Apart from dialysis, what can be offered to patients with end-stage CKD?
What is the best option out of dialysis and renal transplant?
Which type of renal transplant has the best prognosis?
Those from LIVE, RELATED donors
e.g your bro
What CKD stage corresponds with end-stage disease?
What is the GFR threshold?
GFR < 15
What GFR will patients achieve at best
a) on dialysis
b) after a transplant?
a) 7 (so they'll still feel miserable)
b) 50 (more freedom, better QOL)
From which groups of donors can transplants be taken?
___ is required to prevent organ rejection.
Which patients are less likely to receive kidney transplants?
Co-morbidities, less likely to achieve good outcomes
In which situations are organs taken from cadaveric donors?
Brain stem death (so intubated, HB but no signs of life)
No heart beat (very rapidly after death)
organs taken very rapidly and transported to patient
Why are cadaveric organs from brain stem death donors more useful than those from recently dead donors?
Brain stem death - organs still perfused
Recently dead - "ischaemic hit"
Donation from living donors is also known as ___ donation.
Organ donation involving the exchange of money/services is ___.
in the UK
Patients with CKD5 are only considered for transplant if they are going to live for more than ___ years.
What affects a patient's suitability for surgery?
Co-morbidities - frailty, bleeding, CVD
Response to anaesthetic
What must the donor be assessed for before somebody receives their organ?
stuff like hepatitis, HIV, cytomegalovirus...
How is a patient's CVD and pulmonary risk assessed before they receive a transplant?
Chest X-ray, pulmonary function tests
What organ structures must be checked before a patient receives a renal transplant?
Current renal blood supply
What are conditions are contraindications to renal transplant?
why would you immunosuppress these patients
otherwise: severe CVD, respiratory problems
What contraindicates someone from donating a kidney?
Not physically fit
Poor renal function - existing renal disease?
Co-morbidities - e.g DM
Kidneys not structurally, immunologically suitable
Donor is being cooerced
Donors with blood group ___ can donate to anyone.
What are the four blood groups?
compatible with what the other person's got
O covers all
How are tissues matched in organ donation?
If the donor tissue doesn't match the recipient's blood group and HLA genotype, what occurs?
What events can sensitise patients to antigens and predispose them to organ rejection?
Why may a woman be sensitised to her husband's kidneys?
Which patients are given priority on the kidney transplant list?
How can patients be desensitised to donor tissue?
Biologics (e.g rituximab - B cell inhibitor)
What is the down side of desensitisation?
so patient is at less risk of rejection but increased risk of all the side effects
Where is the incision made in a kidney transplant?
Which artery and vein are transplanted kidneys connected to?
External iliac artery
External iliac veins