Renal transplantation

Question 1

what is the most common diagnosis in patients receiving renal transplant?

Answer 1

malignant HTN

Question 2

what makes an extended criteria donor?

Answer 2

• age over 60

- age 50-59 with 2 out of 3 of HTN / death from CVA / scr over 1.5

Question 3

MHC I and II are located on which chromosome?

Answer 3

6

Question 4

what are the two phases of immunosuppression?

Answer 4

• induction

- maintenance

Question 5

what therapies are included in the induction phase of immunosuppression?

Answer 5

• corticosteroids
• anti-thymocyte globulin
• IL-2 receptor antagonists

Question 6

what therapies are included in the maintenance phase of immunosuppression?

Answer 6

• corticosteroids
• calcineurin inhibitors
• mTOR inhibitors
• antimetabolites

Question 7

cyclosporine and tacrolimus are what class of immunosuppressors?

Answer 7

calcineurin inhibitors

Question 8

what are the main surgical complications of renal transplant

Answer 8

• graft thrombosis

- urine leak

Question 9

what is a cause for dialysis in the first week after transplantation?

Answer 9

delayed graft function

Question 10

what are the causes of delayed graft function?

Answer 10

• ATN from prolonged cold ischemia
• acute rejection
• recurrent disease

Question 11

what is a lymphocele? what is the treatment?

Answer 11

• collection of lymph caused by leakage from iliac lymphatics
• treatment: surgery

Question 12

hyperacute rejection is mediated by _________ that recognize ___________ in donor organ

Answer 12

PREFORMED ANTIBODIES that recognize HLA ANTIGENS in donor organ

Question 13

what type of necrosis characterizes hyperacute rejection?

Answer 13

fibrinoid

Question 14

acute rejection is mediated by ____________ after recognition of ___________ either directly or after being processed and presented by ________

Answer 14

• activated T cells
• graft antigen
• APCs

Question 15

acute rejection occurs in what time frame?

Answer 15

first 6 months

Question 16

how does acute rejection manifest in terms of labs?

Answer 16

• increase in serum creatinine

- with or without oliguria

Question 17

treatment of acute rejection

Answer 17

• steroids
• anti T cell Abs
• plasma exchange
• IVIG

Question 18

when does chronic rejection manifest? how?

Answer 18

• after 6 months (or weeks to years)

- heavy proteinuria

Question 19

histology of chronic rejection

Answer 19

• glomerulosclerosis
• interstitial fibrosis
• obliteration of arteriolar lumina

Question 20

what is the most common viral infection following renal transplantation?

Answer 20

CMV

Question 21

BK virus is in what family?

Answer 21

polyomavirus

Question 22

what pathogen represents an increasing risk of allograft failure?

Answer 22

BK virus

Question 23

what is the most common malignancy following transplantation?

Answer 23

skin cancer

Question 24

what are the CCB agents of choice in post transplantation HTN?

Answer 24

• nifedipine
• amlodipine
• isradapine

Question 25

what are the risk factors for new onset DM after transplant?

Answer 25

• pretransplant IGT
• polycystic kidney disease
• acute rejection