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My2 renal > Transplant > Flashcards

Transplant Flashcards

1
Q

what does a kidney transplant increase GFR to

A

50

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2
Q

what are the 3 types of donor transplant

A

decreased heart beating donors (DBD - brain dead), non-heart beating donors (DCD), live donation (best outcome)

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3
Q

what contraindications are there for recipients

A

malignancy, active infection, hostile bladder, severe comorbidities eg IHD, severe airway disease, vasculitis, severe PVD

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4
Q

what is involved in the live donor assessment

A

fitness, renal function, anatomically normal kidneys, co-morbidities, immunologically and physiologically compatible, NO COERCION

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5
Q

who can a type O donate to

A

everyone: O, A, B, AB

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6
Q

who can a type A donate to

A

A or AB

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7
Q

who can a type B donate to

A

B or AB

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8
Q

who can a type AB donate to

A

AB

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9
Q

what is HLA tissue typing

A

HLA is on surface proteins on cells and immune system will attack if non-self so donor and recipient must be matched

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10
Q

what are the 3 main types of HLA

A

HLA A, HLA B, HLA DR

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11
Q

what are sensitising events where a patient may have been exposed to different blood and tissue types

A

blood transfusions, pregnancy, previous transplant

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12
Q

why can sensitising events prove challenging in finding a mach

A

formation of pre-formed antibodies make it more difficult to match

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13
Q

how do you desensitise a patient

A

active removal of blood group or donor specific antibodies, plasma exchange, B cella antibodies

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14
Q

where is the donor transplant attached to the patient

A

inserted in iliac fossa and attached to external iliac artery and vein (patients kidneys remain in place)

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15
Q

what are immediate complications of the surgery

A

bleeding, arterial stenosis, venous stenosis, ureteric stricture, wound infection, lymphocele

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16
Q

what are the signs of immediate graft function

A

urine output increases, urea and creatinine fall

17
Q

what is seen in delayed graft function

A

post transplant ATN, starts working within 10-30 days but needs a biopsy

18
Q

what is a primary non-functioning transplant

A

kidney does not work but is not rejected

19
Q

what type of autoimmune reaction is a hyper-acute rejection

A

type 2 - where there are preformed antibodies

20
Q

how do you manage a hyper-acute rejection

A

removal of transplant - unsalvageable

21
Q

what type of reaction is an acute rejection

A

cellular/ antibody mediated

22
Q

how do you manage an acute rejection

A

increased immunosuppression

23
Q

what is seen in chronic rejection

A

slowly progressive decline in renal function - poorly responsive to treatment

24
Q

what medications are used for induction of immunosuppressants in kidney transplants

A

basiliximab, dacluzimab

25
Q

what maintenance treatment is used in kidney transplants

A

calcineurin inhibitors eg cyclosporine / azathioprine / prednisolone

26
Q

what is CMV associated with

A

early graft loss (first 3 months) - common if recipient is not immune but donor had previous infection

27
Q

what can CMV infection result in (5)

A

hepatorenal dysfunction, oesophagitis, pneumonitis, colitis, increased risk of rejection

28
Q

what investigations are done for CMV

A

PCR and IgM

29
Q

how do you treat CMV in kidney transplants

A

prophylactic valganciclovir or IV ganciclovir

30
Q

what is BK nephropathy

A

BK viral infection usually from over immunosuppression (reduce immunosuppressants to treat)

31
Q

what is post-transplant lymphoproliferative disease (PTLD)

A

usually related to EBV which causes monoclonal proliferation of B cells

32
Q

how do you treat PTLD

A

reduce immunosuppression and start on chemo

My2 renal (27 decks)

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