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Year 2 > Renal transplantation > Flashcards

Renal transplantation Flashcards

1
Q

What happens to the non-functioning kidneys in renal transplant?

A

Nothing - leave them where they are

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2
Q

Where is a kidney transplant placed?

A

Right iliac fossa

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3
Q

Which vessels are kidney transplants anastomosed onto?

A

External iliac artery and vein

Ureter

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4
Q

What needs to be compatible with regard to transplants?

A

Blood group

Human leucocyte antigen matching (tissue typing)

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5
Q

What is blood group compatibility?

A

Blood antigens must match as antibodies for the other blood antigens are found within the blood

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6
Q

Which blood group does not have an antibody against it?

A

O

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7
Q

What are human leucocyte antigens?

A

Cell surface proteins which activate the immune system when foreign antibodies bind

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8
Q

What are the 3 important types of HLA with respect to transplantation?

A

HLA DR
HLA A
HLA B

(Dr Ab)

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9
Q

With respect to each HLA A, B & DR there are two antigen subtypes. Why is this?

A

Each parent passes on one subtype to their offspring

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10
Q

Why is HLA relevant?

A

If a patient has been exposed to their donors HLA antigen before they might have developed an antibody against it and this will therefore cause tissue rejection

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11
Q

A more closely matched kidney is associated with improved survival length of the transplant. T/F

A

True

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12
Q

How might a patient be exposed to other HLA antibodies?

A

Blood transfusions
Pregnancy (placental maternal blood flow)
Previous transplants

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13
Q

Reduced cold ischaemic time is associated with better transplant survival. T/F

A

True

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14
Q

Explain transplant rejection

A

HLA antigen binds to dendritic cells –>
Antigen presenting cells express antigen on MHC complex –>
Helper T cells are activated –>
Increase B cell efficiency ; complement pathway activation ; increase in NK cells and cytotoxic T cells –>
Antibody production ; Direct cell killing –>
Rejection

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15
Q

What is the difference between cellular rejection and antibody mediated rejection?

A

Cellular rejection - NK cells and CD8 cells

Antibody mediated - B cells

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16
Q

Immunosuppression increases the risk of what?

A

Infection

Malignancy

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17
Q

Which infections are immunosuppressed patients prone to?

A

CMV (herpes group)
Pneumocystitis jirovecii
Recurrent UTI
BK virus

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18
Q

Which malignancies are immunosuppressed patients prone to?

A

Non melanoma skin cancer (SCC)

Post transplant lymphoma

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19
Q

Why is CMV important in terms of transplant immunology?

A

Giving a patient not infected with CMV a CMV infected kidney is bad news unless you give antivirals (valganciclovir)

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20
Q

How is pneumocystis jirovecii treated?

A

Co-tramoxazole

21
Q

EBV post-transplant increases risk of what?

A

Lymphoma

22
Q

How is post transplant lymphoma treated?

A

Reduction in immunosuppression + anti cancer agents

23
Q

What biochemical marker might help to warn of kidney transplant rejection?

A

Serum creatinine

24
Q

Which cells must be repressed post-transplantation?

A

T helper cells
B cells

Hence complement & cytokines

25
Q

List the types of transplant rejection

A

Hyperacute
Acute
Chronic

26
Q

What causes hyperacute transplant rejection? How long does it take to occur? How is it managed?

A

Preformed antibodies to transplant antigens
Minutes
Transplant removal

27
Q

How is acute transplant rejection caused? How is it managed?

A

T cells or B cells
Early
Increased immunosuppression (+ steroids in short term)

28
Q

How is chronic transplant rejection caused? How is it managed?

A

Immunological and vascular deterioration

Unsure how to treat

29
Q

Describe how transplant patients are immunosuppressed

A

Induction - high dose steroids, MMF, cyclosporin, tacrolimus, antibodies
Consolidation - lowered doses
Maintenance - balanced low doses

30
Q

Name two calcineurin inhibitors

A

Cyclosporin

Tacrolimus

31
Q

How do calcineurin inhibitors work?

A

Reduce NK and CD8 cell activation and thus decrease cytokine release (preventing B cell proliferation and antibody production)

32
Q

What are the side effects of calcineurin inhibitors?

A

Renal dysfunction
Hypertension
Diabetes (in at risk populations)
Tremors

33
Q

Which organ are calcineurin inhibitors metabolised by? Why is this relevant?

A

Liver
The specific liver pathway that metabolises calcineurin inhibitors also metabolises lots of other drugs hence drug interactions can be an issue

34
Q

How do azathioprine and mycophenolate work?

A

Block purine synthesis thereby suppressing the proliferation of lymphocytes and B cells

35
Q

What are the side effects of azathioprine and mycophenolate?

A

Leucopaenia
Anaemia
GI disturbance

36
Q

Which drug should you not give azathioprine with?

A

Allopurinol

37
Q

How do steroids work with regards to immunosuppression?

A

Non selective suppression of T cells and B cells

38
Q

What are the side effects of steroids?

A

Osteoporosis
Weight gain
Infection
Diabetes

39
Q

What types of kidney donation exist?

A

Deceased brain dead
Deceased cardiac death
Live donor
Kidney pancreas

40
Q

Which type of diabetes patients are suitable for pancreas transplantations?

A

Type 1 diabetics with renal failure

41
Q

What is the criteria for a patient to be eligible for transplant?

A

Life expectancy >5 yr
No cadaveric transplant if >6 months prior to starting haemodialysis
Tissue type match (person who has been on list longest gets organ)

42
Q

How must transplant patients be assessed?

A 
CVS risk (ECG, cholesterol, ETT +/- angiogram, echo)
Virology (hepatitis, HIV, CMV, EBV)
Chest x-ray
Bladder assessment 
Investigation of co-morbidity
43
Q

Which viruses should be treated prior to transplant?

A

Hep B
Hep C
HIV

44
Q

What are the absolute contraindications to transplant?

A 
Untreated malignancy 
Untreated TB
Severe IHD
Severe airways disease
Active vasculitis 
Severe peripheral vascular disease
45
Q

How is a live donor assessed?

A 
ECG
Chest x-ray
Virology 
GFR (direct measure)
Proteinurea quantification 
24hr blood pressure 
Renal angiogram
X-match against recipient
46
Q

What might a renal transplant scar look like?

A

Like appendix scar but bigger and with underlying mass

47
Q

What are the complications of transplant?

A

Haemorrhage
Stenosis/thrombosis
Ureteric stricture and hydronephrosis
Wound infection

48
Q

Why do post transplant patients get a central line?

A

To measure central venous pressure

49
Q

How will delayed graft function present? How is it treated?

A

Post transplant acute tubular necrosis

Haemodialysis until begins to work within 10-30 days

Year 2 (72 decks)

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