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Renal - Phase II > Renal transplants > Flashcards

Renal transplants Flashcards

1
Q

What assessments needs to be done before a patient undergoes renal transplant?

A

Virology status - CMV, HCV, HBV, HIV, VZV, EBV
TB
CV disease

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2
Q

What are the absolute contraindications for renal transplants?

A

Active infection
Cancer
Severe heart disease
Other co morbidities

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3
Q

What are the different types of grafts which can be used for a renal transplant?

A

Cadaveric: brainstem death with CV support
Non-heart beating donor: no active circulation
Live-related:
- Optimal surgical timing
- HLA-matched
- Improved graft survival
Live unrelated

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4
Q

What pre op immunosuppression can be given before a renal transplant?

A

Campath / Alemtuzumab (anti-CD52)

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5
Q

What post op immunosuppression can be given before a renal transplant?

A

Short term - Prednisolone

Long term - Tacrolimus/Ciclosporin

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6
Q

What is the prognosis for a renal transplant?

A

Around 15 years

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7
Q

What are the post op complications of a renal transplant?

A 
Bleeding
Graft thrombus
Infection
Urinary leaks
Hyperacute rejection
Acute rejection
Chronic rejection
↓ Immune Function 
Ciclosporin / tacrolimus nephrotoxicity
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8
Q

What is Hyperacture rejection?

A

Happens within minutes
ABO incompatibility
Thrombosis
SIRS

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9
Q

What is the SIRS criteria?

A

Temp >38 or 90

RR >20 or pCO2 12 x 10(3) or

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10
Q

What is Acute rejection?

A

Happens within 6 months
Rising creatinine (± fever and graft pain)
Responds to immnosuppressants

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11
Q

What is Chronic rejection?

A 
Happens after 6 months
Interstitial fibrosis + tubular atrophy
Gradual ↑ in creatnine 
Proteinuria
Doesn't respond to immunosuppressants
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12
Q

What are the two types of Ciclosporin / tacrolimus nephrotoxicity?

A

Acute: reversible afferent arteriole constriction → ↓GFR
Chronic: tubular atrophy and fibrosis

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13
Q

What are the risks of a decreasing immune system?

A

↑ risk of infection: opportunists, fungi, warts

↑ risk of malignancy: BCC, SCC, lymphoma (EBV)

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14
Q

What CV complication can occur with a renal transplant?

A

HTN

Atherosclerosis

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15
Q

What are the differentials for a rising creatinine in a transplant patient?

A

Rejection
Obstruction
Acute tubular necrosis
Drug toxicity

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16
Q

What are the relative contraindication for a renal transplant?

A 
HBV
Obesity
Atherosclerosis
Uncontrolled HTN
Smoking
Psychological issues?

Renal - Phase II (13 decks)

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