renal transplants Flashcards
how are patient and donor kidneys matched
based on human leukocyte antigen (HLA)
-type A, B and C on chromosome 6
how is a transplant done
- donors vessels are connected with patients pelvic vessels
- donors ureter is anastomosed directly with patients bladder
- hockey stick incision with a hockey stick scar
life long immunosuppression regime for kidney transplants
- tacrolimus
- mycophenolate
- prednisolone
complications of renal transplant
- transplant rejection
- transplant failure
- electrolyte imbalances
complications of immunosuppressants
- ischaemic heart disease
- type 2 diabetes
- infections
- Non-Hodgkin lymphoma
- skin cancer
what do you assess for a renal transplant
-immunology
-virology
-cardiorespiratory risk
-mental state
-bladder function
-peripheral vessels
-
contraindication for renal transplant
- malignancy
- active infection
- severe IHD
- severe airways disease
- active vasculitis
- PVD
- hostile bladder
blood group tissue typing
what is desensitisation
actively remove blood groups or donor specific HLA antibody to make it safer to transplant
forms of pre-transplant antibody depletion
- plasma exchange
- B cell antibody (rituximab)
signs of a good transplant
- good urine output
- creatine and urea spontaneously fall
types of rejection
- hyperacute
- acute
- chronic
what is hyperacute rejection
- due to preformed antibodies
- unsalvageable
- transplant nephrectomy required
what is acute rejection
- cellular or antibody mediated
- can be treated with increased immunosuppression
what is chronic rejection
antibody mediated slowly progressive decline in renal function
poorly responsive to treatment
