Renal Transplantation Flashcards Preview

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Flashcards in Renal Transplantation Deck (20)
1

Due to +ve Xmatch (preformed antibodies to the Tx)
Unsalvageable
Remove kidney

Hyperacute rejection (minutes)

2

T cell or B cell mediated response
Can be treated with increased immunosupression

Acute rejection
(usually early)

3

Immunological and vascular deterioration of the Tx

Chronic rejection of the transplant

4

Immunosuppression used in transplantation?
(S&M, CT)

Steroids
MMF
CyA
Tacrolimus
Antibodies

5

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

6

Side effects of cyclosporin and tacrolimus?

Renal dysfunction
Hypertension
Diabetes
Tremor

-metabolised by cytochrome p450 so lots of drug interactions

7

Antimetabolites by blocking purine synthesis
Leads to suppression of proliferation of lymphocytes and B cells

Aziathioprine and mycophenolate

8

Side effects of aziathioprine and mycophenolate?

Leucopenia
Anaemia
GI side effects

(LAG)

9

Act non selectively to suppress activity of T cells and proliferation of B cells?

Steroids

10

The 3 types of kidney donor?

Deceased brain dead
Deceased cardiac death
Live donor kidney, kidney pancreas dual transplant

11

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

12

Assessment of cardiovascular risk?

ECG, Cholesterol, ETT, Coronary Angiogram, Echocardiogram

13

Virology assessment pre-transplant

HBV, HCV, HIV, CMV, EBV
HBV, HCV and HIV should be treated and controlled pre transplant

14

When would you do a bladder assessment before transplantation?

If PHx or urological problems

15

Absolute contraindications for kidney transplant

Malignancy
Known untreated malignancy
Hx of solid tumour within 2 years (For some tumours 5 years)
Untreated TB
Severe IHD not amenable to surgery (should be carried out prior to Tx)
Severe airways disease
Active vasculitis
Severe PVD (Unusable vessels)

16

Surgical complications of kidney transplant

Bleeding (arterial or venous)
Arterial Stenosis / Thrombosis
Venous stenosis / Thrombosis
Ureteric Stricture and hydronephrosis
Wound infection

17

Post transplant care

HDU Care post op
Central Line to measure CVP
Bladder catheter for measuring urine output
IV Fluids to maintain hydration
Oxygen

Maintain hydration
Daily monitor of UE’s and drug levels
Regular MSU to look for infection
Discharge about 7 Days

18

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)

19

Primary non function?

Transplant never works

20

Which type of cancer is associated with kidney transplant?

Skin cancer