Clinical Medicine-Renal Transplantation Flashcards
What are the three types of kidney donors?
Standard Criteria Donor, Extended Criteria Donor (stoke, HTN, serum creatinine >1.5) and Deceased Cardiac Death. The risk of graft rejection goes up in each group.
What is KDPI and EPTS?
KDPI (Kidney donor profile index) grades donors. EPTS (Estimated Post Transplant Survival) grades recipients.
What is the only criteria that must to be met to have a living kidney donor?
ABO compatibility. HLA-typing does help.
What do most patients die from after transplantation?
CV events, infection and skin cancer from immunosuppression.
What do you need to rule out and confirm before doing a transplant?
Infection? Sensitization? Malignancy? Vascular Integrity? Bladder Capacity?
What are the different categories of transplant rejection?
Hyperacute (preformed antibodies activate complement and kill the organ instantly), Acute (T-cell mediated, easily treated w/steroids), Chronic (multifactorial atrophy and fibrosis)
What determines if a T-cell is activated, inactivated or has no response?
Both APC signals binding to T-cell proteins.
What happens if you don’t have CTLA4?
You become a giant lymph node because you can’t turn off the T-cell response.
What do you need to do as far as immunosuppression goes in the operating room?
Induction immunosuppression by depleting lymphocytes and blocking IL2 receptors (used with glucocorticoids)
What do you need to do as far as immunosuppression goes long term?
Maintenance immunosuppression
What do you need to do as far as immunosuppression goes during rejection?
Humoral-mediated rejection are the most difficult to deal with.
What are the major side effects of chronic immunosuppression?
Opportunistic infection and malignancy
