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Transplantation > Transplant Chapter NHBR > Flashcards

Transplant Chapter NHBR Flashcards

1
Q

What is C4d negative ABMR?

A

C4d negative AMR is characterized by the presence of microvascular injury in the presence of DSAbut without
PTC C4d staining.

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2
Q

What are the RF for PTDM?

A
  • AA
  • ≥40 years
  • Male
  • HLA mismatch
  • PKD
  • Hep C / CMV
  • HypoMg2+
  • Proteinuria
  • CNI / mTORi /steroid
  • Obesity
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3
Q

What is the treatment of dn anti-GBM disease post-transplant in Alport’s?

A
  • Plasmapheresis

- CYC

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4
Q

What treatment measures can be employed in ABMR?

A
  • TPE
  • IVIg
  • Rituximab
  • Bortezomib
  • Eculizumab
  • rATG
  • Steroids
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5
Q

What drugs may potentiate CNI toxicity?

A
  • NSAIDs
  • mTORi
  • Tenofovir
  • Amphortericin
  • Foscarnet
  • Cidofovir
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6
Q

What drugs and foods increase absorption of CNIs?

A
  • Metoclopramide

- Grapefruit juice

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7
Q

What is the recurrence rate of membranous GN post transplant?

A

10-30%

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8
Q

What is the recurrence rate of lupus nephritis post transplant?

A

3-10%

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9
Q

What is optimal timing for transplant in anti-GBM disease?

A

> 6 months after antibody disappearance

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10
Q

What is the recurrence rate for ANCA?

A

10-20%

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11
Q

What is the recurrence rate for aHUS?

A
  • 20-25%, but 80% graft loss

- at least 1 year of queiescence is recommended

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12
Q

Why do X-linked Alport’s females not develop anti-GBM post-transplant?

A
  • They carry a normal copy of the affected gene
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13
Q

When would you use rATG in ACMR?

A
  • refractory to steroids

- Banff IIA rejection

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14
Q

When would they perform a DGF transplant biopsy in the highly sensitised patient at Brigham?

A
  • Day 3-5

- Rebiopsy again if no rejection on initial but DGF persists by day 5-7

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15
Q

When would you biopsy the low-risk DGF patient? (at Brigham)

A
  • Day 7-10
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16
Q

What cold-ischaemia and warm ischaemia times increase the risk for DGF?

A
  • Cold ischaemia >15 hrs

- Warm ischaemia >45 minutes

17
Q

What KDPI is most associated with DGF?

A

> 85%

18
Q

What is the effect of diarrhoea on CNI levels?

A
  • Diarrhoea causes an increase in CNI levels
19
Q

What statin should be avoided in patients on CNI?

A
  • Simvastatin carries a FDA black box warning for co-administration with FK
20
Q

What statins are safe to use with FK506?

A
  • Fluvastatin
  • Atorvastatin (lower risk of interaction)
  • Rosuvastatin, but Atorvastatin favoured on basis of PLANET trial.
21
Q

What is the most common cause of DGF?

A

ATN

22
Q

Whom does KDIGO recommend depletion therapy for at induction?

A
  • increased number of HLA mismatches
  • Younger recipient and older donor
  • AA people
  • PRA higher
  • Presence of DSA
  • ABO incompatibility
  • Delayed onset graft function
  • Cold ischaemia time >24 hours
23
Q

How does hypertension effect CV mortality in transplant recipients?

A
  • Each 20mmHg leads to a 32% increase in CVD risk, and a

- 13% increased risk of mortality.

24
Q

What are the available strategies for DSA removal?

A
  • Plasmapheresis
  • Immunoadsorption
  • Rituximab
  • Bortezomib
25
Q

Give an example of a desensitisation protocol.

A
  • TPE, 2-3 sessions for low DSA titre, 6-10 sessions for high titres followed by IVIg
  • Tacrolimus and MMF, commence 2-3 weeks before the transplant
26
Q

How do you manage AMR?

A
  • TPE and IVIg (first line)
  • TPE, IVIg, Ritux and bortezomib (second line)
  • Eculizumab (third line)
27
Q

What features confer a greater risk of HCC in a kidney transplant candidate?

A
  • HBV viral load
  • HBeAg positive
  • HBsAg positive
  • Asian or African ethnicity
28
Q

What are the conditions for performing a kidney transplant in a person with HIV?

A
  • HIV viral load <50 copies/mL
  • CD4 count >200/mm3
  • No opportunistic infections in the past year
29
Q

What single parameter is associated with the highest risk for allograft loss in a transplant patient wishing to become pregnant?

A
  • pre-pregnancy creatinine, ideally <1.5mg/dL
30
Q

Birth defects are more common in babies fathered by transplant recipients. true/false

A
  • true
31
Q

What is the incidence of ESRD among kidney donors?

A

<0.5% at 15 years

32
Q

What is the Banff Classification for ACR?

A

1:
1A: Tubulitis, focal (>4 lymph)
1B: Tubulitis, severe (>10 lymph)

2A: Arteritis, <25% of luminal area
2B: Arteritis, >25% of luminal area

3: Transmural inflammation and necrosis of the media

33
Q

What are the 2013 Banff Criteria for AMR?

A
  1. Serological evidence of DSAs against HLA or other antigen
  2. Histological evidence of tissue injury in the absence of another cause
  3. Evidence of current/recent interaction of an antibody with the vascular endothelium.
    - C4d staining
    - Increased expression of gene transcripts in the the biopsy indicative of endothelial injury
34
Q

What is the pathogenesis for chronic rejection?

A
  • Alloantigen dependent
    1. Acute rejection episodes
    2. Ab mediated immune response
    3. Poor HLA matching
    4. Inadequate immunosuppression
  • Alloantigen independent
    1. CNI toxicity
    2. BK nephropathy
    3. CMV infection
35
Q

What is the most common type of peritransplant fluid collection?

A
  • Lymphocoele

- Incidence is higher with sirolimus

36
Q

What is the treatment for transplant erythrocytosis? Hb >17, HCT >52%

A
  • ACEi/ARB

- Phlebotomy

Transplantation (3 decks)

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