W3L5 Surgical Aspects of Renal Transplantation

Question 1

Treatment Of ESRD

Answer 1

1. Renal transplant

2. Dialysis

Question 2

Causes renal failure?

Answer 2

Adult:
-Chronic GN
-HTN nephrosclerosis
-Diabetes
-ADPK
Children:
-Nephropathy
-Obs uropathy

Question 3

CI renal transplant

Answer 3

Absolute:
-Active inf
-Active malig
Relative:
-Age
-Viral hepatitis
-Systemic disease

Question 4

Types donor?

Answer 4

Living donor:
-related -unrelated
Deceased donor

Question 5

Choice donor

Answer 5

Living
• General fitness.
• ABO & HLA compatibility, cross match
• IVP, angiography, renogram

Deceased
• Free of generalized disease
• Age 2-60
• ABO & HLA compatibility, cross match

Question 6

Living donor nephrectomy?

Answer 6

• Technique
• Flushing(Ringer’s lactate-isotonic)
• No storage

Question 7

Deceased donor nephrectomy?

Answer 7

• Technique(liver+ kidney+ panc + heart & lung)
• Flushing(hypertonic)
• Storage
  
  • Surface cool(simple, common)
  • Pulsatile perfusion(difficult, limited)

Question 8

Technique of renal transplantation?

Answer 8

• Incision
• Preparation renal bed
• Vascular anastomosis
  
  • Vein
  • Artery
• Uretero-vesical anastomosis

Question 9

Immunology of Transplantation?

Answer 9

1. Autograft(own tissue)
2. Isograft(gen identical)
3. Allograft(gen non-iden,same spec)
4. Xenograft(dif species)

Question 10

Immunosuppression?

Answer 10

• Azathioprine
• Corticosteroids
• Cyclosporine
• Antilymphocyte/ antithymocyte globulin (ALG/ATG)
• OKT3
• FK 506
• Rapamycin

Question 11

Comp renal transplant?

Answer 11

- Vacular complications
  • Renal artery thrombosis
  • Renal artery stenosis
- Urological complications
  • Urinary extravasation
  • Ureteral obstruction 
- Lymphocele
- Infections
- Cancer

Question 12

Graft Survival

Answer 12

1- year 90%
5-year 60%
10-year 40%