Renal Transplant

Question 1

1. Blood type antigen relationships

2. Type of rejection if incompatible, with mechanism

Answer 1

O has antiA and antiB. Only can have O
AB has neither, can have any type
-hyperacute –> antibody mediated kidding of endothelium

Question 2

Major histocompatibility complex

1. what is it?
2. role
3. types (2)

Answer 2

1. surface glycoproteins on alomst all cells,
2. Allows immune cells to distinguish self vs non
3. Class 1 (A, B, C) and class 2 (D, Dr, Dq, Dp)

Question 3

HLA Class 1

1. three types
2. Found on which cells, Attract what type of cell
3. What type of immunity
4. How to test for compatibility

Answer 3

1. A, B, C
2. nearly all cells. CD8 (cytotoxic, killer Ts)
3. Cellular immunity
4. Complement mediated microcytotoxicity

Question 4

HLA class 2

1. Types
2. Found on which cells, attract which cells
3. Testing

Answer 4

1. D, Dr, Dq, Dp
2. Found on B lymphocytes, APCs. Attract CD4 T cells
3. mixed lymphocyte culture (5-7 days)

Question 5

Renal Txp pre-op

1. # 1 cause of death after TXP
2. Absolute contraindications to txp (2)
3. status of hep C and HIV

Answer 5

1. Heart disease
2. Untreated malignancy and active infection
3. No longer contraindications

Question 6

Diseases that recur in TXP

Answer 6

antibody mediated (IgA, goodpastures)
FSGS, membranous, membranoprolif
Amyloidosis
Cystinosis

Question 7

Diseases that do not recur in renal txp

Answer 7

PCKD, primary hyperoxaluria (need renal, liver)

Question 8

Preop testing prior to renal txp

1. Blood tests (3) with optimal results
2. Imaging

Answer 8

1. ABO negative to donor
   HLA crossmatch: negative
   PRA (panel reactive analysis), multiple HLA types, as close to 0% as possible
2. CT to evaluate renal vascular anatomy

Question 9

Cancer waiting periods prior to renal txp

1. Kidney (2 scenarios)
2. Bladder (2 scenarios)\
3. Testicular/Prostate
4. Breast, melanoma, cervical

Answer 9

1. small < 4 cm (no wait vs simultaneous); large = 2 years after treatment with no recurrence
2. CIS (no wait); Stage >2, = 2 years
3. 2 years
4. 5 years

Question 10

Living kidney donors

1. Exclusion criteria; age, medical conditions, GFR, other
2. Which kidney generally preferred
3. Which kidney should stay w donor
4. Which kidney in young females
5. Best predictor of immediate graft function in living donor txp

Answer 10

1. <18 or > 65; DM, HTN, proteinuria, GFR <80, stones, clotting disorder, psych
2. left d/t longer renal vein
3. Best kidney
4. Right kidney d/t R hydro during pregnancy
5. Donor urine output

Question 11

Cadaveric kidney donor

1. Normal type of donor
2. Expanded criteria. Age, comorbid
3. Increased risk with expanded

Answer 11

1. Brain death
2. Age > 60 or 50-60 with CVA, HTN, renal failure
3. 70% greater risk of failure compared to standard

Question 12

Pre-transplant recipient nephrectomy

1. indications (7)
2. only time to do renal embo to fix

Answer 12

1. HTN not controlled medically
2. recurrent infection
3. Stones or obstruction
4. Severe proteinuria
5. Polycystic kidneys below iliac crest
6. Bleeding
7. Severe enlargement, tumor
8. Severe proteinuria