renal transplantation

Question 1

Where are transplanted kidneys placed in the body

Answer 1

Into the iliac fossa and anastomosed with the iliac vessels

Question 2

What happens to the original kidneys that failed

Answer 2

They normally remain in situ and are not removed unless they become too large like in polycystic kidney disease or if the native kidney is a source of infection

Question 3

How are donor kidneys preserved in living donor nephrectomies

Answer 3

As soon as the kidney is taken out, the timer begins from when the kidney is without blood supply - the kidney is placed into a cold storage solution after it is taken out of the donor

Question 4

What is a lymphocele

Answer 4

Collection of lymph in a cavity

Question 5

What are complications of kidney transplants

Answer 5

Bleeding
Arterial and venous thrombosis
Lymphocele
The ureter of the donor kidney is implanted in the donor so there is a chance that ureteric leak may occur

Question 6

What are the standard immunosuppressive agents after renal transplant

Answer 6

An induction agent - anti-CD25 - basiliximab

Calcineurin inhibitor - tacrolimus

Mycophenolate mofetil agents with corticoid steroids

Question 7

What are side effects of corticosteroids

Answer 7

Hypertension, hyperglycaemia, infection risk, bleeding in the GI tract and bone loss

Question 8

What are side effects of tacrilomus which is a calcineurin inhibitor

Answer 8

Hypoglycaemia, AKI and tremor

Question 9

What are side effects of cyclosporin

Answer 9

hirsutism - abnormal growth of hair on a woman
Hypertension
AKI
gout

Question 10

What are the side effects of mycophenolate mofetil which is given with corticoid steroids

Answer 10

Cytopenia where there is a lower blood count than usual
It can also cause GI upset - specifically GI upset

Question 11

What are the types of deceased donors

Answer 11

Donation after brain death

Donation after cardiac death

Question 12

What is the difference between donation after brain death and donation after cardiac death

Answer 12

In the brain death, the heart is still pumping blood to the kidneys so it is still perfused compared to the cardiac death donor whos kidneys has stopped being perfused

Question 13

What are the types of living donors

Answer 13

Living related donor

Living unrelated donor

Question 14

What is the criteria for brain death

Answer 14

Coma - unresponsive to stimuli
Cannot breathe without ventilator
Abscense of cephalic reflexes such as corneal, gag and pupillary

Question 15

What is expanded criteria in organ donation

Answer 15

Description of organs which have a higher rate of failing

Donor aged oleder than 60 or 50-59 with comorbidity such as hypertension, death from cerebrovascular accident or a high serum creatinine above 133 micromol per litre

Question 16

Which type of donation has better survival rates

Answer 16

Living donor transplants

Question 17

What age is transplants more common in

Answer 17

Younger patients because transplants have a lot of risks so it may not be worth the complications in an elderly patient

Question 18

What is an altruistic donor

Answer 18

Random donor donating to someone they do not know

Question 19

What happens to the GFR of the donor

Answer 19

there is a initial decrease in GFR but eventually the remaining kidney begins to work better and the GFR comes back to a normal range

Question 20

What are complications after renal transplant

Answer 20

Rejection of organs
Cardiovascular- hypertension
Infection
Malignancy

Question 21

What are the parts of t cell mediated rejection

Answer 21

tubulointerstitial, arteritis and arterial fibrinoid necrosis

Question 22

What are the parts of acute antibody mediated rejection

Answer 22

ATN-like
Capillaries and or glomerular inflammation
Arterial inflammation

Question 23

What is seen on histology when looking at T cell mediated rejection

Answer 23

T cells invading the tubules - tubulitis
lymphocytes getting into the intima which results in endothelialitis

Question 24

What can be done to prevent antibody mediated rejection

Answer 24

A test can be done to check if the patient has got antibodies against the donor cells and how many are there and which antigen specifically are they against

Question 25

What causes diabetes mellitus after transplantation

Answer 25

The mix of immunosuppression with steroid use

Question 26

What is the most important transplant-related infection

Answer 26

cytomegalovirus