Transplant and Dialysis Flashcards
What two things are assessed when matching donor tissues?
Blood group
HLA
Would you still need to give a patient immunosuppression if they received an organ from a monozygotic twin?
Yes - over time DNA slightly changes and this is enough to trigger an immune response
(however they will need less drugs)
What is the gold standard method of delivering dialysis?
Where is this put in?
Arteriovenous fistula (AVF)
Both upper limbs
Name 2 complications of peritoneal dialysis
Peritonitis
infection at site of catheter
Under what 4 circumstances would dialysis need to be started?
- resistant hyperkalaemia
- eGFR <7ml/min
- urea >40mmol/l
- unresponsive metabolic acidosis (dialysis gives HCO3-)
(not everyone with ESKD goes on dialysis - dependant on whether QoL will improve as a result)
What immunosuppression is used for transplants?
Prednisolone
Tacrolimus
MMF/azathioprine
What is the most common side effect of immunosuppression?
What is the lung condition that is a form of pneumonia only found in immunosuppressed?
Bacterial infections
PCP/PJP
- pneumocystis pneumonia
What virus is an important cause of morbidity in immunosuppressed patients in the first 3 months post transplant?
It can occur if donor has been exposed and patient hasn’t
How is it managed?
CMV
Cytomegalovirus
IV ganciclovir
Phrophylactic PO valganciclovir in high risk patients
What is BK nephropathy a result of?
Over immunosuppression
BK virus can be prevalent in the uroepithelium and if over surpassed can run riot and mimic rejection
What is the most common cancer patients get when on immunosuppression?
Non-melanoma skin cancers
What diet changes will have to be made for a patient on dialysis?
Reduced water intake (fruit and veg - weight = 100% water)
Low salt
Low phosphate
Low potassium
To be placed on the transplant list what criteria should you reach?
- be/expected to be on dialysis
What is the timeframe in which hyperacute rejection of a transplant will occur?
Same for acute and chronic graft failure
Hyperacute - Within minutes
Acute graft failure - within 6 mnths
Chronic - 6 mnths - 1 year
What is fistula steal syndrome?
What is the other name for it?
Distal to anastomosis can undergo narrowing either due atherosclerosis or vasculitis
->
Leads to numbness and distal ischaemia of hand esp after usage
Dialysis hypo perfusion ischaemic syndrome
