Kidney transplant Flashcards
What are the two possible complications of kidney transplants?
Surgical
Immunological
What technique was used in the early days to test susceptibility?
Skin grafts
Compatible = no raised skin Incompatible = raised skin
What are the two sources of donor organs?
Living - altruistic, friends or family
Cadaveric - with or without a heartbeat
Which source of organs has the best outcome?
Patients that are living and related/ married
Why do cadaveric organ transplants have such bad outcomes?
High levels of antigens and adhesion molecules formed as a result of injury from inflammatory events that happened around the time of brain death
What are the risks of transplantation?
Infections
Malignancies
Drug related side effects
Why do transplant patients have increased susceptibility to infections?
Posttransplantation lymphoproliferative disease caused by Epstein-barr virus infection
Infects the B cells
Virus can be reactivated post-transplant or come from primary EBV infection
Why do transplant patients have increased cancer risks?
Cytotoxic T cells are suppressed by immunosuppressants
What are drug related side effects that arise in transplant patients?
Nephrotoxicity
Metabolic effects - diabetes and hypertension
Bone marrow suppression - low WBC count or haematological malignancies
Calcineurin inhibitor toxicity - induce injury to the kidneys
What are common drugs used in transplantations?
Clacineurin inhibitors - prevent T cell activation
Anti-proliferative agents - prevent B and T cells from proliferating
Steroids
mTOR inhibitors
Induction agents - suppress lymphocyte activation
What does mTOR do?
mTOR is a signalling pathways that serves as a central regulator of:
Cell metabolism
Growth
Proliferation
Surivival
What is a type of induction agent?
Anti-CD25 blocking monoclonal antibody
What stage do induction agents target?
Initial stage of the transplant when there is greates immune response
What is the difference between warm and cold ischaemia?
Warm ischaemia - kidney is in the body but not perfused with blood
Cold ischaemia - when kidney is removed and placed in ice
Why are organs placed on ice?
To cool down and reduce metabolic requirement
What has more effect on the survival outcome, warm or cold ischaemic time?
Cold ischamic time
What is the mean time for survival of kidney transplant?
14 years
What increases survival of renal failure more, transplant or dialysis?
Dialysis
Why are there criteria for brain stem death?
To secure the knowledge that there is no chance of recovery
What are the criteria for brainstem death?
Brainstem function must have ceased
No corneal reflex
Taken off ventilator and increasing CO2 levels should cause patient to breathe on their own
How many doctors must confirm brainstem death?
2 independent doctors
Why must 2 independent doctors confirm brain stem death?
Relay anxiety that organs are being removed from dying patients
Is passing brainstem death test enough to take organ from cadaveric patient?
No. The donor must have signed a donor card
