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Abdominal > Renal/Liver transplants (test 3) > Flashcards

Renal/Liver transplants (test 3) Flashcards

1
Q

What are the most commonly transplanted organs?

A

1=Kidney

2=Liver

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2
Q

What are common reasons for kidney transplants?

A

Treatment for patients with ESRD.

Improves longevity quality of life compared to dialysis.

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3
Q

What is the most common cause of ESRD?

A

Diabetes

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4
Q

What is the reason for liver transplants?

A

Treatment of acute or chronic liver failure.

6000 per year.

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5
Q

What are allograft renal transplants?

A

Living donors
Cadaver donors
Allograft=human tissue transplanted from one person to another

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6
Q

Where are renal transplants typically placed?

A

Right (preferred) or left iliac fossa.

Extraperitoneally.

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7
Q

What is a Carrel patch for cadaver transplants?

A

Main renal artery and surrounding patch of aortic wall are harvested.
Allows for larger anastomosis, may reduce RAS compared to living donor.

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8
Q

Cadaver transplants are anastomosed where?

A

end-to-side to external iliac artery.

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9
Q

What happens during a living donor transplant?

A

Main renal artery harvested.
End-to-side anastomosis to EIA or end-to -end anastomosis to IIA.
Harvested renal vein anastomosed to EIV with end-to end.

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10
Q

Renal transplant exam indications

A

Post-op
Suspected transplant dysfunction or complications.
RAS- htn, graft bruit, decreased renal function

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11
Q

Renal transplant risk factors?

A 
Trauma from surgery.
Renal vein thrombosis.
Atherosclerosis in donor or recipient renal or iliac arteries.
Acute tubular necrosis.
Renal biopsy.
Tortuous renal arteries
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12
Q

Renal transplant B-mode protocol

A 
Done 24-48 hours post-op.
Supine.
Kidney length- long axis.
Upper, mid, lower poles- trans
Assess for fluid around kidney
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13
Q

Color and Doppler duplex protocol

A 
Main renal artery:
anastomosis, prox, mid, distal
Main renal vein.
Ipsilateral EIA and EIV (prox, mid, dist to anast).
Intrarenal flow-upper, mid, lower poles
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14
Q

Renal transplant duplex protocol measurements

A 
Measure:
PSV
EDV
Acceleration time
Acceleration index
Resistive index.
Transplant renal artery to iliac artery PSV ratio.
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15
Q

What is duplex used for in regards to renal transplants?

A

Evaluate possible causes of graft dysfunction.

Differentiate medically treated causes of graft failure, acute tubular necrosis, graft failure requiring intervention.

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16
Q

Normal duplex findings with renal transplants

A

Kidney appears similar to native.
Intrarenal and renal artery= low-resistance.
RI<0.70
Renal vein and iliac vein=phasic, continuous flow.
Iliac artery=monophasic or biphasic prox to anastomosis. triphasic distal to it.

17
Q

What happens during renal allograft rejection?

A 
Immune system attacks new kidney.
No urine, decreased urine, swelling at site, increased blood urea nitrogen, hypertension.
3 types: hyperacute, acute, chronic.
PSV may increase, EDV decrease.
RI>0.8
Causes tubular and interstitial edema
18
Q

What is the most common cause of graft loss?

A

Renal allograft rejection

19
Q

What is hyperacute renal allograft rejection?

A

immediately post-op

20
Q

What is acute renal allograft rejection?

A

About 2 weeks post-op, usually withing first 3 months.

21
Q

What is acute tubular necrosis?

A

In surgery, a period of time with kidney has no perfusion and results in ATN.
Caused by ischemia.
More common in cadaver transplants.
Occurs early post-op~ day 2 or 3.

22
Q

Other renal transplant complications

A

Perinephric fluid collection:

Hematomas, Urinomas, Lymphoceles

23
Q

What are urinomas?

A

Collection of urine leaking from the ureteral anastomosis or focal area of ureteral necrosis.
Decreased urine output.
Located between kidney and bladder.
First few weeks post-op

24
Q

What is suspected with acute pain in transplant area or anuria?

A

Arterial or venous thrombosis.
Considered medical emergency.
<1% occurrence.

25
Q

Renal artery stenosis

A

Most common complication, 10% patients.
Severe uncontrolled HTN.
PSV>200-250, renal/EIA ratio >2.0-3.0, post-stenotic turbulence >50-60% RAS

26
Q

Renal vein thrombosis

A

<4% patients.

Enalarged RV, no color or Doppler signal

27
Q

Post-biopsy complications

A

Arteriovenous fistula-abnormal connection between artery and vein.
Pseudoaneurysm

28
Q

Liver transplants overview

A

Acute or chronic live failure.
Unresponsive to medical treatment.
Indications for liver failure: Hep C, alcohol liver disease, Budd-Chiari syndrome, primary biliary cirrhosis.

29
Q

What happens during a liver transplant?

A

Whole cadaver liver transplanted.
Placed in same place as original liver.
Possible to have partial living donor, often the right lobe is donated

30
Q

Whole liver transplants

A

Variations in anatomy.
Donor bile duct to recipient common hepatic duct.
donor common hepatic artery to recipient hepatic artery.
IVC interposition or piggy-backed

31
Q

Partial liver transplant

A

Right lobe common.
Include rt HV, rt PV, rt HA, rt Hep bile duct.
Oppositee included with left lobe transplanted.

32
Q

Liver transplant complications

A 
Graft falure/rejection.
Bilary complications.
Abnormal liver function tests.
Ascites.
Varices
Sepsis.
33
Q

Role of duplex for liver transplants?

A

Cannot diagnose rejection.

Can asses for fluid collections, vascular complications, bilary tree abnormalities

34
Q

B-mode of liver transplant

A

Appearance.
Fluid may be present few days post-op.
Intraheptaic arteries (main, Rt, Lt)
PV (main, rt, lt)

35
Q

Color and Doppler for liver transplants

A

Intrahepatic arteries.
PV.
IVC

36
Q

Liver transplant duplex assessment

A

IVC patency.
HV patency.
PV for venous stenosis and flow direction.
Hepatic artery for stenosis.

37
Q

Liver transplant complications

A

Hepatic artery thrombosis: most common, 2-12%
Hepatic artery stenosis: up to 11% patients. typically at anastomosis site, rare.
Portal vein thrombosis: signs of portal hypertension.
Portal vein stenosis: anastomosis site, PSV>125, velocity ratio 3:1
IVC stenosis/thrombosis.

Abdominal (7 decks)

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