Renal Transplantation

Question 1

Induction of immunosuppression?

Answer 1

basilixmab

Question 2

maintenance of immunosuppression?

Answer 2

tacrolimus + mycophenolate + steroids

steroid free if possible

Question 3

brain death criteria in donors?

Answer 3

coma, unresponsive to stimuli
apnoea off ventilator with oxygen despite Co2 build up
absence of cephalic reflexes
- pupillary, corneal, gag
body temperature above 34
absence of drug intoxication

Question 4

complications after renal transplantation?

Answer 4

rejection - cell mediated or humoral (Ab)
cardiovascular
infective
malignancy

Question 5

transplant rejection can be?

Answer 5

hyperacute rejection

acute rejection

Question 6

acute rejection?

Answer 6

T cell mediated rejection (Banff I, II & III)

Question 7

T cell mediated rejection? (2)

Answer 7

lymphocyte infiltrate - tubulitis

endarteritis - endothelialitis

Question 8

antibody mediated rejection?

Answer 8

microvascular inflammation
- neutrophil infiltration
- glomeruli
- peritubular capillaries
donor specific antibodies
positive CD4

Question 9

what is the most important transplant related infection?

Answer 9

cytomegalovirus

8% of patients despite prophylaxis

Question 10

how does CMV manage to affect patient? (2)

Answer 10

transmission from donor tissue

reactivation of latent virus

Question 11

what happens in CMV infection?

Answer 11

CMV viremia

tissue invasive disease

Question 12

malignancy after renal transplant?

Answer 12

non melanoma skin/NHL - 20
renal - 15
melanoma, cervical - 5
testicular bladder - 3
colon, lung, breast - 2