Kidney Transplantation Flashcards
why has the number of donors increased
- due to the number of cardiovascular deaths being allowed to be used for donation instead of just using brain injured patients
why do we do kidney transplants
- best treatment for kidney failure
describe the length of time spent of the transplant list and survival rates
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
name the transplantation outcomes
1 year graft survival 80-90%
5 year graft survival 60-70%
10 year graft survival 50-60%
what are major barriers to successful transplantation
Major barriers
- Blood group antibodies
- HLA antibodies
what are the minor barriers to successful transplantation
- Degree of HLA matching
- Donor characteristic - size, age, co morbidity
- Recipient characteristic - size, age, co morbidity
CIT - Donor type - LD, DD, NHBD
what are HLA
Polymorphic antigens present on the surface of cells
what are the two types of HLA
- class I and class II
describe class I and class II
Class I - A,B,Cw - present on most cells constitutively
Class II - DR, DQ,DP - present on B cells and activated/injured other cells
for kidney transplantation which HLA are we interested in
Class I - HLA-A, HLA-B
Class II - HLA-DR
- Inherit 1 of each from each parent
“Closeness of match” - improves results
the degree of mismatching…
If your degree of mismatching effects how the kidney functions
when do you receive HLA antibodies
- these are not naturally occurring and occur when you see non self HLA
happens in
- Pregnancies
- Blood products
- Previous transplants
as you increase in sensitising events…
then this increases your risk of transplantation
what is crosshatching
- done before a kidney transplantation
- White cells from donor added to serum of recipients
- Complement added
- Cell membrane destroyed if antibody binds to antigen
what are the options for non compatible transplants
Desensitisation
- ABOi
- (+)ve XM
- ABOi and (+)ve XM
what are the advantages of live donor versus deceased donor
Donor screened
- Medical problems
- Renal function
Short CIT
Elective procedure - deceased has to be used in a certain period of time
describe the immunosuppression medication
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
name some examples of calcineurin inhibitors
Tacrolimus (FK)
Ciclosporin
name some anti proliferative medicine
MMF
Azathioprine
describe the infections that you can get during a kidney trasnplant
- 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
