Renal Transplantations Flashcards
(23 cards)
Most common causes of ESRD that result in the need for a kidney transplantation?
DM
HTN
Glomerulonephritis
Exclusion criteria for renal transplantation =
Significant cardiac disease Incurable terminal infection (cancer) Medication compliance issues Mental illness Ongoing substance abuse
Surgical procedure =
Do not remove old kidney
Put new kidney at a new place with a new blood supply like the renal artery to the external iliac artery and same for the vein
New kidney =
Urination right away!
After transplantation…
GRF may be normal immediate but chemical indicators of function are not
Anemia, calcium and phosphate imbalances will take several weeks
Need for dialysis could be a sign of delayed graft function (DGT)
Primary cause of DGT =
Acute tubular necrosis
Acute allograft rejections
T cell infiltrate into the allograft causing inflammatory and cytotoxic effects
0-6 months
Chronic allograft rejection
Can occur and graft loss can occur if inadequate immunosuppression persists
>6 months
Pathophysiology of Rejections
T cell activation caused by interaction of T cells, MHC, adhesion molecules, costimulatory molecules
Calcineruin activations cause IL2 activation and release causing T cell proliferation to the region
Donor Matching
Identified according to human leukocyte antigens (HLA- A,-B, -DR) which we have 6 HLAs
Hyperacute rejection
Time period of minutes but not common in kidney
Acute rejection
20% of patients within first 6 months
Humoral rejection
Vascular rejection that is antibody related against HLA antigen present on donor endothelium
Chronic rejection
> 6 months
Common
Include humoral rejection
Major cause of graft loss/rejection for transplant
Calcineurin inhibitors
Cyclosporine and tacrolimus
Inhibit T cell proliferation
AE: Nephrotoxicity (renal vasoconstriction)
Antimetabolites MPA
Inhibits nucleotide synthesis and lymphocyte proliferation
Prodrug
AE: GI
ORAL
Corticosteroids
Inhiibt cytokine activation
AE: increased appetite, insomnia, indigestion, mood changes
ORAL
Prednisione = prodrug
Antimetabolites Azothiaprine
Prodrug
Disrupts DNA, RNA and protein syntehsis
AE: Hematologic
ORAL
Proliferative Signal Inhibitors
Sirolimus and everolimus
Inhibits response to cytokines
AE: Myelosuppression and thrombocytopenia
ORAL
Costimulatory Signal Inhibitor
Belatacep
Prevents T cell activation
AE: anemia, neutropenia, peripheral edema
IV
Polyclonal Antibodies
Anti-thymocyte Globin (ATG) and RATG
Complement mediated cell lysis
AE: Myelosuppresion and increased risk of infection
IV
Monoclonal Antibodies
Basiliximab and Daclizumab
Prevent T cell proliferation
Few AE
IV
Monoclonal Antibodies OKT3
Decrease T cell number
AE: Cytokine release syndrome, pulmonary edema, capillary leak
IV
