Renal Transplantation

Question 1

most common reasons for transplanting?

Answer 1

Diabetes

20-39, and 40-59 year olds

Question 2

Is transplant cheaper than dialysis?

Answer 2

Yes

Question 3

What to asses prior to transplanting?

Answer 3

Age
Cardiovascular fitness
Comorbidity
Obesity, cancer, infections, respiratory disease, smoking
Renal history
original diagnosis, duration of dialysis, previous transplants
Blood group
Tissue type
Potential living donor?

Question 4

What conditions does brain stem death require tobe for transplantation?

Answer 4

Identifiable pathology causing irremediable brain damage
Not hypothermic
Not due to drugs
Reversible circulatory, metabolic, endocrine disturbances excluded
Deeply unconscious
Apnoeic

Two doctors
GMC registered > 5 years
At least one Consultant
Not members of the transplant team
Acting together
Two occasions

Question 5

Test for brain stem death?

Answer 5

No pupillary response (II, III)
No corneal reflex (V, VII)
No motor response in cranial nerve distribution (V, VII)
No cough or gag reflex (IX, X)
No vestibulo-ocular response – caloric testing (VIII, III)
Apnoea test

Question 6

Clases of HLA?

Answer 6

Class I MHC proteins (HLA A, B, Cw)
Present on all nucleated cells
Present peptides derived from cytosolic degradation (both self and non-self, eg virus)

Class II MHC proteins (HLA DP, DQ, DR)
Present on specific immune cells - “Professional Antigen Presenting Cells” (APCs)
Present peptides derived from extracellular sources, eg bacteria

Question 7

common HLA 1 types?

Answer 7

Common
A1 (37%) A2 (51%)
B8 (30%) B12 (34%)
DR3 (30%) DR4 (37%)

Question 8

family transplant?

Answer 8

Complete match (25%)
 Share half (50%)
 Complete mismatch (25%)

Question 9

Rejection mechanism?

Answer 9

Hyperacute
Minutes – hours following transplantation
Due to preformed antibodies (ABO or HLA)
Antibodies identified by screening and cross-matching
This should not happen!

Acute
Occurs in first few days - months
Immune mediated

Chronic
Gradual attrition over months – years
Multifactorial

Question 10

Port transplant management?

Answer 10

Immunosuppression for life
Steroids
Cyclosporin or tacrolimus – prevent Il-2 activation of T cells
Azathioprine or mycophenolate mofetil – anti-proliferative
Prophylaxis against opportunistic infections
Long term surveillance for malignancy
Long term of control of cardiovascular risk factors

Question 11

What are the risks?

Answer 11

Long term
Blood pressure
Proteinuria
Kidney function
Pregnancy after donation
Life expectancy
Better than general population