Renal Transplant Flashcards
Where are kidney transplants located?
Right iliac fossa
Why are kidney transplants located in the right iliac fossa?
More accessible than where the kidneys are anatomically situated. Advantage of shorter ureter
What are the contraindications to kidney transplant?
Hypertension Hypotension Diseases that will recur in transplant Age - if frail and comorbid Patients without bladders Calcified blood vessels
What type of kidney donors are mostly used in the UK national kidney sharing scheme?
Living donors - relatives and altruistic
What is the average waiting time for a deceased donor kidney?
2-3 years
What is the advantage of a living kidney. donor compared to deceased donors?
Allows pre-emptive transplantation
Better kidding as donor fits, healthy and have excellent kidney function
Longer kidney survival
When is rejection of a transplanted kidney most likely to occur?
First few weeks after surgery
What immunosupressants are used in kidney transplant?
Basiliximab
Tacrolimus
Mycophenolaye mofetil
Steroids
What is the mechanism of action of basiliximab?
Anti IL2 receptor monoclonal antibody
What is the mechanism of action of tacrolimus?
Calcineurin inhibitor
What is the mechanism of action of mycophenolate mofetil?
Inhibits inosine 5’ monophosphatase dehydrogenase which inhibits proliferation of T and B lymphocytes
How is cell mediated rejection of a transplanted kidney treated?
Steroids
Cell mediated rejection of a. transplant kidney is harder to treat than antibody mediated. T/F?
False - the opposite is true
How does cell mediated rejection of a donor kidney damage the kidney?
Interstitial inflammation and tubulitis
How does antibody mediated rejection of a donor kidney damage the kidney?
Endothelial swelling
Glomerulonephritis
Peri-tubular nephritis
What infections can occur in patients with a renal transplant?
Check infection, urine infections and skin/wound infections with common organisms
Reactivation infections e.g. MCV
Uncommon organism infections e.g. pneumocystitis jiroveci
How are infections in renal transplant treated?
Reduction of immmunosuppresion
Antibiotics or antivirals
CMV reactivation can occur with immunosuppression in kidney transplant. How can this manifest?
Pneumonitis
Colitis
Hepatitis
Renal disease
What malignancies can commonly occur as a result of immunosuppression in renal transplant?
Kaposi sarcoma Skin malignancies Non-Hodgkin's and Hodgkin's lymphoma Lung cancer Kidney cancer Colon and rectal cancer Pancreatic cancer Melanoma
How are malignancies as a. result of immunosuppression in renal transplant treated?
Reducing immunosuppression +/- rituximab or chemotherapy
