Nphro - transplant Flashcards
treatment of choice for advanced chronic renal failure
transplantation
deceased donor grafts 1 year survival
92%
living donor grafts 1 year survival
97%
Mortality rate after transplantations are highest
within the first year, ages >=50 to 60 years
Non-heart-beating donor donation after cardiac death
category I
Brought in dead
Non-heart-beating donor donation after cardiac death
category II
Unsuccessful resuscitation
Non-heart-beating donor donation after cardiac death
category III
awaiting cardiac arrest
Non-heart-beating donor donation after cardiac death
category IV
cardiac arrest after brainstem death
Non-heart-beating donor donation after cardiac death
category V
cardiac arrest in a hospital patient
scoring to quantify potential risk of graft failure after kidney transplant based on 10 donor factors
KDPI
KDPI <20% kidneys are allocated to what kind of recipients?
potential recipients with highest expected post transplant survival
KDPI >85% given to
usually older patients who are expected to fare less well on dialysis
current standard of cares is that a candidate for transplant to be put on a deceased organ wait list should have a life expectancy of
> 5 years
Immunologic contraindications to transplantation
ABO incompatibility
HLA Class I (A, B, C)
HLA class II (DR, DQ, DP)
Donor selection: survival rates favor what donor?
a. 3/6 mismatched family donor
b. 6/6 mismatched family donor
c. random cadaver donor
A
True of donor selection EXCEPT
a. it is important to evaluate risk of developing DM
b. renal arteriography should be performed on donors
c. deceased donors with malignant neoplastic disease can still be given provided they are on remission
d. Hep C and HIV positive organs may be used in previously infected recipients under certain circumstances
C; should not be given
Increased risk of graft failure when donor is
elderly
or has acute renal failure
prolonged ischemia of kidney
preferred ischemic time
<24 hrs. although could be for up to 48 h on cold pulsatile perfusion or with simple flushing and cooling
Depleting agent targeting CD52 protein
alemtuzumab
Two types of immunosuppressive agents given for induction
depleting agents
nondepleting agents
examples of depleting agents
anti thymocyte globulin
alemtuzumab
examples of non depleting agents
target IL-2 receptor
Examples of antimetabolites
Azathioprine
mycophenolate mofetil
Cycloporine is a/n
a. TOR inhibitor
b. Steroid
c. antimetabolite
d. Calcinuerin inhibitor
D
Tacrolimus is what kind of drug?
Calcineurin inhibitor
Example of TOR inhibitor
Sirolimus
CD80 CD86 inihibitor
Belatacept
Presentation of rejection episode
rise in serum crea
reduction in urine vol
T/F are fever swelling, tenderness over the allograft common manifestations of rejection episodes?
no
These drugs have an afferent arteriolar constrictor effect on the kidney and may produce permanent vascular and interstitial injury after sustained high dose therapy
Calcineruin inhibitors
This is useful in ascertaining changes in renal vasculature and in renal blood flow
doppler utz
Treatment for first rejection episode
IV methylprednisolone 50-100 mg daily for 3 days
Treatment for first rejection episode is IV methylprednisolone 50-100 mg daily for 3 days. What is given if patient fails to respond?
ATG
CMV and P. jirovecci pneumonia are common opportunistic infections in immunosuppressed patients. Prophylaxis for these infections should be given for how long?
6-12 months
Infections most common during the 1st month (peritransplant)
wound infections
herpes virus
oral candidiasis
UTI
Infections most common during the 1-6 mos. (early)
P. carinii Legionella Listeria CMV HepB HpC
Infections most common during the >6 mos (late)
Aspergillus Nocardia BK virus (polyoma) Herpes zoster Hep B Hep C
most common malignant lesions in immunosuppressed
cancer of the skin lips cervix lymphomas
True of complications of kidney trnasplant EXCEPT
a. higher incidence of death from MI and Stroke
b. more than 50% of renal recipient mortality is associated with Cardiovascular disease
c. CCBs are more frequently used initially for hypertension in posttransplant patients
d. Hypercalcemia may develop after transplant and may indicate failure of hyperplastic thyroid glands to regress
NOTA, all are true
Anemia can develop post transplant attributable to
bone marrow suppressan immunosuppressive medications such as
SAM
Sirolimus
Azathioprine
Mycophenolate
