steroids on the long run
Thank you Prof. Ahmad for this nice lecture
Thanks a lot professor Halwa, comprehensive talk
thanks a lot our prof for great and very informative lecture
Thank you
Not necessarily females, but females have the advantage of less muscle mass and subsequently less nephron mass required compared to men.
When we talk about graft survival, we mean death=censored graft survival.
We prefer NOT to give young patients an ECD kidney unless they are desprate (long waiter).
Thank you, professor Halawa.
Dual kidney transplant get a higher risk for rejection?
Thank you
No, nearly the same risk and subject to other factors such as DSA, HLA profile, etc
Thanks alot Prof.Halawa for important and informative about ECD.
My question about this criteria only in kidney donor or used different type of ECD in liver transplant .
thanks you very much .
Thank you
Liver transplant has different criteria. The talk is about the kidney
Thanks a lot Prof Halawa for this lecture.
My question is, for dual kidney transplantation in a recipient with ADPK that is massive, do we still leave the native kidney if not in the pelvis
Thank you Isaac
We have to remove at least one of the native kidneys in case of APKD especially if big to creat space. Generally, APKD are not suitable for DKT,