Renal Transplant Flashcards Preview

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Flashcards in Renal Transplant Deck (34):
1

A transplanted kidney is placed where?

Iliac fossa and anastomosed to the iliac vessels

2

What happens to native kidneys during a renal transplant?

Usually remain in situ

3

What are the indications for native nephrectomy?

Size (polycystic kidneys)

Infection (chronic pyelonephritis)

4

What is the Supply-Demand deficit for kidney transplants like currently?

Take on rate for end stage renal failure is increasing

Demand for transplantation is increasing

Marginal increase in transplant rate

Ever increasing size of waiting list and length of wait to first offer

5

How are countries dealing with increased kidney dornor demand?

More education
-Increase people willing to donate

More ABO incompatible
-Transplants of differing blood types

More dead donors

6

What are the different organ sources that can increase our donor pool?

Cadaver "brain dead" donors
-Standard/ extended criteria

Non heart beating donors
-Donation after cardiac death

Living Related donor

Living Unrelated donors
-Spousal
-Altruistic
-Paired/pooled

7

What are the brain death criteria?

Coma, unresponsive to stimuli

Apnoea off ventilator (with oxygenation) despite build up of CO2

Absence of cephalic reflexes

Body temperature above 34 degrees celcius

Absebce of drug intoxication
-Ethanol
-Anaesthetic drugs
-Paralysing drugs

8

What do we mean by abcence of cephalic (brainstem) reflexes in brain death criteria?

-Pupillary
-Oculovestibular
-Oculocephalic
-Corneal
-Gag
-Purely spinal reflexes may be present

9

How are deceased donor kidneys selected?

Standard criteria (DBD)

Extended criteria (ECD)
-Donor aged >60 years
-Donor aged >50 years with history of hypertension
-Stroke as a cause of death

Donation after cardiac death (DCD)

10

What are the different systems for living kidney donation?

Live related donor

Live unrelated donor (e.g. spousal)

Live unrelated donor - altruistic, non- directed

Paired/ pooled

ABO incompatible/ HLA incompatible

11

What are the positives and negatives of live unrelated kidney donation?

Negatives:
-Usually poorly matched
-Heavier immunosuppression
-Higher rate of sensitisation if it fails

Positives:
-High degree of donor/ recipient satisfaction
-Same survival as living related, better than cadaveric

12

What is paired donation?

Imagine 2 recipients.

Recipient 1 has a wife willing to donate but they have a cross-match incompatibility

Recipient 2 has a brother willing to donate but they have a blood type incompatibility.

With paired donation wife or recipient 1 can donate to recipient 2 and brother of recipient 2 can donate to recipient 1

Allowa sensitive individuals to find the correct pair and undergo transplant.

13

What is pooled donation?

Same principle as paired donation but more people involved -> potentially better match

Some dont want to enter a pool donation

14

What is the relative risk of death post op?

Is surgery worth it?

Higher risk of death around time of surgery

As this goes on -> around maybe 4 months the survival risk will decrease below relative risk

Transplant isnt without risk but long term seems to be worth it

15

What is the survival rate for kidney donors compared to the general population?

Vertually just as high as controls from the general population

Donation isnt associates with decreased survival as long as donors aren't inactive, bad diet etc

16

What complications can occur after a renal transplant?

REJECTION

Cardiovascular

Infective

Malignancy

17

What rejection complecations can occur after renal transplantation?

Cell mediated
Humoral (Ab mediated)

18

What cardiovascular complications may occur after renal transplantation?

Underlying renal disease
Chronic Renal Failure
Hypertension
Hyperlipidaemia
PT diabetes

19

What malignancy complications may occur after renal transplantation?

Skin
Lymphoma
Solid cancers

20

Why does hyperacute rejection occur?

Pre-existing alloreactivity to donor

21

What are the two types of acute rejection?

Acute T cell mediated rejection
-Acute cellular rejection

Acute antibody mediated rejection
-Acute humoral rejection, C4D+

22

What does Type I acute rejection involve?

Lymphocytic infiltrate

Tubulitis

23

What does Type II acute rejection involve?

Endarteritis

Endothelialitis

24

What does humoral rejection involve?

Neutrophil infiltration
-Glomeruli
-Peritubular capillaries
-> Endothelial swelling

Positive C4D
-peritubular capillaries

25

How does rejection come about?

Rediculously basic version

Antigen-presenting cells of host or donor origin migrate to T-cell areas of secondary lymphoid organs. These T cells ordinarily circulate between lymphoid tissues.

4 APCs present donor antigen to naive and central memory T cells. Antigen triggers T-cell receptors and synapse formation.

26

Describe immunosuppression agents and their action briefly

Non-specific
-Prednisolone
-Azathioprine

T-cell activation specific
-Cyclosporin
-Tacrolimus

mTOR inhibitors
-Rapamycin (sirolimus)

Anti-IL2 receptor antibodies

T cell antibodies
-ATG
-OKT3

27

What infection do you need to keep an eye out for in transplant patients?

CMV

Most common opportunistic infection after transplantation

High mortality if untreated

28

What are the primary effects of CMV infection?

-CMV syndrome
-Gastroenteritis
-Nephritis
-Hepatitis
-Pneumonitis
-Retinitis

29

how do you avoid CMV in renal transplant patients?

Prophylaxis for CMV shows increased survival

Usually given for 6 months

30

What problem can Human polyomaviruses cause?

Human polyomaviruses infect many types of cells, including kidney, brain, liver, retinal, lung, blood, lymphoid, heart, muscle, and vascular endothelial cells.

Viral particles bind a specific cell-surface receptor on a permissive cell type and produce T antigens early in the infection cycle. These antigens bind intracellular proteins to promote viral replication and block tumor-suppressor proteins (p53 and p105).

31

What viruses are included in polyomaviruses?

BK virus
JC virus

Murine polyoma virus
SV40

32

Why do we need to look out for BK virus?

BK virus (BKV) causes nephropathy in renal-transplant recipients and hemorrhagic cystitis in patients with AIDS and those who have undergone bone marrow transplantation

33

What is JC virus associated with

JC virus (JCV) is associated with progressive multifocal leukoencephalopathy (PML), primarily in patients with AIDS

34

How do you treat BK virus infection?

Antiviral therapy
-Cidofovir (+/- probenicid)
-Leflunomide

Modification of immunosuppression