Question 5 -Living donor contraindications

A 55 year old woman is evaluated in the transplant clinic as a possible living donor to her daughter who has renal failure due to membrane-capillary glomerulonephritis. Significant past medical history includes asthma, breast fibroadenoma, and fibromuscular dysplasia which was treated with angioplasty at the age of 25. She takes PRN salbutamol.

O/E BP 125/65, cardiovascular examination unremarkable, no renal bruit.

Cr 65, Ur 3.8, K 4.5, Na 136, Hb 12.0

Renal USS – symmetrical 11.5cm unobstructed kidneys.

The potential donor should be advised:

1. The history of fibromuscular dysplasia is an absolute contra-indication to kidney donation.
2. Asthma is an absolute contra-indication to donation.
3. The donor and recipient should be informed of the unknown risk to both, but it could proceed.
4. The history of breast fibro-adenoma precludes kidney donation
5. The donor should undergo imaging and reconstruction of the affected artery prior to donation.

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Question 4 – Vaccines

A 24 year old female transplant recipient sought advice regarding vaccination for a forthcoming trip to South America. She had received a living-related donor transplant 1 year previously due to end-stage renal failure caused by vesico-ureteric reflux. Medications included lisinopril 5mg od, tacrolimus 2mg bd, mycophenolate 500mg bd, omeprazole 20mg od, and aspirin 75mg od. BP 130/85, Ur 6.2, Cr 90 mol/L, Hb 12.1 g/L, WCC 4.1, PLT 201, Neutrophils 3.5.

Which medication should be avoided from the list below?

1. Doxycycline
2. Oral polio vaccine
3. Influenza vaccine injection
4. Hepatitis A
5. Diphtheria and tetanus
6. Polysaccharide Typhoid vaccine

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Question 3 – living kidney donation

A 40 year old man is reviewed in the living donor kidney transplant clinic with a view to donating a kidney to his sister who has end stage renal failure. Which of the following would not be a contraindication to live donation?

1. Single renal stone (4mm) with no known predisposing factor.
2. Abnormal glucose tolerance test.
3. Sickle cell disease.
4. Thin basement membrane disease with urine PCR of 35.
5. Class 1 angina, medically managed.
6. Thalassaemia intermedia.

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Question 1 – living kidney donation

A 40 year old man is reviewed in the live kidney donor clinic with a view to donating a kidney to his sister who has end-stage renal failure. Which condition(s) in the donor would not be a contraindication to live donation:

1. Duke’s C bowel cancer resected 5 years ago with no recurrence.
2. Non-small cell lung carcinoma resected 5 years ago with curative intent and no recurrence.
3. Localized melanoma excised 8 years ago with no recurrence.
4. Localized squamous skin cancer on the arm, resected 1 year ago with no recurrence.
5. Myeloma – in remission after autologous bone marrow transplant.

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