Renal transplantation Flashcards Preview

Year 2 > Renal transplantation > Flashcards

Flashcards in Renal transplantation Deck (49):
1

What happens to the non-functioning kidneys in renal transplant?

Nothing - leave them where they are

2

Where is a kidney transplant placed?

Right iliac fossa

3

Which vessels are kidney transplants anastomosed onto?

External iliac artery and vein
Ureter

4

What needs to be compatible with regard to transplants?

Blood group
Human leucocyte antigen matching (tissue typing)

5

What is blood group compatibility?

Blood antigens must match as antibodies for the other blood antigens are found within the blood

6

Which blood group does not have an antibody against it?

O

7

What are human leucocyte antigens?

Cell surface proteins which activate the immune system when foreign antibodies bind

8

What are the 3 important types of HLA with respect to transplantation?

HLA DR
HLA A
HLA B

(Dr Ab)

9

With respect to each HLA A, B & DR there are two antigen subtypes. Why is this?

Each parent passes on one subtype to their offspring

10

Why is HLA relevant?

If a patient has been exposed to their donors HLA antigen before they might have developed an antibody against it and this will therefore cause tissue rejection

11

A more closely matched kidney is associated with improved survival length of the transplant. T/F

True

12

How might a patient be exposed to other HLA antibodies?

Blood transfusions
Pregnancy (placental maternal blood flow)
Previous transplants

13

Reduced cold ischaemic time is associated with better transplant survival. T/F

True

14

Explain transplant rejection

HLA antigen binds to dendritic cells -->
Antigen presenting cells express antigen on MHC complex -->
Helper T cells are activated -->
Increase B cell efficiency ; complement pathway activation ; increase in NK cells and cytotoxic T cells -->
Antibody production ; Direct cell killing -->
Rejection

15

What is the difference between cellular rejection and antibody mediated rejection?

Cellular rejection - NK cells and CD8 cells
Antibody mediated - B cells

16

Immunosuppression increases the risk of what?

Infection
Malignancy

17

Which infections are immunosuppressed patients prone to?

CMV (herpes group)
Pneumocystitis jirovecii
Recurrent UTI
BK virus

18

Which malignancies are immunosuppressed patients prone to?

Non melanoma skin cancer (SCC)
Post transplant lymphoma

19

Why is CMV important in terms of transplant immunology?

Giving a patient not infected with CMV a CMV infected kidney is bad news unless you give antivirals (valganciclovir)

20

How is pneumocystis jirovecii treated?

Co-tramoxazole

21

EBV post-transplant increases risk of what?

Lymphoma

22

How is post transplant lymphoma treated?

Reduction in immunosuppression + anti cancer agents

23

What biochemical marker might help to warn of kidney transplant rejection?

Serum creatinine

24

Which cells must be repressed post-transplantation?

T helper cells
B cells

Hence complement & cytokines

25

List the types of transplant rejection

Hyperacute
Acute
Chronic

26

What causes hyperacute transplant rejection? How long does it take to occur? How is it managed?

Preformed antibodies to transplant antigens
Minutes
Transplant removal

27

How is acute transplant rejection caused? How is it managed?

T cells or B cells
Early
Increased immunosuppression (+ steroids in short term)

28

How is chronic transplant rejection caused? How is it managed?

Immunological and vascular deterioration
Unsure how to treat

29

Describe how transplant patients are immunosuppressed

Induction - high dose steroids, MMF, cyclosporin, tacrolimus, antibodies
Consolidation - lowered doses
Maintenance - balanced low doses

30

Name two calcineurin inhibitors

Cyclosporin
Tacrolimus

31

How do calcineurin inhibitors work?

Reduce NK and CD8 cell activation and thus decrease cytokine release (preventing B cell proliferation and antibody production)

32

What are the side effects of calcineurin inhibitors?

Renal dysfunction
Hypertension
Diabetes (in at risk populations)
Tremors

33

Which organ are calcineurin inhibitors metabolised by? Why is this relevant?

Liver
The specific liver pathway that metabolises calcineurin inhibitors also metabolises lots of other drugs hence drug interactions can be an issue

34

How do azathioprine and mycophenolate work?

Block purine synthesis thereby suppressing the proliferation of lymphocytes and B cells

35

What are the side effects of azathioprine and mycophenolate?

Leucopaenia
Anaemia
GI disturbance

36

Which drug should you not give azathioprine with?

Allopurinol

37

How do steroids work with regards to immunosuppression?

Non selective suppression of T cells and B cells

38

What are the side effects of steroids?

Osteoporosis
Weight gain
Infection
Diabetes

39

What types of kidney donation exist?

Deceased brain dead
Deceased cardiac death
Live donor
Kidney pancreas

40

Which type of diabetes patients are suitable for pancreas transplantations?

Type 1 diabetics with renal failure

41

What is the criteria for a patient to be eligible for transplant?

Life expectancy >5 yr
No cadaveric transplant if >6 months prior to starting haemodialysis
Tissue type match (person who has been on list longest gets organ)

42

How must transplant patients be assessed?

CVS risk (ECG, cholesterol, ETT +/- angiogram, echo)
Virology (hepatitis, HIV, CMV, EBV)
Chest x-ray
Bladder assessment
Investigation of co-morbidity

43

Which viruses should be treated prior to transplant?

Hep B
Hep C
HIV

44

What are the absolute contraindications to transplant?

Untreated malignancy
Untreated TB
Severe IHD
Severe airways disease
Active vasculitis
Severe peripheral vascular disease

45

How is a live donor assessed?

ECG
Chest x-ray
Virology
GFR (direct measure)
Proteinurea quantification
24hr blood pressure
Renal angiogram
X-match against recipient

46

What might a renal transplant scar look like?

Like appendix scar but bigger and with underlying mass

47

What are the complications of transplant?

Haemorrhage
Stenosis/thrombosis
Ureteric stricture and hydronephrosis
Wound infection

48

Why do post transplant patients get a central line?

To measure central venous pressure

49

How will delayed graft function present? How is it treated?

Post transplant acute tubular necrosis
Haemodialysis until begins to work within 10-30 days

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