In the prevention of graft rejection, cyclosporine:
The introduction of cyclosporine in the early 1980s dramatically altered the field of transplantation by significantly improving outcomes after kidney transplantation. Cyclosporine binds with its cytoplasmic receptor protein, cyclophilin, which subsequently inhibits the activity of calcineurin, thereby decreasing the expression of several critical T-cell activation genes, the most important being for IL-2. As a result, T-cell activation is suppressed.
The most common cause of renal failure in the United States is:
Diabetes and hypertension are the leading causes of chronic renal disease. Concomitant cardiovascular disease (CVD) is a common finding in this population. An estimated 30% to 42% of deaths with a functioning kidney graft are due to CVD. Therefore, assessment of the potential kidney transplant candidate's cardiovascular status is an important part of the pretransplant evaluation.
The best method of monitoring the development of acute rejection in a patient after cardiac transplantation is:
The goal of immunosuppression is to prevent rejection, which is assessed by immunosuppressive levels and, early on, by endomyocardial biopsy. Both T-cell-mediated (cellular) and B-cell-mediated (antibody-mediated) rejection are monitored.
Absolute contraindications to renal transplantation for a patient with chronic renal failure include all of the following EXCEPT:
Active infection or the presence of a malignancy, active substance abuse, and poorly controlled psychiatric illness are the few absolute contraindications to a kidney transplant. Studies have demonstrated the overwhelming benefits of kidney transplants in terms of patient survival, quality of life, and cost-effectiveness, so most patients with end stage renal disease (ESRD) are referred to for consideration of a kidney transplant. However, to achieve optimal transplant outcomes, the many risks (such as the surgical stress to the cardiovascular system, the development of infections or malignancies with long-term immunosuppression, and the psychosocial and financial impacts on compliance) must be carefully balanced.
All of the following is true for living renal transplant EXCEPT:
The kidney, the first organ to be transplanted from living donors, is still the most common organ donated by these individuals. The donor's left kidney is usually preferable because of the long vascular pedicle. Use of living donor kidneys with multiple renal arteries should be avoided, in order to decrease the complexity of the vascular reconstruction and to help avoid graft thrombosis. Most donor nephrectomies are now performed via minimally invasive techniques, that is, laparoscopically, whether hand-assisted or not. With laparoscopic techniques, an intraperitoneal approach is most common: it involves mobilizing the colon, isolating the ureter and renal vessels, mobilizing the kidney, dividing the renal vessels and the distal ureter [C6], and removing the kidney (Fig. below). Extensive dissection around the ureter should be avoided, and the surgeon should strive to preserve as much length of the renal artery and vein as possible.
La paroscopic left donor nephrou reterectomy. A. Ta ke down of splenic flexure of colon to expose the left renal hilum. B. Dissection of left ureter off the psoas muscle. C. Dissection of left renal vein and gonadal vein. Left ureter was seen lateral to the dissection. D. Dissection of left renal artery. Lumbar veins were clipped and divided. E. Endo-TA stapler to transect the left renal artery. F. Pl acement of ports and Pfannenstiel incision for the donor kidney extraction.
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