Transplant

Question 1

What is an autograft?

Answer 1

Tissue from the same body

Question 2

What is an isograft?

Answer 2

Tissue from an identical donor

Question 3

What is an allograft?

Answer 3

Tissue from a non-identical donor of the same species?

Question 4

What is a xenograft?

Answer 4

Tissue from another species.

Question 5

What are some contra-indications to donation of an organ?

Answer 5

HIV, CJD, HepB/C, Syphilis, TB, Malignancy
>80 years
Previous transplant
Neurological disease

Question 6

What are the stages of organ rejection?

Answer 6

Hyperacute: during surgery.
This occurs due to preformed antibodies such as ABO incompatibility. Renal transplants are at the greatest risk - they swell and discolour due to platelet and RBC clumping causing interstitial haemorrhage.

Acute: during the first 6 months.
This is T cell mediated as they recognise antigens bound to HLA DR, A, B, C
This can be controlled or reversed with steroids.

Chronic: after 6 months, due to myointimal proliferation/ vascular changes causing ischaemia

Question 7

What are some other complications of renal transplant (not rejection)?

Answer 7

Vascular: renal artery thrombosis, renal vein thrombosis, anastomotic leak, stenosis

Urinary: urine leaks, strictures

Lymphocele

Infection (CMV/EBV)

Transient non-functioning

Question 8

How would a renal artery thrombosis present after renal transplant?

Answer 8

Sudden onset of anuria, needs urgent surgery due to high risk of graft loss.

Question 9

How would a renal vein thrombosis present after renal transplant?

Answer 9

Pain, swelling, haematuria, oligouria

Question 10

How would a renal artery stenosis present after renal transplant?

Answer 10

Uncontrolled HTN, graft dysfunction and oedema.
Needs IR intervention

Question 11

How do you confirm chronic kidney transplant rejection?

Answer 11

biopsy

Question 12

How would a urine leak present after renal transplant?

Answer 12

High creatinine, low urine output, fever, pain
USS is likely to show a perigraft collection
Needs revision surgery

Question 13

How would a lymphocele present after renal transplant?

Answer 13

Palpable mass in the flank
Can be drained/sclerotherapy

Question 14

What infections are typical after renal transplant?

Answer 14

<6 months - CMV
> 6 months - EBV

Question 15

What are the indications for a liver transplant?

Answer 15

PBC
PSC
Alcoholic liver disease
Alpha-1-antitrypsin
Wilsons
Haemochromatosis
Biliary atresia
HepB/C
Budd Chiari

Question 16

What are the contraindications for a liver transplant?

Answer 16

++ comorbid
malignancy
sepsis
portal vein thrombosis
psychosocial

Question 17

What are the potential complications of liver transplant?

Answer 17

• Primary non function - - PT rises dramatically in first 24 hours.
• Early rejection- deteriorating LFT, trials steroids initially.
• Chronic rejection - needs re-transplant
• Increased risk of SCC.
• Infection
• Renal failure
• Biliary tree damage
• Vessel thrombosis
• Haemorrhage

Question 18

What immunosuppression should be given in transplant?

Answer 18

At the time of surgery give prednisilone and monoclonal antibodies

Then maintanence therapy is triple therapy:
steroids, calcineurin inhibitors (tacrolimus and ciclosporin), antiproliferative agents (MMF, azothioprine)