Renal Transplantation

Question 1

Due to +ve Xmatch (preformed antibodies to the Tx)
Unsalvageable
Remove kidney

Answer 1

Hyperacute rejection (minutes)

Question 2

T cell or B cell mediated response

Can be treated with increased immunosupression

Answer 2

Acute rejection

usually early

Question 3

Immunological and vascular deterioration of the Tx

Answer 3

Chronic rejection of the transplant

Question 4

Immunosuppression used in transplantation?

S&M, CT

Answer 4

Steroids
MMF
CyA
Tacrolimus
Antibodies

Question 5

How do ciclosporin and tacrolimus work?

Answer 5

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

Question 6

Side effects of cyclosporin and tacrolimus?

Answer 6

Renal dysfunction
Hypertension
Diabetes
Tremor

-metabolised by cytochrome p450 so lots of drug interactions

Question 7

Antimetabolites by blocking purine synthesis

Leads to suppression of proliferation of lymphocytes and B cells

Answer 7

Aziathioprine and mycophenolate

Question 8

Side effects of aziathioprine and mycophenolate?

Answer 8

Leucopenia
Anaemia
GI side effects

(LAG)

Question 9

Act non selectively to suppress activity of T cells and proliferation of B cells?

Answer 9

Steroids

Question 10

The 3 types of kidney donor?

Answer 10

Deceased brain dead
Deceased cardiac death
Live donor kidney, kidney pancreas dual transplant

Question 11

Suitability for transplantation?

Answer 11

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

Question 12

Assessment of cardiovascular risk?

Answer 12

ECG, Cholesterol, ETT, Coronary Angiogram, Echocardiogram

Question 13

Virology assessment pre-transplant

Answer 13

HBV, HCV, HIV, CMV, EBV

HBV, HCV and HIV should be treated and controlled pre transplant

Question 14

When would you do a bladder assessment before transplantation?

Answer 14

If PHx or urological problems

Question 15

Absolute contraindications for kidney transplant

Answer 15

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)

Question 16

Surgical complications of kidney transplant

Answer 16

Bleeding (arterial or venous)
Arterial Stenosis / Thrombosis
Venous stenosis / Thrombosis
Ureteric Stricture and hydronephrosis
Wound infection

Question 17

Post transplant care

Answer 17

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

Question 18

Immediate graft function vs delayed graft function

Answer 18

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)

Question 19

Primary non function?

Answer 19

Transplant never works

Question 20

Which type of cancer is associated with kidney transplant?

Answer 20

Skin cancer