Renal Transplantation Flashcards
what are contraindications of kidney transplantation
- Active infection or malignancy
- Severe heart disease not suitable for correction
- Severe lung disease
- Reversible renal disease
- Uncontrolled substance abuse, psychiatric illness
- On-going treatment non-adherence
- Short life expectancy
what are the 3 methods of transplantation
- living related donor
- living unrelated donor
- deceased donor
Survival of kidney allograft and patients are significantly low compared to live donor transplantation
what are the 4 forms of living unrelated donor transplantation
- live-donor paired exchange
- live donor/deceased-donor exchange
- live-donor chain
- altruistic donation
what is involved in the induction treatment of renal transplantation
- At the moment of transplantation potent immunosuppressive drugs are used to create tolerance of the graft - hyperacute rejection is now rarely seen
- include methylprednisolone + 1 of: basiliximab and thymoglobulin
- less commonly used are alentuzumab and rituximab
what is the maintenance treatment of renal transplantation
- Treatment that will be used immediately after transplantation and for long term to prevent acute or chronic rejection
- Steroids: prednisolone (or prednisone)
- Calcineurin inhibitors (CNI): tacrolimus, cyclosporine, voclosporin
- Antimetabolite medications: mycophenolate, azathioprine
- Rapamycin inhibitors: sirolimus and everolimus
- T-cell regulation: Belatacept and belimumab
what is involved in the long term care of the transplant patient
- For the firsts months, follow up happens several times a month, after 6 months it happens less often
- Monitor GFR, CNI levels, proteinuria, Ca, phosphate and PTH, lipids and glucose
- Screen for infections (common and opportunistic)
- Vaccination (except live or live attenuated viral vaccines)
- Monitor and control cardiovascular disease, bone and mineral metabolism disease
- Screen for malignancies as patients are three times more likely to have any cancer
- Annual skin checks for skin cancers
- Contraception is obligatory in the first year, counsel about pregnancy one year after
what does infection within <4 weeks of transplant suggest
nosocomical infection or related to donor
what does infection within 1-12 months of transplant suggest
activation of latent infections, relapsed, residual or opportunistic infection
what does infection <12 months of transplant suggest
community acquired
which condition can patients develop within the first year of having a renal transplant
NODAT - new onset diabetes after transplant
what is it important to screen renal transplant patinets
increased risk of malignancy
- skin
- cervix
- breast
- prostate
- renal and urothelial
- liver
- colorectal
- lymphoproliferative disease
what are examples of simultaenous kidney transplantations
- Liver-kidney: patients with liver failure or cirrhosis and ESRF can be candidates for simultaneous transplant
- Pancreas-kidney: selected patients with Type 1 diabetes mellitus. Can be done simultaneous or sequential
- Patients with kidney transplant who progress into ESRF can be re-transplanted
give 2 examples of carbonic anhydrase inhibitors
acetazolamide
brinzolamide
what are 2 indications of CA inhibitors
- glaucoma
- benign intracranial HTN
what are common side effects of carbonic anhydrase inhibitors
- flushing
- metabolic acidosis
- agranulocytosis
- liver failure
