Kidney transplant Flashcards
How long does a kidney transplant add to a persons life compared to dialysis?
10 years
What would you do with the damaged kidney?
Leave it in situ
When would you not leave the kidney in situ?
Polycystic- size
Chronic pyelonephritis- infection
What is donor matching based on?
Huma leukocyte antigen (HLA) type A, B OR C on chromosome 6
Does the donor have to match exactly?
No- can desensitise them
Describe the procedure of the kidney transplant
- Place kidney in iliac fossa
- Match donor vessels with external iliac vessels
- Donor ureter with patients bladder
- Hockey sticks scar
What long term immunosuppression should the patient be put on after a kidney transplant?
- Mycophenolate
- Tacrolimus
- Steroid: Prednisolone
What can tacrolimus cause?
Tremor
What can steroids cause?
Avascular necrosis
When does a hyper-acute transplant rejection occur?
Minutes to hours of transplant
What causes a hyper-acute transplant rejection?
Pre-existing antibodies against ABO or HLA
How does a hyper-acute transplant rejection present?
Worsening pain on transplant site
Febrile
Tender over transplant
What type of hypersensitivity reaction is a hyper-acute transplant rejection?
Type 2 hypersensitivity reaction
What does a hyper-acute transplant rejection lead to?
Leads to widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ
What is the management of a hyper-acute transplant rejection?
No management
Remove graft
When does an acute graft failure occur?
Within 6 months of transplant
What is an acute graft failure due to?
Mis-matched HLA
What type of reaction is an acute graft failure?
Cell-mediated (cytotoxic T cells)
What are other possible causes of an acute graft failure?
Cytomegalovirus
Is an acute graft failure reversible?
Possibly
How would you reverse an acute graft failure?
Steroids
Immunosuppressants
What is the main complication of a kidney transplant?
Cytomegalovirus
How does cytomegalovirus present?
- Generally unwell and anorexia
- Fatigue and arthralgia
- Sclera are jaundiced
- Widespread lymphadenopathy and hepatomegaly
What are some post-op problems of a kidney transplant?
- ATN of graft
- vascular thrombosis
- urine leakage
- UTI
When would you remove the graft?
If there is graft failure due to:
• Acute renal failure
• Hyperacute transplant rejection
What would you do if there was no urine output since the operation?
Immediate return to theatre and removal of transplant
What does a kidney transplant increase the risk of?
Squamous cell carcinoma of the skin
