Kidney transplant

Question 1

What is the gold standard treatment for end-stage chronic kidney disease?

Answer 1

Kidney transplant.

Question 2

How many patients are on the waiting list for KT in Italy?

Answer 2

More than 6,000 patients.

Question 3

How many kidney transplants are performed yearly in Italy?

Answer 3

Approximately 1,500.

Question 4

How many of the transplants in Italy are from living donors?

Answer 4

About 200.

Question 5

Who is responsible for patient eligibility and medical management for KT?

Answer 5

Nephrologists.

Question 6

When was the first kidney auto-transplantation performed in a dog?

Answer 6

1902

Question 7

Who performed the first successful human kidney transplant in twins?

Answer 7

Joseph E. Murray in 1953.

Question 8

Who received the Nobel Prize for vascular anastomosis?

Answer 8

Alexis Carrel in 1912.

Question 9

When was the first human robotic-assisted kidney transplant performed?

Answer 9

2010 by Pier Cristoforo Giulianotti.

Question 10

Which drugs revolutionized KT starting in the 1960s?

Answer 10

Azathioprine, cyclosporine, corticosteroids.

Question 11

What are absolute contraindications to KT?

Answer 11

Recently diagnosed tumors and infections.

Question 12

What is the serum creatinine threshold for end-stage renal disease?

Answer 12

SCr levels > 8 mg/dl.

Question 13

What is the eGFR threshold for end-stage renal disease?

Answer 13

eGFR < 10 ml/min/1.73m2.

Question 14

Name two types of deceased donors.

Answer 14

Donors after brain death and donors in cardiac arrest.

Question 15

What is a major advantage of living donor KT?

Answer 15

Shorter waiting time and elective surgery.

Question 16

What tests are performed for living donor evaluation?

Answer 16

Blood chemistry, CT with contrast, renal scintigraphy.

Question 17

What are the expanded criteria for deceased donors?

Answer 17

Older age, cerebrovascular death, hypertension, creatinine > 1.5 mg/dL.

Question 18

What does the Remuzzi score assess?

Answer 18

Kidney suitability for transplantation based on histological lesions.

Question 19

What Remuzzi score indicates an unsuitable kidney?

Answer 19

7 or more.

Question 20

What are the common causes of brain death donors?

Answer 20

Head trauma (40-60%), stroke (30-45%), anoxic encephalopathy (8-10%).

Question 21

What is Maastricht classification used for?

Answer 21

Categorizing non-heart-beating organ donors.

Question 22

What conditions must be corrected before transplantation in recipients?

Answer 22

Comorbidities, lower urinary tract obstruction, recurrent infections.

Question 23

What gene chromosome carries HLA genes?

Answer 23

Chromosome 6.

Question 24

Which HLA antigens are tested before transplantation?

Answer 24

HLA A, B, and DR.

Question 25

What is cross-matching?

Answer 25

Testing donor lymphocytes with recipient serum to detect hyperacute rejection risk.

Question 26

What ABO incompatibility rule applies to KT?

Answer 26

ABO compatibility is preferred but sometimes incompatible KT is done with immunosuppression.

Question 27

What is the initial surgical step in living donor nephrectomy?

Answer 27

General anesthesia and trocar insertion.

Question 28

What solution is used for kidney perfusion before implantation?

Answer 28

Ice-cold Marshall's solution.

Question 29

What are two kidney harvesting methods from deceased donors?

Answer 29

Separate harvesting and en-bloc harvesting.

Question 30

What is 'bench surgery'?

Answer 30

Preparation of the kidney including perfusion, fat removal, inspection, and vessel preparation.

Question 31

What is the first step in vascular anastomosis during KT?

Answer 31

Vein anastomosis.

Question 32

What are early surgical complications?

Answer 32

Wound infection, bleeding, hematuria, laparocele.

Question 33

What is the most common site for urinary fistulas?

Answer 33

Ureteral site.

Question 34

How often does thrombosis occur post-KT?

Answer 34

In about 0.5% of cases.

Question 35

What is a common late complication occurring up to 10 years post-KT?

Answer 35

Ureteral stenosis.

Question 36

What is lymphocele?

Answer 36

Collection of lymphatic fluid in the pelvic fossa.

Question 37

How is vesicoureteral reflux initially treated?

Answer 37

Endoscopic injection of bulking agent.

Question 38

What is the principle of immunosuppression?

Answer 38

The balance of survival.

Question 39

What are main drugs used for immunosuppression?

Answer 39

Tacrolimus, cyclosporine, mycophenolate, steroids, basiliximab, ATG.

Question 40

What are the two main types of rejection?

Answer 40

T-cell mediated rejection (TCMR) and antibody mediated rejection (ABMR).

Question 41

Which type of rejection may lead to hyperacute rejection?

Answer 41

Antibody-mediated rejection (ABMR).

Question 42

How is rejection diagnosed?

Answer 42

Kidney biopsy.

Question 43

What is the survival rate of living donor transplants after 1 year?

Answer 43

0.95

Question 44

What is the survival rate of deceased donor transplants after 1 year?

Answer 44

0.9

Question 45

What is the 5-year survival rate for living donor transplants?

Answer 45

0.8

Question 46

What is the 5-year survival rate for deceased donor transplants?

Answer 46

0.69

Question 47

What does ATG stand for in immunosuppression?

Answer 47

Anti-thymocyte globulin.

Question 48

What is the function of calcineurin inhibitors?

Answer 48

Suppress T-cell activity to prevent rejection.

Question 49

What is hyperacute rejection?

Answer 49

Immediate rejection due to preformed antibodies.

Question 50

What surgical procedure may be needed if rejection treatment fails?

Answer 50

Graft nephrectomy.