renal transplant Flashcards
what are post-op problems after a renal transplant?
ATN of graft
vascular thrombosis
urine leakage
UTI
bleeding
why does hyperacute rejection (mins to hours) happen after a renal transplant?
ABO incompatibility
thrombosis + SIRS
due to pre-existing antibodies against ABO or HLA antigens
eg of a type 2 hypersensitivity reaction
leads to widespread thrombosis of graft vessels -> ischaemia + necrosis of transplanted organ
what is the management of hyperacute rejection of renal transplant?
graft must be removed
why does acute graft failure (<6 months) occur after renal transplant?
due to mismatched HLA
cell-mediated cytotoxic T cells
other causes: CMV infection
usually asymptomatic - rise in creatinine, pyuria + proteinuria
what are the features of acute graft failure/rejection <6 months?
rising creatinine
+/- fever and graft pain
what is the management of acute graft failure after renal transplant?
may be reversible with steroids + immunosuppressants
what are the causes of chronic graft failure (>6 months) after renal transplant?
both antibody + cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy)
recurrence of original renal disease (MCGN > IgA > FSGS)
what are features of chronic graft rejection/failure >6 months?
interstitial fibrosis + tubular atrophy
gradual rise in creatinine + proteinuria
not responsive to immunosuppression
what are the risks of immunsuppression?
increased risk of infection
increased risk of malignancy
risk of which cancer increases with renal transplant?
all skin cancers- in particular SCC
lymphoma
cervical cancer
due to immunosuppression
what is an example of renal transplant immunosuppression?
initial: ciclosporin/tacrolimus w a monoclonal antibody
maintenance: ciclosporin/tacrolimus w MMF (mycophenolate mofetil) or sirolimus
add steroids if more than one steroid-responsive acute rejection episode
what are the risks of tacrolimus?
high incidence of impaired glucose intolerance + diabetes
HTN
nephrotoxic
what are the risks of ciclosporin?
hypertension
hyperlipidaemia
nephrotoxic
higher incidences of acute rejection compared to tacrolimus/recurrence of original disease in transplanted kidney
what are the risks of MMF/mycophenolate mofetil?
GI and marrow suppression
what are the risks of sirolimus/rapamycin?
hyperlipidaemia
