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The Abdomen > Transplant Surgery > Flashcards

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
Q

What marks the start of the cold ischaemic time

A

Perfusion of the organs with ice-cold perfusion solution and cessation of ventilation

26
Q

What does perfusion solution contain

A
  • Impermeable solutes to minimise cellular swelling
  • Buffers for pH balance
  • Free radical scavengers
  • Membrane stabilisers
  • Adenosine for ATP synthesis
27
Q

Which out of DBD and DCD has the longer warm ischaemic time and why

A

DCD - due to peri-arrest period of hypotension

28
Q

How is warm ischaemic time categorised in DCD donors

A
  • Primary warm ischaemic time

- Functional (true) warm ischaemic time

29
Q

What is functional (true) ward ischaemic time

A

Commences when the SBP has a sustained (2 minute) fall <50mmHg

30
Q

Who regulates live donors

A

Human tissue authority

31
Q

What type of liver transplant is performed from adult to child

A

Lateral segment

32
Q

What type of liver transplant is performed from adult to adult

A

Right hepatectomy

33
Q

What complications can live kidney donors develop later in life

A
  • HTN

- Proteinuria

34
Q

What 3 matching processes are required for transplant

A
  • ABO blood group
  • HLA matching
  • Antibody cross-matching
35
Q

Which HLA antigen is most important in kidney transplants

A

HLA-DR

36
Q

What immunosupression is given at the time of surgery

A
  • Methylprednisolone 1g

- Anti-CD25 monoclonal antibody

37
Q

When is the repeat dose of anti-CD25 monoclonal antibody (e.g. Basiliximab) given following surgery

A

4 days

38
Q

Outline triple therapy maintenance immunosuppression

A
  1. Calcineurin inhibitor
  2. Antiproliferative agent
  3. Steroid (Prednisolone)
39
Q

Give examples of calcineurin inhibitors

A
  • Ciclosporin

- Tacrolimus

40
Q

Give examples of antiproliferative agents

A
  • Mycophenalate

- Azathioprine

41
Q

What malignancy are transplant patients most susceptible to

A

SCC skin (65x)

42
Q

Cause of hyperacute rejection

A

Due to the presence of recipient antibodies against the donor kidney

43
Q

When does hyperacute rejection occur

A

Within minutes of revascularisation

44
Q

What are the signs of hyperacute rejection

A
  • Kidney swells and becomes discoloured

- There is clumping of RBCs and platelets, fibrin is deposited, interstitial haemorrhage occurs

45
Q

How is hyperacute rejection definitely managed

A

Transplant nephrectomy is required

46
Q

When does acute transplant rejection occur

A

Within 6 months

47
Q

What are the two types of acute rejection

A
  1. Cell-mediated (T-cell most common)

2. Antibody mediated

48
Q

How is acute rejection managed

A
  1. Steroids

2. Monoclonal antibodies

49
Q

What are the most prominent changes in chronic transplant rejection

A

Vascular changes leading to organ ischaemia

50
Q

What indications for renal transplant have the greatest risk of recurrence

A
  1. FSGS
  2. IgA
  3. MCGN
  4. HUS
51
Q

What are the contraindications to renal transplant

A
  • Active malignancy (must be cancer-free for 2 years)
  • Active infection
  • Advanced atheromatous disease
52
Q

How are renal transplant vessels anastomosed

A

End-to-side with the external iliac vessels

Live renal donor kidneys may require end-to-end due to shorter vessels

53
Q

Where is the transplanted kidney typically sited

A

Extraperitoneal in the RIF/LIF

54
Q

What is the most common cause of delayed graft function

A

ATN

55
Q

What is a Lymphocele

A

Swelling over graft with normal function

56
Q

What infections are renal transplant patients susceptible to

A

EBV

57
Q

Define fulminant liver failure

A

Onset of encephalopathy within 8 weeks of symptoms in a person with previous normal liver function

58
Q

What incision is used for liver transplant

A

Mercedes or Rooftop

59
Q

Define a heterotopic transplant

A

Transplant of unrelated organ to different site

60
Q

Define orthotopic transplant

A

Transplant of unrelated organ to same site

The Abdomen (8 decks)

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