Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal SCE > Transplant > Flashcards

Transplant Flashcards

1
Q

How does BK present post transplant

A

Initially high viral load in the urine before going into the blood stream and causing graft issues
DECOY CELLS in the urine is diagnostic

Present with erythematous skin changes
Mainly asymptomatic increase in creat

Treatment - reduce IS.
Cidofovir can be used as antiviral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Drugs that interact with Tacrolimus

A

Fluconazole - antifungals
Diltiazem - calcium channel blockers
Clarithromycin - Marolides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Contraindications to transplantation

A

Malignancy, infection life expectancy <5yr

  • Need to be cancer free for 2 yrs
  • Breast / bowel/ lymphoma = cancer free for >5yrs
    Cancers insitu such as bladder, prostate, skin, renal can be transplanted straight away if surgery was curative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Induction immunosuppressive agents

A

Non Depleting
- Basiliximab = Anti CD25, used most commonly, given day 0 and day 4

Depleting
- ATG = T cell depletion, used in acute rejection and indication, can cause reactions
- Campath (aka Alemtuzumab) = Anti CD 52, Can cause persistent lymphopenia, used mainly in SPK
- OKT3 = used as treatment for refractory rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Complications of Sirolimus

A

Skin cancer
Pneumonitis
Can cause FSGS in transplant patients
Raised lipids
If used with MMF can cause anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is meant by Antibody mediated rejection versus Cellular rejection

A

Antibody mediated Rejection (AMR)
-T and B cells involved
- Development of anti-donor antibodies = positive DSAs
-Trends to occur after a sensitizing event
- Causes activation of the classical pathway = Increased C4d

Cellular Rejection
- T cell driven process with macrophage activation
- Most common type of rejection especially in the first 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of AMR

A

1)PLEX and then IVIG

Ritux thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Biopsy features of AMR

A

Positive C4D staining
Peritubular capillaritis
Glomerulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of T cell mediated rejection

A

Pulsed IV MTP
Switch ciclosporin to tacrolimus
Increase MMF and add in steroids
Consider ATG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of T cell mediated rejection of Bx

A

Tubulitis
Increased inflammatory cells (mainly neutrophils and eosinophils) - causing interstitial oedema -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TMA in transplants

A

TMA occurs in 2 contexts
1) Recurrent HUS
2) New TMA = Caused by = Acute AMR, infection, CNI

treatment - Stop CNI, Eculizumab +/- PLEX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Biopsy findings in TMA in transplants

A

Double contouring
Looks like MPGN
Capillary thrombi in the glomerulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Transplant Glomerulopathy

A

Is a chronic histopathological diagnosis
Often due to chronic ABMR
DSAs tend to be positive
Chronic renal impairment and UPCR
Bx = double contouring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CNI Toxicity - Bx findings

A

Tends to be with prolonged use of tacrolimus, levels >8

Biopsy
- Stripe fibrosis and tubule vaculosation

Treatment = Switch to Sirolimus, or if raised UPCR then just reduce dose of tac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PTLD

A

Associated with EBV
Risk factors
- Increased IS and young age
-Recipient EBV -ve, donor +ve
-1st year from transplant

Treatment - RCHOP, Reduce IS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cancer risks In transplant patients

A

Skin cancer - squamous
Renal cell ca - especially if previously on dialysis
PTLD - EBV
Kaposis sarcoma = HHV8 infection

17
Q

RAS in transplant

A

tends to occur 3-6 months post transplant
Present with increased BP and reduced eGFR
May also get unilateral leg claudication and bruit over transplant

18
Q

CMV treatment

A

Prophylactic - If donor +ve but recipient -ve
Valganciclovir (po) for 90 days

Treatment of infection
- BD valganciclovir
-IV ganciclovir for those that cant tolerate oral

Note - if develops neutro/lymphopenia on ganciclovir then add in GCSF but don’t stop

19
Q

Recurrent disease - most to least common

A

FSGS - High chance graft loss
IgA - Low chance of graft loss
Membranous
MCGN
Diabetes - Low chance graft loss
HUS - high chance graft loss

20
Q

Risk factors for acute AMR

A

Delayed graft function
Sensitizing event
Repeated transplantation
Higher HLA mismatch

21
Q

Immune checkpoint inhibitors and transplantation

A

Immune checkpoint inhibitors upregulate the immune system so can cause acute rejections. In addition= can cause AKI by other mechanisms such as AIN, TMA, IgA nephropathy, C3 Glomerulopathy and pauci-immune GN.

To minimize the risk of rejection switch from tacrolimus to sirolimus, and increase the doses of corticosteroids before initiating ICIs.

22
Q

Cancer screening post transplant

A

mammography every 2 years beyond the age of 50.

Cervical screening is as per general population, with 5-yearly cervical screening in individuals over the age of 50.

Skin cancer surveillance = twice-annual check by a trained healthcare professional up to 5 years post-transplant, with an annual review from 5 years.

23
Q

Post transplant diabetes

A

Common and needs to be treated often with insulin due to the potential effects on graft function
Hepatitis C is strongly associated with risk of developing post transplant diabetes

24
Q

Criteria for live donor

A

If BP indeterminate in clinic then needs ambulatory / 24 monitoring

BP needs to be controlled < 140/90 on one or two antihypertensive agents.
Urinary ACR < 30
BMI up to 30 is acceptable

25
Q

Features of ureteral stenosis

A

Tends to occur post stent removal around 6 months
If donor is of older age this is a risk factor
Tend to present with gradual, asymptomatic worsening of renal function
Investigation with anterograde pyelogram

26
Q

What are complement dependent crossmatch (CDC) and Flow crossmatch (Fcxm)

A

Checks for donor and recipient cross matching of B + T cells = which are essentially DSAs. If positive then very likely to reject and contraindication to transplant.

Flow crossmatch - Fcxm - similar to the above but more sensitive. If negative CDC but positive FCXM then will likely need desensitization but its not a contraindication to transplant

27
Q

Graft Intolerance Syndrome

A

Inflammation caused by failed renal allografts left in situ, usually presented with fever, poorly controlled hypertension, abdominal pain, gross haematuria, and enlargement of the graft.
It is always associated with elevated acute phase reactants (ESR, CRP), hypoalbuminaemia, and resistant anaemia.

28
Q

Recurrence of FSGS in transplant

A

Common initially after transplant

Risk factors:
-Those that developed ESRD in teenage years
-Disease course rapid
-Previous recurrence in transplant

Treatment = 1)PLEX, 2) Standard triple IS and ACE-inhibitor
Long courses of PLEX may be needed if UPCR remains high

29
Q

Unsafe vaccinations in transplant and IS patients

A

Live vaccines:
-Shingles
-Oral typhoid
-Yellow fever
-BCG
-MMR
-oral Polio

30
Q

BANNFF criteria for TCMR - acute and chronic

A

Active TCMR
IA=Moderate tubulitis and Inflammation
IB = Severe tubulitis and inflammation
IIA = Mild arteritis
IIB = Severe arteritis
III = Severe and fibrinoid necrosis

Chronic Active TCMR
1A - As above but scarred cortical inflammation
IB - as above but scarred cortical inflammation
II-fibrosis with nononuclear cell inflammation

31
Q

Calcium phosphate crystals / phosphate nephropathy in transplant biopsy

A

Positive Von Kossa stain is diagnostic
Negative birefringence under polarised light
Often caused by phosphate supplements post biopsy

32
Q

CNI induced pain syndrome

A

Raised ALP, Joint effusion, marrow oedema and joint pain
Caused by increased cyclosporine levels which can lead to intraosseous vasoconstriction causing pain.
Treatment is usually by nifedipine, reducing CNI levels or switching ciclosporin to tacrolimus

33
Q

Minimum eGFR a donor can have to donate

A

> 60ml/min

34
Q

Parathyroidectomy in transplant

A

Aim to do it before transplantation where possible.
There are worse outcomes in those with parathyroidectomy post transplant
If not able to do before (e.g DCD transplant) then aim for 1 year post transplant when graft function is stable and IS is reduced

Indications = PTH >500 if on cinacalcet and >1000 if not on cinacalcet or gland diameter >10mm

35
Q

Transplant Renal Vein thrombosis

A

First few weeks from transplant
Presents with hematuria, oligoanuria, painful and swollen graft

risk factors:
- right donor kidney (as it has a shorter renal vein)
-prolonged ischemic time
-vascular injuries of the donor organ
-older age of the donor.
- pediatric recipient
-peri-operative hypotension.
- kink in the allograft vein or injury to the vascular endothelium

imaging = angiography

Treatment =surgical thrombectomy.
Graft loss remains very common

36
Q

Features of Parvovirus B19

A

Causes Pure red cell aplasia - reduced Hb and reticulocyte count

37
Q

What RBC transfusion requirements are needed for transplant patients

A

Irradiated blood products

38
Q

Post transplant infections

A

1-6 months
- Viral - CMV, HSV, VAZ
-EBV BK
-TB
-opportunistic

> 6 months
-typical community infections
-BK, EBV, PTLD

39
Q

Treatment of CMV pneumonitis

A

IV gancilovir
IV IG

Treatment of end organ CMV disease should be continued for min of 3 weeks

Renal SCE (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions