Ch 23 Kidney + Liver Transplants Flashcards
What is an allograft?
Any tissue transplanted from 1 human to another human
What are immunosuppression drugs used for?
To inhibit the body’s formation of antibodies to an allograft
What is an orthotopic transplant?
A transplant that is placed in the same anatomic location as the native organ
(ex. a whole liver transplant)
Are renal transplants orthotopic in location?
No!
What is transplant rejection?
Failure of transplant due to the formation of antidoner antibodies by the recipient, leading to loss of the transplant
Who would qualify for a renal transplant?
Pt’s with end-stage renal disease
What are the 3 m/c signs of end-stage renal disease?
-Diabetes
-Hypertension
-Glomerulonephritis
Kidney donors + recipients MUST have the same ___?
Human leukocyte antigen
(or else donated kidney will attack recipient’s immune system)
Where are renal transplants m/c placed in adults?
In extraperitoneal space in the RT iliac fossa
(b/c LT iliac fossa has sigmoid colon)
Where can renal transplants be placed in children?
Intraperitoneally
How do kidney transplants differ if the donor is deceased vs living?
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
What is a ureteral anastomosis?
When the donor’s ureter gets implanted into the dome of the recipient’s bladder
(aka ureteroneocystostomy)
What is an en-bloc transplant?
Special type that uses cadavers (corpse) of small pediatric pt’s (<5 y/o)
What does the recipient receive with an en-bloc kidney transplant?
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
Where are transplant kidneys placed with an en-bloc transplant?
In extraperitoneal space in RLQ (both on same side)
What is the pt prep for a kidney transplant?
-Fast overnight
-Fill bladder (helps us see jets + UVJs)
When is a baseline sonogram obtained following a renal transplant?
Within 24-48 hours post-op
With a kidney transplant, are the recipient’s native kidneys typically removed?
No, they are left in place
Transplant kidneys in the RLQ are ___ in location?
Superficial
(hilum is inferior + posterior)
What measurements should we obtain when scanning a transplant kidney?
Length, width + AP (volume)
How does the renal length differ b/w a transplant vs native kidney?
Transplant kidney is slightly larger (reaches max size 6 months post-op)
What is the protocol for imaging a renal transplant in 2D?
-Images of kidney, arterial/venous anastomosis sites + bladder (rule out urinoma)
-Check perinephric space for fluid collections
What is the protocol for imaging a renal transplant with CD + spectral doppler?
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
Do we routinely take PSV measurements of the arterial or venous velocities with transplants?
Arterial
