Transplantation

Question 1

what is the need for kidney transplant?

Answer 1

survival benefit, QOL increases and major cost benefit (after first year especially)

Question 2

what is the perfect match for transplantation

Answer 2

genetically identical mice

Question 3

what is the universal donor

Answer 3

O

Question 4

what are the 3 important HLA types

Answer 4

HLA A and HLA B and HLA DR (type 2)

Question 5

why do more women get more antibodies than males?

Answer 5

pregnancy

Question 6

where do you get antibodies from

Answer 6

previous transplant

Question 7

what happens if there is no rejection

Answer 7

lots of infections- cytomegalovirus (herpes), recurrent UTI, pneumonitis jirovecii- co trimoxazole, BK virus- transplant disfunction, EBV post transplant,

Question 8

what type of malignancy is associated with transplantation

Answer 8

squamous cell carcinoma§

Question 9

what types of rejections are there

Answer 9

hyperacute- minutes due to mismatch- remove kidney
acute- usually early
chronic- immunological and vascular deterioration

Question 10

what do we do to reduce immunosuppression after transplant

Answer 10

steroids, CyA, MMF Tacromilus antibodies

Question 11

what do tacrolimus and cyclosporin do

Answer 11

reduce NK cells and cytotoxic T cell activation

Question 12

what are side effects of cyclosporin and tarcolimus

Answer 12

renal dysfunction, hypertension, diabetes, tremors

Question 13

what do azathioprine and mycophenolate do

Answer 13

block purine synthesis

Question 14

what does azathioprine interact with

Answer 14

allopurinol- V V BAD- leukopenia and anaemia

Question 15

what are side effects of steroids

Answer 15

osteoporosis, weight gain, infection and diabetes

Question 16

what are the 3 types of donors

Answer 16

deceased brain dead, deceased cardiac dead and live kidney

Question 17

who usually donates a live kidney

Answer 17

sibling or parent

Question 18

what is the criteria for transplantation

Answer 18

>5 years life expectancy and operation 
more than 6 months on dialysis 
assess CV risk- ECG, Coronary angiogram, echo
Virology- HIV, hep B ect 
CXR
bladder assessment if PH of urological problems 
comorbidity
severe peripheral vascular disease

Question 19

what are surgical complications

Answer 19

bleeding, arterial and venous stenosis, ureteric stricture, wound infection