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Nephrology > Kidney Transplantation > Flashcards

Kidney Transplantation Flashcards

1
Q

Define transplant

A

Transfer (living tissue or organ) to another part of the body to or another body

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2
Q

Define autologous transplant

A

Donor and recipient are the same individual

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3
Q

Define syngenic transplant

A

Donor and recipient are genetically identical twins

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4
Q

Define allogenic transplant

A

Donor and recipient are not genetically identical twins but are of the same species

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5
Q

Define Xenogenic transplant

A

Donor and recipient are from different species

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6
Q

What the difference in survival is the donor is living and not dead?

A

5 years.

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7
Q

What systemic is place in the UK for donations?

A

NHS Blood and Transplant (NHSBT)

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8
Q

Blood type A what antigen and antibody are present and who are compatible donors?

A

Antigen on RBC: A
Antibody is plasma: anti-B
Compatible donors: A, O

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9
Q

Blood type B what antigen and antibody are present and who are compatible donors?

A

Antigen on RBC: B
Antibody is plasma: anti-A
Compatible donors: B, O

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10
Q

Blood type AB what antigen and antibody are present and who are compatible donors?

A

Antigen on RBC: AB
Antibody is plasma: none.
Compatible donors: A, B, AB, O

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11
Q

Blood type O what antigen and antibody are present and who are compatible donors?

A

Antigen on RBC: O
Antibody is plasma: anti-A, anti-B
Compatible donors: O

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12
Q

What’s the risk of donating with blood group incompatibility?

A

Hyperacute rejection of transplated organ

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13
Q

What is the MHC?

A

Major Histocompatibility complex

- genes present which are associated with acceptance and rejection of transplanted material

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14
Q

Where is MHC located?

A

Chromosome 6

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15
Q

What does MHC contain?

A

Human leukocyte antigen (HLA)

- polymorphic

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16
Q

How many classes of HLA are there (relevant)

A

HLA I

HLA II

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17
Q

What does HLA I bind?

A

peptides derived from IC proteins

- including peptides from viruses

18
Q

What are the HLA I molecules?

A

HLA-A
HLA-B
HLA-B

19
Q

Where are HLA I molecules expressed?

A

All cells, including platelets

20
Q

Where are HLA I polymorphs located?

A

Exons 2 and 3

21
Q

Where are HLA II polymorphs located?

A

Exon 2

22
Q

What’s the structure of HLA I?

A

3 alpha units with 1 beta unit

23
Q

Whats the structure of HLA II?

A

2 alpha units

2 beta units

24
Q

What does HLA II bind?

A

peptide derived from EC and cell surface peptide

- including those from bacteria

25
Q

What are the HLA II molecules?

A

HLA-DR
HLA-DQ
HLA-DP

26
Q

Where are HLA II molecules expressed?

A

APCs

27
Q

What’s the difference between HLA I and HLA II?

A
  • structural differences affecting peptide binding
  • specialised
  • immune response
28
Q

Why is there huge diversity within a HLA population?

A

increases chances of species surviving after exposure to pathogen

29
Q

Give an advantage to HLA polymorphism

A

Protection against different pathogens

30
Q

Give a disadvantage to HLA polymorphism

A

Transplantation of tissues and organs between HLA incompatible individuals

31
Q

How can HLA mis-matching be overcome?

A

Immunosuppression

32
Q

When should you definitely avoid transplantation?

A

When donor specific antibodies are present in recipient

33
Q

How can patients make antibodies against non-self HLA?

A
  1. Pregnancy
  2. Blood transfusions
  3. Previous transplant
  4. Viral infection
34
Q

What is HLA sensitisation

A

Status of recipients must be determined prior to transplant

35
Q

Give one contraindication to transplant

A

presence of donor specific HLA antibodies

36
Q

How are transplants allocated in the UK

A
  1. Paediatric patients (HLA match), highly sensitised - priority based on waiting time
  2. Other paediatric patients (HLA match) - priority based on waiting time
  3. Adults (HLA match), high sensitised - priority based on waiting time
  4. Other adult patients - priority based on waiting time
  5. All other eligible patients
    * 1, 2, and 3 priority given according on a point score based on: waiting time, HLA match, age, age difference, location, HLA homozygosity, and blood group match
37
Q

What is meant by highly sensitised?

A

A highly sensitised immune system is one that that would attack the transplanted kidney or pancreas

Have high donor antibodies (>85% across panel)

38
Q

What test would you perform prior to transplant?

A
  • HLA type patient
  • HLA type donor
  • Screen patients for preform HLA allo-antibodies (every 3months)
  • Cross-match patient and donor
39
Q

What would you do post-transplant?

A

Monitor for presence of donor-specific antibodies

40
Q

How many transplants do patients usually receive?

A

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Nephrology (6 decks)

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