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Year 2 - Renal (DP) > Surgery > Flashcards

Surgery Flashcards

1
Q

In transplantation, what are the three most important HLA-types and what HMC classes do they belong to?

A 
MHC I:
     - HLA A
     - HLA B
MHC II:
     - HLA DR
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2
Q

What cells have MHC I on their surface?

A

All nucleated cells

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3
Q

What cells have MHC II on their surface?

A

APCs

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4
Q

How might a donor produce specific HLA antibodies?

A

Exposure to HLA antigen:

 - Blood transfusion
 - Placenta
 - Previous transplant
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5
Q

Put the following steps in a possibel model for transplant rejection in order:

  • CD4+ (Th) cells activate B cells, NK cells and complement + cytokines
  • B cells produce antibodies
  • CD4+ cell activated by HLA Ag presented to it on MHC
  • HLA Ag is taken up by an APC
  • Antibodies, NK cells and CD8+ (Tc) cells result in rejection
  • APC presents HLA Ag via MHC
A
  1. HLA Ag is taken up by an APC
  2. APC presents HLA Ag via MHC
  3. CD4+ cell activated by HLA Ag presented to it on MHC
  4. CD4+ (Th) cells activate B cells, NK cells and complement + cytokines
  5. B cells produce antibodies
  6. Abs, NK cells and CD8+ (Tc) cells result in rejection
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6
Q

What infections can result if there is too much immunosuppression?

A

BK virus
CMV
Recurrent UTIs
Pneumocystic jiroveci

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7
Q

What cancers can arise if there is too much immunosuppression? What might predispose to these?

A

Non-melanome skin cancer:
- Squamous and fast growing (usually)
Lyphoma:
- Espeically if not EBV immune

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8
Q

What can result if there is too little immunosuppression?

A

Graft dysfunction

Graft loss

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9
Q

What is the first sign of graft dysfunction/loss?

A

Rise in serum creatinine

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10
Q

What causes a hyperacute transplant rejection?

A

Due to a positive crossmatch:

 - Preformed Abs to transplant
           - > eg. Different blood types
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11
Q

How is a hyperacute kidney rejection treated?

A

Immediate removal

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12
Q

What mediates an acute transplant rejection?

A

T or B cells

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13
Q

How can an acute transplant rejection be treated?

A

Immunosuppression

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14
Q

What can cause a chronic transplant rejection?

A

Immunological and vascular deterioration of the transplant

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15
Q

What are the two examples of calcineurin inhibitors?

A

Cyclosporin

Tacrolimus

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16
Q

How do calcineurin inhibitors work?

A

Reduced NK cell activation
Reduce Tc activation
Reduce cytokine release -> Stops B cell proliferation -> Reduces Ab production

17
Q

Which of the following is not a side effect of calcineurin inhibitors:

  • Renal dysfunction
  • Hypertension
  • Leukopaenia
  • DM
  • Tremors
A

Leukopaenia

18
Q

What metabolises calcineurin inhibitors and what implications does this have?

A

Cytochrome P450:

- Lots of drug interactions

19
Q

What type of drugs are Azathioprine and MMF?

A

Anti-metabolites:

- Block purine synthesis

20
Q

What do Azathioprine and MMF cause?

A

Reduced lymphocyte and B cell proliferation

21
Q

Which of the following is not a side effect of Azathioprine and MMF:

  • Leukopaenia
  • Anaemia
  • Increased risk of TB reactivation
  • Colitis (Diarrhoea and Oesophagitis)
A

Increased risk of TB reactivation

22
Q

What drug does Azathioprine interact with heavily? What effect does this have?

A

Allopurinol:

 - Hugely potentiates azathioprine's effects
           - > ++ Leukopaenia
           - > Aplastic anaemia
23
Q

What happens when a kidney is removed from a Deceased Brain Dead donor?

A

Flushed with cooling solution and carried on ice to recipient

24
Q

If a patient dies from cardiac arrest, how is the kidney removal carried out?

A

Femoral artery catheter -> Flushes cooling perfusant

Remove kidney ASAP

25
Q

Why is a donated kidney from a cardiac arrest patient more likely to be used locally?

A

Increased risk of ischaemia -> Reduced graft survival

26
Q

In what patients is a Kidney-Pancreas Dual Transplant indicated?

A

T1DM with kidney disease

27
Q

What should the life expectancy be of a patient who is receiving a transplant?

A

> 5 years

28
Q

How is the allocation of an organ carried out in the UK?

A

1st -> Tissue typing

2nd -> Time on list

29
Q

What infections must be treated prior to transplant?

A

HBV
HCV
HIV

30
Q

If a patient has a PMHx of a solid tumour, how long must they be in remission before they can receive a transplant?

A

2 years

31
Q

In what cancers is the waiting time for transplant 5 years?

A

Colorectal

Breast

32
Q

Which of the following is not an absolute contraindication for transplant:

  • Known and untreated malignancy
  • Untreated TB
  • Severe IHD not treatable by surgery
  • HIV
  • Severe airway disease
  • Acute vasculitis
  • Severe PVD
A

HIV

33
Q

What are the features of a kidney transplant surgery?

A

Extraperitoneal
3-4hrs
Stent inserted between ureter and bladder
15-20cm wound in iliac fossa

34
Q

If a graft has immediate function, what clinical features should be expected?

A

Good urine output

Reducing plasma levels of creatinine and urea

35
Q

If a graft has delayed function, what clinical features should be expected?

A

Acute Tubular Necrosis:

- For 10-30 days -> Then it will work

36
Q

In delayed graft function, what can be given in the interim before it works?

A

Haemodialysis

37
Q

How do we assess blood flow to a non-functioning transplant?

A

USS

Renograms

38
Q

If we take a biopsy of a non-functioning kidney, what are we looking for?

A

Rejection
Acute Tubular Necrosis
Cortical necrosis

Year 2 - Renal (DP) (15 decks)

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