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RENAL > Kidney Transplantation > Flashcards

Kidney Transplantation Flashcards

1
Q

What are the main types of kidney transplant?

A

Deceased Heart Beating Donors (Brain stem death)(DBD)

Non-Heart Beating Donors (DCD)

Live Donation (altruistic)

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2
Q

What is the difference between a directed and undirected altruistic donor?

A

Directed - family member or friend is motivated to donate after someone they know becomes ill

Undirected - anyone off the street comes in to say they wish to donate their kidney

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3
Q

What percentage of kidney function is restored by either haemodialysis or peritoneal dialysis?

A

7%

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4
Q

Receiving dialysis before a kidney transplant is better than if no dialysis is used. TRUE/FALSE?

A

FALSE

dialysis has many risks (e.g. CVD) => it is better to not require it at all before a transplant

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5
Q

Why does dialysis predispose to a cardiovascular event?

A

It stiffens the vasculature

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6
Q

The number of deceased non heart beating donors is increasing. TRUE/FALSE?

A

TRUE

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7
Q

How many years left of life expectancy must a patient have in order to be suitable for receiving a kidney?

A

> 5yrs

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8
Q

What factors of a kidney donation surgery should you ensure the receiver is able to tolerate?

A
  • General Anaesthetic
  • Surgical Procedure itself
  • Immunosupression
  • Immediate post-operative period (3 months)
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9
Q

What are the various parts of the recipient assessment?

A 
Immunology – tissue typing etc
Virology (to exclude active infection)
Assess:
- Cardiorespiratory risk
- peripheral vessels
- bladder function
- mental state
- co-morbidity/PMHx which may influence transplant OR be exacerbated by immunosuppression
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10
Q

What are some of the contraindications to a transplant?

A
  • Malignancy
  • active HCV/HIV infection
  • Untreated TB
  • Severe Ischaemic Heart OR airways disease
  • Active vasculitis
  • Severe Peripheral Vasc. Disease (unusable vessels)
  • Hostile bladder
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11
Q

What must be checked in the live donor assessment?

A 
Fit for surgery?
Enough renal function in remaining kidney?
Anatomically normal kidneys?
Co-morbidities?
Hypertension, Proteinuria, Haematuria?
Immunologically compatible?
Psychologically compatible?
Coming forward without coercion?
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12
Q

What are the two parts of tissue typing?

A

Blood typing

HLA antigen matching

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13
Q

A badly matched kidney for a patients first transplant indicates that they may have problems with further transplants. TRUE/FALSE?

A

TRUE

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14
Q

What is meant by paired donation?

A

It occurs between more than two people to make the best immunological fit for each

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15
Q

How is a patient densensitised?

A
  • Active removal of blood group or donor specific antibody
  • plasma exchange
  • B cell antibody (rituximab)
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16
Q

Where is the transplanted kidney placed in the body?

A
  • iliac fossa
  • Attached to external iliac artery and vein
  • Ureter plumbed into bladder with stent
17
Q

What are the main surgical complications of a kidney transplant?

A 
Bleeding
Arterial/Venous stenosis OR kinking
Ureteric stricture => hydronephrosis
Wound infection
Lymphocele
18
Q

What is meant by delayed graft function?

A
  • Post-transplant Acute Tubular Necrosis (kidney asleep)
  • Often need Haemodialysis in interim
  • Usually works within 10-30 days
19
Q

What is meant by Primary Non-function?

A

Transplant never works/ wakes up

20
Q

What are the different types of rejection?

A

Hyperacute rejection

  • preformed antibody reaction
  • Unsalvageable
  • Transplant nephrectomy required

Acute Rejection

  • Cell/Antibody mediated
  • Tx with increased immunosupression

Chronic Rejection

  • Antibody mediated
  • slow decline in renal function
21
Q

What induction treatments are used for immunosuppression during kidney transplants?

A

Basiliximab/Dacluzimab

22
Q

What steroid is given IV during a transplant operation?

A

Prenisolone

23
Q

What agents are used for maintenance immunosuppression after a kidney transplant?

A

Prednisolone, tacrolimus, MMF
Prednisolone, ciclosporin, azathioprine

covers all bases in the immune system

24
Q

What treatments are specifically to prevent rejection of kidney transplants?

A

IV methylprednisolone
Immunoglobulins
Plasma
Monoclonal Antibodies

25
Q

What infections can kidney transplant patients develop due to the immunosuppression?

A

Bacterial infection:
UTI (especially females)
Give prophylaxis for Pneumocystis Jirovecci Pneumo.

Viral infections:
CMV, HSV, BK

Fungal infections:
e.g. candida

26
Q

Kidney transplants can predispose to what types of skin cancer?

A

non-melanoma

=> BCC/SCC

27
Q

What infection can cause Post transplant Lymphoproliferative Disease?

A

EBV

depending on level of immunosuppression

28
Q

What treatment is given for Post transplant Lymphoproliferative disease?

A

NO ANTIVIRALS

  • Reduce immunosupression
  • Chemotherapy

RENAL (24 decks)

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