Renal Transplant Flashcards

1
Q

reasons to give a transplant

A

cheaper to maintain than dialysis

better quality of life

high survival rates

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2
Q

what are the types of kidney donor you can get

A

Deceased heart beating donors (brain stem death)

Non-heart beating donors

Live donation

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3
Q

what do you need to asses to see if a patient can get a transplant

A

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
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4
Q

what are some contraindications to a renal transplant

A
Malignancy 
Active HCV/HIV infection 
Untreated TB
Severe CVD
Severe airway disease 
vasculitis (active) 
severe PVD
Hostile bladder
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5
Q

what assessment is done of live donor

A
Physical fitness
Enough renal function to be fine after nephrectomy 
Anatomically normal kidneys 
co-morbidities 
immunological compatibility 
coming forward without coercion
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6
Q

what do you have to match between a donor and a patient for the transplant

A

blood group (O can give to everyone, A to A and AB, B to B and AB, AB to AB)

HLA antibody matching

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7
Q

what are the benefits of HLA matching

A

without immunosuppression - critical

with immunosuppression - gives better graft survival

if HLA is badly matched it gives sensitisation to subsequent transplants

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8
Q

what are sensitising events

A

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

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9
Q

what is the list of priorities for a kidney

A
  1. Paediatric recipient
  2. Ideal match (0,0,0 mismatch)
  3. mismatch favourable (1,00,010,110)
  4. other match (unfavourable)
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10
Q

what is paired donation

A

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

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11
Q

what is desensitisation

A

active removal of blood group or donor specific antibody

plasma exchange
B cell antibody

monitor antibody levels and transplant when blow acceptable threshold

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12
Q

where is a transplanted kidney inserted

A

in the iliac fossa

attached to external iliac after and vein

ureter attached to bladder with stent

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13
Q

what are some complications from the operation

A
bleeding 
arterial stenosis 
venous stenosis 
ureteric stricture and hydronephrosis 
wound infection 
lymocele
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14
Q

what causes delayed graft function

A

post transplant necrosis

usually starts working within 10-30 days (usually needs biopsy to check if rejection)

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15
Q

what are the 3 types of rejection

A

Hyperacute rejection

Acute rejection

Chronic rejection

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16
Q

what is hyperacute rejection

A

immediate rejection due to pre-formed antibodies

unsalvageable - must remove transplanted kidney

should never happen bc the recipient is screened

17
Q

what is acute rejection

A

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

18
Q

what is chronic rejection

A

Antibody mediated slowly progressive decline in renal function

poor response to treatment

19
Q

what is anti-rejection therapy

A

therapy to reduce activation of T cells

aims to prevent host vs transplant mediated response

20
Q

What immunosuppressive therapy is used

A

Induction treatment
-basiliximab/dacluzimab

prednisolone IV during operation

Maintenance treatment:
-prednisolone, tacrolimus, MMF

21
Q

what infections are commonly caused by immunosuppression

A

Bacterial infections

  • UTI
  • LRTI

Give pneumocystis jiroveci pneumonia prophylaxis

viral infections
-CMV, HSV, BK

fungal infections

22
Q

when is CMV disease common after transplant

A

in patient is not immune and donor has had evidence of previous infection

23
Q

what are the most common malignancies seen after renal transplant

A

non-melanoma skin cancer (50% will get one)

lymphoma

solid organs

need regular dermatology review