Kidney Transplant

Question 1

WHat are the different Deceased donor types?

Answer 1

Standard Criteria Donor
Extended Criteria donors:
->60yo
-50-59 w/HTN, Death from CVA
Donation after Cardiac Death
CDC High risk

Question 2

What are absolute contraindications for kidney donation?

Answer 2

Active Malignancy
Acute infection
Active SLE or vasculitis
Substance abuse
Pos T cell Crossmatch

Question 3

What are relative contraindications for kidney donation?

Answer 3

Advanced Cardiopulm disease
Peripheral vasc disease
Severe Chron liver dis
Morbid Obesity
Psychiatric Disorder
ABO or HLA incompatible
Life Span

Question 4

What are the major immunologic barriers to transplant?

Answer 4

ABO Blood Group
MHC loci
Preformed circulating Ab in host reactive to HLA Ag

Question 5

What are the medications for induction of Immunosupression?

Answer 5

Corticosteroids
Anti-thymocyte globulin
IL-2 receptor Antagonists

Question 6

What are the medications for Maintenence of Immunosupression?

Answer 6

Corticosteroids
Calcineurin Inhibitors
mTOR inhibitors
Antimetabolites

Question 7

What are common complications of Transplantation?

Answer 7

Early: Surgical, slow graft funct, lymphocele
Acute rejection
Infectious complications 
Malignancy
Chronic Allograft dysfunction

Question 8

What are the surgical Complications of Transplantation?

Answer 8

Graft Thrombosis

Urine Leak

Question 9

What is the management of Delayed graft function? Causes?

Answer 9

Need dialysis in first week after transplant
Cause: Prolonged cold ischemia
Acute Rejection
Recurrent Disease

Question 10

What are the S and S of Lymphocele?

Answer 10

Compression of kidney, ureter, bladder, iliac vessels, lower ext edema
Abdominal mass

Question 11

What is the cause of Hyperacute rejection?

Answer 11

Preformed antibodies that recognize HLA antigens in donor organ
=> Fibrinoid necrosis
Tx Plasmapheresis and pulse steroid

Question 12

What is the cause of Acute rejection?

Answer 12

Activated T-Lymphocytes
In first 6 mon
S and S: Increase in s. creatinine +/- Oliguria

Question 13

What is the Tx of Acute rejection?

Answer 13

Cellular: Steroids, Anti T cell Ab
Humoral: Plasma exchange
IVIgG
Rituximab
Bortezomib

Question 14

What are the signs of Chronic Allograft Rejection?

Answer 14

Slow and gradual decline in renal function >6mon after transplant

Question 15

What drug is used for prophylaxis against CMV?

Answer 15

Vlgancyclovir

Question 16

What is the Treatment of extensive/invasive CMV?

Answer 16

IV Gancyclovir

Question 17

What is the Treatment of BK virus infection?

Answer 17

Carefully reduce Immunosupression
Leflunomide
IVIg

Question 18

Why are transplant recipients more suceptible to Malignancy?

Common types?

Answer 18

Impaired immune surveillance
Kaposi Sarcoma
Post-Transplantlymphoproliferative disorder

Question 19

What meds are used for post transplant HTN?

Answer 19

CCBs: Nifedipine
Amlodipine
Isradapine

Question 20

What meds are NEVER used for post transplant HTN?

Answer 20

Diltiazem
Nicardipine
Verapamil

Question 21

What causes Hyperkalemia after Transplant?

Answer 21

Hypoaldosteronism in Diabetics

Beta Blockers

Question 22

What are the immunosupressive drugs safe to use in pregnancy?

Answer 22

Tacrolimus
Cyclosporine
Azathioprine
Prednisone(low dose, avoid if possible)

Question 23

What Are the combo of drugs used to prolong the Life of transplant?

Answer 23

Aspirin CVD
ACEI/ARB
HMGCoA
Oral Vancyclovir
Bacterim
TUMS for osteoporosis
Viamin D
Sunscreen