22. Renal transplantation

Question 1

What is the recommended eGFR limit for preemptive kidney transplantation?

Answer 1

eGFR < 20 ml/min/1,73 m2.

Question 2

What are the two options for treating chronic kidney disease?

Answer 2

Conservative therapy and dialysis or transplantation.

Question 3

What is the concept of the “transplantation window”?

Answer 3

The optimal timing for transplantation to maximize its efficiency.

Question 4

What are the absolute contraindications for transplantation related to cardiovascular diseases?

Answer 4

• Severe, irreversible peripheral atherosclerosis,
• severe, irreversible coronary vascular disease,
• severe, unstable, irreversible cardiac failure,
• high pulmonary artery blood pressure.

Question 5

What are the absolute contraindications for transplantation related to other medical conditions (not CV)?

Answer 5

• Decompensated hepatic cirrhosis,
• severe irreversible respiratory failure,
• psychosocial instability
• BMI > 40 obesity

Question 6

What is the optimal age for transplantation?

Answer 6

Age is not an absolute contraindication, but the optimal age is <75 years.

Question 7

Is HIV seropositivity an absolute contraindication for transplantation?

Answer 7

No, it is not an absolute contraindication if the patient has been treated successfully and sustained by (HA)ART.

Question 8

What are the temporary contraindications of transplantation?

Answer 8

1. Surgical/technical cause
2. Increased peri-and early postoperative risk (i.e. myocardial infarctus, stroke)
3. Increased risk of immunosuppression (infections, malignancies, etc.)
4. If an active disease is directly harmful for the kidney graft (e.g. an immunologically yet active recurring glomerulonephritis)

Question 9

What are the different types of deceased donors?

Answer 9

Heart beating donor (Donation after brain death, DBD) and Non-heart beating donor (Donation after circulatory death, DCD)

Question 10

What is negative crossmatch (XM) in organ transplantation?

Answer 10

There is no antibody in the recipient’s serum against donor HLA antigenes (donor-specific antibody - DSA) which would make transplantation incompatible.

Question 11

What are the advantages of living kidney donation for the recipient?

Answer 11

• Better graft survival,
• longer kidney half-life,
• no need for dialysis in the postoperative period,
• shorter waiting time for transplantation.

Question 12

What are the advantages of living kidney donation for the donor?

Answer 12

• Surgically safe,
• quick healing,
• discharge after 4 days,
• return to their usual life after 4 weeks.

Question 13

What is Delayed Graft Function (DGF)?

Answer 13

A rare complication in the early postoperative period (first 2 weeks) that can occur after kidney transplantation, where the transplanted organ doesn’t start working right away

Question 14

What groups of drugs can be used in transplant induction of immunosuppression?

Answer 14

• IL-2R monoclonal antibody (anti CD25)
• Anti CD52 monoclonal antibody
• Anti-thymocyte polyclonal antibody immunoglobulines

Question 15

What are drugs that can be used in transplant maintenance of immunosuppression

Answer 15

• Corticosteroids
• m-TOR inhibitors
• Calcineurin inhibitors
• Lymphocyte proliferation inhibitors

Question 16

What is NODAT?

Answer 16

New-onset diabetes after transplantation.

Question 17

Does living kidney transplantation have better outcomes than dialysis?

Answer 17

Yes, living kidney transplantation has better outcomes than dialysis.

Question 18

Does the length of time on dialysis affect the outcome of transplantation?

Answer 18

Yes, the longer the dialysis, the worse the outcome of transplantation.

Question 19

What is the life expectancy of patients with a functioning graft compared to those on dialysis?

Answer 19

Patients with a functioning graft have a life expectancy twice as long as those on dialysis.