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Renal YR3 > Renal transplant > Flashcards

Renal transplant Flashcards

1
Q

Best renal replacement therapy?

A
  • Kidney transplant - best for patient survival and quality of life
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2
Q

What does kidney transplant require to see if suitable?

A
  • Careful evaluation to establish if candidate
  • It is important to document immunisation episodes eg blood transfusion, pregnancies and prior transplants as these people are harder to find a match for
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3
Q

Contraindications to transplant of kidney

A
  • Active infection or malignancy
  • Severe heart disease not suitable for correction
  • Severe lung disease
  • Reversible renal disease
  • Uncontrolled substance abuse or psychiatric illness
  • On going treatment non adherance
  • Short life expectancy
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4
Q

Types of transplant origin

A
  1. Living related donor
  2. Living non related donor
  3. Deceased donor
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5
Q

Living related donor transplant

A
  • Best possible transplant
  • Transplantation can happen within months
  • Elective procedure with selected donor
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6
Q

4 forms of living unrelated donor transplant

A
  • Live-donor paired exchange
  • Live-donor/deceased- donor exchange
  • Live-donor chain
  • Altruistic donation
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7
Q

How long does living unrelated donor transplant take?

A

Months

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8
Q

Deceased donor transplant - how common?

A
  • 60% of transplants
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9
Q

How does deceased donor transplant happen

A

Patient receives kidney (or two from same receipient) with little time for prep

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10
Q

Time for deceased donor transplant

A

Years

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11
Q

Deceased donor vs live donor survival of kidney

A

Survival of kidney allograft and patients are significantly low compared to live donor transplant

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12
Q

What is the induction treatment for transplant?

A
  • Potent immunosupressive drugs are used to create tolerance for graft
  • Hyperacute rejection is now rarely seen due to this
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13
Q

Examples of immunosupressive drugs used in induction treatment

A

Methylprednisolone with any of the following:
* Basiliximab and thymoglobulin
* Alentuzumab and rituximab (less common)

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14
Q

Maintenance treatment post transplant - when is this used

A

Immediately after transplant and for long term to prevent acute or chronic rejection

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15
Q

Drugs commonly used for maintenance treatment

A
  • Steroids - prednisolone
  • Calcineurin inhibitors - tacrolimus, cyclosporine, voclosporin
  • Antimetabolite - mycophenolate, azathioprine
  • Rapamycin inhibitors - sirolimus, everolimus
  • T cell regulation - Belatacept, Belimumab
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16
Q

Long term care for transplant patient

A
  • First few months follow up happens multiple times a month, after 6 months –> less often
  • Screen for infections
  • Vaccinate (except live/live attenuated viral vaccines)
  • Monitor and control CV disease, bone and mineral metabolism disease
  • Screen for malignancies - 3x more likely to have any cancer
  • Annual skin checks for skin cancer
  • Contraception - obligatory in first year, counsel about pregnancy 1 yer after
17
Q

Monitoring tests for transplant patient

A
  • eGFR
  • Calcineurin inhibitors levels
  • Proteinuria
  • Ca+
  • Phosphate
  • PTH
  • Lipids
  • Glucose
18
Q

What is mortality from transplant related to?

A
  • Cardiovascular disease
  • Infections
  • Malignancies
19
Q

Complications of transplant - what is usually the cause of acute ones within first month?

A

Related to surgery or infection

20
Q

Timeframe for transplant infections

A
  • Less than 4 weeks - hospital infections or related to donor
  • 1-12 months - activation of latent infections, relapsed, residual or opportunistic infections
  • More than 12 months - community acquired
21
Q

Important germs to consider in infection of transplant patient

A
  • CMV
  • Hepatitis B
  • Herpes simplex virus
  • Varicella zoster
  • EBV
  • BK virus
  • Aspergillus
  • Pneumocystis jirovecii
  • Listeria
  • Mycobacterium tuberculosis
  • Toxoplasma gondii
22
Q

What can some patients develop within the first year of transplant?

A
  • New onset diabetes after transplant (NODAT)
  • Important to remember personal risk factors and new factors such as medications (steroids and calcineurin inhibitors) and new gluconeogenic kidney
23
Q

What do we do because of increased risk of cancer in transplant patients?

A
  • Screen for skin, cervic, breast, prostate, renal, urothelial, liver, colorectal and lymphoporliferative disease
  • Lymphoproliferative disease is common on patients with EBV
24
Q

What is simultaneous kidney transplant?

A
  • Patients with liver failure and cirrhosis and ESRF can have liver and kidney transplant at same time
  • Selected T1DM patients can have pancreas and kidney
  • Patients with kidney transplant who progress into ESRF can be retransplanted
25
Q
A

Renal YR3 (11 decks)

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