Kidney transplant Flashcards Preview

Kidneys and Hormones > Kidney transplant > Flashcards

Flashcards in Kidney transplant Deck (23):
1

What are the two possible complications of kidney transplants?

Surgical

Immunological

2

What technique was used in the early days to test susceptibility?

Skin grafts

Compatible = no raised skin
Incompatible = raised skin

3

What are the two sources of donor organs?

Living - altruistic, friends or family

Cadaveric - with or without a heartbeat

4

Which source of organs has the best outcome?

Patients that are living and related/ married

5

Why do cadaveric organ transplants have such bad outcomes?

High levels of antigens and adhesion molecules formed as a result of injury from inflammatory events that happened around the time of brain death

6

What are the risks of transplantation?

Infections

Malignancies

Drug related side effects

7

Why do transplant patients have increased susceptibility to infections?

Posttransplantation lymphoproliferative disease caused by Epstein-barr virus infection

Infects the B cells

Virus can be reactivated post-transplant or come from primary EBV infection

8

Why do transplant patients have increased cancer risks?

Cytotoxic T cells are suppressed by immunosuppressants

9

What are drug related side effects that arise in transplant patients?

Nephrotoxicity

Metabolic effects - diabetes and hypertension

Bone marrow suppression - low WBC count or haematological malignancies

Calcineurin inhibitor toxicity - induce injury to the kidneys

10

What are common drugs used in transplantations?

Clacineurin inhibitors - prevent T cell activation

Anti-proliferative agents - prevent B and T cells from proliferating

Steroids

mTOR inhibitors

Induction agents - suppress lymphocyte activation

11

What does mTOR do?

mTOR is a signalling pathways that serves as a central regulator of:

Cell metabolism
Growth
Proliferation
Surivival

12

What is a type of induction agent?

Anti-CD25 blocking monoclonal antibody

13

What stage do induction agents target?

Initial stage of the transplant when there is greates immune response

14

What is the difference between warm and cold ischaemia?

Warm ischaemia - kidney is in the body but not perfused with blood

Cold ischaemia - when kidney is removed and placed in ice

15

Why are organs placed on ice?

To cool down and reduce metabolic requirement

16

What has more effect on the survival outcome, warm or cold ischaemic time?

Cold ischamic time

17

What is the mean time for survival of kidney transplant?

14 years

18

What increases survival of renal failure more, transplant or dialysis?

Dialysis

19

Why are there criteria for brain stem death?

To secure the knowledge that there is no chance of recovery

20

What are the criteria for brainstem death?

Brainstem function must have ceased

No corneal reflex

Taken off ventilator and increasing CO2 levels should cause patient to breathe on their own

21

How many doctors must confirm brainstem death?

2 independent doctors

22

Why must 2 independent doctors confirm brain stem death?

Relay anxiety that organs are being removed from dying patients

23

Is passing brainstem death test enough to take organ from cadaveric patient?

No. The donor must have signed a donor card