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Renal Week 3 2017/18 > 4: Renal transplantation > Flashcards

4: Renal transplantation Flashcards

1
Q

Apart from dialysis, what can be offered to patients with end-stage CKD?

A

Kidney transplant

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2
Q

What is the best option out of dialysis and renal transplant?

A

Renal transplant

by far

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3
Q

Which type of renal transplant has the best prognosis?

A

Those from LIVE, RELATED donors

e.g your bro

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4
Q

What CKD stage corresponds with end-stage disease?

What is the GFR threshold?

A

CKD5

GFR < 15

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5
Q

What GFR will patients achieve at best

a) on dialysis
b) after a transplant?

A

a) 7 (so they’ll still feel miserable)

b) 50 (more freedom, better QOL)

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6
Q

From which groups of donors can transplants be taken?

A

Live donors

Cadaveric donors

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7
Q

___ is required to prevent organ rejection.

A

Immunosuppression

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8
Q

Which patients are less likely to receive kidney transplants?

Why?

A

Elderly

Co-morbidities, less likely to achieve good outcomes

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9
Q

In which situations are organs taken from cadaveric donors?

A

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

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10
Q

Why are cadaveric organs from brain stem death donors more useful than those from recently dead donors?

A

Brain stem death - organs still perfused

Recently dead - “ischaemic hit”

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11
Q

Donation from living donors is also known as ___ donation.

A

altruistic

charitable, generous

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12
Q

Organ donation involving the exchange of money/services is ___.

A

illegal

in the UK

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13
Q

Patients with CKD5 are only considered for transplant if they are going to live for more than ___ years.

A

five years

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14
Q

What affects a patient’s suitability for surgery?

A

Age

Co-morbidities - frailty, bleeding, CVD

Response to anaesthetic

Immunosuppressed

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15
Q

What must the donor be assessed for before somebody receives their organ?

A

Infection

stuff like hepatitis, HIV, cytomegalovirus…

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16
Q

How is a patient’s CVD and pulmonary risk assessed before they receive a transplant?

A

ECG

Echocardiogram

Chest X-ray, pulmonary function tests

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17
Q

What organ structures must be checked before a patient receives a renal transplant?

A

Current renal blood supply

Bladder

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18
Q

What are conditions are contraindications to renal transplant?

A

Malignancy

Active infection

why would you immunosuppress these patients

otherwise: severe CVD, respiratory problems

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19
Q

What contraindicates someone from donating a kidney?

A

Not physically fit

Poor renal function - existing renal disease?

Co-morbidities - e.g DM

Kidneys not structurally, immunologically suitable

Donor is being cooerced

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20
Q

Donors with blood group ___ can donate to anyone.

A

O

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21
Q

What are the four blood groups?

A

O

A

B

AB

compatible with what the other person’s got

O covers all

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22
Q

How are tissues matched in organ donation?

A

Blood group

HLA genotype

23
Q

If the donor tissue doesn’t match the recipient’s blood group and HLA genotype, what occurs?

A

Rejection

24
Q

What events can sensitise patients to antigens and predispose them to organ rejection?

A

Blood transfusion

Pregnancy

Previous transplant

25
Q

Why may a woman be sensitised to her husband’s kidneys?

A

Coincidental

Previous pregnancy

26
Q

Which patients are given priority on the kidney transplant list?

A

Children

27
Q

How can patients be desensitised to donor tissue?

A

Plasma exchange

Biologics (e.g rituximab - B cell inhibitor)

28
Q

What is the down side of desensitisation?

A

Further immunosuppression

so patient is at less risk of rejection but increased risk of all the side effects

29
Q

Where is the incision made in a kidney transplant?

A

Iliac fossa

30
Q

Which artery and vein are transplanted kidneys connected to?

A

External iliac artery

External iliac veins

31
Q

After transplant, the kidney is (retroperitoneal / intraperitoneal / extraperitoneal).

A

extraperitoneal

anterior, not within peritoneum at all

32
Q

What are

a) vascular
b) urological
c) other

complications of kidney transplant surgery?

A

a) Haemorrhage, stenosis

b) Stenosis

c) Infection

33
Q

If the transplanted kidney works immediately, kidney function will ___.

A

improve

34
Q

If the transplanted kidney takes time to function, what occurs acutely?

A

Tubular necrosis

35
Q

What are three types of organ rejection?

A

Hyperacute

Acute

Chronic

36
Q

What immune components mediate

a) hyperacute
b) acute
c) chronic

organ rejection?

A

a) Pre-formed antibodies

b) Cell/antibody-mediated

c) Antibody mediated, slower than acute

37
Q

How is hyperacute rejection treated?

A

Removal of transplant

38
Q

How is acute rejection treated?

A

Increased immunosuppresion

39
Q

Which drugs are given in induction immunotherapy?

A

Monoclonal antibodies (block CD4+ T cells)

Steroids

40
Q

What type of drug are tacrolimus and ciclosporin?

A

Calcineurin inhibitors

Also inhibit T cells

41
Q

Which drugs can be used in

a) induction
b) maintenance

immunosuppression for transplant?

A

a) Monoclonal antibodies, steroids

b) Tacrolimus, ciclosporin, azathioprine, mycophenolate

42
Q

What is the major side effect of excessive immunosuppression?

A

Atypical infections

43
Q

Where do bacterial infections secondary to immunosuppression occur?

A

Urinary tract

Lower respiratory tract

44
Q

Which virus commonly causes death in immunosuppressed transplant patients?

A

Cytomegalovirus

45
Q

How is immunosuppression-related CMV infection prevented?

A

Viral prophylaxis

46
Q

Which virus classically reactivates and causes kidney disease in excessive immunosuppression?

What does this mimic?

A

BK virus

Mimics organ rejection

47
Q

Which

a) bacteria
b) viruses

clasically reactivate to cause disease in patients who are immunosuppressed?

A

a) TB

b) HIV, Hepatitis, CMV, BK

48
Q

Apart from infection, what is another major complication of immunosuppression secondary to renal transplant?

A

Malignancy

49
Q

Which type of cancer commonly occurs in renal transplant patients?

Why?

A

Skin cancer

Immunosuppression

50
Q

Which type of skin cancer presents in renal transplant patients?

A

Non-melanoma

so BCC or SCC

51
Q

What is the second most common cancer to develop in renal transplant patients?

A

Lymphoma

52
Q

Which virus is related to lymphoma secondary to renal transplanation?

A

Epstein-Barre virus (EBV)

think of the glange

53
Q

Renal transplant patients are followed up for how long?

A

Life

54
Q

What commonly causes death following renal transplant?

A

Organ rejection

CVD, infection and malignancy (as in dialysis)

Renal Week 3 2017/18 (12 decks)

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