Renal replacement therapy

Question 1

What are the absolute contraindications for renal transplant?

Answer 1

Active infection
Cancer (if >5 years and considered cured then may be possible)
Significant co-morbidities

Question 2

What are the different types of graft for RRT?

Answer 2

Cardiac death - problems of long ischaemic time
Brainstem death - body kept on life support after death to keep organs perfused
Living donor - best option

Question 3

What are the regimens of immunosuppression for renal transplant?

Answer 3

Induction - Basiliximab, an anti-IL-2R monoclonal antibody
- many centres are now using alemtuzumab, which provides broad immunosuppression and allows for a steroid free regimen (useful in diabetes)

Maintenance - Triple therapy:

1) Calcineurin inhibitor (ciclosporin)
2) Antimetabolite (azathioprine, mycophenolate)
3) Prednisolone

Question 4

What are the complications of renal transplant?

Answer 4

• Surgical complications
• Delayed graft function
• Rejection - acute or chronic

Question 5

What is the most common infective complication post-transplant?

Answer 5

Cytomegalovirus CMV