Renal Transplantation Flashcards
Due to +ve Xmatch (preformed antibodies to the Tx)
Unsalvageable
Remove kidney
Hyperacute rejection (minutes)
T cell or B cell mediated response
Can be treated with increased immunosupression
Acute rejection
usually early
Immunological and vascular deterioration of the Tx
Chronic rejection of the transplant
Immunosuppression used in transplantation?
S&M, CT
Steroids MMF CyA Tacrolimus Antibodies
How do ciclosporin and tacrolimus work?
Inhibit activation of T cells
- Reduce NK cells activation
- Reduce cytotoxic T cell activation
- Decrease cytokine release so prevent B cell proliferation and antibody production
Side effects of cyclosporin and tacrolimus?
Renal dysfunction
Hypertension
Diabetes
Tremor
-metabolised by cytochrome p450 so lots of drug interactions
Antimetabolites by blocking purine synthesis
Leads to suppression of proliferation of lymphocytes and B cells
Aziathioprine and mycophenolate
Side effects of aziathioprine and mycophenolate?
Leucopenia
Anaemia
GI side effects
(LAG)
Act non selectively to suppress activity of T cells and proliferation of B cells?
Steroids
The 3 types of kidney donor?
Deceased brain dead
Deceased cardiac death
Live donor kidney, kidney pancreas dual transplant
Suitability for transplantation?
Patient should have reasonable life expectancy ( >5 years)
To ensure equity of provision should not get cadaveric Tx > 6 months prior to starting HD.
Allocation of kidneys in UK is based predominantly on Tissue typing and then time on list, not the other way round
Assessment of cardiovascular risk?
ECG, Cholesterol, ETT, Coronary Angiogram, Echocardiogram
Virology assessment pre-transplant
HBV, HCV, HIV, CMV, EBV
HBV, HCV and HIV should be treated and controlled pre transplant
When would you do a bladder assessment before transplantation?
If PHx or urological problems
Absolute contraindications for kidney transplant
Malignancy Known untreated malignancy Hx of solid tumour within 2 years (For some tumours 5 years) Untreated TB Severe IHD not amenable to surgery (should be carried out prior to Tx) Severe airways disease Active vasculitis Severe PVD (Unusable vessels)
Surgical complications of kidney transplant
Bleeding (arterial or venous) Arterial Stenosis / Thrombosis Venous stenosis / Thrombosis Ureteric Stricture and hydronephrosis Wound infection
Post transplant care
HDU Care post op Central Line to measure CVP Bladder catheter for measuring urine output IV Fluids to maintain hydration Oxygen
Maintain hydration
Daily monitor of UE’s and drug levels
Regular MSU to look for infection
Discharge about 7 Days
Immediate graft function vs delayed graft function
Immediate Graft Function
Urine Output good
Falling creatinine and Urea
Delayed Graft Function Post Tx acute tubular necrosis Tx will work after 10-30 days Will need Haemodialysis in interim Difficult to detect rejection ( Need Bx)
Primary non function?
Transplant never works
Which type of cancer is associated with kidney transplant?
Skin cancer
