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Renal Transplant Flashcards

1
Q

Where is a transplanted kidney placed?

A

Into the iliac fossa and anastomosed to iliac vessels

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2
Q

Indications for native nephrectomy?

A

Size- eg polycystic kidneys

Infection- eg chronic pyelonephritis

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3
Q

Preservation steps for a donor kidney?

A

Cold storage solutions, minimise oedema, preserve integrity of tissues ans buffer free radicals

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4
Q

What are some vascular complications of a kidney transplant surgery?

A

Bleeding- usually anastomotic sites, perirenal haematoma (can be arterial or venous),
Arterial thrombosis,
Venous thrombosis,
Lymphocele

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5
Q

Others renal transplant complications other than vascular?

A

Ureteric- urine leak, infections

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6
Q

Immunosuppresssive agents used after renal transplants?

A

Corticosteroids,
Calcineurin inhibitors (tacrolimus, cyclosporine),
Anti-proliefratives (mycophenolate mofetil, azathiopriine)
mTOR inhibitors (sirolimus)
Costimulatory signal blockers (belatacept)
Depleting agents (Basiliximub (anti-CD25), anti-thymocyte globulin (ATG), rituximab (anti-CD20)

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7
Q

Side effects of corticosteroids?

A

Hypertension, hyperglycaemia, infections, bone loss, GI bleeed

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8
Q

Side effects of tacrolimus?

A

Hyperglycaemia, AKI, tremor

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9
Q

Side effects of cyclosporin?

A

Hirsuitism, hypertension, AKI, gout

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10
Q

Side effects of mycophenolate mofetil?

A

Cytopenia, GI upset

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11
Q

Side effects of sirolimus?

A

Lipidogenic, diabetogenic, pneumonia

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12
Q

Side effects of ATG

A

Infections,PTLD

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13
Q

What is the induction immunosuppresion drug used?

A

Basiliximab

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14
Q

What is the brain death criteria to become a DBD

A

Coma, unresponsive to stimuli,
Apnoea off ventilator despite build up of CO2,
Absence of cephalon reflexes (pupillary, oculocephalic, oculovestibular, corneal, gag, purely spinal reflexes may be present),
Body temperature above 34C,
Absence of drug intoxication

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15
Q

When is extended donor criteria used?

A

If donor is aged >60years,
If donor is aged 50-59 + history of hypertension, death from cerbrovascular accident or terminal creatinine of >132umol/l

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16
Q

What are some of the risks of being a live kidney donor?

A

compensatory increase in GFR of remaining kidney to 70%

17
Q

Complications that can occur from renal transplant?

A

Rejection, infective, cardiovascular, malignancy

18
Q

What type of rejection can occur from renal transplant?

A

Cell mediated, humoral (Ab mediated)

19
Q

What kind of cardiovascular complications can occur from renal transplant?

A

Underlying renal disease, CRF, hypertension, hyperlipidaemia, PT diabetes

20
Q

What type of T cell mediated rejection can occur after renal transplant?

A

Tubulointerstitial (Banff I)
Arteritis/ endotheliatlitis (Banff II)
Areterial fibrinoid necrosis (banff III)

21
Q

What type of acute antibody mediated rejection can occur after a kidney transplant?

A

ATN-like (Banff I)
Capillaries and or glomerular inflammation (Banff II)
Arterial inflammation (Banff III)

22
Q

What can be seen under microscopy for T cell mediated rejections folllowing a renal transplant?

A

Lymphocytic infiltrate, tubulitis, endarteritis, endothelialitis

23
Q

What can be seen microscopically with antibody mediated rejection?

A

Micro vascular inflammation (neutrophil infiltration, glomeruli, peritubular capillaries), donor specific antibodies, positive D4d (peritubular capillaries0

24
Q

What is the most important transplant-related infection?

A

Cytomegalovirus

25
Q

How are post-tanslant patients affected by cytomegalovirus?

A

Transmission from donor tissue, reactivation of latent virus

26
Q

What tissue invasive diseases can occur after a renal transplant

A

Pneumonitis, hepatitis, retinitis, gastroenteritis, colitis, nephritis

27
Q

What viruses commonly cause polyomaviridae after transplantation?

A

BK virus, JC virus

28
Q

What are the clinical manifestations of BK virus after renal transplantation?

A

Urethral stenosis, interstitial nephritis, ESRf

29
Q

What are risk factors for BKAN after renal transplantation?

A

Intensity of immunosuppresion, patient determinants (older age, male, white, DM, negative BKV, serostatus), organ determinants (graft injury, HLA mismatches, ureteral stents), viral determinants (changes in epitopes of viral capsid protein VP-1)

30
Q

treatment for BKAN

A

Rediuce immunosuppresion, antiviral therapy (cidofovir +/- IVIG), leflunomide

31
Q

Types of malignancies that can occur after renal transplantation?

A 
Non-melanoma skin, Kaposi Sarcoma, Non Hodgekins lymphoma, 
Renal,
Melanoma, leukaemia, cervical,
Testicular, bladder, 
Colon, lung, breast

Urinary (9 decks)

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