Transplantation 2 Flashcards
Rejection within minutes
Hyperacute
What is acute rejection?
Early rejection, T cell or B cell mediated response
-Can be treated with increased immunosuppression
Name 2 calcineurin inhibitors
Cyclosporin, tacrolimus
How do calcineurin inhibitors work?
Inhibit activation of T helper cells (NK cells, cytotoxic cells, decrease cytokine release - prevent B cell proliferation)
Side effects of calcineurin inibitors
Renal dysfunction
Hypertension
Diabetes
Tremors
What is chronic reaction?
Antibody-mediated vascular damage (months to years, controversial)
How do azathioprine and mycophenalate work?
Suppression of proliferation of B cells (block purine synthesis)
Side effects of azathioprine and mycophenolate?
Leucopaenia Anaemia
GI side effects
Leucopaenia
Anaemia
GI side effects
Azathioprine and mycophenolate
Renal dysfunction
Hypertension
Diabetes
Tremors
Calcineurin inhibitors
How do steroids work?
Suppress activity of T cells
Suppress proliferation of B cells
Is vasculitis a contra-indication to kidney transplant?
Active vasculitis is a contra-indication
Absolute contraindications to kidney transplant
Malignancy Known untreated malignancy Hx of solid tumour within 2 years (For some tumours 5 years) Untreated TB Severe IHD not amenable to surgery (should be carried out prior to Tx) Severe airways disease Active vasculitis Severe PVD (Unusable vessels)
What is the surgery like for kidney transplantation?
procedure
Usually 3-4 Hours
Stent inserted between ureter and bladder
Wound 15-20 cm long
Surgical complications
Bleeding (arterial or venous) Arterial Stenosis / Thrombosis Venous stenosis / Thrombosis Ureteric Stricture and hydronephrosis Wound infection
