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Transplant Surgery Flashcards

1
Q

Define chronic kidney disease

A

eGFR <60 for >=3 months

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2
Q

What are the top 3 causes of CKD

A
  1. Diabetic nephropathy - 34%
  2. HTN - 29%
  3. Glomerulonephritis - 14%
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3
Q

Why is pericarditis a complication of CKD

A

Caused by uraemia

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4
Q

Describe renal bone disease

A

Osteodystrophy - caused by secondary hyperparathyroidism and vitamin D deficiency

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5
Q

At how much greater risk are CKD patients of cardiovascular disease

A

10-20x

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6
Q

What type of diet should those on CKD abide by

A
  • Low protein (reduces accumulation of nitrogenous waste)
  • Low potassium
  • Fluid intake = output + 500ml
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7
Q

What two principles does dialysis rely upon

A
  1. Diffusion

2. Ultrafiltration

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8
Q

What type of catheter is used for peritoneal dialysis

A

Indwelling peritoneal (Tenchkoff) catheter

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9
Q

What are the complications of peritoneal dialysis

A
  1. Peritonitis

2. Sclerosing peritonitis

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10
Q

What is an autologous fistula

A

Direct joining of a vein with a neighbouring artery (usually end-vein to side-artery using Brescia-Cimino technique)

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11
Q

What is an autologous bridge fistula

A

A vein and artery are joined using a separate vein graft (e.g. saphenous vein)

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12
Q

What is a synthetic loop graft fistula

A

An artery and vein are joined by a loop of graft tunnelled subcutaneously

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13
Q

List the sites of AV fistula in order of preference

A
  1. Radiocephalic
  2. Brachiocephalic
  3. Brachiobasilic
  4. Forearm loop
  5. Thigh loop using graft
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14
Q

What nerves are most susceptible to injury during AV fistula formation

A
  • Radial

- Median

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15
Q

What is ‘steal phenomenon’ associated with AV fistula

A

Claudication symptoms due to inadequate perfusion

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16
Q

How is Steal Phenomenon treated

A

Ligation of the artery just distal to the graft (except in proximal fistulas which require bypass)

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17
Q

Describe Allograft

A

Transplant tissue from a genetically non-identical donor from the same species

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18
Q

Describe Isograft

A

Graft of tissue between two individuals who are genetically identical

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19
Q

Describe Autograft

A

Transplantation of organs or tissues from one part of the body to another in the same individual

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20
Q

Describe Xenograft

A

Tissue transplanted from another species

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21
Q

What criteria is used to classify donors after circulatory death

A

Maastricht criteria

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22
Q

Define the warm ischaemic time

A

Interval from withdrawal of life to cold organ preservation (the heart is still beating - brain stem death)

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23
Q

Define the cold ischaemic time

A

Time that the organ is removed from the body and packaged in ice for transport

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24
Q

What is the maximum cold ischaemic time for A) kidneys, and B) livers

A

A) 24 hours

B) 12 hours

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25
What marks the start of the cold ischaemic time
Perfusion of the organs with ice-cold perfusion solution and cessation of ventilation
26
What does perfusion solution contain
- Impermeable solutes to minimise cellular swelling - Buffers for pH balance - Free radical scavengers - Membrane stabilisers - Adenosine for ATP synthesis
27
Which out of DBD and DCD has the longer warm ischaemic time and why
DCD - due to peri-arrest period of hypotension
28
How is warm ischaemic time categorised in DCD donors
- Primary warm ischaemic time | - Functional (true) warm ischaemic time
29
What is functional (true) ward ischaemic time
Commences when the SBP has a sustained (2 minute) fall <50mmHg
30
Who regulates live donors
Human tissue authority
31
What type of liver transplant is performed from adult to child
Lateral segment
32
What type of liver transplant is performed from adult to adult
Right hepatectomy
33
What complications can live kidney donors develop later in life
- HTN | - Proteinuria
34
What 3 matching processes are required for transplant
- ABO blood group - HLA matching - Antibody cross-matching
35
Which HLA antigen is most important in kidney transplants
HLA-DR
36
What immunosupression is given at the time of surgery
- Methylprednisolone 1g | - Anti-CD25 monoclonal antibody
37
When is the repeat dose of anti-CD25 monoclonal antibody (e.g. Basiliximab) given following surgery
4 days
38
Outline triple therapy maintenance immunosuppression
1. Calcineurin inhibitor 2. Antiproliferative agent 3. Steroid (Prednisolone)
39
Give examples of calcineurin inhibitors
- Ciclosporin | - Tacrolimus
40
Give examples of antiproliferative agents
- Mycophenalate | - Azathioprine
41
What malignancy are transplant patients most susceptible to
SCC skin (65x)
42
Cause of hyperacute rejection
Due to the presence of recipient antibodies against the donor kidney
43
When does hyperacute rejection occur
Within minutes of revascularisation
44
What are the signs of hyperacute rejection
- Kidney swells and becomes discoloured | - There is clumping of RBCs and platelets, fibrin is deposited, interstitial haemorrhage occurs
45
How is hyperacute rejection definitely managed
Transplant nephrectomy is required
46
When does acute transplant rejection occur
Within 6 months
47
What are the two types of acute rejection
1. Cell-mediated (T-cell most common) | 2. Antibody mediated
48
How is acute rejection managed
1. Steroids | 2. Monoclonal antibodies
49
What are the most prominent changes in chronic transplant rejection
Vascular changes leading to organ ischaemia
50
What indications for renal transplant have the greatest risk of recurrence
1. FSGS 2. IgA 3. MCGN 4. HUS
51
What are the contraindications to renal transplant
- Active malignancy (must be cancer-free for 2 years) - Active infection - Advanced atheromatous disease
52
How are renal transplant vessels anastomosed
End-to-side with the external iliac vessels | Live renal donor kidneys may require end-to-end due to shorter vessels
53
Where is the transplanted kidney typically sited
Extraperitoneal in the RIF/LIF
54
What is the most common cause of delayed graft function
ATN
55
What is a Lymphocele
Swelling over graft with normal function
56
What infections are renal transplant patients susceptible to
EBV
57
Define fulminant liver failure
Onset of encephalopathy within 8 weeks of symptoms in a person with previous normal liver function
58
What incision is used for liver transplant
Mercedes or Rooftop
59
Define a heterotopic transplant
Transplant of unrelated organ to different site
60
Define orthotopic transplant
Transplant of unrelated organ to same site

The Abdomen (8 decks)

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