Transplantation Flashcards
Types
brain stem dead (DBD)
non-heart beating donors (DCD)
live donors
what must the recipient be able to do?
life expectancy >5 years
able to survive operation
assessments for transplant match
immunology= tissue typing and antibody screening
virology= HBV, HCV, HIV, EBV, CMV, VZV, toxo, syphilis
cardiorespiratory health, peripheral vessels, bladder function, mental state and co-morbidities (immunosuppression)
contra-indications for transplantation
malignancy (2-5 years) HCV HIV TB IHD airway disease vasculitis PVD hostile bladder
assessment for live donor
physical fitness enough renal function for one kidney anatomically normal kidneys co-morbidities immunology psychology (no coercion)
two categories in tissue typing
blood group
HLA
types of HLA
A
B
DR
sensitising events in immunology
blood transfusion
pregnancy/ miscarriage
previous transplant
define desensitisation
removal of active blood group of donor specific antibody by plasma exchange or B cell antibody (rituximab)
surgical procedure
extraperitoneal procedure where transplant is inserted into iliac fossa and attached to external iliac’s with ureter into bladder
wound is 15-20cm long
surgical complications
bleeding stenosis stricture hydronephrosis infection lymphocele
variations in how long transplant takes to work
- immediate graft function
- delayed graft function (HD in interim, usually works in 10-30 days)
- primary non-function (never works)
types of rejection
hyperacute (nephrectomy required)
acute (increase immunosuppression)
chronic (slow decline in function)
immunosuppression
basiliximab/dacluzimab (monoclonal antibodies blocking IL-2 on CD4 T)
prednisolone (inhibit lymphocytes)
tacrolimus, ciclosporin (calcineurin inhibitors inhibit T cells)
MMF and azathioprine (anti-metabolites block purine synthesis and proliferation of lymphocytes)
adverse of immunosuppression
bacterial infections risk of CMV in first 3 months BK nephropathy non-melanoma skin cancer lymphoma (EBV)
