Several risk factors for graft failure or dysfunction can be identified prior to surgery. These include:
- HLA mismatch - non favourable ie DR mismatches
- Preformed antibodies to HLA or a panel reactivity of 50-100%
- Number of previous transplants
- The presence of delayed graft function (the requirement for dialysis during the first week after transplant except for hyperkalaemia).
- The number of rejection episodes / severity of rejection episodes
- Donor age
- Ischaemic time
Management
Taking the above factors into account, patients who are at greater risk of graft failure may be identified and in some cases used to influence the decision to go ahead, or to vary immunosuppression or other therapy.
e.g. plasma exchange and other treatment options may be considered if there are high titres of preformed HLA Antibodies.
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