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URINARY > Transplant (renal replacement therapy 2) > Flashcards

Transplant (renal replacement therapy 2) Flashcards

1
Q

where is the transplanted kidney placed

A

into the iliac fossa

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2
Q

onto what is the transplanted kidney attached

A

anastomosed to the iliac vessels

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3
Q

what happens to the native kidneys

A

usually stay in situ - however some situations call for a kidney to be removed

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4
Q

what are indications for native nephrectomy

A

size - polycystic kidneys

infection - chronic pyelonephritis

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5
Q

how can a donor kidney be preserved

A

cold storage solutions - minimise oedema - preserve integrity of tissues - buff free radicals

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6
Q

what is cold ischaemia time

A

the time a donor kidney is without blood supply

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7
Q

why is cold ischaemia time important

A

the longer the cold ischaemia time - the poorer the outcome of the transplant is going to be

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8
Q

what are the three types of complications in transplantation

A
  1. vascular
  2. ureteric
  3. infections
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9
Q

what are vascular complications of transplantation

A
  1. bleeding
  2. arterial thrombosis
  3. venous thrombosis
  4. lymphocele
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10
Q

what are the most common types of bleeding complications

A
  1. usually anastomotic sites

2. perirenal haematoma - can be arterial or venous

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11
Q

what is a ureteric complication of transplantation

A

urine leak - medical emergency - need to go back to surgery

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12
Q

what is used to minimise risk of rejection

A

immunosuppressive agents

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13
Q

what is the immunesuppression protocols

A

induction - basiliximab

maintenance - tacrolimus + mycophenolate + steroids*

**steroid free when possible - e.g. paediatric patients can often cope without

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14
Q

what can be used instead if a patient is intolerant to tacrolimus

A

belatacept

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15
Q

what are some of the side effects of corticosteroids

A

hypertension, hyperglycaemia, infections, bone loss, GI bleeding

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16
Q

what are some of the side effects of tacrolimus

A

hyperglycaemia, AKI (acute kidney injury), tremor

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17
Q

what are some of the side effects of mycophenolate

A

cytopenia, GI upset

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18
Q

what are some of the side effects of belatacept

A

infections, malignancy

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19
Q

what are 2 types of kidney donors

A

deceased donors

living donors

20
Q

what are the different types of deceased donors

A
  1. donation after brain death (DBD)

2. donation after cardiac death (DCD)

21
Q

what are the different types of living donors

A
  1. living related

2. living unrelated - spousal, altruistic, paired/pooled

22
Q

what are the two sets of criteria for deceased donors

A

standard and extended

23
Q

what is the different implications between standard and extended criteria transplants

A

standard criteria donor transplants are more successful than organs from extended criteria donors

24
Q

what is the standard brain death criteria

A
  1. coma, unresponsive to stimuli
  2. apnoea off ventilator despite build up of CO2
  3. absence of cephalic reflexes
  4. body temp > 34C
  5. absence of drug intoxication
25
Q

what is the extended criteria for deceased donors

A
  1. donor aged >60yrs

2. donor aged 50-59yrs + history of HBP, death from cerebrovascular accident or terminal certain of >132 micro mol/L

26
Q

are older patients more or less likely to get a transplant

A

less likely - as they are less likely to a) survive procedure b) accept kidney and c) more prone to complications

27
Q

what does an ABO incompatible transplant mean

A

donor organ is from someone with a different blood type to recipient - can be done but recipient must be on immunosuppressants before and after treatment to minimise chance of rejection

28
Q

what does a HLA incompatible transplant mean

A

recipient has antibodies that are incompatible with donor organ (HLA = human leukocyte antigens)

29
Q

which type of incompatible transplant is more successful - ABO or HLA

A

ABO

30
Q

what is a paired donation

A

If donor A cannot give to recipient A, they can instead give to recipient B while donor B gives to recipient A

e.g. mother (A) not a match for son (a) and 
husband (B) not a match for wife (b)
BUT
A is a match for b
B is a match for a

so these sets of people can cross over donors

31
Q

what is pooled donation

A

knock on domino effect of donations - can include multiple people

e.g. starts with altruistic donor giving to A - A’s brother gives to B - B’s husband gives C etc etc

32
Q

what are the risks of kidney donation

A
  1. similar patient survival to general population
  2. lower rate of ESRD compared to general population
  3. compensatory increase in GFR of remaining kidney to 70% of premonition value
33
Q

what are longer term complications of renal transplantation

A
  1. rejection
  2. infection
  3. cardiovascular
  4. malignancy
  5. new onset diabetes mellitus
34
Q

what are the different types of acute rejection

A
  1. T cell mediated rejection
  2. acute antibody mediated rejection (ABMR)

**ABMR causes more damage and is more difficult to control than T cell mediated rejection

35
Q

what occurs at the three levels of T cell mediated rejection

A

Banff 1 - tubulointerstitial
Banff 2 - arteritis/endothelialitis
Banff 3 - arterial fibrinoud necrosis

36
Q

what occurs at the three levels of acute AMBR

A

Banff 1 - ATN-like
Banff 2 - capillaries or glomerular inflammation
Banff 3 - arterial inflammation

37
Q

what are the most common infections straight after transplant

A

wound infection and UTI

38
Q

what is the most common (and important) infection after 6 months and why

A

cytomegalovirus - patient put on prophylaxis therapy for CMV for first 6 months post transplant - after this at risk of CMV infection

**high mortality and morbidity if untreated

39
Q

what two common ways can a patient receive CMV

A
  1. transmission from donor tissue

2. reactivation of latent virus

40
Q

what are the two types of CMV

A
  1. viraemia

2. tissue invasive - pneumonitis, hepatitis, retinitis, gastroenteritis, colitis, nephritis

41
Q

what virus is common after transplant

A

BK virus (BKAN)

42
Q

what are risk factors for BKAN

A
  1. intensity of immunosuppression
  2. patient determinants - older age, male, white, -ve BKV aerostats (paed patients)
  3. organ determinants - graft injury, HLA mismatch, ureteral stents
  4. viral determinants - changes in epitopes of viral capsid protein VP-1
43
Q

what is the treatment for BKAN

A
  1. reduce immunosuppression

2. antiviral therapy - cidofovir +/- IVIG leflunomide

44
Q

what is the outcome of BKAN infection on graft

A

allograft dysfunction and loss of graft in 45-80%

45
Q

what are the relative risks of different malignancies after renal transplantation

A

colon, lung, breast - 2

testicular, bladder - 3

melanoma, leukaemia,

cervical - 5

renal - 15

non-melanoma skin, kaposi sarcoma, non-hodgkin lymphoma - 20

46
Q

what is the relationship between supply and demand of renal transplants

A

demand MUCH HIGHER than supply

URINARY (27 decks)

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