RRT - Transplant Flashcards
When are native kidneys removed in transplantation?
Size - Cystic kidneys
Infection - chronic pyelonephritis
Where are transplanted kidneys placed?
Iliac fossa
What vascular complications are associated with transplant?
Bleeding
Venous thrombosis
Arterial thrombosis
Lymphocele
What complications are associated with transplant?
Vascular
Ureteric
Infections
Which agents are used as immunosuppressives in transplantation?
Corticosteroids Calcineurin inhibitors (Tacrolimus, ciclosporin) Anti-proliferatives (Azathioprine, MM) mTOR inhibitors (sirolimus) Costimulatory signal blockers (Belatacept) Depleting agents (-ximab)
What side effects are associated with corticosteroids?
Hypertension Hyperglycaemia Infections Bone loss GI bleed
What side effects are associated with tacrilimus?
Hyperglycaemia
AKI
tremor
What side effects are associated with ciclosporin?
Hirsutism
Hypertension
AKI
gout
What side effects are associated with Mycophenolate mofetil?
Cytopenia
GI upset
What side effects are associated with sirolimus?
Lipidogenic
Diabetogenic
Pneumonia
What side effects are associated with Betalacept?
Infections
Malignancy
What side effects are associated with ATG?
Infections
PTLD
What drug is used to induce immunosuppression in transplant?
Basiliximab
What are the immunosuppression protocols in transplant?
Induction
Maintenance
Steroid free if possible
What drug is used to maintain immunosuppression in transplant?
Tacrolimus \+ Mycophenolate \+ Steroids
What are the different forms of deceased donation?
Donation after brain death
Donation after cardiac death
What are the different forms of living donation?
Related
Spousal
Altruistic
Paired/pooled
What are the criteria for brain death?
Coma Apnoea off ventilator Absence of cephalic reflexes Body temp >34C Absence of intoxication
Which cephalic reflexes are criteria for brain death?
Pupillary Oculocephalic Oculovestibular Corneal Gag NOT SPINAL
What are the extended criteria for brain death?
Donor age >60y
Donor 50-59 + history HTN, death for cerebrovascular accident or terminal creatinine >132umol/L
Why is it more difficult for asian patients to find donors in the UK?
Asian largely group B
UK mostly A/O
What is paired donation?
Donor A with recipient B,
Donor B with recipient A
How do survival rates of transplant patients compare to dialysis?
Greater risk before 100 days
Lower risk continuing for years
What risks are associated with kidney donation?
Compensatory GFR increase (greater in younger donors)
Older age and high BMI associated with GFR<60
What complications are associated with renal transplantation?
Rejection Infection Malignancy New onset DM Hypertension Hyperlipidaemia CRF
Hyperacute rejection is associated with what?
Pre-existing alloreactivity to donor
What are the main types of acute rejection?
T-cell mediated (TMCR)
Acute antibody mediated (ABMR)
What classes are used for kidney transplant rejection?
BANFF (1-3)
T-cell mediated rejection is associated with what?
Lymphocytic infiltrate
Tubulitis
Endarteritis
Endothelialitis
Antibody mediated rejection is associated with what?
Microvascular inflammation (neutrophil –> glomeruli, peritubular capillaries)
Donor specific antibodies
Positive C4d
New onset DM after transplantation is associated with what?
Tacrolimus and steroids
What is the most important transplant-related infection?
Cytomegalovirus
8% of recipients
How is a transplant patient infected with Cytomegalovirus?
Transmission from donor
Reactivation of latent virus
Which polyomaviridae are associated with transplant?
BK virus
JC virus
Murine polyoma virus
SV40
BK virus is associated with what conditions?
Renal transplant
Bone marrow transplant
AIDS
How does BK virus present in renal transplant?
Ureteral stenosis
Interstitial nephritis
ESRF
How does BK virus present in bone marrow transplant?
Haemorrhagic cystitis
Pneumonitis
Hepatitis
How does BK virus present in AIDS?
Nephritis ESRF Retinitis Meningoencephalitis Pneumonitis
What are the risk factors for BK associated Nephropathy?
Intensity of immunosuppression
Patient determinants
Organ determinants
Viral determinants
What immunosuppressives are associated with BK associated Nephropathy?
Tacrolimus
Mycophenolate mofetil
Antilymphocyte globulins
What patient determinants are associated with BK associated Nephropathy?
Older age Male gender White ethnicity DM Negative BKV serostatus (children)
What organ determinants are associated with BK associated Nephropathy?
Graft injury
HLA mismatch
Ureteral stents
What viral determinants are associated with BK associated Nephropathy?
Changes in epitopes of viral capsid protein VP-1
How is BK associated Nephropathy managed?
45-80% graft loss Reduce immunosuppression Antivirals - Cidofovir +/- IVIG - Leflunomide
What malignancies are associated with renal transpantation?
Renal
Non-melanoma skin
Non-hodgkins lymphoma
Kaposi sarcoma
