Renal Transplant Flashcards by Sumaya L

When is renal transplantation considered?

For patients with end stage renal failure or CKD stage 4 and co-morbidities like:
Diabetes
Hypertension
Glomerulonephritis

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What are absolute contraindications to renal transplantation?

Untreated malignancy
Active infection (including untreated HIV)
Active systemic vasculitis
Life expectancy < 2 years for any reason
Current IV drug abuse

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What are the types of dead donors?

Donors after Brian death and donors after circulatory death
-> delayed graft function is more common with donors after circulatory death

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What imaging is required prior to transplantation?

Chest X ray and ECG
CT chest to screen for occult lung cancer
Echocardiogram and cardiac stress test for Oder patients or diabetics
Cystoscope for those at high risk of bladder cancer

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Which diagnostic tests

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What are the diagnostic biochemical tests prior to transplantation?

Baseline blood test
FBC, U&Es and LFTs
Group and saves
Testing for viral infections like CMV, EBV, Hepatitis and HIV

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What is the therapy for post-transplantation?

Induction therapy with quadruple agent:
Basiliximab: monoclonal antibody
Tacrolimus
Steroids
Mycophenolic acid (MMF)

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What is the standard maintenance therapy for renal transplantation?

Tacrolimus
Mycophenolate mofetil (MMF)
Steroids

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Where is the donor kidney placed?

Extraperiotneally in the right iliac fossa with native kindeys left in origami L location

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When are native kidneys removed?

Autosomal dominant polycystic kidney disease
Recurrent pyelonephritis

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What is the prognosis of a decreased transplant?

15-20 years

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What is the prognosis of a living transplant?

20-25 years

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What is hyperacute rejection?

Type II hypersensitivity reaction occurring minutes to hours mediated by pre-formed antibodies due to ABO or HLA incompatibility but this is rare

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What is delayed graft function?

Type of AKI where Dialysis is required first week after transplant, which is a risk factor for graft rejection

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What is warm ischaemia?

Time between the kidney being perfused by the donor to when it is perfused with preservation solution

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What is cold ischaemia?

Time between the kidney being perfused with preservation solution to when it is re-perfused by the recipient’s blood

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What is a longer term risk with kidney transplantation?

Renal vein thrombosis with reduced urine output, haematuria, refractory pain and deteriorating renal function

Renal artery thrombosis with

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What is the risk factors for renal artery thrombosis?

Hypercoagulable states
Prolonged cold ischaemia time
Hypovolemia

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How do patients present with renal artery thombosis?

Sudden onset oliguria with pain and tenderness over the graft site

What is wound dehiscence

Rupturing of wound at surgical site with higher risk becauase of prolonged uraemia and anaemia

What is acute graft rejection?

Occurs in first few weeks or months after transplant, with a T-cell mediated immune response against the graft

What is the management of acute graft rejection?

IV methylprednisolone

What is chronic graft rejection?

Must be a year after transplant characterised by a gradual deterioration in graft function, with interstitial fibrosis and tubular atrophy on biopsy

What is the most common infection after renal transplant?

CMV
EBC may reactivate causing glandular fever or posttransplant lymphoproliferative disorder

What are the side effects of corticosteroids?

insomnia, weight gain, diabetes, hypertension, osteoporosis, Cushing syndrome, avascular necrosis of the hip

What is the side effects of Ciclosporin use?

Nephrotoxicity due to acute interstitial nephritis causing gum hypertrophy, hirsutism, dyslipidemia and hypertension

Whjat are the side effects of use of mycophenolate mofetil? (MMF)

Gastrointestinal upset, leukopenia, photosensitivity

What are the side effects with use of Azathriopine?

Myelosuppression, pancreatitis, nausea

Which cancaers are patients who have transplants at risk of?

Renal cell carcinoma Lymphoma Non-melanoma skin cancer

Which cancer is most common?

Non melanoma skin cancer, that commonly metastasises

What is a risk with immunosuppression?

Cytomegalovirus causing leukopenia and cholestasis picture with raised bilirubin. Colitis is typical and leads to abomdinal pain and diarrhoea.

Which drug causes excessive hair growth?

Hypertrichosis

What is the threshold for acute rejection?

6 months

What is the HLA matching?

Two sets of HLA in an individual, with three in each HLA set. 50% chance from parent 25% chance from sibling

Which nephrotic syndrome has a high risk ofreccurence in transplant?

focal segmental glomerulosclerosis

What is continuous ambulatory peritoneal dialysis?

each exchange lasting 30-40 minutes and each dwell time lasting 4-8 hours. The patient may go about their normal activities with the dialysis solution inside their abdomen

What is automated perioneal dialysis?

a dialysis machine fills and drains the abdomen while the patient is sleeping, performing 3-5 exchanges over 8-10 hours each night

Which dialysis type has risk of endocarditis?

Haemodialysis

Which dialysis type has risk of constipation and fluid retention?

Perioneal

What is the life expectancy of a patient with renal failure that does not receive renal replacement therapy?

6 months

What is the cause of chronic graft failure?

both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy) recurrence of original renal disease

Which renal diseases have hig risk of recurrence to cause chronic graft failure?

Membranoprolfierative is most common IgA nephropathy Focal segmental glomerulosclerosis

What are the importance of the HLA antigens?

DR > B > A

What are the post op issues with a grade?

ATN of graft vascular thrombosis urine leakage UTI

Where is HLA coded for?

Chromosome 6

What is the most common cause of peritonitis in perionteal adialysus? s

Staphylococcus epidermidis

What should be added to dialysis solution? v

Vancomycin and ceftazidime