Renal Transplant Flashcards
reasons to give a transplant
cheaper to maintain than dialysis
better quality of life
high survival rates
what are the types of kidney donor you can get
Deceased heart beating donors (brain stem death)
Non-heart beating donors
Live donation
what do you need to asses to see if a patient can get a transplant
if they have a life expectancy >5 years
safe to under go operation (anaesthetic, surgery, immunosuppression, immediate post-op period)
Immunology screening Virology (to exclude infection) Asses cardiorespiratory risk Asses peripheral vessels Asses bladder function Asses mental state Asses any co-morbidity which may influence transplant or be exacerbated by immunosuppression
what are some contraindications to a renal transplant
Malignancy Active HCV/HIV infection Untreated TB Severe CVD Severe airway disease vasculitis (active) severe PVD Hostile bladder
what assessment is done of live donor
Physical fitness Enough renal function to be fine after nephrectomy Anatomically normal kidneys co-morbidities immunological compatibility coming forward without coercion
what do you have to match between a donor and a patient for the transplant
blood group (O can give to everyone, A to A and AB, B to B and AB, AB to AB)
HLA antibody matching
what are the benefits of HLA matching
without immunosuppression - critical
with immunosuppression - gives better graft survival
if HLA is badly matched it gives sensitisation to subsequent transplants
what are sensitising events
events leading to the formation of pre-formed antibodies to the non-self antigens the body is exposed to
blood transfusion
pregnancy of miscarriage
previous transplant
what is the list of priorities for a kidney
- Paediatric recipient
- Ideal match (0,0,0 mismatch)
- mismatch favourable (1,00,010,110)
- other match (unfavourable)
what is paired donation
when one donor wants to donate to a person but does not match
another donor wants to donate to a person that does not match
they switch the kidneys so they match to the recipients
what is desensitisation
active removal of blood group or donor specific antibody
plasma exchange
B cell antibody
monitor antibody levels and transplant when blow acceptable threshold
where is a transplanted kidney inserted
in the iliac fossa
attached to external iliac after and vein
ureter attached to bladder with stent
what are some complications from the operation
bleeding arterial stenosis venous stenosis ureteric stricture and hydronephrosis wound infection lymocele
what causes delayed graft function
post transplant necrosis
usually starts working within 10-30 days (usually needs biopsy to check if rejection)
what are the 3 types of rejection
Hyperacute rejection
Acute rejection
Chronic rejection
what is hyperacute rejection
immediate rejection due to pre-formed antibodies
unsalvageable - must remove transplanted kidney
should never happen bc the recipient is screened
what is acute rejection
cellular or antibody mediated rejection
can be treated by increasing immunosuppreison
often caused by patient not taking pills or if immunosuppression needs stopped during infection
what is chronic rejection
Antibody mediated slowly progressive decline in renal function
poor response to treatment
what is anti-rejection therapy
therapy to reduce activation of T cells
aims to prevent host vs transplant mediated response
What immunosuppressive therapy is used
Induction treatment
-basiliximab/dacluzimab
prednisolone IV during operation
Maintenance treatment:
-prednisolone, tacrolimus, MMF
what infections are commonly caused by immunosuppression
Bacterial infections
- UTI
- LRTI
Give pneumocystis jiroveci pneumonia prophylaxis
viral infections
-CMV, HSV, BK
fungal infections
when is CMV disease common after transplant
in patient is not immune and donor has had evidence of previous infection
what are the most common malignancies seen after renal transplant
non-melanoma skin cancer (50% will get one)
lymphoma
solid organs
need regular dermatology review
