Renal Transplantation Flashcards
(52 cards)
What is a transplant?
Tissue taken from one person and placed in another = donor may be living or dead
Why must patients who receive a transplant started on immunosuppression?
The transplant is recognised as foreign by the immune system = must be suppressed to prevent rejection
What are some types of donors?
Decreased heart beating donors = brainstem death Non-heart beating donors Live donation (altruistic) = directed/undirected, paired donation, financially procured
What must be life expectancy of a patient be for them to be considered to receive a transplant?
> 5 years after transplant
How long does it take for a survival benefit from a transplant?
3 months after transplant
How are patients assessed before a transplant?
Immunology = tissue typing, antibody screening
Virology = HBV, HCV, HIV, EBV, VZV, syphilis
Assess CV risk = ECG, echo +/- ETT, angiogram, CXR
Assess peripheral vessels, bladder function, mental state and any co-morbidities
What are the contra-indications to getting a transplant?
Malignancy = known untreated cancer, solid tumour in last 2-5 years
Active HCV/HIV infection or untreated TB
Severe IHD, not amenable to surgery
Severe airways disease or peripheral vascular disease
Active vasculitis or hostile bladder
How are potential donors assessed?
Physical fitness for surgery and not being coerced
Anatomically normal kidneys
Enough renal function to remain independent after
Co-morbidities = hypertension, protein/haematuria
Immunologically compatible
What blood groups are compatible with each other?
Group O = all blood types
Group A = A and O
Group B = B and O
Group AB = O and AB
Why is HLA matching important?
Matching HLA is critical without immunosuppression and gives better graft survival with immunosuppression
What does HLA matching identify?
Sensitisation to subsequent transplants
What are sensitising events?
Lead to formation of pre-formed antibodies = blood transfusion, pregnancy/miscarriage, previous transplant
What is desensitisation?
Active removal of blood group or donor specific antibody = plasma exchange or B cell antibody (rituximab)
What kind of procedure is a transplant?
Extraperitoneal = wound usually 15-20cm long, operation lasts 2-3hrs
Where is the transplant inserted?
Iliac fossa = attached to external iliac artery and vein, ureter plumbed into bladder with stent
How long is the recovery from the operation?
7-10 days in hospital = usually back to normal activities and work in 3 months
What are some of the complications from surgery?
Bleeding, arterial stenosis, venous stenosis or kinking, ureteric stricture and hydronephrosis, wound infection, lymphocele
What are the outcomes after transplantation surgery?
Immediate graft function, delayed graft function or primary non-function
How can you tell if there is immediate graft function?
Good urine output, falling urea and creatine
What are some features of delayed graft function?
Post transplant ATN, often need haemodialysis in interim, usually need biopsy to exclude rejection, works within 10-30 days
What is the outcome of primary non-function?
Transplant never works
What are the types of transplant rejection?
Hyperacute, acute, chronic
What causes a hyperacute rejection?
Preformed antibodies = unsalvageable, transplant nephrectomy required
What causes acute rejection?
Cellular or antibody mediated = can be treated with increased immunosuppression
