Kidney Transplantation

Question 1

why has the number of donors increased

Answer 1

• due to the number of cardiovascular deaths being allowed to be used for donation instead of just using brain injured patients

Question 2

why do we do kidney transplants

Answer 2

• best treatment for kidney failure

Question 3

describe the length of time spent of the transplant list and survival rates

Answer 3

when you undergo transplantation then the risk of coming to harm during the period of operation is 5 x more than if you are waiting on the list, by about 6 months after the operation you begin to see that the relative risk falls back down to 1, everyone waiting on the list has different complciations, within 6 months or longer your gaining a survival advantage from waiting on the transplant list

Question 4

name the transplantation outcomes

Answer 4

1 year graft survival 80-90%
5 year graft survival 60-70%
10 year graft survival 50-60%

Question 5

what are major barriers to successful transplantation

Answer 5

Major barriers

• Blood group antibodies
• HLA antibodies

Question 6

what are the minor barriers to successful transplantation

Answer 6

• Degree of HLA matching
• Donor characteristic - size, age, co morbidity
• Recipient characteristic - size, age, co morbidity
  CIT
• Donor type - LD, DD, NHBD

Question 7

what are HLA

Answer 7

Polymorphic antigens present on the surface of cells

Question 8

what are the two types of HLA

Answer 8

• class I and class II

Question 9

describe class I and class II

Answer 9

Class I - A,B,Cw - present on most cells constitutively

Class II - DR, DQ,DP - present on B cells and activated/injured other cells

Question 10

for kidney transplantation which HLA are we interested in

Answer 10

Class I - HLA-A, HLA-B
Class II - HLA-DR

• Inherit 1 of each from each parent
  “Closeness of match” - improves results

Question 11

the degree of mismatching…

Answer 11

If your degree of mismatching effects how the kidney functions

Question 12

when do you receive HLA antibodies

Answer 12

• these are not naturally occurring and occur when you see non self HLA

happens in

• Pregnancies
• Blood products
• Previous transplants

Question 13

as you increase in sensitising events…

Answer 13

then this increases your risk of transplantation

Question 14

what is crosshatching

Answer 14

• done before a kidney transplantation
• White cells from donor added to serum of recipients
• Complement added
• Cell membrane destroyed if antibody binds to antigen

Question 15

what are the options for non compatible transplants

Answer 15

Desensitisation

• ABOi
• (+)ve XM
• ABOi and (+)ve XM

Question 16

what are the advantages of live donor versus deceased donor

Answer 16

Donor screened

• Medical problems
• Renal function

Short CIT

Elective procedure - deceased has to be used in a certain period of time

Question 17

describe the immunosuppression medication

Answer 17

At the time you have an induction immunosuppressed which is an antibody Rx

Then you have oral medication for the rest of your life
1 calcineurin inhibitor – for long as transplants works
1 antiproliferative medication- for as long as transplants works
Steroids - depends - can be stopped entirely
Infectious prophylaxis - only used for a loosely defined period after the operation but you may need to go back on it

Question 18

name some examples of calcineurin inhibitors

Answer 18

Tacrolimus (FK)

Ciclosporin

Question 19

name some anti proliferative medicine

Answer 19

MMF

Azathioprine

Question 20

describe the infections that you can get during a kidney trasnplant

Answer 20

• nosocomial or technical - during the first month such as MRSA
• activation of latent infection - such as HCV, C,diffle in the first 1-6 months
• community acquired but more susceptive greater than 6 months