4: Renal transplantation Flashcards
Apart from dialysis, what can be offered to patients with end-stage CKD?
Kidney transplant
What is the best option out of dialysis and renal transplant?
Renal transplant
by far
Which type of renal transplant has the best prognosis?
Those from LIVE, RELATED donors
e.g your bro
What CKD stage corresponds with end-stage disease?
What is the GFR threshold?
CKD5
GFR < 15
What GFR will patients achieve at best
a) on dialysis
b) after a transplant?
a) 7 (so they’ll still feel miserable)
b) 50 (more freedom, better QOL)
From which groups of donors can transplants be taken?
Live donors
Cadaveric donors
___ is required to prevent organ rejection.
Immunosuppression
Which patients are less likely to receive kidney transplants?
Why?
Elderly
Co-morbidities, less likely to achieve good outcomes
In which situations are organs taken from cadaveric donors?
Brain stem death (so intubated, HB but no signs of life)
No heart beat (very rapidly after death)
organs taken very rapidly and transported to patient
Why are cadaveric organs from brain stem death donors more useful than those from recently dead donors?
Brain stem death - organs still perfused
Recently dead - “ischaemic hit”
Donation from living donors is also known as ___ donation.
altruistic
charitable, generous
Organ donation involving the exchange of money/services is ___.
illegal
in the UK
Patients with CKD5 are only considered for transplant if they are going to live for more than ___ years.
five years
What affects a patient’s suitability for surgery?
Age
Co-morbidities - frailty, bleeding, CVD
Response to anaesthetic
Immunosuppressed
What must the donor be assessed for before somebody receives their organ?
Infection
stuff like hepatitis, HIV, cytomegalovirus…
How is a patient’s CVD and pulmonary risk assessed before they receive a transplant?
ECG
Echocardiogram
Chest X-ray, pulmonary function tests
What organ structures must be checked before a patient receives a renal transplant?
Current renal blood supply
Bladder
What are conditions are contraindications to renal transplant?
Malignancy
Active infection
why would you immunosuppress these patients
otherwise: severe CVD, respiratory problems
What contraindicates someone from donating a kidney?
Not physically fit
Poor renal function - existing renal disease?
Co-morbidities - e.g DM
Kidneys not structurally, immunologically suitable
Donor is being cooerced
Donors with blood group ___ can donate to anyone.
O
What are the four blood groups?
O
A
B
AB
compatible with what the other person’s got
O covers all
How are tissues matched in organ donation?
Blood group
HLA genotype
If the donor tissue doesn’t match the recipient’s blood group and HLA genotype, what occurs?
Rejection
What events can sensitise patients to antigens and predispose them to organ rejection?
Blood transfusion
Pregnancy
Previous transplant
Why may a woman be sensitised to her husband’s kidneys?
Coincidental
Previous pregnancy
Which patients are given priority on the kidney transplant list?
Children
How can patients be desensitised to donor tissue?
Plasma exchange
Biologics (e.g rituximab - B cell inhibitor)
What is the down side of desensitisation?
Further immunosuppression
so patient is at less risk of rejection but increased risk of all the side effects
Where is the incision made in a kidney transplant?
Iliac fossa
Which artery and vein are transplanted kidneys connected to?
External iliac artery
External iliac veins
After transplant, the kidney is (retroperitoneal / intraperitoneal / extraperitoneal).
extraperitoneal
anterior, not within peritoneum at all
What are
a) vascular
b) urological
c) other
complications of kidney transplant surgery?
a) Haemorrhage, stenosis
b) Stenosis
c) Infection
If the transplanted kidney works immediately, kidney function will ___.
improve
If the transplanted kidney takes time to function, what occurs acutely?
Tubular necrosis
What are three types of organ rejection?
Hyperacute
Acute
Chronic
What immune components mediate
a) hyperacute
b) acute
c) chronic
organ rejection?
a) Pre-formed antibodies
b) Cell/antibody-mediated
c) Antibody mediated, slower than acute
How is hyperacute rejection treated?
Removal of transplant
How is acute rejection treated?
Increased immunosuppresion
Which drugs are given in induction immunotherapy?
Monoclonal antibodies (block CD4+ T cells)
Steroids
What type of drug are tacrolimus and ciclosporin?
Calcineurin inhibitors
Also inhibit T cells
Which drugs can be used in
a) induction
b) maintenance
immunosuppression for transplant?
a) Monoclonal antibodies, steroids
b) Tacrolimus, ciclosporin, azathioprine, mycophenolate
What is the major side effect of excessive immunosuppression?
Atypical infections
Where do bacterial infections secondary to immunosuppression occur?
Urinary tract
Lower respiratory tract
Which virus commonly causes death in immunosuppressed transplant patients?
Cytomegalovirus
How is immunosuppression-related CMV infection prevented?
Viral prophylaxis
Which virus classically reactivates and causes kidney disease in excessive immunosuppression?
What does this mimic?
BK virus
Mimics organ rejection
Which
a) bacteria
b) viruses
clasically reactivate to cause disease in patients who are immunosuppressed?
a) TB
b) HIV, Hepatitis, CMV, BK
Apart from infection, what is another major complication of immunosuppression secondary to renal transplant?
Malignancy
Which type of cancer commonly occurs in renal transplant patients?
Why?
Skin cancer
Immunosuppression
Which type of skin cancer presents in renal transplant patients?
Non-melanoma
so BCC or SCC
What is the second most common cancer to develop in renal transplant patients?
Lymphoma
Which virus is related to lymphoma secondary to renal transplanation?
Epstein-Barre virus (EBV)
think of the glange
Renal transplant patients are followed up for how long?
Life
What commonly causes death following renal transplant?
Organ rejection
CVD, infection and malignancy (as in dialysis)
