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Urinary > Kidney transplant > Flashcards

Kidney transplant Flashcards

1
Q

How long does a kidney transplant add to a persons life compared to dialysis?

A

10 years

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2
Q

What would you do with the damaged kidney?

A

Leave it in situ

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3
Q

When would you not leave the kidney in situ?

A

Polycystic- size

Chronic pyelonephritis- infection

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4
Q

What is donor matching based on?

A

Huma leukocyte antigen (HLA) type A, B OR C on chromosome 6

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5
Q

Does the donor have to match exactly?

A

No- can desensitise them

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6
Q

Describe the procedure of the kidney transplant

A
  • Place kidney in iliac fossa
  • Match donor vessels with external iliac vessels
  • Donor ureter with patients bladder
  • Hockey sticks scar
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7
Q

What long term immunosuppression should the patient be put on after a kidney transplant?

A
  • Mycophenolate
  • Tacrolimus
  • Steroid: Prednisolone
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8
Q

What can tacrolimus cause?

A

Tremor

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9
Q

What can steroids cause?

A

Avascular necrosis

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10
Q

When does a hyper-acute transplant rejection occur?

A

Minutes to hours of transplant

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11
Q

What causes a hyper-acute transplant rejection?

A

Pre-existing antibodies against ABO or HLA

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12
Q

How does a hyper-acute transplant rejection present?

A

Worsening pain on transplant site
Febrile
Tender over transplant

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13
Q

What type of hypersensitivity reaction is a hyper-acute transplant rejection?

A

Type 2 hypersensitivity reaction

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14
Q

What does a hyper-acute transplant rejection lead to?

A

Leads to widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ

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15
Q

What is the management of a hyper-acute transplant rejection?

A

No management

Remove graft

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16
Q

When does an acute graft failure occur?

A

Within 6 months of transplant

17
Q

What is an acute graft failure due to?

A

Mis-matched HLA

18
Q

What type of reaction is an acute graft failure?

A

Cell-mediated (cytotoxic T cells)

19
Q

What are other possible causes of an acute graft failure?

A

Cytomegalovirus

20
Q

Is an acute graft failure reversible?

A

Possibly

21
Q

How would you reverse an acute graft failure?

A

Steroids

Immunosuppressants

22
Q

What is the main complication of a kidney transplant?

A

Cytomegalovirus

23
Q

How does cytomegalovirus present?

A
  • Generally unwell and anorexia
  • Fatigue and arthralgia
  • Sclera are jaundiced
  • Widespread lymphadenopathy and hepatomegaly
24
Q

What are some post-op problems of a kidney transplant?

A
  • ATN of graft
  • vascular thrombosis
  • urine leakage
  • UTI
25
Q

When would you remove the graft?

A

If there is graft failure due to:
• Acute renal failure
• Hyperacute transplant rejection

26
Q

What would you do if there was no urine output since the operation?

A

Immediate return to theatre and removal of transplant

27
Q

What does a kidney transplant increase the risk of?

A

Squamous cell carcinoma of the skin

Urinary (38 decks)

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