kidney transplantation Flashcards
1
Q
types of transplant
A
- deceased heart beatingdonors (brain stem death)
- nonheart beating donors
- live donation (altruistic)
directed and undirected
paired donation
financially procured (illegal in most countries)
2
Q
assessing potential recipients
A
- reasonable life expectancy (>5yrs)
- make sure patient able to undergo anaesthetic, procedure, immunsuppression, post-op
(takes about 3months until after 3months)
3
Q
things assessed:
A
- immunology – tissue typing & antibody screening
- virology (exclude active infection)
HBV, HCV, HIV, EBV, CMV, VZV, Toxo, Syphilis - cardioresp risk ECG, Echo +/- ETT, Coronary angio CXR, +/- PFT, CPEX
- periph vessels
- bladder function
- mental state
- any co-morbidity/PMHx which may influence transplant or be exacerbated by immunosuppression
- independent assessment
4
Q
contrainds
A
- malignancy
(known untreated malignancy
solid tumour in last 2-5 years) - active infection
- severe IHD, not amenable to surgery
- severe airways disease
- active vasculitis
- severe PVD (unusable vessels)
- hostile bladder
5
Q
assessing live donors
A
- physical fitness
- they fine after 1 kid? isotope GFR
- normal anatomy kidneys
- co morbs (hypertension, proteinuria, haematuria)
- immunological compatible
- psych compat?
- no coercion?
6
Q
***tissue typing
A
blood group
HLA (major histocompatibility complex MHC)
7
Q
impmortance of hla mathcing
A
w/o immuno supp - critical!!
if immunosup then better graft survival
sensitisation to subsequent transplants
8
Q
sensitising events other than transplantation
A
- blood transfusion
- pregnancy or miscarriage
- previous transplant
- lead to formation of antibodies to non-self antigens
9
Q
- ? how to overcome immunological barriers in living donation
A
paired donation or altruistic donation
10
Q
desensitisation
A
- active removal of blood group or donor specific HLA antibody
- pre-transplant antibody depletion
plasma exchange
B cell antibody (rituximab) - monitor antibody levels and transplant when below acceptable threshold
- associated with greater immunosuppression and higher rejection rates.
11
Q
transplant procedure itself
A
- extra peritoneal procedure
- transplant inserted in iliac fossa
(attached to external iliac arterty & vein
ureter plumbed into bladder with stent) - wound ~15-20cm long
- average 2-3 hour operation
- 7-10 days in hospital
- regular clinic follow up
- usually back to full activities & work in 3 months
12
Q
surgical complications of kidney transplant
A
- bleeding
- arterial stenosis
- venous stenosis / kinking
- ureteric stricture & hydronephrosis or leak
- wound infection/dehiscence
- lymphocele
13
Q
signs that tranplant working
A
- immediate graft function
- good urine output
- falling urea & creatinine - delayed graft function
- post-transplant ATN
- often need HD in interim
- usually works within 10-30days
- usually need biopsy (difficult to detect rejection) - primary non function
- transplant never works and is explanted
14
Q
types of rejection
A
- hyperacute rejection
- due to preformed antibodies
- unsalvageable
- transplant nephrectomy required - acute rejection
- cellular or antibody mediated
- can be treated with increased immunosupression - chronic rejection
- antibody mediated slowly progressive decline in renal function. Poorly responsive to treatment.
15
Q
what is anti-rejection therapy and its ideal treatment
A
reduces activation of T cells
aim is to prevent host V transplant mediated immune response
ideal treatment:
- specific
- few side effects
- able to monitor its effect on immune system
- actual treatment is not ideal
