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abdominal > Renal and Liver Transplants > Flashcards

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
Q

What are the clinical presenations of renal allograft rejection?

A
  • 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
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26
Q

What are the 3 types of renal allograft rejection?

A
  1. Hyperacute: immediately post-op
  2. Acute: approx. 2 weeks post-op, typically within first 3 months
  3. Chronic
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27
Q

What does renal allograft rejection cause?

A

It causes tubular and intersitial edema, as well as an endovasculitis, all which increase vascular impedance.

28
Q

How do the velocities differ in renal allograft rejection?

A

Peak velocities may increase but end diastolic velocities decrease in proportion to the degree of rejection.

29
Q

What is the criteria for rejection?

A
  • Renal/iliac ratio is normal
  • RI >.8
  • Renal vein patent
30
Q

What is acute tubular necrosis caused by?

A

Ischemia.

31
Q

Where is acute tubular necrosis more common in?

A

More common in cadaver transplants.

32
Q

When does acute tubular necrosis occur?

A

It occurs early post-op (usually day 2 or 3)

33
Q

What are other renal transplant complications?

A

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
Q

What are urinomas?

A

It is a collection of urine leaking from ureteral anastomosis or a focal area of ureteral necrosis.

it causes: urine output decrease

35
Q

Where are urinomas typically located?

A

They are typically located between the kidney and bladder.

It occurs first few weeks post-op.

36
Q

What are some renal transplant vascular complicaions?

A

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
Q

What is the incidence of renal arterial thrombosis?

A

Occurs in less than 1% of patients

38
Q

What are the risk factors for renal arterial thrombosis?

A
  • Hypercoaguable state
  • Hypotension
  • Trauma
  • Vascular kinking
39
Q

What is the renal vein thrombosis incidence?

A

Occurs in less than 4% of patients

40
Q

What are the risk factors for renal vein thrombosis?

A
  • Hypercoaguable state
  • Hypotension
  • External compression from perinephric fluid collection
41
Q

What are the duplex characterisitics of renal vein thrombosis?

A
  • Enlarged renal vein
  • Absence of color flow
  • Absence of Doppler signal
42
Q

Wha is the most common vascular complication?

A

Renal artery stenosis

43
Q

What is the incidence of renal artery stenosis?

A

It occurs in about 10% of patients

44
Q

How do patients with a renal artery stenosis present?

A

Severe uncontrolled HTN

45
Q

What are the causes of renal artery stenosis?

A
  • Dissection
  • Intimal hyperplasia
  • Athersclerosis
  • Rejection
46
Q

What are the velocity presented with renal artery stenosis?

A

PS >200-250 cm/s

Renal/EIA ratio of >2.0 to 3.0

Post-stenotic turbulence.

47
Q

What are some indications for liver failure?

A
  • Hepatitis C
  • Alcoholic liver disease
  • Budd-Chiari syndrome
  • Primary biliary cirrhosis
48
Q

What are the two types of liver transplants?

A
  1. Whole cadaver liver (aka orthotopic liver transplant)
  2. Partial living donor liver
49
Q

Where are whole cadaver livers placed?

A

Placed in normal anatomic position.

50
Q

Where is a partial living donor liver placed?

A

More often the right lobe is transplanted.

51
Q

How are whole liver transplants anastomosed?

A

Typically, most vessels and common bile duct are anastomosed in end-to-end fashion.

52
Q

Which lobe is most commonly used in a partial liver transplant?

A

Right lobe is more common

53
Q

Which vessels is included in a right lobe transplant?

A
  • RHV
  • RPV
  • RHA
  • RHBD

Opposite if the left lobe is transplanted.

54
Q

What are the clinical presenations of potenial liver transplant complications?

A
  • Graft failure/rejection
  • Billary complications
  • Abnormal liver function test
  • Ascites
  • Varices
  • Sepsis
  • Splenomegaly
55
Q

Can duplex ultrasound diagnosis liver transplant rejection?

A

No.

It can assess for:

  • Fluid collection
  • Vascular complications
  • Biliary tree abnormalities
56
Q

What is the B-mode liver transplant duplex protocol?

A
  • 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
Q

What is the color and spectral Doppler duplex protocol?

A
  • Intrahepatic arteries(main. right, left)
  • Portal vein (main, right, left)
  • IVC
58
Q

What should be assessed in a liver transplant duplex?

A
  • Assess IVC patency
  • Assess HV patency
  • Assess portal veins
    • venous stenosis
    • flow direction
  • Assess hepatic artery
    • Stenosis
59
Q

What is the most common liver transplant vascular complication?

A

Hepatic artery thrombosis.

It occurs in 2-12% of liver transplant patients.

60
Q

What is the incidence of a hepatic artery stenosis?

A

up to 11% of liver transplant patients.

61
Q

Where does hepatic artery stenosis typically occur?

A

@ anastomosis site.

62
Q

What is a rare vascular complication of liver transplants?

A

Hepatic artery pseduoaneurysm

63
Q

Where do portal vein thrombosis usually occur?

A

Typically in the extrahepatic segment

64
Q

What is the clinical presentation of portal venous thrombosis?

A

Signs of portal hypertension

65
Q

Where do portal vein stenosis typically occur?

A

@ anastomosis site.

PSV >125 cm/s

VR: 3:1

abdominal (6 decks)

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