Renal Transplantation

Question 1

Adv of transplant

Answer 1

No need for dialysis

Imrpoved hemodynamics

Morbidity of ESRD is lifted

Independnece

Question 2

Disadv of transplant

Answer 2

Surgical risk

Immunosuppression risk

Question 3

Donor operation

Answer 3

Isolate celiac-foregut, SMA - midgut, and IMA-hindgut arteries

Drain mesenteric veins through liver and systemic veins through cava

Question 4

Preservation solution

Answer 4

Remove blood,

Cooling

Replace ECF with fluid similar to IC fluid

Low freezing point

Question 5

Pulsatile perfusion

Answer 5

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)

Question 6

Recipients

Answer 6

EPTS - age, time, diabetes, previous transplant?

Question 7

DOnors

Answer 7

KDPI

Question 8

Sensitive

Answer 8

Panel reactive Ab

Higher result means more likely to have positive XM so no Txp

Increased priority balances that

Question 9

Diabetes

Answer 9

Most common cause of trnapslant

Diabetic glomeruloneprhitis

CAN recur after trnasplant

Question 10

HTN

Answer 10

Most common diagnosis

YES - can recur in trnapslant bc while HTN caused by kidney can also damage kidne y

Question 11

POlycystic kidney dz

Answer 11

CANNOT recur after trnapslant

Various penetrance but most proress to ESRD

Question 12

FSGS

Answer 12

INcludes IGA neprhopathy, vasculidities

Injury to podocyte by circulating factor

CAN recur

Question 13

Obstructive

Answer 13

Post renal causes

Children - posteriro urethral valve

Elderly- BPH

CANNOT recur if you do job right

Question 14

Goodpastures

Answer 14

Anti-GBM to collagne 4…constellation of RPGN and pulmonary hemorrhage

CAN reucr

Question 15

Alport’s

Answer 15

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

Question 16

Principles of immunosuppression

Answer 16

Prevent rejection, minimize infection and toxicity

Question 17

Phases of immunosupp

Answer 17

Induction - intense
Maintencnace - chronic slowly tapering

Salvae - resuce after rejection

Question 18

Immune rsponse in 1 slide

Answer 18

1 - TCR binding

2 - co stim

3 - trigger for clonal expansion

Question 19

Antiboeis

Answer 19

Binding - activate

Depleting - MOA is mediating cell death…ADCC or compliment activaqtion

Question 20

OKT3

Answer 20

Depleting Ab against CD 3…very effective

Question 21

Anti-thymocyte globulin

Answer 21

ABs to T-lymphos

POlyclonal

Non-sepcific immune response ot human lymphocytes

Question 22

Basiliximab
Alemtuzumab
Rituximab
Belatacept

Answer 22

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

Question 23

Eculizumab
Alafecept
Bortzomib

Answer 23

INhibits MAC assmelby…binds C5

LFA3 analog…inhibits LFA3.CD2 costim

Inhibitor of 26S proteosome…leads to apop

Question 24

Clacineurin ihibit

Answer 24

Second messenger to TCR

Leads to IL-2 that promotes T cell act

Question 25

Cyclosproine

Answer 25

Neprhotox, neurotox, diabetogencitiy INcreased B cell lymphoma and cosmetic changes

Question 26

Tacroliumus

Answer 26

More efficacious than CSA but similar side effects

Question 27

CSA vs. TAC ``` Nephro Diabeto HTN Lipids CV risk SKin cancer ```

Answer 27

``` = TAC CSA CSA CSA = ```

Question 28

TAC vs CSA other

Answer 28

TAC may reduce acute, steroid reiss rejection TAC hass btter late graft function TAC better CV TAC is choise

Question 29

mTOR inhibt

Answer 29

Rapamycin Blocks isgnal 3...stops signal to final common path of clonal expansion

Question 30

mTOR pros

Answer 30

Not as effective BUT Anti-neoplastic, anti-rpolif, may reduce CMV

Question 31

mTOR cons

Answer 31

``` Delayed ATN recovery Imapired wound healing Hepatic artery thrombosis Thrombocyto Hyperlipid Mouth ulcers ```

Question 32

azathiprine

Answer 32

Puring analog...prodrug of 6-MP Inhibits PRPP amidotransferase...rate limiting purine syntehsis step

Question 33

Inosine monophosphate dehydrogenase inhibitors

Answer 33

Purine synth inhibitor Like an anti-T cell antibiotic...interferes with pruien synthesis and T cells lack a slavage pathway Mcyphenolic acid

Question 34

Mycophenolic acid pros and cons

Answer 34

Use without monitioring...effective in combo Cons - diarrhea, anemia, neutropneia

Question 35

Phases

Answer 35

Induction - thymoglublin, basilizimab Main - CNI, anti-prolifs, steroids