Renal Transplantation Flashcards
Adv of transplant
No need for dialysis
Imrpoved hemodynamics
Morbidity of ESRD is lifted
Independnece
Disadv of transplant
Surgical risk
Immunosuppression risk
Donor operation
Isolate celiac-foregut, SMA - midgut, and IMA-hindgut arteries
Drain mesenteric veins through liver and systemic veins through cava
Preservation solution
Remove blood,
Cooling
Replace ECF with fluid similar to IC fluid
Low freezing point
Pulsatile perfusion
Control flow, measure resistance and pressure
V=IR or I=V/R
Brain death releases cytokine storm
Kidney has increased reisstant due to nvasosspasm from brain death, cold, and vasc dz
Pump will dilate physiologic lesions (vasospasm) and not affect fixed lesions (vasc dz)
Recipients
EPTS - age, time, diabetes, previous transplant?
DOnors
KDPI
Sensitive
Panel reactive Ab
Higher result means more likely to have positive XM so no Txp
Increased priority balances that
Diabetes
Most common cause of trnapslant
Diabetic glomeruloneprhitis
CAN recur after trnasplant
HTN
Most common diagnosis
YES - can recur in trnapslant bc while HTN caused by kidney can also damage kidne y
POlycystic kidney dz
CANNOT recur after trnapslant
Various penetrance but most proress to ESRD
FSGS
INcludes IGA neprhopathy, vasculidities
Injury to podocyte by circulating factor
CAN recur
Obstructive
Post renal causes
Children - posteriro urethral valve
Elderly- BPH
CANNOT recur if you do job right
Goodpastures
Anti-GBM to collagne 4…constellation of RPGN and pulmonary hemorrhage
CAN reucr
Alport’s
XL dz of collagen 4 with deafness and lens abnormailities…affects BM
CANNOT recur…except might develop ant-GBM to wild type collagne type 4
Principles of immunosuppression
Prevent rejection, minimize infection and toxicity
Phases of immunosupp
Induction - intense
Maintencnace - chronic slowly tapering
Salvae - resuce after rejection
Immune rsponse in 1 slide
1 - TCR binding
2 - co stim
3 - trigger for clonal expansion
Antiboeis
Binding - activate
Depleting - MOA is mediating cell death…ADCC or compliment activaqtion
OKT3
Depleting Ab against CD 3…very effective
Anti-thymocyte globulin
ABs to T-lymphos
POlyclonal
Non-sepcific immune response ot human lymphocytes
Basiliximab
Alemtuzumab
Rituximab
Belatacept
Il-2 antag
DDepleting against CD52…present of all lymphs
Depleting against CD20s…all B cells but plasma
Humanized CTLA4 analog…competitive inhibt of CD80/86
Eculizumab
Alafecept
Bortzomib
INhibits MAC assmelby…binds C5
LFA3 analog…inhibits LFA3.CD2 costim
Inhibitor of 26S proteosome…leads to apop
Clacineurin ihibit
Second messenger to TCR
Leads to IL-2 that promotes T cell act
Cyclosproine
Neprhotox, neurotox, diabetogencitiy
INcreased B cell lymphoma and cosmetic changes
Tacroliumus
More efficacious than CSA but similar side effects
CSA vs. TAC
Nephro Diabeto HTN Lipids CV risk SKin cancer
= TAC CSA CSA CSA =
TAC vs CSA other
TAC may reduce acute, steroid reiss rejection
TAC hass btter late graft function
TAC better CV
TAC is choise
mTOR inhibt
Rapamycin
Blocks isgnal 3…stops signal to final common path of clonal expansion
mTOR pros
Not as effective BUT
Anti-neoplastic, anti-rpolif, may reduce CMV
mTOR cons
Delayed ATN recovery Imapired wound healing Hepatic artery thrombosis Thrombocyto Hyperlipid Mouth ulcers
azathiprine
Puring analog…prodrug of 6-MP
Inhibits PRPP amidotransferase…rate limiting purine syntehsis step
Inosine monophosphate dehydrogenase inhibitors
Purine synth inhibitor
Like an anti-T cell antibiotic…interferes with pruien synthesis and T cells lack a slavage pathway
Mcyphenolic acid
Mycophenolic acid pros and cons
Use without monitioring…effective in combo
Cons - diarrhea, anemia, neutropneia
Phases
Induction - thymoglublin, basilizimab
Main - CNI, anti-prolifs, steroids
