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Renal > Transplantation > Flashcards

Transplantation Flashcards

1
Q

Name three types of transplant

A

Deceased heart beating
Non-heart beating
Live donations

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2
Q

What investigations do potential recipients have to undergo before they can receive a transplant?

A 
Immunology 
Virology 
Cardiorespiratory risk 
Peripheral vessel assessment 
Bladder function 
Mental state 
Comorbidities
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3
Q

What infections are tested for in potential recipients?

A 
Hepatitis 
HIV 
EBV
CMV 
VZV
Toxo
Syphilis
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4
Q

State the contraindications for transplant

A 
Malignancy 
Active HCV/HIC
Untreated TB 
Severe IHD 
Severe airway disease 
Active vasculitis 
Severe PVD 
Hostile bladder
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5
Q

What assessments needs to be done if it is a live donor?

A

Fit for surgery, enough renal function to remain independent with only one kidney, anatomically normal kidneys, co-mobitities, immunologically and psychologically compatible. No coercion

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6
Q

Describe tissue typing related to blood group

A

Donor O can give to O, A, B or AB
Donor A can give to A or AB
Donor B can give to B or AB
Donor AB can only give to AB

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7
Q

Why is HLA tested?

A

HLA molecules bind fragments of protein antigens into a groove for recognition by T cells. T cells recognise self proteins but in an unmatched transplant immune attack can occur

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8
Q

What HLA are specifically looked at?

A

HLA A
HLA B
HLA DR

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9
Q

What is the significance of sensitising events?

A

They lead to formation of pre-formed antibodies to non-self antigens - blood transfusion, pregnancy, transplant

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10
Q

Describe desensitisation

A

Active removal of a blood group/donor specific antibody by plasma exchange or B cell antibody - rituximab. Transplant can be carried out when levels are below acceptable threshold

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11
Q

Where is a kidney transplant inserted?

A

Iliac fossa and attached onto the external iliac artery and vein

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12
Q

How is the donor ureter connected to the recipient bladder?

A

With a stent

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13
Q

How long does it take to recover from a kidney transplant?

A

3 months

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14
Q

What are the complications?

A 
Bleeding 
Arterial stenosis 
Venous kinking 
Ureteric stricture 
Hydronephrosis 
Infection 
Lymphocele
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15
Q

State the three possible outcomes of a transplant

A

Immediate Graft Function
Delayed Graft Function
Non function

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16
Q

How will a patient with immediate graft function present?

A

Good urine output, reduced urea/creatinine

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17
Q

What is often required in patients with delayed graft function?

A

Haemodialysis usually takes 10-30 days - need to do a biopsy to check

18
Q

State the three types of rejection

A

Hyperacute
Acute
Chronic

19
Q

Describe hyperacute rejection

A

Preformed antibodies, requires transplant nephrectomy

20
Q

Describe acute rejection

A

Cellular/antibody mediated, requires increased immunosuppression

21
Q

Describe chronic rejection

A

Slow progressive decline, antibody mediated with poor response to treatment

22
Q

What is the purpose of anti-rejection therapy?

A

Reduces T cell activation and prevents host vs. transplant immune response

23
Q

Name the induction immunosuppression

A

Basiliximab, dacluzimab

24
Q

What immunosuppressive drug is given during a transplant operation?

A

IV prednisolone

25
Q

What are the two combinations of immunosuppression given for maintenance post op?

A

Prednisolone, tacrolimus, MMF

Prednisolone, ciclosporin, azathiprine

26
Q

Name some anti-rejection drugs

A

Methylprednisolone, anti-thymocyte globulin, IV immunoglobulin, plasma exchange, rituximab, bortezimab, eculizumab

27
Q

What are the side effects of immunosuppression?

A

Infection and cancers

28
Q

What are common infections due to immunosuppression?

A

Bacterial - URTI/UTI (common)
Viral - CMV, HSV, BK
Fungal

29
Q

Describe the effect of CMV

A

First 3 months, associated with early graft loss and causes renal/hepatic dysfunction, oesophagitis, pneumonitis, colitis, increased risk of rejection

30
Q

How is CMV investigated and treated?

A

IgM and PCR
Prophylactic - valganciclovir
IV ganciclovir if active infection

31
Q

Where is BK prevalent?

A

Uroepithelium

32
Q

What is the effect of BK?

A

Mimics rejection

33
Q

How is BK treated?

A

Reduce immunosuppression and monitor PCR

34
Q

Other than renal where do transplantation also attend a regular review?

A

Dermatology

35
Q

What are the commonest cancers due to immunosuppression?

A

Non-melanoma skin cancer
Lymphoma
Solid organs

36
Q

What virus is post transplant lymphoproliferative disease related to?

A

EBV - causes polyclonal B cell proliferation then monoclonal proliferation and finally lymphoma

37
Q

How is post transplant lymphoproliferative disease treated?

A

Reduced Immunosuppression if unresponsive chemotherapy may be required

38
Q

How do monoclonal antibodies work?

A

Block IL2 receptor on CD4 T cells and prevent activation

39
Q

What can calcineurin inhibitors cause?

A

Renal dysfunction, hypertension, diabetes, tremor

40
Q

Name two anti-metabolites

A

Azathioprine and MMF

41
Q

How do anti-metabolites work?

A

Block purine synthesis to suppress lymphocyte proliferation

42
Q

What can anti-metabolites cause?

A

Leucopenia
GI upset
Anaemia

Renal (20 decks)

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