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Year Two - Urinary System > Renal Transplant > Flashcards

Renal Transplant Flashcards

1
Q

What is a renal transplant?

A

A surgical procedure involving a healthy kidney from a living or decreased donor being placed into a patient whose kidney is no longer functioning properly due to end stage kidney disease

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2
Q

Describe the renal transplant procedure

A

Renal transplantation involves the surgeon making an incision in the lower aspect of the abdomen

The donated kidney is then placed in the iliac fossa where it is anastomosed with the patient’s pelvic vessels, usually the external iliac vessels

The ureter of the donor kidney is then anatomised with the patient’s bladder

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3
Q

What vessels are anastomosed with the donated kidney?

A

External iliac vessels

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4
Q

In which three situations are the native kidneys removed during renal transplantation?

A

Polycystic Kidneys

Chronic Pyelonephritis

Renal Calculi

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5
Q

Why are polysystic kidneys removed in renal transplants?

A

This is due to the fact that the kidneys are abnormally large and therefore space is required for the donated kidney

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6
Q

Why are chronic pyelonephritis kidneys removed in renal transplants?

A

The infection could spread to the donated kidney

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7
Q

What is donor matching based on?

A

Human leukocyte antigen (HLA) type A, B and C on chromosome six

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8
Q

What do we do if the donors don’t fully match?

A

Recipients can receive treatment to desensitise them to the donor HLA

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9
Q

What are the two types of donors?

A

Deceased donors

Living donors

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10
Q

What is a deceased donor?

A

A deceased donor is someone who has just died

This person or their family members decided to donate healthy organs at the time of death in order to benefit people who need transplants

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11
Q

What are the two types of deceased donors?

A

Donation after Brain Death (DBD)

Donation after Cardiac Death (DCD)

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12
Q

What is donation after brain death (DBD)?

A

This means that the patient’s heart is still beating and therefore the kidney will continue to be perfused until the time of organ retrieval.

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13
Q

What is donation after cardiac death (DCD)?

A

This means that the patient’s heart is no longer beating and therefore the kidney would be deprived of blood before the time of organ retrieval

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14
Q

What is the standard criteria of deceased donors?

A

These are donors who are under the age of 50 and suffered brain death from any number of causes

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15
Q

What is the expanded criteria of deceased donors?

A

Expanded criteria donors are those over the age of 60, or those between the age of 50-59 and fulfil two of the following criteria…

Hypertension History

Death from Cerebrovascular Event

Terminal Creatinine > 133µmol/L

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16
Q

Which criteria of deceased donors indicates a greater risk of transplantation failure?

A

Expanded criteria

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17
Q

What is living donation?

A

It occurs when a living person donates an organ, or part of an organ, for transplantation to another person

These donations have a smaller chance of rejection in comparison to deceased donations

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18
Q

What are the two categories of living donors?

A

Living Related Donor

Living Unrelated Donor

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19
Q

What are living related donors?

A

These donors are biologically related to the patient

This therefore includes family members, such as a parents, children, brothers or sisters

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20
Q

What is the advantage of family members offering to donate to the recipient?

A

They are the most likely to be compatible living kidney donors

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21
Q

What are living unrelated donors?

A

These donors are those not biologically related to the patient

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22
Q

What are the three subclassifications of living unrelated donors?

A

Spousal Donors

Altruistic Donors

Paired Donors

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23
Q

What are altruistic donors?

A

These are donors that wish to donate with no intended recipient; they simply want to donate to someone who can benefit from a transplant

24
Q

What are paired donors?

A

In paired donation, living donors and their recipients aren’t compatible for a transplant. However, the donor of each pair is compatible with the recipient of the other pair

25
Q

What are donation chains?

A

This is when more than two pairs of donors and recipients may be linked with a nondirected living kidney donor

26
Q

What four criteria exclude donors from donation?

A

The donor has been diagnosed with an active invasive cancer in the last three years

The donor has a haematological malignancy

The donor has an untreated systemic infection

The donor has HIV disease (however not HIV infection)

27
Q

What are the three complications for recipients after renal transplantation?

A

Transplant rejection

Infection

Malignany

28
Q

How does transplant rejection occur?

A

When the body’s immune system recognise the donated kidney as foreign

This specifically occurs when an antigen-presenting cell presents the donated kidney’s antigens to T-cells, which then recognise it as foreign via three signalling pathways

29
Q

What are the three types of transplant rejection?

A

Hyperacute Transplant Rejection

Acute Transplant Rejection

Chronic Transplant Rejection

30
Q

What is hyperacute transplant rejection?

A

It is characterised by ischaemia and necrosis of the graft that occurs from the time of transplant to 48 hours after transplant

31
Q

What is acute transplant rejection?

A

It occurs from the first week to three months after transplantation

32
Q

What is chronic transplant rejection?

A

It occurs over several years after transplantation

33
Q

How do we prevent transplant rejection?

A

We prescribe drugs which inhibit these three signalling pathways

These drugs are known as immunosuppressants

34
Q

What four immunosuppressants are used to prevent transplant rejection?

A

Basiliximab

Tacrolimus

Mycophenolate

Prednisolone

35
Q

How does basixilimab work? When do we prescribe it?

A

It inhibits the interleukin-2 (CD25) protein in the third signalling pathway

This is the immunosuppressant prescribed initially in the induction phase

36
Q

How does tacrolimus work? When do we prescribe it?

A

It inhibits the calcineurin protein in the first signalling pathway

This is prescribed long-term, and patients tend to take this for the rest of their life.

37
Q

How does mycophenolate work? When do we prescribe it?

A

It is anti-proliferative agent and therefore prevents proliferation of the T-cells once a foreign antigen has been detected

This is prescribed long-term, and patients tend to take this for the rest of their life

38
Q

How does prednisolone work? When do we prescribe it?

A

It inhibits cytokine gene transcription and therefore prevents recruitment and activation of T-cells

This is prescribed long-term, and patients tend to take this for the rest of their life.

39
Q

What do we prescribe if patients are intolerant to tacrolimus?

A

Betacept

40
Q

What are the four complications of immunosuppressants?

A

Hypertension

Type Two Diabetes

Osteoporosis

Ischaemic Heart Disease

41
Q

When do infections tend to occur after renal transplantation?

A

Within the first six months

42
Q

What two infections occur in renal transplant patients?

A

Cytomegalovirus (CMV)

BK Virus

43
Q

What is CMV?

A

It is a viral infection of the herpes virus

44
Q

When does the general population tend to be infected with CMV?

A

It tends to affect the general population at a young age and therefore most adult patients are resistant

45
Q

What are the usual clinical features of CMV?

A

It is a harmless virus that causes cold sores and chicken pox

46
Q

How is CMV a complication of renal transplantation?

A

In cases where the donor is CMV positive, however the recipient is CMV negative

47
Q

Why is CMV infection more serious in renal transplant patients?

A

This is due to the fact that immunosuppression will be minimised and therefore the risk of rejection increases

48
Q

How do we prevent CMV infection in renal transplant patients?

A

We prescribe a six-month prophylaxis against CMV infection with valaciclovir after renal transplantation

49
Q

What is BK virus?

A

It is usually a harmless, asymptomatic viral infection that tends to affect the general population at a young age

50
Q

What are the three complications of BK virus in renal transplant patients?

A

Ureteral stenosis

Interstitial nephritis

End stage kidney disease.

51
Q

How do we treat BK virus in renal transplant patients?

A

We reduce immunosuppression

We prescribe antiviral therapy, such as cidofovir and leflunomide

52
Q

What two malignancies tend to arise in renal transplant patients?

A

Skin

Lymphoma

53
Q

What are the three complications of renal transplants for donors?

A

End Stage Kidney Disease

Albuminuria

Hypertension

54
Q

Why is end stage kidney disease a complication for donors? How do we prevent this?

A

This is due to hypertrophy of their contralateral kidney

We assess the donor’s risk of end stage kidney disease before they are considered to be suitable for donation.

55
Q

What is albuminuria?

A

The presence of albumin protein in the urine

Year Two - Urinary System (15 decks)

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