Transplantation Flashcards
(42 cards)
Name three types of transplant
Deceased heart beating
Non-heart beating
Live donations
What investigations do potential recipients have to undergo before they can receive a transplant?
Immunology Virology Cardiorespiratory risk Peripheral vessel assessment Bladder function Mental state Comorbidities
What infections are tested for in potential recipients?
Hepatitis HIV EBV CMV VZV Toxo Syphilis
State the contraindications for transplant
Malignancy Active HCV/HIC Untreated TB Severe IHD Severe airway disease Active vasculitis Severe PVD Hostile bladder
What assessments needs to be done if it is a live donor?
Fit for surgery, enough renal function to remain independent with only one kidney, anatomically normal kidneys, co-mobitities, immunologically and psychologically compatible. No coercion
Describe tissue typing related to blood group
Donor O can give to O, A, B or AB
Donor A can give to A or AB
Donor B can give to B or AB
Donor AB can only give to AB
Why is HLA tested?
HLA molecules bind fragments of protein antigens into a groove for recognition by T cells. T cells recognise self proteins but in an unmatched transplant immune attack can occur
What HLA are specifically looked at?
HLA A
HLA B
HLA DR
What is the significance of sensitising events?
They lead to formation of pre-formed antibodies to non-self antigens - blood transfusion, pregnancy, transplant
Describe desensitisation
Active removal of a blood group/donor specific antibody by plasma exchange or B cell antibody - rituximab. Transplant can be carried out when levels are below acceptable threshold
Where is a kidney transplant inserted?
Iliac fossa and attached onto the external iliac artery and vein
How is the donor ureter connected to the recipient bladder?
With a stent
How long does it take to recover from a kidney transplant?
3 months
What are the complications?
Bleeding Arterial stenosis Venous kinking Ureteric stricture Hydronephrosis Infection Lymphocele
State the three possible outcomes of a transplant
Immediate Graft Function
Delayed Graft Function
Non function
How will a patient with immediate graft function present?
Good urine output, reduced urea/creatinine
What is often required in patients with delayed graft function?
Haemodialysis usually takes 10-30 days - need to do a biopsy to check
State the three types of rejection
Hyperacute
Acute
Chronic
Describe hyperacute rejection
Preformed antibodies, requires transplant nephrectomy
Describe acute rejection
Cellular/antibody mediated, requires increased immunosuppression
Describe chronic rejection
Slow progressive decline, antibody mediated with poor response to treatment
What is the purpose of anti-rejection therapy?
Reduces T cell activation and prevents host vs. transplant immune response
Name the induction immunosuppression
Basiliximab, dacluzimab
What immunosuppressive drug is given during a transplant operation?
IV prednisolone
