Rhesus
Rh -ve young female recipients with Rh +ve donor require anti D immunoglobulin at induction (can be given up to 72 hours later if overlooked initially).
Hepatitis B
1. HBsAg -, HBcAb + renal tx recipients
- Before renal transplant surgery, if time allows, check the HBsAb levels and give a booster dose if levels are <10 mIU/mL; otherwise, give a booster dose regardless of HBsAb levels unless one was given in the previous 8 weeks.
- Monitor HBsAg monthly for the first 3 months post-transplant surgery, and every 3-4 months subsequently for at least a year.
2. HBsAg -, HBcAb- renal tx recipient with HBsAg -, HBcAb + renal donor
- Before renal transplant surgery, if time allows, check the HBsAb levels and give a booster dose if levels are <10 mIU/mL; otherwise, give a booster dose regardless of HBsAb levels unless one was given in the previous 8 weeks.
- At the time of renal transplant surgery, give HBV immunoglobulin (HBIG) according to the following schedule:
- HBIG 4,000 IU iv stat.
Measure HBsAb levels at day 7 and repeat dose if levels are <500 mIU/mL.
Monitor HBsAg monthly for the first 3 months post-transplant surgery, and every 3-4 months subsequently for at least a year.
Fasting Type I Diabetic patients
In practice, all fasting type I diabetic patients go on a sliding scale as shown below (taken from Lothian Adult Medical Emergencies Handbook). All patients need a background fluid infusion; we would suggest 20mls/hour of 10% dextrose as most patients are anuric.
| BM | Insulin Infusion (units actrapid/hours = ml/hr) |
| >16 | 6 |
| 13-15.9 | 4 |
| 10-12.9 | 3 |
| 7.0-9.9 | 2 |
| 5.0-6.9 | 1 |
| 4.0-4.9 | 0.5 |
| <4 | 0 (call Dr, sliding scale may need revision |