Kidney Transplant Flashcards
The risk for BK nephropathy is highest at ___ months post-transplant?
2-6 months
can a recipient who is Hepatitis C negative receive a kidney that is HepC positive?
yes. Then treat the recipient with hep C antivirals with weekly HepC titers (monitored weekly)
which commonly used immunosuppressants are contraindicated in pregnancy?
MMF and mTOR inhibitors. These should be changed to azathioprine. There are no data on belatacept, so it is not used at this time
what complication can develop if azathioprine is combined with allopurinol?
decrease in azathioprine metabolism (higher AZT levels) which can lead to pancytopenia
what is the 1st line treatment for posttransplant erythrocytosis?
ACEi or ARB
what are the common signs and symptoms of BK viremia
None. it does not cause symptoms
what is the most common cause of death after transplant?
cardiovascular disease
what will happen to cyclosporin levels if patient is on phenytoin?
cyclosporin levels will decrease
a patient who is 3 years posttransplant is asx but has a urine culture with > 50,000 cfu/mL of E. coli. what is the best management?
no treatment for asx bacteriuria in uncomplicated renal transplant
what is the common posttransplant cancer?
squamous cell cancer
what is the first change in management after lymphoproliferative disease?
decrease immunosuppression
what is a positive long term outcome after taking belatacept?
- decreased risk of CVE vs CNIs
- improved GFR
- adherence may improve (no need for drug monitoring)
can a transplant patient receive recombinant zoster vaccine?
Yes. Live vaccines should be avoided but this vaccine does not pose increased risks. Vaccines to avoid are MMR, rotavirus, smallpox, varicella, intranasal flu, and yellow fever
if a transplant patient has new onset proteinuria with a stable creatinine value, what would you do next?
transplant biopsy. there has been significant rejection or GN in these situations. Use of RAAS blockade is also important, but the biopsy should NOT be forgotten
who has a higher risk of rejection, a patient who develops de novo DSAs or one with pretransplant DSA
a patient with de nova DSA has a higher risk
if patient has a sulfa allergy, what is the ppx for PCP pneumonia
pentamidine or atovaquone
what is the effect of tacrolimus on hair?
hair loss; Cyclosporin = hair growth
a transplant patient has new onset tremor. what meds is implicated?
Tacrolimus
true or false, rates of graft rejection increase during pregnancy?
true
name meds that are appropriate for the treatment of graft rejection during preg
steroids, rituximab, IVIG, tacrolimus
what is the risk created by combining cyclosporin or gemfibrozil with statins?
rhabdomyolysis
Pravastatin is preferred; simvastatin & atorvastatin are not recommended
which immunosuppressive med is most likely to cause hyperlipidemia?
mTOR inhibitors; but CsA and prednisone can also cause it
what de novo GN can develop after transplantation in patients with Alport’s disease?
anti-GBM disease but without the pulmonary hemorrhage
what renal disease can recur within hours of receiving a renal transplant?
Primary FSGS. thought to be related to a circulating factor.
what CNI is more likely to cause glucose intolerance, TAC or Csa
tacrolimus
name 3 parts to the criteria for ABMR?
- histologic evidence: peritubular capillaritis, TMA, ATN
- Ab activation: C4d stain or microvascular inflammation
- donor specific Abs
- validated transcripts/classifiers
what eGFR qualifies an adult patient for transplant listing?
eGFR of 20 ml/min
which drug affects spermatogenesis? Sirolimus or Tacrolimus?
Sirolimus
How long can you wait for Transplant to occur after a cardiac balloon angioplasty?
1 month
How long can you wait for Transplant to occur after placement of bare metal stent?
1 months
How long can you wait for Transplant to occur after placement of a drug eluting stent?
6 months
what is the waiting time for transplant if a patient has prostate cancer, < 5cm without tumor invasion?
2 years
what is the waiting time for transplant if a patient has prostate cancer > 5 cm?
5 years
what is the waiting time for transplant if a patient has prostate cancer of < 5 cm but with tumor invasion?
5 years
what is the waiting time for transplant in patients with a history of Lymphoma, Invasive cervical CA or Colon CA?
5 years
what is the waiting time for transplant in patients with a history of Invasive bladder cancer, Wilm’s tumor, or Uterine cancer?
2 years
how long does a patient have to conceive after a kidney transplant?
wait one year after transplant before planning to conceive
what is the most likely outcome of pregnancy in transplant patients?
Low birth weight, and early AOG (average is 35 weeks)
What bladder capacity (mL) in ESKD patients is considered a risk factor for bladder atrophy?
< 300 mL
Kaposi’s sarcoma is a/w what infection?
HHV-8
Non Hodgkin Lymphoma is a/w what infection?
EBV
EBV is associated with what cancers? (4)
PTLD, nHL, Hodgkin’s lymphoma and plasma cell neoplasm
