Transplant

Question 1

Describe the indications for renal transplantation [2]

Answer 1

1. given to patients with or progressing to severe renal failure
2. to live longer and live better with better QoL and less time in hospital

Question 2

What factors would make patients not suitable for renal transplantation? [8]

Answer 2

1. patients with reduced life expectancy
   
   • older age
   • presence of co-morbidities
2. relative contraindications:
   
   • hypertension
   • hypotension
   • CVD/congestive heart failure
3. absolute contraindications:
   
   • cancer with metastases
4. surgical contraindications:
   
   • no bladder
   • calcified blood vessels

Question 3

Which renal diseases are managed at the…

1. dialysis clinic? [4]
2. transplant clinic? [4]

Answer 3

1. dialysis clinic:
   
   • renovascular disease
   • type 2 diabetic nephropathy
   • vasculitis
   • obstructive uropathy
2. transplant clinic:
   
   • APKD
   • glomerulonephritis
   • reflux nephropathy
   • type 1 diabetic nephropathy

Question 4

Describe the methods of kidney transplantation:

1. living donor transplantation? [2]
2. deceased donor transplantation? [2]

Answer 4

1. living donor transplantation:
   
   • from relative/friend etc.
   • best graft function and survival, especially if HLA matched
2. deceased donor transplantation: can be from either
   
   • donor after brain death or
   • donor after cardiac death

Question 5

What are the methods of immunosuppression used in kidney transplantation? [4]

Answer 5

1. Basiliximab
   
   • monoclonal antibody directed against IL-2 receptor
2. Tacrolimus
   
   • calcineurin inhibitor
3. Mycophenolate mofetil
   
   • inhibitor of inosine-5’-monophosphate dehydrogenase
   • depletes guanosine nucleotides in T and B lymphocytes and inhibits proliferation
4. +/- Steroids

Question 6

What are the short- and long-term clinical consequences of renal transplantation and immunosuppression and state the treatment for each complication? [3]

Answer 6

1. Rejection
   
   • Cell-mediated rejection
     
     • interstitial inflammation and tubulitis
     • often easily treated with steroids if caught early
   • Antibody-mediated rejection
     
     • characterised by endothelial swelling, glomerulitis and peri-tubular capillaritis
     • caused by donor specific antibodies
     • often difficult to treat ​
   • treatment = increase immunosuppression
2. Infection
   
   • e.g. chest infections, urine infections, skin/wound infections
   • treatment = reduce immunosuppression and treat with antibiotics/anti-viral medication
3. Malignancy
   
   • e.g. Kaposi sarcoma, skin cancer, non-Hodgkin lymphoma, lung, kidney, colon/rectum, pancreas, Hodgkin lymphoma and melanoma
   • treatment = reduce immunosuppression +/- rituximab or chemotherapy