Flashcards in Renal Transplantation Deck (20)
Due to +ve Xmatch (preformed antibodies to the Tx)
Hyperacute rejection (minutes)
T cell or B cell mediated response
Can be treated with increased immunosupression
Immunological and vascular deterioration of the Tx
Chronic rejection of the transplant
Immunosuppression used in transplantation?
How do ciclosporin and tacrolimus work?
Inhibit activation of T cells
-Reduce NK cells activation
-Reduce cytotoxic T cell activation
-Decrease cytokine release so prevent B cell proliferation and antibody production
Side effects of cyclosporin and tacrolimus?
-metabolised by cytochrome p450 so lots of drug interactions
Antimetabolites by blocking purine synthesis
Leads to suppression of proliferation of lymphocytes and B cells
Aziathioprine and mycophenolate
Side effects of aziathioprine and mycophenolate?
GI side effects
Act non selectively to suppress activity of T cells and proliferation of B cells?
The 3 types of kidney donor?
Deceased brain dead
Deceased cardiac death
Live donor kidney, kidney pancreas dual transplant
Suitability for transplantation?
Patient should have reasonable life expectancy ( >5 years)
To ensure equity of provision should not get cadaveric Tx > 6 months prior to starting HD.
Allocation of kidneys in UK is based predominantly on Tissue typing and then time on list, not the other way round
Assessment of cardiovascular risk?
ECG, Cholesterol, ETT, Coronary Angiogram, Echocardiogram
Virology assessment pre-transplant
HBV, HCV, HIV, CMV, EBV
HBV, HCV and HIV should be treated and controlled pre transplant
When would you do a bladder assessment before transplantation?
If PHx or urological problems
Absolute contraindications for kidney transplant
Known untreated malignancy
Hx of solid tumour within 2 years (For some tumours 5 years)
Severe IHD not amenable to surgery (should be carried out prior to Tx)
Severe airways disease
Severe PVD (Unusable vessels)
Surgical complications of kidney transplant
Bleeding (arterial or venous)
Arterial Stenosis / Thrombosis
Venous stenosis / Thrombosis
Ureteric Stricture and hydronephrosis
Post transplant care
HDU Care post op
Central Line to measure CVP
Bladder catheter for measuring urine output
IV Fluids to maintain hydration
Daily monitor of UE’s and drug levels
Regular MSU to look for infection
Discharge about 7 Days
Immediate graft function vs delayed graft function
Immediate Graft Function
Urine Output good
Falling creatinine and Urea
Delayed Graft Function
Post Tx acute tubular necrosis
Tx will work after 10-30 days
Will need Haemodialysis in interim
Difficult to detect rejection ( Need Bx)
Primary non function?
Transplant never works