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MIDS 237 > Ch 23 Kidney + Liver Transplants > Flashcards

Ch 23 Kidney + Liver Transplants Flashcards

1
Q

What is an allograft?

A

Any tissue transplanted from 1 human to another human

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2
Q

What are immunosuppression drugs used for?

A

To inhibit the body’s formation of antibodies to an allograft

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3
Q

What is an orthotopic transplant?

A

A transplant that is placed in the same anatomic location as the native organ

(ex. a whole liver transplant)

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4
Q

Are renal transplants orthotopic in location?

A

No!

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5
Q

What is transplant rejection?

A

Failure of transplant due to the formation of antidoner antibodies by the recipient, leading to loss of the transplant

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6
Q

Who would qualify for a renal transplant?

A

Pt’s with end-stage renal disease

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7
Q

What are the 3 m/c signs of end-stage renal disease?

A

-Diabetes
-Hypertension
-Glomerulonephritis

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8
Q

Kidney donors + recipients MUST have the same ___?

A

Human leukocyte antigen

(or else donated kidney will attack recipient’s immune system)

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9
Q

Where are renal transplants m/c placed in adults?

A

In extraperitoneal space in the RT iliac fossa

(b/c LT iliac fossa has sigmoid colon)

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10
Q

Where can renal transplants be placed in children?

A

Intraperitoneally

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11
Q

How do kidney transplants differ if the donor is deceased vs living?

A

Deceased:
-RA + part of Ao is taken and anastomosed to recipient’s EIA (carrel patch)

Living:
-RA is directly anastomosed with recipient’s EIA or IIA
-Increased risk of thrombus/stenosis

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12
Q

What is a ureteral anastomosis?

A

When the donor’s ureter gets implanted into the dome of the recipient’s bladder

(aka ureteroneocystostomy)

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13
Q

What is an en-bloc transplant?

A

Special type that uses cadavers (corpse) of small pediatric pt’s (<5 y/o)

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14
Q

What does the recipient receive with an en-bloc kidney transplant?

A

Both kidneys, ureters, renal arteries, renal veins, part of suprarenal Ao + part of infrarenal IVC

Ao = anastomosed to recipient’s EIA
IVC = anastomosed to recipient’s EIV
Ureters = implanted into recipient’s bladder

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15
Q

Where are transplant kidneys placed with an en-bloc transplant?

A

In extraperitoneal space in RLQ (both on same side)

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16
Q

What is the pt prep for a kidney transplant?

A

-Fast overnight
-Fill bladder (helps us see jets + UVJs)

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17
Q

When is a baseline sonogram obtained following a renal transplant?

A

Within 24-48 hours post-op

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18
Q

With a kidney transplant, are the recipient’s native kidneys typically removed?

A

No, they are left in place

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19
Q

Transplant kidneys in the RLQ are ___ in location?

A

Superficial

(hilum is inferior + posterior)

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20
Q

What measurements should we obtain when scanning a transplant kidney?

A

Length, width + AP (volume)

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21
Q

How does the renal length differ b/w a transplant vs native kidney?

A

Transplant kidney is slightly larger (reaches max size 6 months post-op)

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22
Q

What is the protocol for imaging a renal transplant in 2D?

A

-Images of kidney, arterial/venous anastomosis sites + bladder (rule out urinoma)
-Check perinephric space for fluid collections

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23
Q

What is the protocol for imaging a renal transplant with CD + spectral doppler?

A

Arterial:
-EIA (prox, at area + dist to RA anastomosis)
-RA (at anastomosis, prox, mid + dist)

Venous:
-EIV (prox, at area + dist to RV anastomosis)
-RV (at anastomosis + dist near hilum)

Overall:
-CD box over entire kidney to assess perfusion
-Obtain SD tracings in segmental + interlobar arteries

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24
Q

Do we routinely take PSV measurements of the arterial or venous velocities with transplants?

A

Arterial

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25
Q

How should perfusion of the renal cortex appear in a kidney transplant?

A

Symmetric + homogeneous

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26
Q

What is the RI formula?

A

PSV-EDV / PSV

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27
Q

What is the normal RI for kidney transplants?

A

0.6-0.7

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28
Q

Do interlobar arteries have a low or high resistance pattern?

A

Low (high EDV)

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29
Q

What is the m/c cause of graft loss with KTs?

A

Rejection

30
Q

Most KT rejections occur within ___ months?

A

6

31
Q

List 3 signs of KT rejection?

A

-Anuria (no urine)
-Oliguria (decreased urine)
-Increase in serum creatinine

32
Q

What are the 3 types of KT rejections?

A

-Hyperacute (mins - hours after)
-Acute (2 weeks - 3 months after)
-Chronic (>3 months after)

33
Q

What causes acute tubular necrosis following KTs?

A

Cold ischemic time (m/c in deceased donor transplants)

34
Q

Is acute tubular necrosis a sign of rejection in KTs?

A

No! Is temporary (occurs on day 2-3 post-op)

35
Q

If ___ remains high, it can be hard to distinguish acute tubular necrosis from rejection?

A

Creatinine (have biopsy)

36
Q

What is page kidney?

A

Hypertension due to compression of kidney by a subcapsular collection (surgically treat this)

37
Q

M/c location for hematomas in a transplant kidney?

A

Lower pole

38
Q

What is suspected if there is urine output decrease or leakage of urine after a kidney transplant?

A

Urinoma (occurs in first few weeks)

39
Q

When would we expect to see a lymphocele after a KT?

A

4-8 weeks post-op

40
Q

Are lymphoceles symptomatic?

A

No!

41
Q

What would cause an elevated RI in a KT?

A

Hydronephrosis

42
Q

Is mild pelvocaliectasis a normal finding in a KT?

A

Yes!

43
Q

Is renal artery thrombosis m/c in adult or pediatric KTs?

A

Peds

44
Q

What is the main sign on spectral doppler that indicates renal vein thrombosis in a KT?

A

Reversed diastolic flow in RAs

45
Q

Pt’s with RA stenosis will present 6-12 months post-op with ___ following their KT?

A

Refractory hypertension

46
Q

What would the RA to EIA ratio be if a pt has RA stenosis?

A

> 2.0

47
Q

When would AVFs be asymptomatic?

A

If small

48
Q

SF of an AVF following KT?

A

CD aliasing with color bruit

49
Q

What is a pseudoaneurysm within a KT?

A

-Leak from parenchymal RA
-Anechoic area within kidney that has no CD flow + no connection with a vein
-Ying yang sign (to-and-fro)

50
Q

Who would qualify for a liver transplant?

A

Pt’s with acute or chronic end-stage liver failure who don’t respond to medical therapy

51
Q

What is the 1st + 2nd m/c organs to be transplanted?

A

1st: kidney
2nd: liver

52
Q

What are the 3 m/c causes of end-stage liver disease?

A

-Alcoholic liver disease
-HCC
-Hep C

53
Q

What is the m/c type of liver transplant?

A

Orthotopoic

54
Q

What is an orthotopic liver transplant (OLT)?

A

When recipient receives whole liver from decreased donor + gets implanted into normal anatomic location

(includes extrahepatic vessels + CBD)

55
Q

With a liver transplant, is the recipient’s native liver + GB typically removed?

A

Yes! This is the anhepatic phase of the process

56
Q

Explain the piggyback technique with a liver transplant?

A

-When the donor’s IVC gets attached to the recipient’s HV confluence
-The recipient’s IVC is left in place

57
Q

What is the PV anastomosed to with a liver transplant?

A

B/w the donor + recipient’s MPV

58
Q

Arterial anastomosis is b/w what with a liver transplant?

A

B/w donor’s CA + recipient’s CHA (at confluence with GDA)

59
Q

With a single lobe transplant, which lobe of the liver will be given to an adult vs a child?

A

Adult: RLL
Child: LLL

60
Q

What vessels will a partial lobe transplant contain?

A

Single HA, PV + HV

61
Q

Is perihepatic fluid + RT sided pleural effusion normal in early post-op after liver transplant?

A

Yes, should resolve within days

62
Q

What vessels should we use spectral doppler on after liver transplant?

A

Arterial:
-Intrahepatic HAs (main, RT, LT)

Venous:
-PVs (main, RT, LT, anastomotic site)
-IVC + anastomotic site
-HVs (main, RT, LT)

63
Q

What are the 3 m/c causes of liver transplant loss?

A

-Graft failure/rejection
-Biliary complications (HA stenosis/occlusion)
-Vascular complications

64
Q

What is the m/c + most serious complication of a liver transplant?

A

HA thrombosis

65
Q

What type of waveform will appear if there is HA thrombosis? What will the RI be?

A

Tardus-parvus pattern with RI < 0.5

66
Q

What will the velocity be if there is HA stenosis?

A

> 200-300 cm/s

67
Q

What causes intrahepatic pseudoaneurysms?

A

Core-needle biopsy or biliary procedure

68
Q

What will the velocity be if there is PV stenosis?

A

> 125 cm/s

69
Q

How will the velocity change if there is an IVC stenosis?

A

3-4x higher velocity

70
Q

If there is a suprahepatic IVC stenosis, what will happen to the flow in the HVs?

A

Reversed flow or loss of phasicity in HVs

MIDS 237 (23 decks)

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