Transplant Flashcards
treatment of choice for ESRD
kidney transplant
advantages of transplant over dialysis
decreased mortality, decreased morbidity, increased fertility, reduced cost
patients with a kidney transplant have a higher risk of what fertility complications?
higher risk of preterm delivery, low birth weight, preeclampsia, and gestational DM (everything else equal to normal population)
compare the costs of hemodialysis, peritoneal dialysis, and transplant
HD = 82K/yr, PD = 61K, tranplant = 30K
absolute contraindications to kidney transplant
non-compliance, active drug use, metastatic cancer or cancer with high recurrence, symptomatic HIV, morbid obesity, advanced systemic disease (unless those organs are simultaneously transplanted as well)
case-by-case considerations for kidney transplant
hepatitis, HIV, DM, morbid obesity, CAD, stroke, PVD, compensated lung/liver dz, remote history of cancer, advanced age, poor social support, HLA sensitivity, retransplantation
who can get a pancreas transplant?
DM1, under 55, simultaneous with kidney, pancreas after kidney
average wait time for kidney transplant
5 years in NC; 2-5 yrs nationally based on blood type
early kidney transplants are important because?
kidney transplant outcomes are inversely proportion to pre-transplant dialysis time
which blood group A subtype confers less immunologic risk?
group A2 (only 20% of A blood though)
what is the greatest predictor of transplant compatibility?
HLA matching (genes on short arm of chromosome 6)
which HLA markers are important for kidney transplant compatibility?
HLA-A, -B, and -DR (A&B are nucleated, DR is an APC)
what other two factors, in addition to HLA matching, contribute to kidney transplant survival?
donor type (living vs dead), years post-transplant
advantages of living donor
reduced waiting time, less time on dialysis, improved early and longterm transplant function, patient and graft survival rates higher
first-year survival rates for living vs deceased donor
96% vs 91% (approximately)
requirements of a living donor
excellent general health and no medical conditions related to kindey dysfunction, free of dz/infection that could be transferred, NO compensation, ok for surgery
risk to the living donor
short-term: surgery and anesthesia; long-term: slight BP increase but no increase in HTN, no increase in CKD or ESRD
desensitization can be used in cases of?
ABO or HLA incompatibility by reducing antibodes in the blood (plasmapheresis, IVIG, anti-B cell Ab)
who can be a deceased donor?
patients who are brain dead, have severe irreversible brain injury (such as after cardiac death)
expanded criteria donors
age over 50 with risk factor, age over 60
signs of acute rejection
usually asymptomatic increase in creatinine
causes of late acute rejection (>3mo)
medication nonadherence, acute infection
diagnosis of acute rejection
kidney biopsy
acute cellular rejection shows what pathology?
tubulointerstitial lymphocytes, edema, HLA-DR staining (worse prognosis if endarteritis is present)
pathology of acute humoral rejection
anti-donor Ab, positive CD4 staining
pathology of chronic rejection
fibrosis in allograft, active T-cell form if arterial intimal fibrosis with mononuclear infiltration
best way to give immunosuppression to transplant recipient
multiple drugs at lower doses with different sites of action to prevent opportunistic infection and malignancy
how to decrease incidence of CMV infection in a donor recipient
valganciclovir x3-6 months post transplant as prophylaxis
signs of CMV infection
fever, fatigue, pancytopenia, pulmonary infiltrates, etc.
transplant/dialysis recipients have a higher risk of what types of cancer?
those associated with viral infections (HPV, EBV, CMV, HHV8, Hepatitis) or renal disease (RCC)
3 most common causes of kidney transplant failure
- death with a functioning graft (CVD, malignancy, infection), 2. chronic rejection, 3. recurrence of kidney dysfunction
the majority of the survival benefit of transplant over dialysis is?
reduced rate of cardiovascular death
transplants and associated immunosuppressive therapy increase risk of?
CVD, DM, HTN, hyperlipidemia
