Kidney transplant

Question 1

What are the two possible complications of kidney transplants?

Answer 1

Surgical

Immunological

Question 2

What technique was used in the early days to test susceptibility?

Answer 2

Skin grafts

Compatible = no raised skin 
Incompatible = raised skin

Question 3

What are the two sources of donor organs?

Answer 3

Living - altruistic, friends or family

Cadaveric - with or without a heartbeat

Question 4

Which source of organs has the best outcome?

Answer 4

Patients that are living and related/ married

Question 5

Why do cadaveric organ transplants have such bad outcomes?

Answer 5

High levels of antigens and adhesion molecules formed as a result of injury from inflammatory events that happened around the time of brain death

Question 6

What are the risks of transplantation?

Answer 6

Infections

Malignancies

Drug related side effects

Question 7

Why do transplant patients have increased susceptibility to infections?

Answer 7

Posttransplantation lymphoproliferative disease caused by Epstein-barr virus infection

Infects the B cells

Virus can be reactivated post-transplant or come from primary EBV infection

Question 8

Why do transplant patients have increased cancer risks?

Answer 8

Cytotoxic T cells are suppressed by immunosuppressants

Question 9

What are drug related side effects that arise in transplant patients?

Answer 9

Nephrotoxicity

Metabolic effects - diabetes and hypertension

Bone marrow suppression - low WBC count or haematological malignancies

Calcineurin inhibitor toxicity - induce injury to the kidneys

Question 10

What are common drugs used in transplantations?

Answer 10

Clacineurin inhibitors - prevent T cell activation

Anti-proliferative agents - prevent B and T cells from proliferating

Steroids

mTOR inhibitors

Induction agents - suppress lymphocyte activation

Question 11

What does mTOR do?

Answer 11

mTOR is a signalling pathways that serves as a central regulator of:

Cell metabolism
Growth
Proliferation
Surivival

Question 12

What is a type of induction agent?

Answer 12

Anti-CD25 blocking monoclonal antibody

Question 13

What stage do induction agents target?

Answer 13

Initial stage of the transplant when there is greates immune response

Question 14

What is the difference between warm and cold ischaemia?

Answer 14

Warm ischaemia - kidney is in the body but not perfused with blood

Cold ischaemia - when kidney is removed and placed in ice

Question 15

Why are organs placed on ice?

Answer 15

To cool down and reduce metabolic requirement

Question 16

What has more effect on the survival outcome, warm or cold ischaemic time?

Answer 16

Cold ischamic time

Question 17

What is the mean time for survival of kidney transplant?

Answer 17

14 years

Question 18

What increases survival of renal failure more, transplant or dialysis?

Answer 18

Dialysis

Question 19

Why are there criteria for brain stem death?

Answer 19

To secure the knowledge that there is no chance of recovery

Question 20

What are the criteria for brainstem death?

Answer 20

Brainstem function must have ceased

No corneal reflex

Taken off ventilator and increasing CO2 levels should cause patient to breathe on their own

Question 21

How many doctors must confirm brainstem death?

Answer 21

2 independent doctors

Question 22

Why must 2 independent doctors confirm brain stem death?

Answer 22

Relay anxiety that organs are being removed from dying patients

Question 23

Is passing brainstem death test enough to take organ from cadaveric patient?

Answer 23

No. The donor must have signed a donor card