Kidney transplantation

Question 1

Currently preferred treatment for End stage renal disease (ESRD)

Answer 1

kidney transplantation

Question 2

Complications of immunosuppression

Answer 2

infxn
cancer
DDI

Question 3

Dialysis complications

Answer 3

Chronic uremia
Cardiac disease
Decreased quality of life

Question 4

Is there a survival benefit (increase life expectancy) for Dialysis? Transplant?

Answer 4

Dialysis no

Transplant: yes (if you can get past 100 days of transplant risk)

Question 5

Which kidney is preferred to be removed? List what each vessel will be anastamosed to in the recipient.
Donors 
vein
artery
ureter

Answer 5

L kidney bc of longer renal vein

vein →external iliac vein
artery→external iliac artery
ureter → bladder)

Question 6

Warm ischemia

Answer 6

time from cardiac death to cold perfusion (max ~60 min)
- more harmful than cold

(moving kidney form one indiv to another will result in variable degrees of ischemia)

Question 7

Cold ischemia

Answer 7

time from cold perfusion to recipient anastamosis
(max 24-26 hours)
- more tolerable + less harmful than warm

(moving kidney form one indiv to another will result in variable degrees of ischemia)

Question 8

Which genes encode proteins that cells use to present peptide antigens to T cells?

Answer 8

MHC genes encode proteins (HLA) that cells then use to present peptide antigen to T cells

Question 9

Class I HLAs

Answer 9

HLA: A, B C

- on all nucleated cells → present INTRAcellular antigen to CD8+ cytotoxic T cells→ direct cytotoxicity

Question 10

Class II HLAs

Answer 10

HLA: DR, DP, DQ
- on APCs → present EXTRAcellular proteins CD4+ helper T cells → → proliferative signal for CD8+T cells, and B cells → Ab production, complement action

Question 11

What do the donor/recipient have to have identical in order for transplant to work?

Answer 11

They have to be HLA identical

- or else recipient T cells will recognize foreign donor HLA antigens as “non self” and mount an attack

Question 12

Tx for Cellular T cell mediated transplant rejection

Answer 12

IV steroids

Thymoglobulin

Question 13

TX for antibody B cell mediated transplant rejection

Answer 13

remove antibody (plasmapheresis),
inhibit antibody production (IVIG, rituximab)

Question 14

Immunosuppression to limit graft damage tx

Answer 14

1st agent: calcineurin inhibitor → Tacrolimus
2nd agent: proliferation inhibitor → MMF, sirolimus
3rd agent: Prednisone