Transplantation

Question 1

What blood type can only receive their type of blood?

Answer 1

blood group O- have anti-A nad anti-B antibodies

Question 2

What is HLA?

Answer 2

cell surface proteins expressed on cells

Question 3

What are the 3 types of HLA important in transplantation?

Answer 3

HLA-A and HLA-B- type 1 and HLA-DR

Question 4

How many types of each HLA does each patient have?

Answer 4

2- 1 from each parent

Question 5

What is a haplotype?

Answer 5

each set of HLA (A, B and DR) are inherited as a set

Question 6

What are the common ways of developing HLA antibodies?

Answer 6

pregnancy; transfusion and transplantation

Question 7

What type of graft has the best chance of survival?

Answer 7

live related donor transplant

Question 8

What happens when the T helper cell is presented with an HLA antigen?

Answer 8

stimulated B cells; NK cells; cytotoxic cells and complement and cytokines which lead to rejection

Question 9

What happens if a patient is given too much immunosuppressive drugs?

Answer 9

BK virus; CMV; recurrent UTI; PCP; non-melanoma skin cancer; lymphoma

Question 10

What is rejection?

Answer 10

non-self tissue is identified and attacked by host immune system causing damage to transplanted organ

Question 11

What is a hyperacute rejection?

Answer 11

due to positive crossmatch (preformed antibodies to the transplant) and the graft is unsalvageable- will go black within minutes

Question 12

What is acute rejection?

Answer 12

T or B cell mediated response

Question 13

How can acute rejection be treated?

Answer 13

increased immunosuppression

Question 14

What causes chronic rejection?

Answer 14

immunological and vascular deterioration of transplant

Question 15

What drugs are given during the induction phase?

Answer 15

steroids; MMF; CyA; tacrolimus; antibodies

Question 16

What drugs are given during the consolidation phase ?

Answer 16

steroids; MMF; CyA and tacrolimus

Question 17

What drugs are given during the maintenance phase?

Answer 17

steroids, MMF, CyA and tacrolimus

Question 18

What are examples of calcineurin inhibitors?

Answer 18

cyclosporin and tacrolimus

Question 19

What is the function of calcineurin inhibitors?

Answer 19

inhibit activation of T helped cells- reduce NK and CD8 cell activation; decrease cytokine release to prevent B cell proliferation and antibody production

Question 20

What are the side effects of calcineurin inhibitors?

Answer 20

renal dysfuction; HT; DM; tremors

Question 21

How are calcineurin inhibitors metabolised?

Answer 21

cytochrome p450

Question 22

What are examples of antimetabolites?

Answer 22

azathioprine and mycophenolate

Question 23

What is the function of antimetabolites?

Answer 23

block purine synthesis by suppressing proliferation of lymphocytes and B cells

Question 24

What are the SE of antimetabolites?

Answer 24

leucopaenia, anaemia, GI

Question 25

What drug should azathioprine not be combined with?

Answer 25

allopurinol

Question 26

What is the function of steroids?

Answer 26

non-selectively suppress the activity of T cells and proliferation of B cells

Question 27

What are the SE of steroids?

Answer 27

OP; weight gain; infeection and DM

Question 28

What are hte 2 types of cadaveric kidneys?

Answer 28

deceased brain dead and deceased cardiac death

Question 29

How is suitability for transplantation decided?

Answer 29

>5 years life expectancy; patients don't get a kidney >6 months prior to starting HD; predominantly based on tissue typing not time on the list

Question 30

How are patients assessed for transplant?

Answer 30

CVS risk; virology; CXR; bladder assessment; any comorbidity

Question 31

What are the absolute CI to transplantation?

Answer 31

malignancy- untreated of within 2/5 years (depending on tumour); untreated TB; severe IHD not amenable to surgery; severe airway disease; active vasculitis; severe PVD (unusable vessels )

Question 32

How are live donors assessed?

Answer 32

ECG; CXR; virology; GFR; quantification of proteinuria; 24hr BP; renal angiogram; Xmatch

Question 33

Where is the transplanted kidney inserted?

Answer 33

pelvis

Question 34

Why is there an increased risk of wound infection with transplantation?

Answer 34

patients are on immunosuppressives

Question 35

What are the surgical complications of transplant?

Answer 35

bleeding; arterial/venous stenosis and thrombosis; ureteric stricture and hydronephrosis

Question 36

What indicates good immediate graft function?

Answer 36

urine output and falling creat and urea

Question 37

What is delayed graft function?

Answer 37

post transplant acute tubular necrosis; will work after 10-30 days

Question 38

What is primary non-function?

Answer 38

transplant never works

Question 39

What is the long term follow up of transplant patients?

Answer 39

late acute rejection; HT and CVS risk; chronic allograft nephropathy; UTI; recurrent primary renal disease; skin cancer surveillance

Question 40

How can the graft be loss?

Answer 40

chronic rejection; cyclosporine/tacrolimus toxicity and ischaemia