Renal transplantation Flashcards
what is the most common diagnosis in patients receiving renal transplant?
malignant HTN
what makes an extended criteria donor?
- age over 60
- age 50-59 with 2 out of 3 of HTN / death from CVA / scr over 1.5
MHC I and II are located on which chromosome?
6
what are the two phases of immunosuppression?
- induction
- maintenance
what therapies are included in the induction phase of immunosuppression?
- corticosteroids
- anti-thymocyte globulin
- IL-2 receptor antagonists
what therapies are included in the maintenance phase of immunosuppression?
- corticosteroids
- calcineurin inhibitors
- mTOR inhibitors
- antimetabolites
cyclosporine and tacrolimus are what class of immunosuppressors?
calcineurin inhibitors
what are the main surgical complications of renal transplant
- graft thrombosis
- urine leak
what is a cause for dialysis in the first week after transplantation?
delayed graft function
what are the causes of delayed graft function?
- ATN from prolonged cold ischemia
- acute rejection
- recurrent disease
what is a lymphocele? what is the treatment?
- collection of lymph caused by leakage from iliac lymphatics
- treatment: surgery
hyperacute rejection is mediated by _________ that recognize ___________ in donor organ
PREFORMED ANTIBODIES that recognize HLA ANTIGENS in donor organ
what type of necrosis characterizes hyperacute rejection?
fibrinoid
acute rejection is mediated by ____________ after recognition of ___________ either directly or after being processed and presented by ________
- activated T cells
- graft antigen
- APCs
acute rejection occurs in what time frame?
first 6 months
how does acute rejection manifest in terms of labs?
- increase in serum creatinine
- with or without oliguria
treatment of acute rejection
- steroids
- anti T cell Abs
- plasma exchange
- IVIG
when does chronic rejection manifest? how?
- after 6 months (or weeks to years)
- heavy proteinuria
histology of chronic rejection
- glomerulosclerosis
- interstitial fibrosis
- obliteration of arteriolar lumina
what is the most common viral infection following renal transplantation?
CMV
BK virus is in what family?
polyomavirus
what pathogen represents an increasing risk of allograft failure?
BK virus
what is the most common malignancy following transplantation?
skin cancer
what are the CCB agents of choice in post transplantation HTN?
- nifedipine
- amlodipine
- isradapine
what are the risk factors for new onset DM after transplant?
- pretransplant IGT
- polycystic kidney disease
- acute rejection
