MDSC174 clinical scenario based on transplant recipient work up


The assignment is a critical review (3000 words) of a set clinical scenario based on transplant recipient work up, given in the clinical case scenario below.


A 61 year old male patient with Chronic Kidney Disease had been on haemodialysis for the last 5 years secondary to Focal Segmental Glomerulosclerosis (FSGS). He can walk for approximately 500 yards before experiencing calf muscle pain (claudication?). He is a known smoker (10 cigarettes/day for the last 17 years). He is on life-­‐long warfarin therapy due to history of venothromboembolism (VTE), specifically Deep Vein Thrombosis (DVT) and Pulmonary Embolus (PE). He had a first kidney transplant from a deceased donor which failed after 7 years, secondary to a recurrence of FSGS. He is highly sensitised due to his previous transplantation, and his calculated reaction frequency (CRF) is 85%.

He has 2 members of his family who have come forward as potential live donors:

  1. His 31 year old eldest son came forward to donate a kidney for him. 111 mismatch. There are DSA mainly due to anti A2 with MFI 1500, B8 with MFI 1000 and A36 with MFI 1400.
  2. Additionally, his 45-­‐year-­‐old stepdaughter is also keen to donate a kidney. 121 mismatch, no DSA, but ABO incompatible (ABOi). The donor is blood group A1 and the recipient is blood group B (Anti-­‐ A IgG 1/128 and IgM 1/64).


Using a robust, current, evidence base:

  1. You should discuss how this patient will be counselled regarding kidney transplantation.
  • Write an evidence based management plan justifying the ‘work up’ required considering both potential donors.
  • It is recognized that the patient has an informed choice, however, you should conclude by summarizing which of the 2 donors you think is most suitable, justifying your rationale based on the expected outcome considering each donor.
  • Relate and reflect critically on your local practice relating to this type of scenario where appropriate.

Suggested essay structure:

  1. There MUST be a clear title, which is descriptive of the nature of your assignment.
  • There should be clearly defined aims, which align with the sections of the main discussion and which you address in your conclusion.
  • DISCUSSION: It is suggested that you consider dividing this into 2 sections:
    • The implications of this patient’s presentation and details of how you would counsel this patient in relation to a proposed further transplant.
    • Suitability of the 2 live donors as potential matches.
  • Conclusion: you should summarise which of the 2 donors you consider is most suitable, with supporting rationale.

Throughout this assignment, you MUST include justification of your plans with robust, clinically current evidence, and where appropriate, link it briefly to your local practice.

References: to be submitted in Vancouver format as per handbook. The references will be checked for their appropriateness and correct use of citation.