Renal Transplant Flashcards
In end-stage renal failure, renal replacement therapies in the form of dialysis or renal transplant exist.
What is a transplant?
A tissue/organ taken from a person who has died or from a living donor and placed inside another person
What are the advantages of renal transplantation over dialysis? (6)
- Transplants mimic true renal function better than dialysis, as the transplanted kidney is operating 24/7 as a normal kidney should
- GFR is restored to ~50, compared to ~7 while on dialysis treatment
- Transplant offers the patient more freedom and so improves quality of life
- Survival is improved
- Financial benefit to patients as they can return to work
- Financial benefit to the NHS as dialysis is more expensive in the long run
What are the age restrictions for receiving a transplant?
There are none
However, co-morbidities often prevent transplant in elderly patients
What are the 3 types of donor that can give a transplant? Which is most common?
Decreased heart beating donors (most common)
Non-heart beating donors
Live donation
Describe each of the 3 types of transplant donor:
Decreased heart beating donors
Non-heart beating donors
Live donation
Decreased heart beating donors:
Patients on life support who have been confirmed as brain stem dead by two doctors, the organs are retrieved while the person’s heart is still beating
Non-heart beating donors:
An organ is retrieved from a person who is officially dead - as in their heart has stopped beating
Live donation:
A person who is still alive offers to have one of their organs removed and given to another
What is the difference between directed and undirected live donation?
Directed - the person wants to donate their organ to someone specifically e.g., a family member with ESRD
Undirected - the person wants to donate their organ but does not name or have an intended recipient to receive it
Number of kidney transplants being carried out has increased/decreased/stayed the same
Number of live donors offering kidneys has increased/decreased/stayed the same
Number of kidney transplants being carried out has increased
Number of live donors offering kidneys has stayed the same
What criteria must a patient/recipient meet to be considered for transplant?
- Life expectancy must be >5 years
- Must be fit enough to survive the operation and post-op period e.g., general anaesthetic, immunosuppression, post-op IV fluids etc.
- Must undergo an extensive assessment process
There is no survival benefit from transplantation until ? months after the transplant
3
What 8 investigations/assessments are carried out for the recipient before they can be considered for transplant?
- Immunology: tissue typing and antibody screening
- Virology (to check for previous or active infection)
- Assessment of cardiorespiratory risk e.g., ECG, Echo, Coronary angio, CXR, PFT
- Assess peripheral vessels (as blood will be shunted to the new kidney so ensure vessels are strong enough to still take blood to the legs)
- Assess bladder function
- Assess mental state (as transplant can exacerbate these)
- Assess any co-morbidity or PMHx which may affect the transplant or be exacerbated by immunosuppression
- Independent assessment by someone outwith the transplant team to ensure all the work-up has been performed adequately
List 8 contraindications to transplant
- Malignancy (current untreated or solid tumour in the past 2-5 years depending on grade)
- Active HCV/HIV infection
- Untreated TB
- Severe ischaemic heart disease, not amenable to surgery
- Severe airways disease
- Active vasculitis (should be suitable for transplant after a few months of treatment)
- Severe PVD (unusable vessels)
- Hostile bladder e.g., bladder outflow obstruction that will put back pressure on the new kidney
What criteria must a live donor meet to be considered as a donor? (7)
- Must be physically fit enough to cope with surgery and post-op period
- Must have adequate renal function to remain independent following nephrectomy
- Kidneys must be anatomically normal
- Should not have co-morbidities that will get worse with one kidney e.g., hypertension, proteinuria
- Should be immunologically compatible with the recipient
- Must be psychologically fit to donate e.g., able to cope with the recovery process
- Reasons for donating must be explored e.g., cannot be because they want to have a hold on/manipulate the recipient, cannot be because they have been coerced by someone else
Tissue typing must be carried out on the donor and recipient before transplant to reduce chance of organ rejection. What are the 2 types of tissue typing?
Blood group compatibility
HLA matching
What blood groups can a recipient have to be compatible with a donor with a blood group of... - O - A - B - AB ...?
- O: Any!
- A: A, AB
- B: B, AB
- AB: AB
What is HLA matching?
When recipients are matched with donors who have the same type of HLA (aka MHC) protein group found on antigen-presenting cells
What are the 3 main types of HLA group?
HLA-A, HLA-B, HLA-DR
Why is HLA matching important?
- There is a better chance of graft survival with immunosuppression
- Without immunosuppression, HLA matching is key to prevent rejection