Renal Transplantation Flashcards
where is a kidney transplanted to
the iliac fossa
what blood vessels are the kidney typically anastomosed onto
iliac vessels
two reasons why you might remove the native kidneys
polycystic kidneys or infection
vascular complications of transplant surgery
bleeding from anastomotic sites
arterial or venous thrombosis
lymphocele (collection of lymphatic fluid where it shouldn’t be)
2 non-vascular complications of kidney transplant
urine leak and infections
first line of immunesuppression
basiliximab
is the kidney put in or out of the peritoneum
outside
long term maintenance immunesuppression
tacrolimus, mycophenolate and steroids
what drug type does mycophenolate belong to (azathioprine is also one)
anti-proliferative immunosuppressants
ciclosporin and tacrolimus are two examples of what kind of drug
immunosuppressants
4 major side effects of the immunosuppressants used
hyperglycaemia, AKI, hypertension, hirtuitism
what does ESRD stand for
end-stage renal disease
patients with what condition should all be considered for transplant
end-stage renal disease
proportion of donors that are dead
85-90%
what immune cells are induction immunesuppressants aimed at
T cells
two types of deceased donors
donation after brain death/cardiac death
3 types of living unrelated donors
spousal, altruistic and paired/pooled
principal of paired donation
two pairs where the donor matches the recipient of the other pair and vice versa
principal of pooled donation
living donors who don’t match their intended recipient but match another
long term, which has better survival rate, transplant or dialysis
transplant
two types of acute rejection
T cell mediated and acute antibody mediated
what is hyperacute rejection
rejection occuring within minutes of transplant, not so common
how does T cell mediated rejection present
fever, swollen kidney, rapidly increasing creatinine
histological signs of TCMR
lymphocytic infiltrate
histological signs of antibody mediated rejection
microvascular inflammation of glomeruli and peritubular capillaries with neutrophil infiltrate
antibody seen on stain in AMR
c4d
what endocrine disorder commonly is onset following transplant
type 2 diabetes
what is the most iomportant transplant related infection and how common is it
cytomegaolvirus - 8%
signs of chronic rejection
gradual rise in creatinine, proteinuria, resistant hypertension.
biopsy signs of chronic rejection
fibrosis, tubular atrophy and vascular changes
which type of rejection is not responsive to increasing immunesuppression
chronic
survival rates at 1 and 10 years
89% and 67%
which donor type has a higher survival at 10 years, living or cadaveric
living
how do human polyomaviruses cause cancer
they produce T antigens which bind to intracellular proteins and block tumour-suppressor proteins
examples of human polyomaviruses
JC and BK
risk factors for BK infection
intense immunosuppresion, older male white diabetic recipient, HLA mismatch
what factor is matched between donor and recipient
HLA (human leukocyte antigen)
7 contraindications of transplant
- cancer
- active infection
- uncontrolled IHD
- acquired immunodeficiency disease
- active viral hepatitis
- peripheral vascular disease
- mental incapacity
which of these is increasing:
a. patients of transplant waiting list
b. transplants from living donors
c. transplants from dead donors
c. transplants from dead donors
people live longest when given a transplant from:
a. living related
b. living unrelated
c. dead
a/b. a living transplant has a greater survival than a cadaveric transplant
true/false living kidney donors are more susceptible to ESRD and have shortened life span
false - similar survival to GP and maybe even a lower rate of ESRD
effect of donating a kidney on GFR
GFR is reduced (because half the kidneys) but the remaining kidney can compensate to up to 70% of original GFR
