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Renal and Liver Transplants Flashcards

1
Q

What is the most common transplanted organ?

A

Kidney transplants

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2
Q

What is the treatment of choice for patients with ESRD?

A

Kindney Transplants

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3
Q

What is the most commong cause of ESRD?

A

Diabetes

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4
Q

What is the 2nd most common transplanted organs?

A

Liver transplants

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5
Q

How many liver transplants occur per year?

A

8,000 per year in the U.S.

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6
Q

What is the treatment for acute or chronic liver failure?

A

Liver transplants

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7
Q

What is an allograft transplant?

A

It is human tissue transplanted from one person to another.

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8
Q

What are the two types of allograft transplants?

A
  • Living donors
  • Cadaver donors
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9
Q

Where are renal transplants usually placed?

A

Typically placed in right (perferred) or left iliac fossa, extraperitoneally.

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10
Q

What is harvested in a cadaver transplant?

A

Main renal artery and surrounding patch of aortic wall is harvested.

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11
Q

What type of anastomosis is created in a cadaver transplants?

A

End-to-side anastomosis to external iliac artery.

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12
Q

What does a harvested patch from a cadaver allow?

A

It allows for a larger anastomosis, may reduce incidence of RAS as compared to living donor transplant.

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13
Q

What is harvested in a living donor?

A

Main renal artery is harvested.

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14
Q

What type of anastomosis is created for a living donor?

A

End-to-side anastomosis to EIA or end-to-end anastomosis to internal iliac artery.

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15
Q

What are some renal transplant exam indications?

A
  • Post-operative, routine
  • Suspected transplant dysfunction or complicationns
  • RAS
    • HTN
    • Graft bruit
    • Decrease renal function
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16
Q

What are some renal transplant risk factors?

A
  • Trauma associated with surgery
  • Renal vein thrombosis
  • Athersclerosis in donor’s or recipient’s renal or iliac arteries
  • Acute tubular necrosis (ATN)
  • Renal biopsy
  • Tortuous renal arteries.
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17
Q

What is the protocol from renal transplant duplex?

A
  • Duplex exams should be preformed within 24-48 post-op to establish baseline
  • B-mode:
    • Kidney length in long
    • Upper, mid, lower poles, transverse
    • Assess for perinephric fluid
  • Color & Doppler:
    • MRA-anastomosis, prox, mid, distal segments
    • MRV
    • Ipsilateral EIA-prox,mid,distal anastomosis
    • Intrarenal flow-upper,mid,lower poles
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18
Q

What are the measurements that must be taken in renal transplant duplex protocal?

A
  • PSV
  • EDV
  • Acceleration time (AT)
  • Acceleration index (AI)
  • Resisitive index (RI)
  • Transplant renal artery to iliac artery PSV ratio
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19
Q

Why is duplex used in renal transplants?

A

To evaulate possible causes of graft dysfunction.

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20
Q

What are some signs of graft dysfunction?

A

Patients may present with renal failure, pain, signs of infection.

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21
Q

Duplex ultrasound exams is used to differentiate what in kidney transplants?

A
  • Medically treated causes of graft failure
    • Acute tubular necrosis, drug toxicity, pyelonephritis
  • Graft failure requiring intervention
    • Hydronephrosis, fluid collections, thromboses, or stenosis.
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22
Q

What are some normal findings in a renal transplant duplex?

A
  • Kidney appearance- smiliar to native kidney
  • Intrarenal flow and renal artery: low-resistance Doppler
  • RI <.70
  • RV and IV: phasic, continuous flow.
  • Iliac artery (IA): monophasic or biphasic flow proximal to the anastomosis and triphasic flow distal to the anastomosis.
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23
Q

What is one of the mst common causes of graft loss?

A

Renal allograft rejection.

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24
Q

Why does renal allograft rejection occur?

A

Immune system attacks transplanted kidney

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25
What are the clinical presenations of renal allograft rejection?
* Anuria (no urine output) * Oliguria (decreased urine output) * Increased serum creatinine, protein, or lympocytes in urine. * Swelling/tenderness at graft site * Increased blood urea nitrogen * Hypertension
26
What are the 3 types of renal allograft rejection?
1. Hyperacute: immediately post-op 2. Acute: approx. 2 weeks post-op, typically within first 3 months 3. Chronic
27
What does renal allograft rejection cause?
It causes tubular and intersitial edema, as well as an endovasculitis, all which increase vascular impedance.
28
How do the velocities differ in renal allograft rejection?
Peak velocities may increase but end diastolic velocities decrease in proportion to the degree of rejection.
29
What is the criteria for rejection?
* Renal/iliac ratio is normal * RI \>.8 * Renal vein patent
30
What is acute tubular necrosis caused by?
Ischemia.
31
Where is acute tubular necrosis more common in?
More common in cadaver transplants.
32
When does acute tubular necrosis occur?
It occurs early post-op (usually day 2 or 3)
33
What are other renal transplant complications?
Perinephric fluid collections * Hematomas: post-op or post-biopsy * Urinomas: collection of urine leaking from ureteral anastomosis or focal area of ureteral necrosis * Lymphoceles
34
What are urinomas?
It is a collection of urine leaking from ureteral anastomosis or a focal area of ureteral necrosis. it causes: urine output decrease
35
Where are urinomas typically located?
They are typically located between the kidney and bladder. It occurs first few weeks post-op.
36
What are some renal transplant vascular complicaions?
Arterial or venous thrombosis may be suspected if the patient experiences acute pain in region of transplant or anuria. **It is considered a medical emergency.**
37
What is the incidence of renal arterial thrombosis?
Occurs in less than 1% of patients
38
What are the risk factors for renal arterial thrombosis?
* Hypercoaguable state * Hypotension * Trauma * Vascular kinking
39
What is the renal vein thrombosis incidence?
Occurs in less than 4% of patients
40
What are the risk factors for renal vein thrombosis?
* Hypercoaguable state * Hypotension * External compression from perinephric fluid collection
41
What are the duplex characterisitics of renal vein thrombosis?
* Enlarged renal vein * Absence of color flow * Absence of Doppler signal
42
Wha is the most common vascular complication?
Renal artery stenosis
43
What is the incidence of renal artery stenosis?
It occurs in about 10% of patients
44
How do patients with a renal artery stenosis present?
Severe uncontrolled HTN
45
What are the causes of renal artery stenosis?
* Dissection * Intimal hyperplasia * Athersclerosis * Rejection
46
What are the velocity presented with renal artery stenosis?
PS \>200-250 cm/s Renal/EIA ratio of \>2.0 to 3.0 Post-stenotic turbulence.
47
What are some indications for liver failure?
* Hepatitis C * Alcoholic liver disease * Budd-Chiari syndrome * Primary biliary cirrhosis
48
What are the two types of liver transplants?
1. Whole cadaver liver (aka orthotopic liver transplant) 2. Partial living donor liver
49
Where are whole cadaver livers placed?
Placed in normal anatomic position.
50
Where is a partial living donor liver placed?
More often the right lobe is transplanted.
51
How are whole liver transplants anastomosed?
Typically, most vessels and common bile duct are anastomosed in end-to-end fashion.
52
Which lobe is most commonly used in a partial liver transplant?
Right lobe is more common
53
Which vessels is included in a right lobe transplant?
* RHV * RPV * RHA * RHBD ## Footnote **Opposite if the left lobe is transplanted.**
54
What are the clinical presenations of potenial liver transplant complications?
* Graft failure/rejection * Billary complications * Abnormal liver function test * Ascites * Varices * Sepsis * Splenomegaly
55
Can duplex ultrasound diagnosis liver transplant rejection?
No. It can assess for: * Fluid collection * Vascular complications * Biliary tree abnormalities
56
What is the B-mode liver transplant duplex protocol?
* Liver appearance * Perihepatic fluid may be present within the first few days post-op * Intrahepatic arteries (main, right, left) * Portal vein (main. right, left)
57
What is the color and spectral Doppler duplex protocol?
* Intrahepatic arteries(main. right, left) * Portal vein (main, right, left) * IVC
58
What should be assessed in a liver transplant duplex?
* Assess IVC patency * Assess HV patency * Assess portal veins * venous stenosis * flow direction * Assess hepatic artery * Stenosis
59
What is the most common liver transplant vascular complication?
Hepatic artery thrombosis. It occurs in 2-12% of liver transplant patients.
60
What is the incidence of a hepatic artery stenosis?
up to 11% of liver transplant patients.
61
Where does hepatic artery stenosis typically occur?
@ anastomosis site.
62
What is a rare vascular complication of liver transplants?
Hepatic artery pseduoaneurysm
63
Where do portal vein thrombosis usually occur?
Typically in the extrahepatic segment
64
What is the clinical presentation of portal venous thrombosis?
Signs of portal hypertension
65
Where do portal vein stenosis typically occur?
@ anastomosis site. PSV \>125 cm/s VR: 3:1

Abdominal (6 decks)

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