*Renal Transplantation Flashcards
What level of GFR can be achieved with transplant versus dialysis?
GFR = 50 (transplant)
(only +7GFR gained with dialysis)
What are the different types of transplants?
Deceased heart beating (brian stem death)
Non-heart beating
Live (alturistic) donation
There is no survival benefit for transplantation until after _______ ________
There is no survival benefit for transplantation until after 3 months
What are the contraindiations to kidney transplant?
Malignancy
Active HCV/HIV infcetion
Untreated Tb
Severe PVD
Active vasculitis
Hostile bladder
What are the two key immunological barriers to transplantation?
Blood group
Genetics
How are genetics assessed before transplanation?
HLA types A, B and DR
What are 3 key sensitising events which can influence the chance of transplant rejection by causing the production of antibodies which may be cross-reactive?
Pregnancy or miscarriage
Blood transfusion
Previous transplant
What can be done if there is a specific antibody that is directed against a potential transplant?
Desensitisation
e.g. Rituximab
What are the main side effects to transplantation which will cause failure?
Bleeding
Arterial stenosis
Venous stenosing
Ureteric stricture and hydronephrosis
Wound infection
What are the types of rejection?
Hyperacute (preformed antibodies) - unsalvagable
Acute rejection (cellular or antibody mediated) - immunosuppression used
Chronic rejection (antibody mediated with slowly progressive decine) - poor response to treatment
What is the aim of anti-rejection therapy?
Reduce activation of T cells
What are induction monoclonal antibodies?
Block IL-2 receptor on CD4+ T cells
What are the benefits to using glucocorticoids as immunosuppression therapy?
Inhibit lymphocyte proliferation, survival and activation
Suppress cytokines
What are the potential side effects in terms of infection as a result of immunosuppression?
UTI
LRTI
Viral infcetions (CMV, HSV, BK)
Fungal infections
