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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?

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
List the types of transplant rejection
Hyperacute Acute Chronic
26
What causes hyperacute transplant rejection? How long does it take to occur? How is it managed?
Preformed antibodies to transplant antigens Minutes Transplant removal
27
How is acute transplant rejection caused? How is it managed?
T cells or B cells Early Increased immunosuppression (+ steroids in short term)
28
How is chronic transplant rejection caused? How is it managed?
Immunological and vascular deterioration | Unsure how to treat
29
Describe how transplant patients are immunosuppressed
Induction - high dose steroids, MMF, cyclosporin, tacrolimus, antibodies Consolidation - lowered doses Maintenance - balanced low doses
30
Name two calcineurin inhibitors
Cyclosporin | Tacrolimus
31
How do calcineurin inhibitors work?
Reduce NK and CD8 cell activation and thus decrease cytokine release (preventing B cell proliferation and antibody production)
32
What are the side effects of calcineurin inhibitors?
Renal dysfunction Hypertension Diabetes (in at risk populations) Tremors
33
Which organ are calcineurin inhibitors metabolised by? Why is this relevant?
Liver The specific liver pathway that metabolises calcineurin inhibitors also metabolises lots of other drugs hence drug interactions can be an issue
34
How do azathioprine and mycophenolate work?
Block purine synthesis thereby suppressing the proliferation of lymphocytes and B cells
35
What are the side effects of azathioprine and mycophenolate?
Leucopaenia Anaemia GI disturbance
36
Which drug should you not give azathioprine with?
Allopurinol
37
How do steroids work with regards to immunosuppression?
Non selective suppression of T cells and B cells
38
What are the side effects of steroids?
Osteoporosis Weight gain Infection Diabetes
39
What types of kidney donation exist?
Deceased brain dead Deceased cardiac death Live donor Kidney pancreas
40
Which type of diabetes patients are suitable for pancreas transplantations?
Type 1 diabetics with renal failure
41
What is the criteria for a patient to be eligible for transplant?
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
How must transplant patients be assessed?
``` CVS risk (ECG, cholesterol, ETT +/- angiogram, echo) Virology (hepatitis, HIV, CMV, EBV) Chest x-ray Bladder assessment Investigation of co-morbidity ```
43
Which viruses should be treated prior to transplant?
Hep B Hep C HIV
44
What are the absolute contraindications to transplant?
``` Untreated malignancy Untreated TB Severe IHD Severe airways disease Active vasculitis Severe peripheral vascular disease ```
45
How is a live donor assessed?
``` ECG Chest x-ray Virology GFR (direct measure) Proteinurea quantification 24hr blood pressure Renal angiogram X-match against recipient ```
46
What might a renal transplant scar look like?
Like appendix scar but bigger and with underlying mass
47
What are the complications of transplant?
Haemorrhage Stenosis/thrombosis Ureteric stricture and hydronephrosis Wound infection
48
Why do post transplant patients get a central line?
To measure central venous pressure
49
How will delayed graft function present? How is it treated?
Post transplant acute tubular necrosis | Haemodialysis until begins to work within 10-30 days

Year 2 (72 decks)

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