Renal transplantation

Question 1

Advantages and siadvantages of transplant

Answer 1

Advantages: removes dialysis burden, imporves renal clearance, restores endocrine function of kidney, improves life expectancy

Disadvantages: peri-operative mortality, rejection, increased risk of ca. due to immunosuppression, 12-20% patientts get transplant related DM

Question 2

Contraindications for tranplant

Answer 2

Cancer = absolute contraindication

Infection, HIV, unstable CVD are temporary contraindications

Question 3

Types of organ donor

Answer 3

Living donor: best graft function and survival

Deceased

Donor after brain death

Donor after cardiac death

Expanded criteria donor: kidneys arent great or patient is >60yrs but better than nothing

Question 4

When is transplantation considered for patients with renal failure?

Answer 4

When they are progressing towards/ have stage 5 CKD

Question 5

What are calcineurin inhibitors?

Answer 5

3 different drugs:

1. Cyclosporine
2. Tacrolimus
3. Pimecrolimus

Inhibit calncineurin which is needed to activate T cells

Calcineurin inhibitors are immunosuppressants used in transplant patients and patients with auto-immune kidney disease

Question 6

1st line treatment for acute transplant rejection?

Answer 6

Glucocorticoids - decrease cytokine transcription

Question 7

Factors contributing to failure of transplanted organ

Answer 7

Age of patient

Health of patient

Infection

Rejection

Recurrent disease in graft

> Although most common outcome is death with a functioning graft <

Question 8

Outline the assessment of a potential transplant patient/ donor

Answer 8

All donors and recipients are assessed by someone from Human Tissue Act to make sure:

• They are not being forced
• Donor is not being paid
• Donor has capacity

Criminal offence to carry out transplant if HTA have not been consulted

Question 9

Donor organ rejection process

Answer 9

Transplant sheds antigens > APCs initiate immune response

Unless donor is identical twin, rejection is inevitable

Interleukin 2 is pivotal and anatagonists of IL-2 are effective in slowing the rejection process - aka anti-CD25 drugs e.g. BASILIXIMAB

Question 10

What is a hyper-acute rejection?

Answer 10

Occurs when recipient already has antibodies against donor kidney e.g. blood donor incompatible transplants

Antibodies bind to the capillaries of the kidney and activate complement >> inflammatory cell infiltration >> thrombosis >> acute rejection

Question 11

How does acute transplant rejection present?

Answer 11

• Feeling like you have the flu: body aches, chills, headache and more.
• Fever
• Urinating less than usual.
• Very high blood pressure.
• Sudden weight gain.
• Ankle swelling.
• Pain or tenderness over the area where your transplant was done.
• Feeling very tired

Question 12

How is acute transplant rejection managed?

Answer 12

Intravenous steroids and T cell depletion remain the standard therapy for T cell–mediated rejection and are effective in reversing most cases