Renal transplant Flashcards
Assessment
Virology: CMV, HIV, VZV, hepatitis Co-morbidities: esp. CVD ABO anti-HLA Abs: may be acquired from blood transfusion Haplotype Importance: HLA-DR > HLA-B > HLA-A 2 alleles @ each locus → 6 possible mismatches ↓ mismatches → ↑ graft survival Pre-implantation cross-match Recipient serum vs. donor lymphocytes
Contraindications
Active infection
Cancer
Severe HD or other co-morbidities
Failed pre-implantation x-match
Types of grafts
Cadaveric: brainstem death ̄c CV support
Non-heart beating donor: no active circulation
Live-related
- Optimal surgical timing, HLA-matched, Improved graft survival
Live unrelated
Immunosuppression
Pre-op: campath / alemtuzumab (anti-CD52)
Post-op: prednisolone short-term and tacro/ciclo long-term
Prognosis
t1⁄2 for cadaveric grafts: 15yrs
t1⁄2 for HLA-identical live grafts: >20yrs
Post-op complications
Bleeding
Graft thrombosis
Infection
Urinary leaks
Hyper acute rejection: minutes
ABO incompatibility
Thrombosis and SIRS
Acute rejection <6 months
Path: Cell-mediated response
Presentation: Fever and graft pain, ↓ urine output, ↑ Cr
Responsive to immunosuppression
Chronic Rejection (>6mo)
Interstitial fibrosis + tubular atrophy
Gradual ↑ in Cr and proteinuria
Not responsive to immunosuppression, supportive Rx
Ciclosporin / tacrolimus nephrotoxicity
Acute: reversible afferent arteriole constriction → ↓GFR
Chronic: tubular atrophy and fibrosis
↓ Immune Function
↑ risk of infection: CMV, PCP, fungi, warts
↑ risk of malignancy: BCC, SCC, lymphoma (secondary EBV)
Cardiovascular Disease
Hypertension and atherosclerosis
Differential of Rising Cr in Tx pt.
Rejection
Obstruction
ATN
Drug toxicity
Commonest indications for transplant
Diabetic nephropathy
GN
Polycystic Kidney Disease
Hypertensive nephropathy
Ciclosporin
Ciclosporin: calcineurin inhibitor (blocks IL2 production)
Nephrotoxic: may contribute to chronic rejection
Gingival hypertrophy
Hypertrichosis
Hepatic dysfunction
