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TransplantBuddies.org Forums » Kidney - Pancreas » Archive through September 05, 2010 » Is my transplant feasible? « Previous Next »
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Atif Shabir
Member
Username: Atifshabir

Post Number: 1
Registered: 08-2010
Posted on Wednesday, August 25, 2010 - 04:09 am:   Edit Post Delete Post Print Post

Hi. I am Atif Shabir from Islamabad Pakistan.

I have been on hemodialysis for about two months and am going to have a transplant next month. My mother will be donating. I have few questions regarding the feasibility of my transplant. Tissue typing says that the match is 4 out of 6. The transplant coordinator said that it is a one haploid match which is quite OK. But the cross-match is positive, the report for cross-match test says that "cytotoxic antibodies were found in the patient's serum against T lymphocytes of the potential donor. 5% cell death". The doctor says that transplant should not be carried out and we should wait for about one month till these antibodies are cleared from my serum. My nephrologist told me that with the passage of time different antibodies are formed and cleared so we should wait for these antibodies to get cleared. He further advised me for a more detailed test (Cmv) which will show whether these antibodies are IgG or IgM. IgM antibodies are cleared with the time and IgG are long lasting.

I just want to see your views especially of those who have had a transplant with one haploid match or those who received kidney from one of their parents.
ed
Member
Username: Ed2001

Post Number: 97
Registered: 03-2010
Posted on Wednesday, August 25, 2010 - 10:19 am:   Edit Post Delete Post Print Post

Your doc is correct. The tissue match is good at 4/6, but cross matching precedes this, so at the moment it's a no go. Some docs choose to treat this via plasmapheresis or IVIG, others choose to wait and see it if changes, while others prefer to look for other donors.

Basically, the a negative crossmatch with a poor tissue match can still work well, whereas a positive crossmatch, renders a good tissue match somewhat useless. The heirarchy is blood type, crossmatch then tissue match, with the best being compatible blood type, negative crossmatch and 6/6 antigen match.

The other thing your doc wants to check is whether you are CMV + or -, and if your donor is + or -. The + means a person has gotten CMV before and thus has antibodies for CMV. This is important because CMV is a very bad infection for us to get. And if your donor is + and you are -, then you have a very good chance to get it. Best case is if you both are + or bothe are -.

Your tissue/antigen match is a good one, you are getting a live donor from a parent with 4 out of 6 antigens matching.

.
Kidney Transplant
April 2001
Atif Shabir
Member
Username: Atifshabir

Post Number: 2
Registered: 08-2010
Posted on Friday, August 27, 2010 - 02:49 am:   Edit Post Delete Post Print Post

Thank you ed it was really helpful reading your post.

I am worried about the chances of this cross-match being negative after some time. Can you tell me what are the chances that the cross-match will go negative? does it always become negative after some wait or it may go other way? I am worried because the only donor in my blood relation is my mother as my brothers are hypertensive and my sis and father have different blood groups.

My doc asked for wait because plasmapheresis or IVIG is extremely expensive procedure specially in Pakistan.

Does CMV has to do anything with the cross-match?

.
ed
Member
Username: Ed2001

Post Number: 98
Registered: 03-2010
Posted on Friday, August 27, 2010 - 03:42 am:   Edit Post Delete Post Print Post

Atif,

The antibody issue is a very tricky one. Some people have more, some people have less. The most common factors are the more infections you've gotten, the more blood transfusions you've had the higher chance having more antibodies. The other common one is pregnancies.

The thing is though, I've seen a couple of people who've had a lot of transfusions and a few pregnancies, but low antibodies, whereas others with none yet high number of antibodies. But these are more of the exception.

In the same way, once they are there, you can't really know if they will go down or not. I've heard some who have seen the lower counts after a while and got their transplant then. But it may not too, I know a person where I used to have dialysis who was there for 6 years and the high count didn't come down. I read that in Britain someone has been doing home dialysis for over 18 years and isn't looking for transplant anymore because in her count doesn't want to go down.

So the short answer is it may, or may not, or it can go up also. Try to avoid getting sick because this can increase your antibodies, As for blood transfusions, you may not have a choice, but try to keep hemoglobin levels up so you won't need them.

There is a test, called the PRA, which kind of tells you how much antibodies you have. In your case, this is helpful if you are on waiting list. If you know your donors, then the cross matching will be a sure fire decision maker to say if you are ok or not.

Your doc makes sense, he is letting nature take its course and see if it works out on its own. On your end, try to keep strong and healthy on dialysis, this is the main problem on dialysis. So time becomes your enemy so to speak. The decision on plasmapheresis or IVIG treatments are really your decision, because it you can wait it out on dialysis then it will be ok, or if another donor comes up.

CMV isn't related to cross matching at all. CMV is like a very bad case of fever and flu that a good percentage of us get at sometime in our lives. For non-transplants, because their immune system is in full strength it isn't dangerous and people just do what they do when they get the flu and it gets well after a time. But of us, with the anti-rejection drugs, CMV can hurt our kidney and it not treated properly can be fatal.

Seeing that you are from Pakistan my guess is you've gotten it. I'm from the Philippines and my doc told me that we have a greater than 97% of being CMV positive. It's a third world thing, our surroundings are a bit dirtier than those in the first world. Think of it as something like Delhi belly, where the locals don't get sick but foreigners do with some of their food. I think this is why your doc isn't prioritizing the CMV, chances are you and your mom are both + also.

Hope this helps, and that things work out for you.
Kidney Transplant
April 2001
Bala
Member
Username: Balapandian

Post Number: 2
Registered: 08-2010
Posted on Friday, August 27, 2010 - 11:32 am:   Edit Post Delete Post Print Post

I'm under the impression that cross match with less than 20% reaction is considered negative, above 20% is positive
Hostess Rise
Board Administrator
Username: Rise

Post Number: 14263
Registered: 05-2003
Posted on Friday, August 27, 2010 - 11:38 am:   Edit Post Delete Post Print Post

Welcome Bala to TransplantBuddies:-)

Thank you everyone for providing excellent support to Bala.

Wishing you all well
Rise'
Cystic Fibrosis- dx at 2yrs. -2nd double lung tx-05
Debra Fertel MD- Si Pham MD, Professor of Surgery---Jackson Memorial Hospital
Anas Hadeh MD, Cleveland Clinic CF care

Questions- Contact Hostess Rise'

Atif Shabir
Member
Username: Atifshabir

Post Number: 3
Registered: 08-2010
Posted on Wednesday, September 01, 2010 - 07:28 am:   Edit Post Delete Post Print Post

Thank you ed. I was out for some time and now am back.

I will again test the cross-match after Ramadan ends, somewhere around 17th of this month. Now I am taking some extra care of mine so that I don't take more antibodies due to any infections.

As far my health after dialysis is concerned, you won't believe but I play all sorts of sports, like cricket, football etc. I don't feel any fatigue, any nausea, any headache. I am 25 yrs and I completely feel how a 25 yrs man should. Even right after dialysis I feel quite OK. In order to keep my protein normal, I take about one full piece of chicken and one egg daily. So I hope dialysis wont be any issue for me.

Thank you for guiding me and I'll surely be taking your help on the course.
.
CiscoKidney07
Forum Leader
Username: Gregg

Post Number: 3865
Registered: 03-2008
Posted on Wednesday, September 01, 2010 - 07:40 am:   Edit Post Delete Post Print Post

What you need to concern yourself with on dialysis is that you follow the diet, and it is challenging. Potassium and phosphorus are the two main problems while on dialysis. CMV is a virus. I got a transplant from my wife, who had gotten CMV as a child--most people have had it by the time they are 21. I had not. So, in order to protect my donated kidney, they put me on an anti-viral called Valcyte until 9 months after my transplant. At that point, I guess they figured that unless I had a particularly bad batch of it, that I would not be in danger of rejection. So, I was aware of what the symptoms of CMV were, so when I got it, I knew what it was and notified them that I had it. Of course, this is determined by blood test, so I went in and had blood taken, and sure enough, I was right, at which point, they told me what to take and gave me prescriptions.
There are not too many things in life worth working my butt off for, but my health is one of them
ed
Member
Username: Ed2001

Post Number: 101
Registered: 03-2010
Posted on Wednesday, September 01, 2010 - 11:03 pm:   Edit Post Delete Post Print Post

Atif,

Cisco is right, in dialysis potassium & phosphorus are important. The other thing is to monitor calcium and vit D levels because bones can get weak during this time and then further weakened by prednisone after transplant. The last thing would be to make sure your hemoglobin levels are always where then need to be, and use epoetin or iron if needed so you avoid blood transfusions. Low hemoglobin also can harm your organs because their may be not enough oxygen delivered to them.

It is good to play sports, and good you are active, make sure to keep away from injury. I was pretty much like you, when I went into dialysis, I was still working long hours and playing sports and continued to do so.

Good luck.
Kidney Transplant
April 2001
Bala
Member
Username: Balapandian

Post Number: 4
Registered: 08-2010
Posted on Thursday, September 02, 2010 - 02:26 am:   Edit Post Delete Post Print Post

I heard dialysis is usually started when the creatinine goes above 5 or 6

if a person undergoes dialysis for 3 times a week, what would be his creatinine and urea? will creatinine come down to 2 or 3?
Atif Shabir
Member
Username: Atifshabir

Post Number: 5
Registered: 08-2010
Posted on Thursday, September 02, 2010 - 03:21 am:   Edit Post Delete Post Print Post

That's a good thing with me that whatever diet I take my potassium level doesn't rise. I am taking LoPhos and Rocaltrol (calcitriol) which keep my phosphorous and calcium levels normal. Now I'll ask my doc to test my vit. D levels also. My hemoglobin had dropped to 9.5 but my doc increased the does of Epoetin and Venofer injections and last month in was on 10.9

Bala,
When my creatinin crossed 8 my doc asked me to have an av fistula formed. By the time my fistula was mature (one month) my creatinin had gone above 16 and urea at that time was about 270 and after that I started dialysis. I know I started very late but I was very reluctant on my side because I was completely asymptomatic except some itching.

.
miocean
Member
Username: Miocean

Post Number: 19
Registered: 07-2010
Posted on Thursday, September 02, 2010 - 10:41 am:   Edit Post Delete Post Print Post

When I was on dialysis my creatine was 8. Since the transplant it has been averaging 1.2.
Diffuse Scleroderma
Kidney Transplant March 11, 2010
St. Barnabas Medical Center, Livingston, NJ

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