kidney transplant Flashcards
how are transplant recipients assessed?
reasonable life expectancy >5years
same to undergo op eg safe for anaesthetic
immunological (make sure there’s a match)
exclude active infection
assess cardiovascular risk
assess bladder function
assess mental state
assess PMH/ co morbidities
what are some contraindications to transplant?
malignancy (untreated or having had cancer in last 2-5 years)
active infection
severe IHD not amenable to surgery
active vascultitis
severe PVD
hostile bladder
what can increase the chance of organ rejection?
blood transfusion
pregnancy/miscarriage
previous transplant
what is desensitisation in a transplant?
the active removal of blood group or donor specific HLA antibody
done through pre transplant antibody depletion through plasma exchange or rituximab
how does the organ get put into the recipient?
inserted into iliac fossa
attached to external iliac artery and vein
ureter plumbed into bladder with stent
what are some surgical complications of the transplant?
bleeding
stenosis
ureter stricture
wound infection
lymphocele
what is hyperacute rejection?
due to performed antibodies
unsalvageable
transplant nephrectomy required
what is acute rejection?
cellular or antibody mediated
can be treated with increased immunosuppression
t cell mediated
what is chronic rejection?
antibody mediated slowly progressive decline in renal function.
poorly responsive to treatment
what is the point of anti rejection therapy?
reduces activation of T cells
what immunosuppressive therapy is used?
induction
maintainance
acute anti rejection
what are the induction therapies?
basiliximab/dacluzimab
prednisolone IV during op
what are the maintainance therapies?
Prednisolone, tacrolimus, MMF
Prednisolone, ciclosporin, azathioprine
what are the acute anti rejection treatments?
Pulsed iv methylprednisolone (ACR)
Anti-thymocyte globulin (ATG), (resistant ACR and AMR))
IV Immunoglobulin (AMR)
Plasma exchange (AMR)
Rituximab, Bortezimab, Eculizumab (AMR)
& intensification of immunosupression
what are some common side effects of the immuno suppression?
UTI
LRTI
prophylaxis for PJP, CMV
