kidney transplantation Flashcards
how are transplant recipients assessed?
reasonable life expectancy (>5 years)
can withstand general anaesthetic. surgery, immunosuppression and immediate post op period
can survive first 3 months as it has bad prognosis
what are some contrainidications to kidney transplant?
- 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
what is transplant desensitisation?
Active removal of blood group or donor specific HLA antibody
how is a kidney transplant attached to its recipient?
Transplant inserted in iliac fossa
Attached to external iliac arterty & vein
Ureter plumbed into bladder with stent
what are the complications of kidney transplantation?
Bleeding
Arterial stenosis
Venous stenosis / kinking
Ureteric stricture & hydronephrosis or leak
Wound infection/dehiscence
Lymphocele
what are the 3 types of kidney transplant rejection?
Hyperacute rejection (rare as donor can now be well matched)
Due to preformed antibodies, Unsalvageable, Transplant nephrectomy required
Acute Rejection (most common)
Cellular or Antibody mediated
Can be treated with increased immunosupression
Chronic Rejection
Antibody mediated slowly progressive decline in renal function. Poorly responsive to treatment.
what is the aim of anti-rejection therapy?
reduces T cell activation, aim is to prevent host vs transplant mediated immune response
what is the induction treatment for a kidney transplant?
Basiliximab/Dacluzimab
Prednisolone iv during operation
what is the maintenance immunosuppressive treatments for kidney transplants?
- Prednisolone, tacrolimus, MMF
- Prednisolone, ciclosporin, azathioprine
what are the most common post transplant cancers?
skin bcc or scc
lymphoma
