Kidney Transplant

Question 1

What is the name of the major histocompatibility complex (MHC) in humans?

Answer 1

Human leucocyte antigen (HLA)

Question 2

On which chromosome is HLA coded for?

Answer 2

Chromosome 6

Question 3

What are the class 1 HLA antigens?

Answer 3

class 1 antigens include A, B and C

Question 4

What are the class 2 HLA antigens?

Answer 4

Class 2 antigens include DP,DQ and DR

Question 5

When transplanting, what is relative importance of the matching the HLA antigens?

Answer 5

DR > B > A

Question 6

What are the possible post op problems of a kidney transplant?

Answer 6

ATN of graft
vascular thrombosis
urine leakage
UTI

Question 7

What are the possible contraindications of a kidney transplant?

Answer 7

Active infections
Cancer
Severe co-morbidity

Question 8

What is the main indication for a kidney transplant?

Answer 8

End-Stage Renal Failure

Question 9

What are the early complications related to the kidney transplant?

Answer 9

Infection
Urinary leak
Haemorrhage
Impaired graft function

Question 10

What are the late complications related to the kidney transplant?

Answer 10

Lymphocele
Ureteric stenosis
Renal artery thrombosis.

Question 11

What are the main complications caused by Rejection of the Transplant?

Answer 11

Hyperacute rejection (minutes to hours)
Acute graft failure (< 6 months)
Chronic graft failure (> 6 months)

Question 12

When does hyperacute rejection occur after the transplant?

Answer 12

Minutes to hours

Question 13

What is a hyperacute rejection due to?

Answer 13

Pre-existing antibodies against ABO or HLA antigens

Question 14

What type of reaction is a hyperacute rejection?

Answer 14

Type II hypersensitivity reaction

Question 15

What does a hyperacute rejection result in?

Answer 15

Widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ

Question 16

What is the management of a hyperacute rejection?

Answer 16

No treatment is possible and the graft must be removed

Question 17

How can a hyperacute rejection be avoided?

Answer 17

Pre-treatment ABO cross-matching.

Question 18

When does an acute graft failure occur?

Answer 18

In the first 6 months

Question 19

What is an acute graft failure due to?

Answer 19

Mismatched HLA

Question 20

What type of reaction is an acute graft failure?

Answer 20

Cell-mediated (cytotoxic T cells)

Question 21

How does an acute graft failure present?

Answer 21

Asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria

Question 22

What is a possible cause of an acute graft failure?

Answer 22

Cytomegalovirus infection

Question 23

What is the management of an acute graft failure?

Answer 23

Reversible with steroids and immunosuppressants

Question 24

How else can an acute graft failure present?

Answer 24

Fever
Pain around the graft site
Impaired renal function

Question 25

When does chronic graft failure occur?

Answer 25

After 6 months

Question 26

What is chronic graft failure characterised by?

Answer 26

Interstitial fibrosis and tubular atrophy.

Question 27

How can chronic graft failure present?

Answer 27

A gradual reduction in renal function and hypertension

Question 28

Does chronic graft failure respond to immunosuppression?

Answer 28

No

Question 29

What immunosuppressive therapy is usually given?

Answer 29

Ciclosporin Tacrolimus Mycophenolate mofetil

Question 30

What infection can occur secondary to immunosuppression?

Answer 30

Cytomegalovirus infection

Question 31

How can cytomegalovirus present?

Answer 31

Fever and disturbed LFTs a few weeks after the transplant operation.

Question 32

How can cytomegalovirus be managed?

Answer 32

Ganciclovir

Question 33

What malignancy can occur secondary to immunosuppression?

Answer 33

Skin (e.g. squamous cell carcinoma) Lymphoma (secondary to EBV re-activation).

Question 34

What would make you think of an acute graft failure?

Answer 34

Pyuria (raised leucocytes on his urine dip). Proteinuria (a raised protein on his urine dip). Rising creatinine (>1.5x from his post-operative baseline). Within a 6 month period

Question 35

What is a possible side effect of tacrolimus?

Answer 35

Impaired glucose tolerance and diabetes

Question 36

What are the possibel side effects of mycophenolate?

Answer 36

GI and marrow suppression

Question 37

What do patients on immunosuppression therapy need to be monitored for?

Answer 37

Cardiovascular disease Renal failure Malignancy