Transplant Flashcards
what does a kidney transplant increase GFR to
50
what are the 3 types of donor transplant
decreased heart beating donors (DBD - brain dead), non-heart beating donors (DCD), live donation (best outcome)
what contraindications are there for recipients
malignancy, active infection, hostile bladder, severe comorbidities eg IHD, severe airway disease, vasculitis, severe PVD
what is involved in the live donor assessment
fitness, renal function, anatomically normal kidneys, co-morbidities, immunologically and physiologically compatible, NO COERCION
who can a type O donate to
everyone: O, A, B, AB
who can a type A donate to
A or AB
who can a type B donate to
B or AB
who can a type AB donate to
AB
what is HLA tissue typing
HLA is on surface proteins on cells and immune system will attack if non-self so donor and recipient must be matched
what are the 3 main types of HLA
HLA A, HLA B, HLA DR
what are sensitising events where a patient may have been exposed to different blood and tissue types
blood transfusions, pregnancy, previous transplant
why can sensitising events prove challenging in finding a mach
formation of pre-formed antibodies make it more difficult to match
how do you desensitise a patient
active removal of blood group or donor specific antibodies, plasma exchange, B cella antibodies
where is the donor transplant attached to the patient
inserted in iliac fossa and attached to external iliac artery and vein (patients kidneys remain in place)
what are immediate complications of the surgery
bleeding, arterial stenosis, venous stenosis, ureteric stricture, wound infection, lymphocele
what are the signs of immediate graft function
urine output increases, urea and creatinine fall
what is seen in delayed graft function
post transplant ATN, starts working within 10-30 days but needs a biopsy
what is a primary non-functioning transplant
kidney does not work but is not rejected
what type of autoimmune reaction is a hyper-acute rejection
type 2 - where there are preformed antibodies
how do you manage a hyper-acute rejection
removal of transplant - unsalvageable
what type of reaction is an acute rejection
cellular/ antibody mediated
how do you manage an acute rejection
increased immunosuppression
what is seen in chronic rejection
slowly progressive decline in renal function - poorly responsive to treatment
what medications are used for induction of immunosuppressants in kidney transplants
basiliximab, dacluzimab
what maintenance treatment is used in kidney transplants
calcineurin inhibitors eg cyclosporine / azathioprine / prednisolone
what is CMV associated with
early graft loss (first 3 months) - common if recipient is not immune but donor had previous infection
what can CMV infection result in (5)
hepatorenal dysfunction, oesophagitis, pneumonitis, colitis, increased risk of rejection
what investigations are done for CMV
PCR and IgM
how do you treat CMV in kidney transplants
prophylactic valganciclovir or IV ganciclovir
what is BK nephropathy
BK viral infection usually from over immunosuppression (reduce immunosuppressants to treat)
what is post-transplant lymphoproliferative disease (PTLD)
usually related to EBV which causes monoclonal proliferation of B cells
how do you treat PTLD
reduce immunosuppression and start on chemo
