Renal: Transplant

Question 1

What are contraindications to renal transplant?

Answer 1

1. Malignancy
   - Known untreated
   - Solid tumour in the last 2- 5 years
   - Active HepC or HIV
   - Untreated TB
   - Severe IHD
   - Severe airways disease
   - Active vasculitis
   - Severe PVD
   - Hostile bladder

Question 2

When you get a renal transplant put in , what vessels is it attached to?

Answer 2

Gets put into the iliac fossa and attached to the external iliac artery and vein.

Question 3

What are the different types of rejection that can occur when you get a renal transplant?

Answer 3

1. Hyperacute
   - Preformed antibodies
   - Unsalvagable and requires transplant nephrectomy
2. Acute
   - Cellular or antibody mediated and can be treated with increased immunosupression
3. Chronic rejection
   - Antibody mediated slowly prorgressive decline in renal function which is poorly responsive to treatment.

Question 4

What anti rejection agents are used following renal transplantation?

Answer 4

1. Induction treatment with dacluzimab (monoclonal antibody which prevents activation of IL2 on CD4 T cells) This is only useful before rejection has started!
2. Prednisolone during operation to inhibit lymphocytes and suppress cytokines.
3. Maintenence treatment with prednisolone, tacrolimus (inhibits T cells and prevents cytokine release), ciclosporin and azathioprine (blocks purine synthesis)

Question 5

What are the general complications of renal transplanatation immunosupression?

Answer 5

1. Infection
   - Bacterial (prophylaxis for PCP given)
   - Viral (CMV, HSV)
   - Fungal

Question 6

What prophylaxis can be given against CMV is transplant patients who are deemed to be at high risk?

Answer 6

Valganciclovir

Question 7

What is the treatment if you suspect CMV in a patient on immunosupression?

Answer 7

IV ganciclovir

Question 8

What are common malignancies seen in immunosupressed patients?

Answer 8

Non melanoma skin cancer

Lymphoma (post transplant lymphoproliferative disease)

Question 9

What is the treatment for post transplant lymphoproliferative disease?

Answer 9

Reduce immunosupression

May not need chemotherapy!

Question 10

What is a lymphocele?

Answer 10

Unilateral leg swelling that occur around 2 weeks after a renal transplant.. They are due to a mass effect with compression of structures adjacent to the implanted kidney. This includes the vessels supplying the kidney. A laparascopic or peritoneal window needs to be made to treat this.