Transplant

Question 1

treatment of choice for ESRD

Answer 1

kidney transplant

Question 2

advantages of transplant over dialysis

Answer 2

decreased mortality, decreased morbidity, increased fertility, reduced cost

Question 3

patients with a kidney transplant have a higher risk of what fertility complications?

Answer 3

higher risk of preterm delivery, low birth weight, preeclampsia, and gestational DM (everything else equal to normal population)

Question 4

compare the costs of hemodialysis, peritoneal dialysis, and transplant

Answer 4

HD = 82K/yr, PD = 61K, tranplant = 30K

Question 5

absolute contraindications to kidney transplant

Answer 5

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)

Question 6

case-by-case considerations for kidney transplant

Answer 6

hepatitis, HIV, DM, morbid obesity, CAD, stroke, PVD, compensated lung/liver dz, remote history of cancer, advanced age, poor social support, HLA sensitivity, retransplantation

Question 7

who can get a pancreas transplant?

Answer 7

DM1, under 55, simultaneous with kidney, pancreas after kidney

Question 8

average wait time for kidney transplant

Answer 8

5 years in NC; 2-5 yrs nationally based on blood type

Question 9

early kidney transplants are important because?

Answer 9

kidney transplant outcomes are inversely proportion to pre-transplant dialysis time

Question 10

which blood group A subtype confers less immunologic risk?

Answer 10

group A2 (only 20% of A blood though)

Question 11

what is the greatest predictor of transplant compatibility?

Answer 11

HLA matching (genes on short arm of chromosome 6)

Question 12

which HLA markers are important for kidney transplant compatibility?

Answer 12

HLA-A, -B, and -DR (A&B are nucleated, DR is an APC)

Question 13

what other two factors, in addition to HLA matching, contribute to kidney transplant survival?

Answer 13

donor type (living vs dead), years post-transplant

Question 14

advantages of living donor

Answer 14

reduced waiting time, less time on dialysis, improved early and longterm transplant function, patient and graft survival rates higher

Question 15

first-year survival rates for living vs deceased donor

Answer 15

96% vs 91% (approximately)

Question 16

requirements of a living donor

Answer 16

excellent general health and no medical conditions related to kindey dysfunction, free of dz/infection that could be transferred, NO compensation, ok for surgery

Question 17

risk to the living donor

Answer 17

short-term: surgery and anesthesia; long-term: slight BP increase but no increase in HTN, no increase in CKD or ESRD

Question 18

desensitization can be used in cases of?

Answer 18

ABO or HLA incompatibility by reducing antibodes in the blood (plasmapheresis, IVIG, anti-B cell Ab)

Question 19

who can be a deceased donor?

Answer 19

patients who are brain dead, have severe irreversible brain injury (such as after cardiac death)

Question 20

expanded criteria donors

Answer 20

age over 50 with risk factor, age over 60

Question 21

signs of acute rejection

Answer 21

usually asymptomatic increase in creatinine

Question 22

causes of late acute rejection (>3mo)

Answer 22

medication nonadherence, acute infection

Question 23

diagnosis of acute rejection

Answer 23

kidney biopsy

Question 24

acute cellular rejection shows what pathology?

Answer 24

tubulointerstitial lymphocytes, edema, HLA-DR staining (worse prognosis if endarteritis is present)

Question 25

pathology of acute humoral rejection

Answer 25

anti-donor Ab, positive CD4 staining

Question 26

pathology of chronic rejection

Answer 26

fibrosis in allograft, active T-cell form if arterial intimal fibrosis with mononuclear infiltration

Question 27

best way to give immunosuppression to transplant recipient

Answer 27

multiple drugs at lower doses with different sites of action to prevent opportunistic infection and malignancy

Question 28

how to decrease incidence of CMV infection in a donor recipient

Answer 28

valganciclovir x3-6 months post transplant as prophylaxis

Question 29

signs of CMV infection

Answer 29

fever, fatigue, pancytopenia, pulmonary infiltrates, etc.

Question 30

transplant/dialysis recipients have a higher risk of what types of cancer?

Answer 30

those associated with viral infections (HPV, EBV, CMV, HHV8, Hepatitis) or renal disease (RCC)

Question 31

3 most common causes of kidney transplant failure

Answer 31

1. death with a functioning graft (CVD, malignancy, infection), 2. chronic rejection, 3. recurrence of kidney dysfunction

Question 32

the majority of the survival benefit of transplant over dialysis is?

Answer 32

reduced rate of cardiovascular death

Question 33

transplants and associated immunosuppressive therapy increase risk of?

Answer 33

CVD, DM, HTN, hyperlipidemia