Renal Transplantation

Question 1

Where is a transplanted kidney situated?

Answer 1

Illiac fossa. The native kidneys tend to be left in place

Question 2

What level of eGFR indicates for a kidney transplant?

Answer 2

7-10ml/min but it is very individual

Question 3

What are the downsides of dialysis?

Answer 3

• Makes patients fatigued,
• Patients are in a fluid restriction and restricted diet (avoid potassium high foods),
• Women are infertile,
• Life expectancy is reduced

Question 4

What are the indications for a kidney transplant?

Answer 4

• Live longer and better with a better QoL, less time in hospital, restoration of fertility and dietary freedom. It is also cost saving

Question 5

What patients are unsuitable for a kidney transplant?

Answer 5

• Reduced life expectancy - Patients who are unlikely to survive 5 years even with transplant or those with co-morbidities.
• Surgical contraindications include no bladder or calcified blood vessels.
  Medical contraindications - Hyper/hypo-tension or diseases which will reoccur in the transplant (malignancy or chronic infections)

Question 6

What are examples of diseases which are common in dialysis clinic and transplant clinics

Answer 6

Dialysis - Renovascular disease, T2 diabetic nephropathy, vasculitis.
Transplantation - APKD, glomerulonephritis, reflux nephropathy, T1 diabetic nephropathy and obstructive uropathy

Question 7

What are the types of kidney donors?

Answer 7

• Deceased donors,
• Living donors - can come from relatives, friends or altruistic donors. Living donors tends to have better kidneys which have a longer survival

Question 8

What is the UK national kidney sharing scheme?

Answer 8

• Starts with altruistic donor which sets of a chain of transplantations. Each recipient has a person willing to donate a kidney but doesn’t match them.

Question 9

What are some potential immunosupression drugs to prevent organ rejection?

Answer 9

• Basiliximab.
• Tacrolimus (calcineurin inhibitor)
• Mycophenolate mofetil (inhibits T and B cell proliferation)
• Steroids

Question 10

What are the two forms of organ rejection?

Answer 10

• Cell mediated rejection - Interstitial inflammation and tubulitis. Easily treated with steroids if caught early.
• Antibody-mediated rejection - Endothelial swelling, glomerulonephritis and peri-tubular capillaries. These are donor specific antibodies which is hard to treat

Question 11

What are the complications of kidney transplantation

Answer 11

• Rejection
• Infection: Common infections (Chest infections, UTIs), reactivation infections (CMV) and uncommon organisms (pneumocystis Jiovecii). Treat by reducing immunosupression and antibacterials/virals.
• Malignancy: Kaposi sarcoma, skin, non-hogkins, kidney (increased risk in organ which has been transplanted) Treatment is reducing immunosupression or chemotherapy.

Question 12

What is an infection often only seen in transplantation patients?

Answer 12

Pneumocystis Jirovecii