ASN QBank Pearls - Renal Transplant Flashcards Preview

Nephrology Board Review Pearls > ASN QBank Pearls - Renal Transplant > Flashcards

Flashcards in ASN QBank Pearls - Renal Transplant Deck (137)
Loading flashcards...
1

what are HLA class 1?

- A, B, C
- all nucleated cells

2

what are HLA class 2?

- DP, PQ, DR
- on Ag presenting cells (APCs)

3

sensitization of immune system occurs from

- blood transfusions
- pregnancy
- prior transplants

4

panel reactive antibodies (PRA)

- tells how sensitized a patient is to HLAs in general population
- 0-100%

5

donor specific antibodies (DSA)

- tests presence of Abs to DONOR'S HLA types only
- semiquantitative

6

crossmatch

- combines donor cells w/ recipient serum

7

positive crossmatch predicts what?

HYPERacute rejection

8

blood groups between donor and recipient must be

compatible (like blood transfusion)

9

crossmatch between donor and recipient must be

negative

10

HLA typing of donor and recipient determines

- matching compatibility
- range from 0/6 to 6/6

11

HLA matching has better outcomes if

match is 6/6

12

can rejection still occur if HLA match is 6/6? and, if yes, why?

- yes!
- non-HLA incompatibilities

13

contraindications to kidney transplantation

- poor cardiac function
- morbid obesity
- psychosocial issues which can affect compliance
- active infection
- recent, unresolved cancer
- ANY serious comorbidity which reduces life expectancy

14

infections that need to be tested for in a transplant recipient

- HBV
- HCV
- EBV
- CMV
- syphilis
- HIV
- latent TB

15

what cancer screening needs to done for transplant recipients?

- mammogram
- PAP smear
- PSA
- colonoscopy

16

waiting time after cancer treatment for most cancers before proceeding w/ transplant?

2 years

17

waiting time after cancer treatment for metastatic breast, colorectal, and melanoma before proceeding w/ transplant?

5 years

18

waiting time after cancer treatment for non-melanoma skin cancer and some in situ malignancies before proceeding w/ transplant?

none, considered low risk

19

contraindications to living donation

- age < 18
- GFR < 80 ml/min
- hematuria
- proteinuria
- HTN
- DM
- obesity
- h/o cancer
- infectious disease
- significant, unresolved medical issues
- psychosocial factors
- inability to give informed consent

20

long term risk of ESRD over 15 years for kidney donor

6 fold increase

21

donor evaluation

- H&P
- CMP
- FLP
- GFR; 24 hour urine
- UA, C+S
- serum hCG
- EKG
- CXR
- TTE
- age-appropriate cancer screening
- CT a/p
- SW evaluation

22

minimum criteria for listing for kidney transplant

- initiation of dialysis (time is backlogged from start time)
- GFR < 20 ml/min (time starts at time of eval and consent given to list)

23

what is a nonstand kidney?

- higher kidney donor profile index (KDPI) score (higher = worse)
- cardiac death donor (longer CIT)
- "higher-risk" donors
- HBV and/or HCV donors

24

thymoglobulin MOA

depletes T cells

25

basiliximab MOA

blocks IL-2 receptors in T cells

26

thymoglobulin adverse effects

- leukopenia
- thrombocytopenia
- fever
- flu-like symptoms

27

CNI MOA

binds FK-binding protein thus inhibiting response to IL-2

28

CNI adverse effects

- Afferent arteriole vasoconstriction
- hyperkalemia
- metabolic acidosis
- hypomagnesemia
- hyperglycemia and HLD by blocking beta cells in pancreas
- renal fibrosis (long-term)

29

azathioprine and MMF adverse effects

- leukopenia
- MMF can cause diarrhea

30

do levels of azathioprine and MMF correlate well with toxicity?

no