4 Kidney transplant

Question 1

What is the best form of renal replacement therapy?

Answer 1

Kidney transplant (the cells cannot regenerate, only replaced with non-functional scar tissue)

Question 2

What is the most widely performed transplantation among solid organs?

Answer 2

Kidneys (60%)! yay!

(next highest is liver, 21%)

Question 3

What are some eligibility criteria for kidney transplant?

Answer 3

• refer patients with CKD stage 4 or GFR <30
• can list patients for transplant when GFR <20
• criteria:
  
  • medical/surgical history
  • social and psychological suitability
  • compliance (strict immunosuppressive protocol after transplant)

Question 4

What is the best time for referral for a kidney transplant?

Answer 4

• ASAP
• younger patients= better outcomes
• less time on dialysis before transplant= better outcomes

Question 5

What are some major contraindications for kidney transplant?

Answer 5

• chronic illness (life expectancy <1 year)
• active infection, malignancy, or glomerulnephritis
• uncontrolled psychosis
• active substance abuse
• severe obesity

**AGE is NOT a contraindication!

Question 6

What are 2 possible donors for a kidney transplant? How do their outcomes differ?

Answer 6

• living (76-90% survival depending on relation)
  
  • no waiting time
  • longer graft survival (short ischemia time meanse less damage to the kidney)
  • better kidney function
• deceased (70% survival)
  
  • 3-5 year wait list

Question 7

Describe HLA antigens

Answer 7

• “human leukocyte antigen” system encoding the major histocompatibility complex (MHC) proteins in humans
• responsible for the regulation of the immune system
• major cause of solid organ transplant rejection

Question 8

What is an induction agent?

Answer 8

• short-term use of an immunosuppressive agent
• decreases the rate of acute rejection
• minimize/avoid need for some maintenance agents (i.e. corticosteroids)
• examples:
  
  • monoclonal antibodies (react with antigen receptors on lymphocytes)
  • polyclonal antibodies (e.g. IgG… reacts with multiple receptors)

Question 9

What medications are necessary following a kidney transplant?

Answer 9

• “maintenance immunosuppression” including:
  
  • calcineurin inhibitors (cyclosporine, tacrolimus)
  • T cell proliferation inhibitors (azathioprine, mycophenolate mofetil)
  • mToR inhibitors (sirolimus)
  • co-stimulation blockade (belatacept)
  • non-specific immunosuppressants (corticosteroids)

Question 10

Where is a transplanted kidney located?

Answer 10

• “heterotopic” transplant (aka in a different spot than normal)
• transplanted to the iliac fossa, extraperitoneally
• transplanted renal artery/vein attach to right iliac artery/vein
• ureter is shorter than normal kidney