Kidney Transplantation

Question 1

Where does a kidney transplant go?

Answer 1

• iliac fossa region
• ureter is shorter (good because it is at risk of ischaemia)
• native kidneys tend to not be taken out (can cause complications)

Question 2

Why are kidney transplants carried out?

Answer 2

• increase life expectancy
• increase QoL
• decrease time in hospital
• restore fertility
• allow dietary freedom for patients

Question 3

Which patients are unsuitable for a kidney transplant?

Answer 3

• reduced life expectancy (older, comorbidity, unlikely to survive 5y)
• hypertension, hypotension, diseases that will recur after transplants
• no bladder, calcified blood vessels

Question 4

What are the advantages of living kidney donation?

Answer 4

• pre-emptive transplantation
• better kidneys
• better outcomes (longer kidney survival)

Question 5

What are the different ways that the body can recognise and reject foreign tissue?

Answer 5

• recognising cell surface proteins as ‘non-self’
• blood group incompatibility
• HLA incompatibility
• T cell mediated and antibody mediated rejection

Question 6

Describe how rejection during kidney transplantation is avoided

Answer 6

• Basiliximab (monoclonal-Ab which inhibits IL-2)
• tacrolimus/mycophenolate mofetil (inhibits calcineurin)
• steroids

Question 7

Describe the complications of kidney transplant

Answer 7

• cell-mediated rejection: interstitial inflammation and tubulitis (can be treated with steroids)
• antibody-mediated rejection: endothelial swelling, glomerulitis and peritubular capillaritis
• infection or reactivation infection
• malignancy eg Kapok’s sarcoma