Kidney transplantation Flashcards
Where is a transplanted kidney placed in the body?
Into the iliac fossa and anastomosed to the iliac vessels.
The native kidneys usually remain where they are. However, sometimes a nephrectomy is required. Why might this be the case?
Size of kidney - polycystic kidneys
Infection - chronic pyelonephritis
Living donor nephrectomy
Gives those in need of a kidney transplant an alternative to waiting for a deceased-donor organ
Complications associated with transplant surgery
Vascular: Bleeding Arterial thrombosis Venous thrombosis Lymphocele
Ureteric:
Urine leak
Infections
Why are immunosuppressive agents given to kidney transplant patients?
To lower the body’s ability to reject a transplanted organ
Which immunosuppressive agents are commonly used in renal transplant cases?
Corticosteroids
Calcineurin inhibitors - Cyclosporine
Anti-proliefratives - Mycophenolate mofetil, Azathioprine
mTOR inhibitors - Sirolimus
Costimulatory signal blockers - Belatacept
Depleting agents - Basiliximab ( anti-CD25),
Side effects of corticosteroids (5)
Hypertension Hyperglycaemia Infection Bone loss GI bleeding
Which immunosuppressant is used for induction (time of kidney transplant)?
Basiliximab
Types of living kidney donors
Live related donor
Live unrelated donor (eg spousal)
Live unrelated donor – altruistic, non-directed
Paired / pooled
ABO incompatible / HLA incompatible
Complications after renal transplantation
Rejection - cell mediated, humoral
Cardiovascular - underlying renal disease, chronic renal failure, high BP, hyperlipidaemia
Infective - bacterial, viral, fungal
Malignancy - skin, lymphoma, solid cancers
What is Cytomegalovirus?
Most important transplant-related infection
Affects around 8% of transplant recipients, despite prophylaxis therapy
High mortality and morbidity if untreated
Recipient affected via
- Transmission from donor tissue
- Reactivation of latent virus
What are examples of cytomegalovirus viraemias - tissue invasive disease? (6)
Pneumonitis Hepatitis Retinitis Gastroenteritis Colitis Nephritis
BK and JC viruses are part of which family?
Polyomaviridae
Clinical manifestations of BK virus in renal transplant patients (3)
Ureteral stenosis
Interstitial nephritis
ESRF - end stage renal failure
Clinical manifestations of BK virus in patients with AIDS (3)
Nephritis ESRF Retinitis Meningoencephalitis Pneumonitis
Risk factors for BK associated nephropathy
Intensity of immunosuppression
Patient determinants - older age, males, white, DM,
Organ determinants - graft injury, HLA mismatches
Viral determinants - changes in epitopes of viral capsi protein VP-1
What is HLA matching?
In organ donation an HLA identical or fully HLA matched sibling is considered the optimal and first choice
Important to match human leukocyte antigens to reduce risk of rejection
Outcome of BK associated nephropathy
Allograft dysfunction (transplant)
Loss of graft in 45-80%
Treatment of BK associated nephropathy
Reduce immunosuppression
Antiviral therapy - cidofovir, leflunomide
Risk of malignancy after renal transplant
From highest to lowest
Non-melanoma skin, Kaposi Sarcoma, Non Hodgkins Lymphoma (PTLD)
Renal
Melanoma, leukaemia, cervical
Testicular, bladder
What is the best way to treat end stage renal disease?
Kidney transplantation
What is paired/pooled donation?
Paired/pooled donation is used if:
The donor and recipient are incompatible (or mismatched), either by blood group or HLA sensitisation, or
The donor and recipient are compatible but are seeking a better age or HLA match
The pair may be matched to another couple in a similar situation so that both people in need of a transplant receive a matched organ or part organ.
What are the mechanisms of acute rejection
T cell mediated rejection (TCMR)
Acute antibody mediated rejection (ABMR)
