Kidney Transplant

Question 1

most common transplant

Answer 1

• kidney

- in US, Europe, and Asia

Question 2

Kidney transplant vs HD

Answer 2

• kidney transplant more cost effective

- 40-60% decrease in death rate vs remaining on HD

Question 3

graft survival rate after 3 years

Answer 3

• cadaveric - 88%

- living donor - 93%

Question 4

paired donor

Answer 4

• have a living donor that is not the same blood type as you, they can donate to another person and then another person will donate to you
• kind of like a trade

Question 5

average waiting time for kidney

Answer 5

4-5 years

Question 6

ESRD etiology

Answer 6

• diabetes (30-40%)
• glomerulonephritis
• polycystic kidney disease
• hypertensive kidney disease
• chronic pyelonephritis
• obstructive uropathy
• SLE
• alport’s syndrome

Question 7

alport’s syndrome

Answer 7

• disease that damages the tiny blood vessels in your kidneys
• lead to kidney damage and kidney failure

Question 8

pathophysiology of ESRD

Answer 8

• reduction of GFR and UOP
• decreased GFR < 30 mL/min
• build up of nitrogenous waste
• retain fluid and lytes
• UOP < 400 mL/day
• multi-system dysfunction
• CV disease major cause of death

Question 9

multisystem effects of ESRD

Answer 9

• CHF
• pleural effusion
• anemic
• vitamin D absorption and calcium absorption decreased so fragile bones
• CV disease

Question 10

organ matching and allocation

Answer 10

• ABO compatibility –> all organ transplants
• HLA profile
• patient specific crossmatch

Question 11

preop evaluation prior to transplant

Answer 11

• EKG (100P)
• also stress echo and/or cardiac cath
• preop beta block (helpful for cardiac protection)
• autonomic neuropathy (gastric reflux, considered full stomach)
• CBC, lytes, coags (plts do not function properly)

Question 12

dialysis

Answer 12

• how much removed
• are thy dry?
• know dry and pre-dialysis weight
• volume and lyte correction may be necessary

Question 13

other preop prep

Answer 13

• may need immunosuppression prior

- antibiotic protocol

Question 14

anesthetic management for kidney

Answer 14

• standard monitors
• art/CVP based on patient comorbidities
• need good, large bore IVs
• GETA –> RSI
• balanced technique –> narcotic/volatiles + TIVA

Question 15

fluids for kidney tx

Answer 15

• plasma lyte preferred or NS
• CVP goal 10-15 mmHg
• SBP >90 mmHg; mean >60 mmHg

Question 16

volatile inhalation agents kidney tx

Answer 16

any are fine

sevo = compound A but generally fine

Question 17

muscle relaxant kidney tx

Answer 17

• succ or roc for intubation
• if using succ, then check a potassium
• cisatricurium for maintenance

Question 18

where is kidney implanted

Answer 18

R iliac fossa, anatomically better

Question 19

clamp time kidney tx

Answer 19

no longer than 15-30 minutes

Question 20

monitoring with reperfusion

Answer 20

• anitcipate hypotension
• build up of metabolites
• fluids, turn gas down, pressors
• pressors to use –> dobutamine, dopa, ephedrine
• pressors to NOT use –> def not neo

Question 21

monitor UOP

Answer 21

• obstruction/irrigation
• US diagnosis - thrombosis in anastomosis
• pharmacologic therapy
• 1st 100 cc of UOP might be flushing kidneys talk to surgeon
• no urine - may be obstructed like ureter or blood clot; rejection can also cause no UOP
• promote UOP with fluids, lasix, mannitol

Question 22

lasix and mannitol use in kidney tx

Answer 22

• promote diuresis

- mannitol scavenges ROS

Question 23

rejection in kidney tx

Answer 23

-hyperacute biopsy for dx

Question 24

how long does heparin need to circulate

Answer 24

3 minutes

Question 25

post op renal transplant management

Answer 25

• analgesia - narcs, PCA

- combination of blocks (intercostal, TAP block)