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Systems: Urinary AB > Transplantation > Flashcards

Transplantation Flashcards

1
Q

Where are transplanted kidneys usually placed?

A

Transplanted kidney is placed into the iliac fossa and anastomosed to the iliac vessels

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2
Q

What happens to native kidneys following transplantation?

A

Usually remain in situ

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3
Q

What indications are there for native nephrectomy?

A

Size
-Polycystic kidneys

Infections
-Chronic pyelonephritis

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4
Q

How are donor kidneys preserved?

A
  • Cold storage solutions to minimise oedema and preserve integrity of tissues
  • Buffer free radicals
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5
Q

What are the possible surgical complications?

A

Vascular complications

  • Bleeding usually at anastomotic sites and perirenal haematomas which can be venous or arterial
  • Arterial thrombosis
  • Venous thrombosis
  • Lymphocele

Ureteric
-Urine leak

Infection

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6
Q

What types of immunosuppressive agents are there?

A
  • Corticosteroids
  • Calcineurin inhibitors
  • Anti-proliferatives
  • mTOR inhibitors
  • Costimulatory signal blockers
  • Depleting agents
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7
Q

Give examples of calcineurin inhibitors.

A
  • Tacrolimus

- Cyclosporin

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8
Q

Give examples of anti-proliferatives.

A

-Mycophenolate mofentil

Azathioprine

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9
Q

Give an example of an mTOR inhibitor

A

Sirolimus

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10
Q

Give an examples of a costimulatory signal blocker.

A

Belatacept

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11
Q

Give examples of depleting agents

A
  • Basiliximab (anti CD25)
  • Anti-thymocyte globulin (ATG)
  • Rituximab (antiCD20)
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12
Q

What are the possible side effects of corticosteroids?

A
  • Hypertension
  • Hyperglycaemia
  • Infection
  • Bone loss
  • GI bleeding
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13
Q

What are the possible side effects of tacrolimus?

A
  • Hyperglycaemia
  • AKI
  • Tremor
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14
Q

What are the possible side effects of cyclosporin?

A
  • Hirsutism
  • Hypertension
  • AKI
  • Gout
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15
Q

What are the possible side effects of mycophenolate mofetil?

A
  • Cytopenia

- GI upset

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16
Q

What are the possible side effects of sirolimus?

A
  • Lipidogenic
  • Diabetogenic
  • Pneumonia
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17
Q

What are the possible side effects of belatacept?

A
  • Infection

- Malignancy

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18
Q

What are the possible side effects of ATG?

A
  • Infection

- PTLD

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19
Q

What immunosuppressive agent is used for induction?

A

Basiliximab

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20
Q

What immunosuppressive agents are used for maintenance?

A

Tacrolimuc + Mycophenolate + steroids

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21
Q

What immunosuppressive agent can be used if calcineurin inhibitors can’t be used?

A

Belatecept

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22
Q

What type of deceased donations are there?

A

Donation after brain death/ DBD
-Standard/extended criteria

Donation after cardiac death/DCD
-Standard/ extended criteria

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23
Q

What type of living donations are there?

A

Living related donor

Living unrelated donor

  • Spousal
  • Altruistic
  • Pool/paired
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24
Q

What is the criteria for brain death donation?

A
  • Coma, unresponsive to stimuli
  • Apnoea off ventilator (with oxygenation) despite build up of CO2
  • Absence of cephalic reflexes
  • Body temperature above 34 C
  • Absence of drug intoxication
25
Q

What cephalic reflexes must be absent for brain death donation?

A
  • Pupillary
  • Oculocephalic
  • Oculovestibular (caloric)
  • Corneal
  • Gag
  • Purely spinal reflexes may be present
26
Q

What is extended criteria?

A
  • Donor aged > 60y

- Donor aged 50-59 + history of hypertension, death from cerbrovascular accident or terminal creatinine of >132µmol/L

27
Q

Describe paired donation.

A
  • Donor A is unable to donate to recipient A and donor B is unable to donate to recipient B
  • Donor A donates to recipient B
  • Donor B donates to recipient A
28
Q

Describe pooled donation.

A
  • Family/friends are unable to donate to individual
  • They are a match for someone else
  • They donate to in a domino effect so that everyone within the group receives or donates
  • May include an altruistic donor
29
Q

How does kidney function and survival compare to general population following transplant?

A
  • Similar patient survival to general population.
  • Lower rate of ESRD compared to general population.
  • Compensatory increase in GFR of remaining kidney to 70% of pre-donation values
  • Compensatory increase greater in younger donors.
  • Older age and high BMI were associated with GFR of <60.
  • Relatively short follow up time (12 years).
30
Q

What are the possible complications following renal transplant?

A
  • Rejection
  • Cardiovascular
  • infective
  • Malignancy
31
Q

What are the 2 types of rejection?

A
  • Cell mediated

- Humoral (Ab mediated)

32
Q

What are the possible cardiovascular complications following transplant?

A
  • Underlying renal disease
  • CRF
  • Hypertension
  • Hyperlipidaemia
  • PT Diabetes
33
Q

What types of infection is there risk of following transplan?

A
  • Bacterial
  • Viral
  • Fungal
34
Q

What types of malignancy are associated with transplant?

A
  • Skin
  • Lymphoma
  • Solid cancers
35
Q

What are the types of acute rejection?

A
  • T cell mediated rejection (TCMR)

- Acute antibody mediated rejection (ABMR)

36
Q

What are the stages of T cell mediated rejection (TCMR)?

A
  • Tubulointerstitial (Banff I)
  • Arteritis/endothelialitis (Banff II)
  • Areterial fibrinoid necrosis (Banff III)
37
Q

What are the stages of acute antibody mediated rejection (ABMR)?

A
  • ATN-like (Banff I)
  • Capillaries and or glomerular inflammation (Banff II)
  • Arterial inflammation (Banff III)
38
Q

Why might hyperacute rejection occur?

A

Pre-existing alloreactvity to donor

39
Q

What inflammatory processes can occur in TCMR?

A
  • Lymphocytic infiltrate
  • Tubulitis
  • Endarteritis
  • Endothelialitis
40
Q

What microvascular inflammation can occur in ABMR?

A
  • Neutrophil infiltration
  • Glomeruli
  • Peritubular capillaries
41
Q

What occurs in ABMR?

A
  • Microvascular inflammation
  • Donor specific antibodies
  • Positive C4D
42
Q

What endocrine condition can occur after transplantation?

A

New onset diabetes mellitus

43
Q

What is the most important transplant related infection?

A

CMV

44
Q

How many transplant patients are affected by CMV?

A

Around 8%

45
Q

How is the recipient affected by CMV?

A
  • Transmission from donor tissue

- Reactivation of latent virus

46
Q

What is the prognosis of CMV if untreated?

A

High mortality and morbidity

47
Q

What can CMV cause in transplant patients?

A

CMV viremia

Tissue invasive disease

  • Pneumonitis
  • Hepatitis
  • Retinitis
  • Gastroenteritis
  • Colitis
  • Nephritis
48
Q

What polyomaviruses are transplant at risk of?

A
  • BK virus
  • JC virus
  • Murine polyoma virus
  • SV40
49
Q

How can BK virus manifest following renal transplantation.?

A
  • Ureteral stenosis
  • Interstitial nephritis
  • ESRF
50
Q

How can BK virus manifest itself following bone marrow transplantation?

A
  • Haemorrhagic cystitis
  • Pneumonitis
  • Hepatitis
51
Q

How can BK virus manifest itself in AIDS?

A
  • Nephritis
  • ESRF
  • Retinitis
  • Meningoencephalitis
  • Pneumonitis
52
Q

What are the risk factors for BKAN?

A
  • Intensity of immunosuppression
  • Patient determinants
  • Organ determinants
  • Viral determinants
53
Q

What patient determinants are risk factors for BKAN?

A
  • Older age
  • Male gender
  • White ethnicity
  • DM
  • Negative BKV serostatus (paediatric recipients
54
Q

What organ determinants are risk factors for BKAN?

A
  • Graft injury
  • HLA mismatches
  • Ureteral stents
55
Q

What viral determinants are risk factors for BKAN?

A

Changes of epitopes of viral capsid protein VP-1

56
Q

What is the outcome of BKAN?

A
  • Allograft dysfunction

- Loss of graft in 45-80%

57
Q

What is the treatment for BKAN?

A

Reduce immunosuppression

Antiviral therapy

  • Cidofovir +/-IBG
  • Leflunomide
58
Q

Give examples of the relative risks of malignancy after renal transplant.

A

2 Colon, lung, breast

3 Testicular, bladder

5 Melanoma, leukaemia, cervical

15 Renal

20 Non-melanoma skin, Kapasi sarcoma, Non-Hodgkin’s lymphoma

Systems: Urinary AB (26 decks)

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