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Urinary > Kidney Transplant > Flashcards

Kidney Transplant Flashcards

1
Q

What is the name of the major histocompatibility complex (MHC) in humans?

A

Human leucocyte antigen (HLA)

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2
Q

On which chromosome is HLA coded for?

A

Chromosome 6

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3
Q

What are the class 1 HLA antigens?

A

class 1 antigens include A, B and C

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4
Q

What are the class 2 HLA antigens?

A

Class 2 antigens include DP,DQ and DR

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5
Q

When transplanting, what is relative importance of the matching the HLA antigens?

A

DR > B > A

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6
Q

What are the possible post op problems of a kidney transplant?

A

ATN of graft
vascular thrombosis
urine leakage
UTI

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7
Q

What are the possible contraindications of a kidney transplant?

A

Active infections
Cancer
Severe co-morbidity

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8
Q

What is the main indication for a kidney transplant?

A

End-Stage Renal Failure

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9
Q

What are the early complications related to the kidney transplant?

A

Infection
Urinary leak
Haemorrhage
Impaired graft function

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10
Q

What are the late complications related to the kidney transplant?

A

Lymphocele
Ureteric stenosis
Renal artery thrombosis.

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11
Q

What are the main complications caused by Rejection of the Transplant?

A

Hyperacute rejection (minutes to hours)
Acute graft failure (< 6 months)
Chronic graft failure (> 6 months)

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12
Q

When does hyperacute rejection occur after the transplant?

A

Minutes to hours

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13
Q

What is a hyperacute rejection due to?

A

Pre-existing antibodies against ABO or HLA antigens

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14
Q

What type of reaction is a hyperacute rejection?

A

Type II hypersensitivity reaction

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15
Q

What does a hyperacute rejection result in?

A

Widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ

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16
Q

What is the management of a hyperacute rejection?

A

No treatment is possible and the graft must be removed

17
Q

How can a hyperacute rejection be avoided?

A

Pre-treatment ABO cross-matching.

18
Q

When does an acute graft failure occur?

A

In the first 6 months

19
Q

What is an acute graft failure due to?

A

Mismatched HLA

20
Q

What type of reaction is an acute graft failure?

A

Cell-mediated (cytotoxic T cells)

21
Q

How does an acute graft failure present?

A

Asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria

22
Q

What is a possible cause of an acute graft failure?

A

Cytomegalovirus infection

23
Q

What is the management of an acute graft failure?

A

Reversible with steroids and immunosuppressants

24
Q

How else can an acute graft failure present?

A

Fever
Pain around the graft site
Impaired renal function

25
Q

When does chronic graft failure occur?

A

After 6 months

26
Q

What is chronic graft failure characterised by?

A

Interstitial fibrosis and tubular atrophy.

27
Q

How can chronic graft failure present?

A

A gradual reduction in renal function and hypertension

28
Q

Does chronic graft failure respond to immunosuppression?

A

No

29
Q

What immunosuppressive therapy is usually given?

A

Ciclosporin
Tacrolimus
Mycophenolate mofetil

30
Q

What infection can occur secondary to immunosuppression?

A

Cytomegalovirus infection

31
Q

How can cytomegalovirus present?

A

Fever and disturbed LFTs a few weeks after the transplant operation.

32
Q

How can cytomegalovirus be managed?

A

Ganciclovir

33
Q

What malignancy can occur secondary to immunosuppression?

A

Skin (e.g. squamous cell carcinoma)
Lymphoma (secondary to EBV re-activation).

34
Q

What would make you think of an acute graft failure?

A

Pyuria (raised leucocytes on his urine dip).
Proteinuria (a raised protein on his urine dip).
Rising creatinine (>1.5x from his post-operative baseline).
Within a 6 month period

35
Q

What is a possible side effect of tacrolimus?

A

Impaired glucose tolerance and diabetes

36
Q

What are the possibel side effects of mycophenolate?

A

GI and marrow suppression

37
Q

What do patients on immunosuppression therapy need to be monitored for?

A

Cardiovascular disease
Renal failure
Malignancy

Urinary (38 decks)

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