13 - Kidney Transplantation Flashcards
What are the advantages of kidney transplantation? Who benefits most?
Surivival advantage as compared to remianing on dialysis.
Younger pts get the most benefit out of transplantation.
Better quality of life.
How long do most people wait for a kidney?
Most people are on the list for 5 years.
Does survival advantage from getting a transplant kick in right after transplant?
Survival advantage doesn’t come right away because they get induction agents that deplete lymphocytes.
Increased risk of infection and CV events.
Takes 6-9 months for survival advantage to kick in.
What are the risks associated with kidney transplantation compated to dialysis?
Risk of death during hte first 2 weeks after transplant was 2.8x as high as that for pts on dialysis.
At 18 months, the risk was much lower (0.32)
The likelihood of survival became equal in the two groups within 5 to 673 days after transplant.
When is the right time for a kidney transplant?
As early as possible!
Ideally, should be transplanted before starting dialysis.
When should a patient be referred for kidney transplantation?
Refer pts with chronic kidney disease stage 4 or GFR <30.
Pts can be listed when GFR <20 ml/min (earlier if they need multipel organs transplanted)
Whatare the three rules of transplant recipient evaluation?
- Do no harm to the individual patient
- Do no harm to the list
- Do no harm to the donor
What are absolute contraindications to transplant?
- Chronic illness that shortens life expectancy to less than 1 year
- Active infection unless effectively treater before proceeding
- Active malignancy that shortens life expectancy, unless remission is certain
- Active glomerulonephritis
- Active substance abuse
- Severe obesity
What are the advantages to recipients of living versus deceased donor kidneys?
No waiting time, versus 3-5 year wait.
Longer graft survival: donors are healthier, shorter cold ischemia time means less kidney damage, less delayed graft function and less rejection
Better kidney function
What type of transplant provides the best 3 year survival?
Transplant from spousal or parental donors.
What are barriers to kidney transplantation?
Recipient and donor have to be ABO compatible.
Recipient should have negative cross match against potential donor and shouldnt be sensitized (HLA antibodies)
What are the goals of induction therapy (immunosuppression)? What drugs are most commonly used?
Decrease rate of acute rejection
To permit delayed initiation, minimization, or avoidance of some of maintenance agents like corticosteroids and calcineuin inhibitors (CNI)
Calcineurin inhibitors such as cyclosporine and tacrolimus most commonly used.
Where is the transplanted kidney placed?
Heterotopic (non-physiologic site): iliac fossa, extraperitoneally.
What are the anastomoses of hte kidney for transplantation?
BVs:
- Common iliac artery and vein
- External iliac artery and vein
- Internal iliac artery and vein
Ureter:
- Neoimplantation
- Uretero-ureteral anastomosis (end to end or -side)
What is the most widely performed transplanted solid organ?
The kidneys!
