Question
Use the clinical case scenario given below.
History
A 30-year-old male patient with Chronic Kidney Disease 5 (CKD5) had been on haemodialysis (HD) for the last 5 years, secondary to lupus nephritis.
There was no history of blood transfusion or previous transplantation.
Transplant Status
The patient received the offer of a kidney from a deceased donor.
Laboratory results at admission for transplantation
His laboratory results when he was admitted to the unit for preparation for transplantation were as follows:
- 1-0-0mismatch.
- Complement dependent cytotoxicity (CDC) crossmatch reported positive for B and T cell, but flow cytometry crossmatch (FCXM) was reported negative for both B and T.
- Luminex-SAB did not identify any Donor Specific Antibodies (DSA).
Task
You are required to write a 2000 word written assignment which is a critical reflection focused on the role of different crossmatch strategies to improve the possible outcome of transplantation in this case.
Advice
When you are preparing to do this work, you should refer to the module handbook which is on VITAL which details how to go about setting out your work and submission. Specifically you MUST read from page 8 of the handbook and ensure that you follow the advice given there EXACTLY.
You should also make use of the resources for writing at Master’s level as you did when you undertook your mock assignment in week 2. These can be found in the left hand tool bar in VITAL. Please also take on board the feedback that was provided on your week 2 assignment as this is meant to inform your future writing.
Additionally, there is a marking rubric also posted under the assessment section of the tool bar which you should use to inform your writing. These are the criteria which will be used to determine a mark. It is imperative you read them prior to writing.
Solution/Answer
Introduction
Successful organ transplantation is dependent on the donor and recipient. This is the same case for the 30-year old male patient suffering from Chronic Kidney Disease 5 (CKD5) and hemodialysis (HD) in the past 5 years, secondary to lupus nephritis. According to Kumar et al. (2017), the Hyperacute Rejection (HAR) which are sourced from the pre-formed cytotoxic antibodies against the Class-I Human Leucocyte Antigen (HLA) in the allograft. Further, from the time of discovering the antibodies and appreciating their possible impact, routine tissue crossmatch is identified as being a critical component in the renal transplantation process. This is supported by Augustine et al. (2005) study that has noted that the role of the pre-transplant crossmatch is identifying the overall pre-existing Donor Specific Antibodies in the serum of the recipient that could potentially be adopted in a successful reaction with the donor antigens. The effectiveness of this is the indication generated that possible immunological compatibility prevailing between the donor-recipient ends up pairing and hence facilitating an aversion of significant complications. The complications would include HAR, Antibody-Mediated Rejection (AMR) and graft loss. In the case study provided, there was no evidence of complications as there were positive for the B and T cell with the flow cytometry crossmatch (FCXM) being reported as being negative for both the B and T.
Description of the Case Prior to the kidney transplant of the patient with the offered kidney from the deceased donor, it would be instrumental for carrying out tests on the donor and recipient to mitigate any scenario of rejection. The most appropriate blood tests would include the blood type matching, HLA antigen matching, and anti-HLA antibody test. The rationale of these tests for the patient is supported by Ciurea et al. (2011) study ………………………………………………………………………………………………………………………Please contact us through rankedtutorials@gmail.com to receive this assessment in full