Kidney Transplants

Question 1

how does transplant compare to dialysis

Answer 1

transplant much better treatment

Question 2

what must be given to prevent rejection of a transplant

Answer 2

immunosuppressive drugs, as the body sees the new organ as foreign tissue

Question 3

what are the different types of transplant donation

Answer 3

deceased heart beating donors, non-heart beating donors and live donation

Question 4

what are some of the contraindications to transplant

Answer 4

malignancy, active infection, untreated TB, severe IHD, active vasculitis, hostile bladder

Question 5

what are the reasons for rejection of a transplant

Answer 5

different blood groups, HLA antigens

Question 6

what is the importance of the HLA matching, and how does immunosuppression affect it

Answer 6

without immunosuppression it is critical

with immunosuppression the graft survival is better even if not an ideal match

Question 7

what sensitising events can occur, that mean a person is more sensitive to a transplant and therefore more likely to reject

Answer 7

previous transplant, blood transfusion, pregnancy/miscarriage,

Question 8

why do sensitising events affect transplants

Answer 8

because they lead to the formation of pre-formed antibodies to the non-self antigens that the person is exposed to

Question 9

describe what the process of desensitisation is

Answer 9

the active removal of a blood group or donor specific antibody, by either plasma exchange or B cell antibody(rituximab)

Question 10

describe the key features of the kidney transplant procedure

Answer 10

extra peritoneal procedure, transplant inserted in the iliac fossa and attached to external iliac artery and vein

Question 11

what are some of the surgical complications of kidney transplants

Answer 11

bleeding, arterial/venous stenosis, ureteric stricture, wound infection, lymphocele

Question 12

what are the signs of immediate graft function

Answer 12

good urine output, falling urea and creatinine

Question 13

describe what delayed graft function is

Answer 13

usually works within 10-30 days, need HD in interim, need biopsy to tell is successfull

Question 14

describe what hyperacute rejection involves

Answer 14

due to preformed antibodies, unsalvageable, transplant nephrectomy needed

Question 15

describe what acute rejection involves

Answer 15

it is cellular or antibody mediated, can be treated with increased immunosuppression

Question 16

describe what chronic rejection involves

Answer 16

antibody mediated slowly progressive decline in renal function, poorly responsive to treatment