RRT - Transplant Flashcards
Where is a kidney transplant placed?
Right iliac fossa and anastomosed to the iliac vessels
What happens to the native kidney? [3]
Usually left in.
Removed if:
- Oversized e.g. polycystic kidney disease
- Infected e.g. Chronic Pyelonephritis
List the medications used for immunosuppression in transplantees? [6]
1) CCS
2) Calcineurin inhibitors (Tacrolimus or Cyclosporin)
3) Anti-proliferative (Azathioprine or Mycophenolate)
4) Sirolimus blocks T cell proliferation
5) Costimulatory signal blockers (Belatacept)
6) Mabs (Rituximab or basiliximab)
Explain how we go about immunosuppressing patients? [3]
- Initial: CICLOSPORIN or TACROLIMUS + BASILXIMAB
- Maintenance: CICLOSPORIN or TACROLIMUS and MYCOPHENOLATE or SIROLIMUS
; add steroids if >1 steroid responsive acute rejection episode
What are the types of kidney donor? [6]
Compare how long graft lasts between cadaver and live
Living:
- Related
- Spouse
- Altruistic
- Pooled/paired
Dead:
- DBD (post brain death)
- DCD (post cardiac death)
; cadaver graft lasts about 9y, live donor monozygotic twin graft can last up to 25y
What are the criteria for donor after brain death? [5]
Coma Apnoea despite CO2 build up Absent cephalic reflexes e.g. pupillary Body temp >34 No drug intoxication
What are the risks to the kidney donator? [3]
Having one kidney puts you at higher risk of renal disease.
But the one compensates by increasing GFR up to 70%
Being older or having a high BMI is associated with ending up with a low GFR
List the complications of transplant? [9]
- Anastomotic bleed
- Perirenal Haematoma
- Arterial/venous thrombosis
- Lymphocele
- Urine leak
- Infection
- Malignancy
- Rejection
- CV problems
What kind of CV problems can arise post transplant? [3]
Hypertension
Hyperlipidaemia
Post transplant Diabetes!
What kind of cancers does a renal transplant predispose to? [3]
Desc. order: 1) Non-melanoma skin cancer 2) Melanoma Leukaemia Cervical 3) Testicular/bladder
What are the major post-transplant infections?
CMV
Polyomaviridae (specifically BK or JC virus)
How do you get a CMV infection?
Either reactivation of latent virus or transmission from donor tissue.
It affects 8% of transplants despite prophylaxis
What can CMV infection cause?
Mx
CMV viraemia –> Tissue invasive disease
Affects many tissues e.g. hepatitis, nephritis, pneumonitis, colitis etc.
(mx is GANCICLOVIR)
What can BK associated nephropathy cause? [3]
Ureteral Stenosis
Interstitial Nephritis
ESRF
What are the risk factors for a BK associated nephropathy post-transplant? [4]
Intense immunosuppression
Patient factors - Old, male, white, DM
Organ factors - HLA mismatch, graft injury or ureteral stent
Viral factors - Changes in viral capsid protein (VP-1)
