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Renal > Transplantation > Flashcards

Transplantation Flashcards

1
Q

What blood type can only receive their type of blood?

A

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

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2
Q

What is HLA?

A

cell surface proteins expressed on cells

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3
Q

What are the 3 types of HLA important in transplantation?

A

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

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4
Q

How many types of each HLA does each patient have?

A

2- 1 from each parent

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5
Q

What is a haplotype?

A

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

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6
Q

What are the common ways of developing HLA antibodies?

A

pregnancy; transfusion and transplantation

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7
Q

What type of graft has the best chance of survival?

A

live related donor transplant

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8
Q

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

A

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

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9
Q

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

A

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

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10
Q

What is rejection?

A

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

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11
Q

What is a hyperacute rejection?

A

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

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12
Q

What is acute rejection?

A

T or B cell mediated response

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13
Q

How can acute rejection be treated?

A

increased immunosuppression

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14
Q

What causes chronic rejection?

A

immunological and vascular deterioration of transplant

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15
Q

What drugs are given during the induction phase?

A

steroids; MMF; CyA; tacrolimus; antibodies

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16
Q

What drugs are given during the consolidation phase ?

A

steroids; MMF; CyA and tacrolimus

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17
Q

What drugs are given during the maintenance phase?

A

steroids, MMF, CyA and tacrolimus

18
Q

What are examples of calcineurin inhibitors?

A

cyclosporin and tacrolimus

19
Q

What is the function of calcineurin inhibitors?

A

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

20
Q

What are the side effects of calcineurin inhibitors?

A

renal dysfuction; HT; DM; tremors

21
Q

How are calcineurin inhibitors metabolised?

A

cytochrome p450

22
Q

What are examples of antimetabolites?

A

azathioprine and mycophenolate

23
Q

What is the function of antimetabolites?

A

block purine synthesis by suppressing proliferation of lymphocytes and B cells

24
Q

What are the SE of antimetabolites?

A

leucopaenia, anaemia, GI

25
Q

What drug should azathioprine not be combined with?

A

allopurinol

26
Q

What is the function of steroids?

A

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

27
Q

What are the SE of steroids?

A

OP; weight gain; infeection and DM

28
Q

What are hte 2 types of cadaveric kidneys?

A

deceased brain dead and deceased cardiac death

29
Q

How is suitability for transplantation decided?

A

> 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

30
Q

How are patients assessed for transplant?

A

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

31
Q

What are the absolute CI to transplantation?

A

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 )

32
Q

How are live donors assessed?

A

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

33
Q

Where is the transplanted kidney inserted?

A

pelvis

34
Q

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

A

patients are on immunosuppressives

35
Q

What are the surgical complications of transplant?

A

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

36
Q

What indicates good immediate graft function?

A

urine output and falling creat and urea

37
Q

What is delayed graft function?

A

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

38
Q

What is primary non-function?

A

transplant never works

39
Q

What is the long term follow up of transplant patients?

A

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

40
Q

How can the graft be loss?

A

chronic rejection; cyclosporine/tacrolimus toxicity and ischaemia

Renal (33 decks)

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