Transplant

Question 1

For patients with established end stage renal disease, the most effective form of renal replacement therapy
is:
a. Daily, home hemodialysis
b. Peritoneal dialysis
c. Deceased donor kidney transplant
d. Living, incompatible kidney transplant
e. Living, compatible kidney transplant

Answer 1

e. living, compatible kidney transplant

Question 2

The most common cause of kidney transplant (graft) failure is: a. Infection

b. Chronic rejection
c. Death with functioning graft d. Medication toxicity

Answer 2

c. death with functioning graft

Question 3

What are the 4 treatment options for someone with eSRD?

Answer 3

do nothing
dialysis
deceased donor
living donor

Question 4

Of the living donor kidney transplants, what are the 2 options?

Answer 4

compatible or incompatible donors

Question 5

If someone is an incompatible donor, what are their options?

Answer 5

desensitization or kidney matching

Question 6

What group needs the most transplants and has the longest wait list?

Answer 6

age 50 and up

Question 7

What 3 patient populations are prioritized under the principle of justice for kidney transplants?

Answer 7

pediatric, longest wait, highly sensitized

i.e. those with greatest need

Question 8

Under the principle of utility, what patient population should be prioritized for kidney transplant?

Answer 8

the youngest and strongest

Question 9

What is the advantage and disadvantage of a waiting time only approach to kidney transplant lists?

Answer 9

predictable but doesn’t maximize outcomes

Question 10

What is an advantage and a disadvantage of a random lottery system for transplants?

Answer 10

no favorites, but unpredictable (which makes it timely and costly)

Question 11

What is an advantage and disadvantage of age matching kidney donations?

Answer 11

seems “fair” but older individuals won’t get kidneys and violates civil rights act

Question 12

What is the newest national kidney donation policy?

Answer 12

a waiting time driven system with points for HLA-DR matching, multi organ recipients, pediatrics and longevity matching

Question 13

who has been positively impacted by the new kidney allocation system?

Answer 13

african americans - changed dialysis wait times to reflect health care access disparities

Question 14

What is the most important factor affecting access to a transplant?

Answer 14

donor service area, ie geography

Question 15

How does the continuous distribution model change kidney allocation practices?

Answer 15

it weights medical urgency, location and biological matching so as to maximize the number of very sick people who get a kidney transplant without relying exclusively on geography

Question 16

What are common complications of immunosuppression?

Answer 16

opportunistic infection (CMV, HSV, EBV, BK polyoma virus) and malignancy (lymphoma and skin cancer)

Question 17

Is a kidney transplant generally allotopic or heterotopic?

Answer 17

heterotopic - it’s implanted in the iliac fossa and the old kidney is left in place

Question 18

What are possible causes of kidney transplant rejection or dysfunction?

Answer 18

medication 
dehydration 
contrast 
rejection 
infections 
allergic reactions

Question 19

What is done routinely at NMH to monitor allografts?

Answer 19

biopsies looking for sub acute injury/rejection - problem is that this is both invasive and expensive

Question 20

How does the new biomarker looking for early inflammation work?

Answer 20

it does a gene expression profile that identifies expression of 7 genes linked to top 10 IPA immune/inflammatory pathways - allows us to skip biopsies for those that test negative