Renal Replacement Therapy - Transplantation Flashcards
Where in the body is the transplanted kidney placed ?
Iliac fossa and anastomosed to the iliac vessels
What happens to the native kidneys?
Remain in situ
Only removed if oversized - polycystic kidney disease or infected - chronic pyelonephritis
How is the donor kidney preserved?
Cold storage
Minimize oedema
Preserve integrity of tissues
Buffer free radicals
Explain the immunosuppression plan.
Induction with a depleting agent - Basiliximab
Maintenance with Tacrolimus (CNI), mycophenolate (Anti-proliferative) and steroids
Steroid free treatments can be used
CNI-free treatments replace tacrolimus with Belatacept
Types of doners?
Living:
- Related
- Spouse
- Altruistic
- Pooled/paired
Dead:
- DBD (post brain death)
- DCD (post cardiac death)
Brain death criteria?
Coma Apnoea despite CO2 build up Absent cephalic reflexes e.g. pupillary Body temp >34 No drug intoxication
Risk of kidney donations to the doner?
Having one kidney puts you at higher risk of renal disease
But the other kidney compensates by increasing GFR up to 70%
Being older or having a high BMI is associated a GFR < 60
Complications of transplant surgery?
- Anastomotic bleed
- Perirenal Haematoma
- Arterial/venous thrombosis
- Lymphocele
- Urine leak
- Infection
- Malignancy
- Rejection
- CV problems
What kind of CV problems can arise after surgery?
Hypertension
Hyperlipidaemia
Post transplant diabetes
Major post surg infections?
CMV - cytomegalovirus
Polyomaviridae (specifically BK or JC virus)
How do you get a CMV infection?
Reactivation of latent virus
Transmission from donor tissue
It affets 8% of donor transplants despite prophylaxis
What can cytomegalovirus lead to?
CMV viremia
Tissue invasive disease afecting many tissues:
Hepatitis
Nephritis
Pneumonitis
Colitis etc
What can BK associated nephropathy cause?
Ureteral Stenosis
Interstitial Nephritis
ESRD
Risk factors for BK associated nephropathy?
Intense immunosuppression
Patient factors - Old, male, white, DM
Organ factors - Graft injury, HLA mismatch or ureteral stents
Viral factors - Changes in epitomes of viral capsid protein (VP-1)
BKAN outcome?
Allograft dysfunctions
Loss of graft in 45-80%
