Renal Transplant

Question 1

Where are kidney transplants located?

Answer 1

Right iliac fossa

Question 2

Why are kidney transplants located in the right iliac fossa?

Answer 2

More accessible than where the kidneys are anatomically situated. Advantage of shorter ureter

Question 3

What are the contraindications to kidney transplant?

Answer 3

Hypertension
Hypotension
Diseases that will recur in transplant
Age - if frail and comorbid
Patients without bladders
Calcified blood vessels

Question 4

What type of kidney donors are mostly used in the UK national kidney sharing scheme?

Answer 4

Living donors - relatives and altruistic

Question 5

What is the average waiting time for a deceased donor kidney?

Answer 5

2-3 years

Question 6

What is the advantage of a living kidney. donor compared to deceased donors?

Answer 6

Allows pre-emptive transplantation
Better kidding as donor fits, healthy and have excellent kidney function
Longer kidney survival

Question 7

When is rejection of a transplanted kidney most likely to occur?

Answer 7

First few weeks after surgery

Question 8

What immunosupressants are used in kidney transplant?

Answer 8

Basiliximab
Tacrolimus
Mycophenolaye mofetil
Steroids

Question 9

What is the mechanism of action of basiliximab?

Answer 9

Anti IL2 receptor monoclonal antibody

Question 10

What is the mechanism of action of tacrolimus?

Answer 10

Calcineurin inhibitor

Question 11

What is the mechanism of action of mycophenolate mofetil?

Answer 11

Inhibits inosine 5’ monophosphatase dehydrogenase which inhibits proliferation of T and B lymphocytes

Question 12

How is cell mediated rejection of a transplanted kidney treated?

Answer 12

Steroids

Question 13

Cell mediated rejection of a. transplant kidney is harder to treat than antibody mediated. T/F?

Answer 13

False - the opposite is true

Question 14

How does cell mediated rejection of a donor kidney damage the kidney?

Answer 14

Interstitial inflammation and tubulitis

Question 15

How does antibody mediated rejection of a donor kidney damage the kidney?

Answer 15

Endothelial swelling
Glomerulonephritis
Peri-tubular nephritis

Question 16

What infections can occur in patients with a renal transplant?

Answer 16

Check infection, urine infections and skin/wound infections with common organisms
Reactivation infections e.g. MCV
Uncommon organism infections e.g. pneumocystitis jiroveci

Question 17

How are infections in renal transplant treated?

Answer 17

Reduction of immmunosuppresion

Antibiotics or antivirals

Question 18

CMV reactivation can occur with immunosuppression in kidney transplant. How can this manifest?

Answer 18

Pneumonitis
Colitis
Hepatitis
Renal disease

Question 19

What malignancies can commonly occur as a result of immunosuppression in renal transplant?

Answer 19

Kaposi sarcoma
Skin malignancies
Non-Hodgkin's and Hodgkin's lymphoma
Lung cancer
Kidney cancer
Colon and rectal cancer
Pancreatic cancer
Melanoma

Question 20

How are malignancies as a. result of immunosuppression in renal transplant treated?

Answer 20

Reducing immunosuppression +/- rituximab or chemotherapy