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RENAL PATHOLOGY > RRT - Transplant > Flashcards

RRT - Transplant Flashcards

1
Q

When are native kidneys removed in transplantation?

A

Size - Cystic kidneys

Infection - chronic pyelonephritis

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2
Q

Where are transplanted kidneys placed?

A

Iliac fossa

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3
Q

What vascular complications are associated with transplant?

A

Bleeding
Venous thrombosis
Arterial thrombosis
Lymphocele

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4
Q

What complications are associated with transplant?

A

Vascular
Ureteric
Infections

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5
Q

Which agents are used as immunosuppressives in transplantation?

A 
Corticosteroids
Calcineurin inhibitors
(Tacrolimus, ciclosporin) 
Anti-proliferatives
(Azathioprine, MM)
mTOR inhibitors
(sirolimus)
Costimulatory signal blockers
(Belatacept)
Depleting agents
(-ximab)
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6
Q

What side effects are associated with corticosteroids?

A 
Hypertension
Hyperglycaemia 
Infections
Bone loss
GI bleed
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7
Q

What side effects are associated with tacrilimus?

A

Hyperglycaemia
AKI
tremor

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8
Q

What side effects are associated with ciclosporin?

A

Hirsutism
Hypertension
AKI
gout

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9
Q

What side effects are associated with Mycophenolate mofetil?

A

Cytopenia

GI upset

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10
Q

What side effects are associated with sirolimus?

A

Lipidogenic
Diabetogenic
Pneumonia

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11
Q

What side effects are associated with Betalacept?

A

Infections

Malignancy

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12
Q

What side effects are associated with ATG?

A

Infections

PTLD

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13
Q

What drug is used to induce immunosuppression in transplant?

A

Basiliximab

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14
Q

What are the immunosuppression protocols in transplant?

A

Induction
Maintenance
Steroid free if possible

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15
Q

What drug is used to maintain immunosuppression in transplant?

A 
Tacrolimus
\+
Mycophenolate
\+
Steroids
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16
Q

What are the different forms of deceased donation?

A

Donation after brain death

Donation after cardiac death

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17
Q

What are the different forms of living donation?

A

Related
Spousal
Altruistic
Paired/pooled

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18
Q

What are the criteria for brain death?

A 
Coma 
Apnoea off ventilator 
Absence of cephalic reflexes
Body temp >34C
Absence of intoxication
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19
Q

Which cephalic reflexes are criteria for brain death?

A 
Pupillary
Oculocephalic
Oculovestibular 
Corneal 
Gag
NOT SPINAL
20
Q

What are the extended criteria for brain death?

A

Donor age >60y

Donor 50-59 + history HTN, death for cerebrovascular accident or terminal creatinine >132umol/L

21
Q

Why is it more difficult for asian patients to find donors in the UK?

A

Asian largely group B

UK mostly A/O

22
Q

What is paired donation?

A

Donor A with recipient B,

Donor B with recipient A

23
Q

How do survival rates of transplant patients compare to dialysis?

A

Greater risk before 100 days

Lower risk continuing for years

24
Q

What risks are associated with kidney donation?

A

Compensatory GFR increase (greater in younger donors)

Older age and high BMI associated with GFR<60

25
Q

What complications are associated with renal transplantation?

A 
Rejection
Infection
Malignancy
New onset DM
Hypertension
Hyperlipidaemia 
CRF
26
Q

Hyperacute rejection is associated with what?

A

Pre-existing alloreactivity to donor

27
Q

What are the main types of acute rejection?

A

T-cell mediated (TMCR)

Acute antibody mediated (ABMR)

28
Q

What classes are used for kidney transplant rejection?

A

BANFF (1-3)

29
Q

T-cell mediated rejection is associated with what?

A

Lymphocytic infiltrate
Tubulitis
Endarteritis
Endothelialitis

30
Q

Antibody mediated rejection is associated with what?

A

Microvascular inflammation (neutrophil –> glomeruli, peritubular capillaries)
Donor specific antibodies
Positive C4d

31
Q

New onset DM after transplantation is associated with what?

A

Tacrolimus and steroids

32
Q

What is the most important transplant-related infection?

A

Cytomegalovirus

8% of recipients

33
Q

How is a transplant patient infected with Cytomegalovirus?

A

Transmission from donor

Reactivation of latent virus

34
Q

Which polyomaviridae are associated with transplant?

A

BK virus
JC virus
Murine polyoma virus
SV40

35
Q

BK virus is associated with what conditions?

A

Renal transplant
Bone marrow transplant
AIDS

36
Q

How does BK virus present in renal transplant?

A

Ureteral stenosis
Interstitial nephritis
ESRF

37
Q

How does BK virus present in bone marrow transplant?

A

Haemorrhagic cystitis
Pneumonitis
Hepatitis

38
Q

How does BK virus present in AIDS?

A 
Nephritis
ESRF 
Retinitis 
Meningoencephalitis
Pneumonitis
39
Q

What are the risk factors for BK associated Nephropathy?

A

Intensity of immunosuppression
Patient determinants
Organ determinants
Viral determinants

40
Q

What immunosuppressives are associated with BK associated Nephropathy?

A

Tacrolimus
Mycophenolate mofetil
Antilymphocyte globulins

41
Q

What patient determinants are associated with BK associated Nephropathy?

A 
Older age
Male gender
White ethnicity
DM 
Negative BKV serostatus (children)
42
Q

What organ determinants are associated with BK associated Nephropathy?

A

Graft injury
HLA mismatch
Ureteral stents

43
Q

What viral determinants are associated with BK associated Nephropathy?

A

Changes in epitopes of viral capsid protein VP-1

44
Q

How is BK associated Nephropathy managed?

A 
45-80% graft loss
Reduce immunosuppression
Antivirals 
- Cidofovir +/- IVIG
- Leflunomide
45
Q

What malignancies are associated with renal transpantation?

A

Renal
Non-melanoma skin
Non-hodgkins lymphoma
Kaposi sarcoma

RENAL PATHOLOGY (16 decks)

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