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Chapter 52: Kidney Transplantation

What clinical syndrome has gained prominent attention and is now frequency screened for during the candidate evaluation for kidney transplantation?

A. Metabolic syndrome

B. Frailty syndrome

C. Antiphospholipid antibody syndrome

D. Painful bladder syndrome (interstitial cystitis)

E. Loin pain hematuria syndrome

The answer is B. Frailty, a syndrome characterized by an elevated risk of catastrophic declines in health and function, is increasingly being screened for during recipient evaluations and follow visits while on the deceased donor waiting list. The most commonly used frailty examination is a simple to perform assessment of grip strength, walking speed, physical activity, and endurance. As the frail recipient has an elevated associated risk of mortality, transplant centers will frequently encourage “prehabilitation,” followed by improvement on reassessment, before proceeding with transplantation.

In addition to death secondary to infection and cardiovascular disease, which of the following is the most common (and rising) cause of post-transplant morbidity and mortality in the kidney transplant recipient?

A. BK viremia

B. Accidental death

C. Chronic allograft failure with patient opting not to return to renal replacement therapy

D. Malignancy

The answer is D. Malignancy is now the third most common cause of death in the kidney transplant recipient. It is now well recognized that patients receiving immunosuppression are at an increased risk for malignancy development than age matched controls in the general population, and that they are more likely to die from malignancy when one occurs.

All of the following have a significantly high likelihood of recurrence after transplantation EXCEPT:

A. Lupus nephritis

B. Focal segmental glomerulosclerosis

C. C3 glomerulonephritis

D. IgA nephropathy

E. Dense deposit disease

The answer is A. In contrast to focal segmental glomerulosclerosis (20–30%), C3 glomerulonephritis (90%), IgA nephropathy (20–50%), and dense deposit disease (90%) which all have a relatively high rate of recurrence following transplantation, recurrent lupus nephritis rarely occurs affecting only 2–3% of at risk recipients. However, when lupus nephritis does recur it is associated with a high likelihood that recurrence will result in allograft failure (95%).

Which therapeutic strategy is currently available to treat patients with chronic antibody mediated rejection?

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