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BPT Renal > Renal Transplantation > Flashcards

Renal Transplantation Flashcards

1
Q

What are the mechanisms for HLA sensitisation?

A

previous transplant, pregnancy, blood transfusions

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2
Q

Why do ABO incompatible transplants have similar long term outcomes to ABO compatible transplants?

A

because you can remove the antibodies to acceptable titres prior to transplantation via plasma exchange

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3
Q

Why are older living donors at a decreased risk of ESKD post donation compared to younger donors?

A

because ESKD takes time to develop

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4
Q

Is there an age cutoff for renal transplantation?

A

no

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5
Q

What are the two main agents for induction?

A

basiliximab and anti-thymocyte globulin

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6
Q

What are the side effects of calcineurin inhibitors?

A

nephrotoxicity, hypertension, hyperlipidaemia

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7
Q

Do calcineurin inhibitors cause bone marrow suppression?

A

no

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8
Q

Are calcineurin inhibitors safe in pregnancy?

A

yes

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9
Q

What are the benefits of tacrolimus compared to cyclosporin?

A

less acute rejection, less de novo DSA, less gum hypertrophy, less hirsuitism, less drug interaction

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10
Q

What are the benefits of cyclosporin compared to tacrolimus?

A

Less diabetes, less hypo Mg/PO4, less tremor/neurotoxicity, less hair loss

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11
Q

How is mycophenolate affected by cyclosporin?

A

cyclosporin lowers mycophenolate levels

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12
Q

What is the mechanism of action of mycophenolate?

A

inhibits IMPDH involved in purine synthesis

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13
Q

At what time period does mycophenolate cause bone marrow suppression/cytopaenia?

A

2-6 months

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14
Q

Is mycophenolate safe in pregnancy?

A

no - need to change to azathioprine

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15
Q

Which causes less acute rejection - mycophenolate or azathioprine?

A

mycophenolate

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16
Q

Which causes more diarrhoea - mycophenolate or azathioprine?

A

mycophenolate

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17
Q

What are the benefits of mTOR inhibitors?

A

less cancer risk, less CMV infection

18
Q

What are the side effects of mTOR inhibitors?

A

wound complications, proteinuria, cytopaenias, hyperlipidaemia, mouth ulcers, oedema, interstitial pneumonitis, contraindicated in pregnancy

19
Q

How is it best to use mTOR inhibitors?

A

in combination with calcineurin inhibitors at a lower dose

20
Q

What are the benefits of using an mTOR inhibitor with calcineurin inhibitor?

A

less CMV, less skin malignancy, less neutropaenia, less diarrhoea

21
Q

What is the most common cause of overall graft loss?

A

death with graft function

22
Q

What is the most common cause of death with graft function in the first year?

A

cardiovascular

23
Q

What is the most common cause of death with graft function?

A

cancer

24
Q

What is the most common cause of graft loss without death in the first year?

A

graft thrombosis

25
Q

What is the most common cause of graft loss without death after the first year?

A

chronic allograft nehpropathy

26
Q

What are the causes of chronic allograft nephropathy?

A

chronic antibody mediated rejection (under immunosuppression and poor HLA matching) and CNI toxicity

27
Q

What causes delayed graft function?

A

usually post ischaemic ATN, but can also be graft thrombosis, obstruction/urine leak, rejection or early recurrences of FSGS/TMA/oxalosis

28
Q

What are the risk factors for post ischaemic ATN?

A

deceased donor, donor AKI, donor age, DCD, cold ischaemic time

29
Q

What are the causes of early worsening graft function?

A

acute rejection, CNI toxicity, renal artery stenosis, obstruction/leak/collection, BK nephropathy, recurrent disease

30
Q

What are the different types of acute rejection?

A

T cell mediated, antibody mediated or mixed

31
Q

What is the treatment for T cell mediated rejection?

A

pulse methyld pred, optomise immunosuppression, if steroid resistant give anti thymoglobulin

32
Q

What is the treatment for antibody mediated rejection?

A

plasma exchange, IVIG

33
Q

What prophylaxis is required in transplant patients?

A

PJP, CMV

34
Q

How do you prevent BK nephropathy?

A

screening by serum PCR in first 12 months

35
Q

What is the treatment for BK nephropathy?

A

reduce immunosuppression

36
Q

What are the risk factors for CMV?

A

D+R- status and higher level immunosuppression

37
Q

Which patients need CMV prophylaxis?

A

D+R- or D-R+ or D+R+

38
Q

What limits duration of prophylaxis for CMV?

A

neutropaenia

39
Q

What is the treatment for CMV?

A

oral valganciclovir and cautious immunosuppression reduction

40
Q

What cancers are more common in renal transplant paients?

A

NHL, kidney, melanoma, skin cancer

BPT Renal (9 decks)

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