Ch 119 - Renal Transplant Flashcards

1
Q

List some factors associated with higher post-op morbidity/mortality

A
  • Cats older than 10yo
  • Creatinine over 10mg/dl and high BUN more likely to die before discharge
  • Pre-op blood pressure and weight
  • In dogs, every 1yr increase in age increases odds of death by 6m by 42%
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2
Q

What test is performed is a recipient cat has recently had a UTI or has a history of recurrent UTI?

A

A cyclosporine challenge test for 2 weeks
- If they have a positive culture result at end of test, they are eliminated as candidates

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3
Q

Can patients with positive toxoplasma titres be candidates for renal transplant?

A

Yes but they will need to be on clindamycin for life

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4
Q

List findings that eliminate a cat as a candidate for renal transplantation

A
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5
Q

What imaging is performed on potential kideny donors?

A

CT angiography

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6
Q

What pre-operative medications can reduce the chances of requiring blood products?

A

Erythropoietin or darbepoietin

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7
Q

What are is the main immunosuppresive combon used in cats?

A
  • Prednisolone
  • Cyclosporine
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8
Q

How does cyclosporine work?

A

Inhibits calcineurin, thus preventing activation of transcription factors regulating genes for cytokines including TNFa, IL-2, IL-4, IFN-gamma and granulocyte-macrophage colony-stimulating factor

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9
Q

What can be added to the immunosuppressive protocol to be able to reduce the dose of cyclosporine?

A

Ketoconazole
- Itraconazole and clarithromycin may also be effective and have less adverse side effects

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10
Q

What kind of donor improves graft survival in dogs?
What is the most common immunosuppresive protocol?

A
  • A major-histocompatibility complex-identical littermate
  • Cyclosporine, prednisolone and azathioprine
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11
Q

What complications can be seen with ketoconazole in dogs?

A
  • Hepatotoxicity
  • Cataract formation
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12
Q

Addition of what substance to immunosuppresive protocol after transplantation from a nonrelated dog improves survival?

A

Rabbit antidog antithymocyte serum

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13
Q

Why is mannitol administerd during renal transplantation?

A
  • Minimise renal artery spasm
  • Improve renal blood flow
  • Protect against injury which may occur during the warm ischaemic period
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14
Q

What intra-op factors are assoc with overall decreased survival?

A
  • Hypotension
  • Prolonged anaesthesia over 6hr
  • Cats older than 12yo
  • Intraop hypoxaemia
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15
Q

What medication can be used to treat periop hypertension?

A

Hydralazine

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16
Q

Which kidney is preferred for transplantation?

A

Left kidney - longer vein

17
Q

List the 2 methods of vascular anastomosis?

A
  • anastomosed to recipient iliac vessels (12% HL complication rate)
  • Renal artery anastomosed end-to-side to aorta uwing 8-0 nylon and renal vein anastomosed end-to-side to caudal vena cava using 7-0 silk
18
Q

After graft harvest, what solution is used for flushing?

A

Ice-cold phosphate buffered sucrose organ preserving solution

19
Q

List the technique options for ureteroneocystostomy

A

Intravesicular
Extravesicular
- Ureter to bladder
- or can save a 2mm cuff of donor bladder around the donor ureter to use for anastomosis

20
Q

What additional procedures may be performed at the time of surgery?

A
  • Pexy kidney to abdominal wall
  • Biopsy of one of the native kidneys
  • Enteroplications in dogs (intussusception in up to 25% of dogs after renal transplantation)
21
Q

What factors are assoc with increased risk of post-op seizures/neuro abnormalities

A
  • An increase of 1mg/dL serum creatinine or 10mg/dL BUN increases liklihood of post-op CNS disease by 1.8x and 1.6x respectively
22
Q

If transplant is successful, how quickly should azotaemia resolve?

A

24-72hr

23
Q

What is haemolytic uraemic syndrome?

A

A rare but fatal complication reported in cats
- Haemolytic anaemia
- Thrombocytopaenia
- Rapid deterioration of renal function secondary to glomerular and renal arteriolar platelet and fibrin thrombi

24
Q

What is the prognosis following renal transplant in cats and dogs?

A

Cats:
- 70-92% discharged from hospital
- MST 360-613 days

Dogs:
MST 24 days in 26 dogs (range 0.5 - 4014)

25
Q

List the most common post-op complications after renal transplant in cats

A
  • Acute rejection 13-26%
  • Chronic rejection
  • Haemolytic uraemic syndrome
  • Calcium ocalate urolithiasis
  • Retroperitoneal fibrosis
  • Ureteral obstruction
  • Infection
  • Diabetes mellitus 13.9% (5.45x more likely)
  • Neoplasia 9.5 - 24%, lymphoma more common. 6.1-6.6x more likely to develop neoplasia
26
Q

List some factors associated with higher post-op morbidity/mortality

A
  • Cats older than 10yo
  • Creatinine over 10mg/dl and high BUN more likely to die before discharge
  • Pre-op blood pressure and weight
  • In dogs, every 1yr increase in age increases odds of death by 6m by 42%