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Renal > SM 210 Transplant > Flashcards

SM 210 Transplant Flashcards

1
Q

What group has the highest incidence of ESRD?

A

Mostly late and middle aged patients

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2
Q

What is the most common treatment for ESRD?

A

Hemodialysis

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3
Q

What is the best treatment for ESRD?

A

Pre-emptive kidney transplant

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4
Q

What ethnic groups have higher rates of ESRD?

A

African and Native Americans

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5
Q

Where is ESRD most prevalent geographic?

A

Areas with high population density and low SES, which leads to disparities as transplants are based on geographic location

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6
Q

What are the four treatments of ESRD?

A

Do Nothing
Dialysis
Deceased Donor Kidney Transplant
Living Donor Kidney Transplant

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7
Q

Which group has better survival outcomes, Dialysis or Transplant, in ESRD?

A

Transplant has much better outcomes and survival

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8
Q

Why do most ESRD patients not get a transplant if it’s the best treatment?

A

Super long waitlist and not enough supply

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9
Q

What had happened as transplant patients became older?

A

Over time, older patients were getting on the transplant list and receiving kidneys more often than younger patients because there are many more older patients that needed a kidney

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10
Q

What are the two principles considered by NOTA, the National Organ Transplant Act?

A

The Principles of Justice and Medical Utility

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11
Q

What is the Principle of Justice?

A

Recognizing the patients with the greatest need

Pediatric px
Px who wait the longest
Px who are highly sensitized

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12
Q

Who does the Principle of Justice prioritize?

A

Pediatric px
Px who wait the longest
Px who are highly sensitized (lots of Ab which make matching hard)

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13
Q

What is the Principle of Medical Utility?

A

Greatest good for most people

Promotes longest survival of organs
Minimizes wastage of organs

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14
Q

What does the Principle of Medical Utility prioritize?

A

Promotes longest survival of organs

Minimizes wastage of organs

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15
Q

What are the current kidney distribution priorities?

A

CRPA (antibodies that make it hard to match)
Kidney + extra renal organ (sickest)
Zero antigen match (best possible outcome)
Prior living donors (gave one away already)
Pediatric (most deserving)

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16
Q

What is the first barrier to getting a transplant?

A

Getting on the transplant list to begin with - you need to have access to healthcare for that, and ESRD effects people of low SES disproportionately

17
Q

Pro’s and con’s of a waiting time only waitlist?

A

Predictability for the transplant center on who to contact is an advantage

No effort to maximize outcomes with biologic matching is a disadvantage

18
Q

Pro’s and con’s of a random lottery?

A

Advantage of not playing favorites

Disadvantage of being unpredictable in terms of which patients to work up and determine compatibility

19
Q

Pro’s and con’s of age matching?

A

Advantage is that it seems fair and uses some biologic factors to maximize outcomes

Disadvantage that donors are younger than candidates, so older candidates get fewer transplants

Also illegal according to DOJ - ageism

20
Q

What is the current kidney allocation policy?

A

Waiting time driven system that awards points for HLA matching and gives priority to multi organ and pediatric transplants

Also introduces longevity matching so longest lasting kidneys end up with longest living recipients

21
Q

Who benefits the most from transplant over dialysis?

A

Younger people - they live longer with transplant than dialysis

22
Q

Why do we discard up to 2/3 of kidneys?

A

Harsh outcomes measures disincentivize using kidneys that aren’t perfect

23
Q

How has equity changed with the new transplant system?

A

Equity is improved with the current kidney allocation policy

24
Q

What is the biggest factor effecting access to transplant?

A

DSA - where you live

25
Q

What is paired kidney donation?

A

Can be an n-way exchange where people give kidneys between pairs so that everyone eventually swaps

26
Q

What is the Norwood Act?

A

Act that decriminalized paired kidney donation in the US

27
Q

What makes some DSA’s better than other’s?

A

The number of organ procurement organizations, which can speed up delivery of a kidney from a donor to a recipient

28
Q

What is multi-listing?

A

Organ waitlists are first come first served, with people signing up for multiple lists and just traveling wherever can get them an organ first - assuming they’re rich

29
Q

What is the new UNOS liver distribution system?

A

Based on concentric circles of 250 nautical miles around a hospital

30
Q

How does the immune system effect transplants?

A

Immune system recognizes the transplant as foreign and rejects it, so it needs to be suppressed, but not too much or you get opportunistic infectious and malignancy

31
Q

What immune inhibitors are used for transplants?

A

Tarcrolimus
Mycophenolate
Steroids or Induction Agents

32
Q

What potential diseases arise from transplant immunosuppression?

A

CMV, HSV< BK Polyoma Virus

Lymphoma, Skin Cancer

33
Q

When are the transplant medicines discontinued after a transplant?

A

Never - it’s for life, and missing a dose can be dangerous

34
Q

Is the old kidney replaced?

A

No, kidney’s are transplanted heterotopically and the old one stays

35
Q

What can cause elevated creatinine after a transplant?

A

Medication, dehydration, medication, rejection, allergic reactions

36
Q

Can a transplant be rejected without creatinine elevations?

A

Yes

37
Q

How can subacute rejection be detected without creatinine or biopsy?

A

Differential gene expression profiles

38
Q

What is chimerism?

A

Stem cells are taken from the host and facilitating cells are used to induce tolerance in the transplanted organ, at the risk of graft vs host disease

Renal (19 decks)

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