Renal transplant Flashcards
What was a negative prognostic indicator for survival in renal transplant cats identified by Friday 2023 in Vet Surg?
The presence of metastatic calcification pre-operative.
What variable was associated with survival in cats undergoing renal transplant according to a study by Aronson 2022 in JAVMA?
Age (increase in death by 11% for every 1 year of patient age)
What is the MST for cats undergoing renal transplant?
613 days
What is the most common cause for renal transplantation?
Chronic interstitial nephritis.
What are some risk factors for survival following renal transplant?
1) Age.
2) Severity of pre-operative azotemia.
3) Preoperative blood pressure and weight.
What conditions make a candidate unsuitable for renal transplantation?
1) Pyelonephritis, or recurrent UTI (cyclosporine trial may be indicated in some cases).
2) Cardiovascular disease (HCM) and hypertension.
3) FIV/FeLV positive.
Toxoplasma gondii positive cats should be treated prophylactically with clindamycin.
What are some preoperative treatments that may be indicated prior to renal transplant surgery?
1) Hemodialysis.
2) Amlodipine (calcium channel blocker) if hypertensive.
3) Cross-matching.
4) Erythropoetin/darbopoetin injections.
5) PRBCs if anemic.
6) Phosphate binders and GI protectants.
What immunosuppressive protocol is used in cats and dogs for renal transplant?
Cyclosporine and prednisolone
+/- azathioprine, ketoconazole (allows once daily dosing).
What are the main side effects associated with the use of azathioprine for immunosuppression?
Hepatoxicity, bone marrow suppression, acute pancreatitis. Cataract formation also reported in dogs.
What surgical/anesthetic risk factors were associated with reduced survival in patients undergoing renal transplant?
1) Increased age (>12 years).
2) Prolonged anesthesia >6 hours.
3) Intraoperative hypoxemia.
4) Intraoperative hypotension.
Why is mannitol administered to the donor cat at the time of renal transplant?
Minimizes arterial spasm, improves renal blood flow, and protects against injury during the warm ischemia period.
Is the right or left kidney preferred for transplantation?
The left as it has a longer vein (minimal length of 0.5 cm required).
What are the two techniques for vascular anastomosis during renal transplant?
1) End-to-end anastomosis to the external iliac artery and vein.
2) End-to-side anastomosis to the caudal aorta (proximal to the caudal mesenteric artery), and caudal vena cava.
Number 2) is preferred due to reduction in pelvic limb complications (pain, limb edema, hypothermia, paresis, or paralysis).
What are the three techniques for ureteroneocystostomy during renal transplant?
1) Intravesiscular mucosal apposition technique.
2) Extravesicular suturing technique.
3) Harvesting of the entire ureter and ureteral papilla from the donor and anastomosis.
What are some potential peri-operative complications associated with renal transplant?
1) Anorexia.
2) Seizures: may be due to post-operative hypertension. If BP exceeds 170 mmHg hydralazine should be administered (acepromazine can be given if refractory).
3) Post-operative renal function: if no improvement in azotemia is observed within 24-72 hours ultrasound should be performed to assess the graft. If evidence of hydronephrosis may require ureteral reimplantation.
Does retroperitoneal fibrosis effect males or females more commonly following renal transplant?
Males.
Treatment involves surgical ureterolysis. Recurrence occurs in 21% of cases.
