Renal Transplantations

Question 1

Most common causes of ESRD that result in the need for a kidney transplantation?

Answer 1

DM
HTN
Glomerulonephritis

Question 2

Exclusion criteria for renal transplantation =

Answer 2

Significant cardiac disease
Incurable terminal infection (cancer)
Medication compliance issues
Mental illness
Ongoing substance abuse

Question 3

Surgical procedure =

Answer 3

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

Question 4

New kidney =

Answer 4

Urination right away!

Question 5

After transplantation…

Answer 5

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)

Question 6

Primary cause of DGT =

Answer 6

Acute tubular necrosis

Question 7

Acute allograft rejections

Answer 7

T cell infiltrate into the allograft causing inflammatory and cytotoxic effects
0-6 months

Question 8

Chronic allograft rejection

Answer 8

Can occur and graft loss can occur if inadequate immunosuppression persists
>6 months

Question 9

Pathophysiology of Rejections

Answer 9

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

Question 10

Donor Matching

Answer 10

Identified according to human leukocyte antigens (HLA- A,-B, -DR) which we have 6 HLAs

Question 11

Hyperacute rejection

Answer 11

Time period of minutes but not common in kidney

Question 12

Acute rejection

Answer 12

20% of patients within first 6 months

Question 13

Humoral rejection

Answer 13

Vascular rejection that is antibody related against HLA antigen present on donor endothelium

Question 14

Chronic rejection

Answer 14

> 6 months
Common
Include humoral rejection
Major cause of graft loss/rejection for transplant

Question 15

Calcineurin inhibitors

Answer 15

Cyclosporine and tacrolimus
Inhibit T cell proliferation
AE: Nephrotoxicity (renal vasoconstriction)

Question 16

Antimetabolites MPA

Answer 16

Inhibits nucleotide synthesis and lymphocyte proliferation
Prodrug
AE: GI
ORAL

Question 17

Corticosteroids

Answer 17

Inhiibt cytokine activation
AE: increased appetite, insomnia, indigestion, mood changes
ORAL
Prednisione = prodrug

Question 18

Antimetabolites Azothiaprine

Answer 18

Prodrug
Disrupts DNA, RNA and protein syntehsis
AE: Hematologic
ORAL

Question 19

Proliferative Signal Inhibitors

Answer 19

Sirolimus and everolimus
Inhibits response to cytokines
AE: Myelosuppression and thrombocytopenia
ORAL

Question 20

Costimulatory Signal Inhibitor

Answer 20

Belatacep
Prevents T cell activation
AE: anemia, neutropenia, peripheral edema
IV

Question 21

Polyclonal Antibodies

Answer 21

Anti-thymocyte Globin (ATG) and RATG
Complement mediated cell lysis
AE: Myelosuppresion and increased risk of infection
IV

Question 22

Monoclonal Antibodies

Answer 22

Basiliximab and Daclizumab
Prevent T cell proliferation
Few AE
IV

Question 23

Monoclonal Antibodies OKT3

Answer 23

Decrease T cell number
AE: Cytokine release syndrome, pulmonary edema, capillary leak
IV