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Renal > Renal transplantation > Flashcards

Renal transplantation Flashcards

1
Q

By how much will renal transplant improve GFR?

A

50

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2
Q

By how much will renal haemodialysis or peritoneal dialysis improve GFR?

A

7

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3
Q

What are the different types of transplant?

A

Deceased heart beating donors (brain stem death)
Non-heart beating donors (DCD)
Live donation: directed and undirected, paired donation

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4
Q

How should potential recipients be screened?

A

Patients with reasonable life expectancy (>5 years)

Patient is safe to undergo the operation: GA, procedure, immunosuppression, fluid (heart failure etc)

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5
Q

What specifically is assessed once someone is eligible for an operation?

A 
Immunology: tissue typing, antibody screening 
Virology: HBV, HCV, HIV, EBV, CMV, VSV, Toxo, Syphilis 
Cardioresp risk: ECG, echo, angio, CXR 
Assesses peripheral vessels
Assess bladder function
Assess mental state
Assess any co-morbidity/ PMHx 
Independent assessment
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6
Q

What are contraindications to transplant?

A 
Malignancy - solid tumor in last 2-5 years 
Active HCV/ HIV infection 
Untreated TB
Severe IHD
Severe airways disease
Active vasculitis 
Severe PVD
Hostile bladder
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7
Q

What does tissue typing involve?

A

Blood group: O can only get from O
AB can get from everyone
HLA

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8
Q

What are common sensitising events?

A

Blood transfusion
Pregnancy or miscarriage
Previous transplant
Leads to formation of preformed antibodies to non-self antigens

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9
Q

Where are transplant kidneys grafted?

A

Onto the iliac vessels (vein and artery) and they graft the ureter to the bladder

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10
Q

What are common surgical complications to kidney transplant?

A 
Bleeding
Arterial stenosis
Venous stenosis/ kinking
Ureteric stricture and hydronephrosis 
Wound infection 
Lymphocele
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11
Q

What is an indication of immediate graft function?

A

Good urine output

Falling urea and creatinine

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12
Q

What is an indication of delayed graft function?

A

Post-transplant ATN
Often need HD in interim
Usually works within 10-30 days
Usually need biopsy

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13
Q

What is hyperacute rejection?

A

Due to preformed antibodies
Unsalvageable
Transplant nephrectomy required

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14
Q

What is acute rejection?

A

Cellular or antibody mediated

Can be treated with increased immunosuppression

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15
Q

What is chronic rejection?

A

Antibody mediated slowly progressive decline in renal function
Poorly responsive to treatment

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16
Q

What do anti-rejection therapy aim to do?

A

Reduce the activation of T cells

Aim is to prevent host V transplant mediated immune response

17
Q

What is the induction immunosuppressive therapy?

A

Basiliximab or daclizumab

18
Q

What immunosuppression is given during the transplant surgery?

A

IV prednisolone

19
Q

What immunosuppressive maintenance treatment is used post transplant?

A

Prednisone, tacrolimus, MMf
OR
Prednisolone, ciclosporin, azathioprine

20
Q

What are the different anti-rejection treatments?

A 
Pulsed IV methylprednisolone
Anti-thymocyte globulin
IV immunoglobulin
Plasma exchange
Rituximab, bortezomib, eculizumab
21
Q

What is the main aim of immunosuppressive therapy?

A

Stops IL-2 release

22
Q

What are common complications of immunosuppression?

A

Bacterial infection: UTI, LRIT
Prophylaxis for PJP
Viral: CMV, HSV, BK
Fungal infections

23
Q

What is the prophylaxis for PJP?

A

Co-trimoxazole

24
Q

What is CMV disease associated with post transplant?

A

Most important cause of morbidity in immunosuppressed patients in first 3 months of transplant
Associated with early graft loss

25
Q

What will CMV disease cause?

A

Renal and hepatic dysfunction
Oesophagitis, pneumonitis and colitis
Increased risk of rejection

26
Q

What treatment is given in CMV disease for post-transplant patients?

A

Prophylactic PO valganciclovir

IV ganciclovir is evidence of infections

27
Q

How can CMV disease be diagnosed?

A

IgM

PCR

28
Q

What cancers are most common in immunosuppressed patients?

A

Non-melanoma skin cancers
Lymphoma (EBV mediated PTLD)
Solid organs

29
Q

Describe the pathogenesis of post-transplant lymphoproliferative disease?

A

EBV infection
Polyclonal B cell proliferation
Monoclonal proliferation
Lymphoma

30
Q

What is the long term follow up of kidney transplant?

A 
Rejection 
Hypertension and assessment of CVS
Chronic allograft nephropathy
UTI
Recurrent primary renal disease
Surveillance for malignancy
Viral mediated graft dysfunction 
Management of CKD
31
Q

What do induction monoclonal antibodies do?

A

Basiliximab or daclizumab
Block IL-2 receptors on CD4 T cells
Prevent activation of these cells and therefore prevent rejection

32
Q

What is the action of steroids?

A

Inhibit lymphocyte proliferation, survival and activation

Suppress cytokines

33
Q

What are the common side effects of steroids?

A

Weight gain
Diabetes
Osteoporosis

34
Q

What is the mode of action of calcineurin inhibitors?

A

Tacrolimus and ciclosporin
Act by inhibiting activation of T cells
Prevent cytokine release

35
Q

What are the side effects of calcineurin inhibitors?

A

Renal dysfunction
Hypertension
Diabetes
Tremor

36
Q

What is the mode of action of anti-metabolites?

A

Azathioprine and MMF

Blocks purine synthesis causing the suppression of proliferation of lymphocytes

37
Q

What are the side effects of anti-metabolites?

A

Leucopenia
GI upset
Anaemia

Renal (22 decks)

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