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Urology

Question
28 out of 129
 

A hypertensive 47-yrs-old man is proposed for kidney transplantation. He is anemic but is otherwise functional. Which of the following would preclude renal transplantation?



A Positive cross-match

B Donor blood type O

C Two-antigen HLA match with donor

D Blood pressure of 180/100 mmHg

Ans. A Positive cross-match (REF. CAMPBELL UROLOGY 9TH EDITION CHP 40 PG 1187)

a. A point system has evolved in the United States for the selection of deceased kidney transplant recipients.

b. Initial screening consists of ABO blood group identity determination and negative microcytotoxicity lymphocyte crossmatches between donor and recipient.

c. The time on the waiting list, histocompatibility between the donor and the recipient, prior vital organ donation, and age younger than 18 years result in additional points.

d. A score is developed for each of the potential recipients, and the candidates are placed in rank order by that score.

e. The patient with the highest score is ranked first for that specific kidney.

f. The kidney graft is then offered in turn to each of the potential recipients by the final rank.

g. If there is no suitable recipient on a local list, the kidney graft is offered to those on a regional list and, if necessary, the national list.

h. There is mandatory distribution of a kidney when there are zero HLA-A, HLA-B, and HLA-DR antigens mismatched between a deceased kidney donor and an ABO blood group–compatible, not identical, recipient on the national waiting list.

i. Candidates for ECD kidney engraftment must agree to receive one of these kidneys before being placed on the waiting list.

j. These kidney transplants are usually recommended for patients older than the age of 60 years, diabetic patients older than the age of 40 years, and patients who have significant dialysis access problems or who are unable to tolerate dialysis.

Urology Flashcard List

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