14134310
Description
Flashcards by Jennifer Huber, updated more than 1 year ago
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Created by Jennifer Huber
over 6 years ago
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| Question | Answer |
| Most important recipient/donor matching human leukocyte antigens | HLA-A, HLA-B, and HLA-DR (DR is more important overall) |
| Universal Donor Blood Type | Type O |
| Universal Recipient Blood Type | Type AB |
| Cross-matching | detects preformed recipient antibodies to the donor organ by mixing recipient serum with donor lymphocytes if positive, expect hyperacute rejection |
| Panel Reactive Antibody | detects preformed recipient antibodie using a panel of HLA typing cells if high (>50%) TXP is contraindicated |
| Management for mild rejection | pulse steroids |
| management of severe rejection | steroid and antibody therapy (ATG or thymoglobulin) |
| #1 malignancy following any transplant | skin cancer, squamous cell |
| Post-transplant lympho-proliferative disorder & treatment | 2nd MC malignancy following transplant EBV related causes SBO, mass, adenopathy Tx: w/draw immunosuppression, rituximab, may need chemo and XRT |
| Rituximab MoA | anti-CD20, decreased B cells |
| Risks associated with long term immunosuppression | cancer, cardiovascular disease, infection, osteopenia |
| Mycophenolate MoA side effects uses | inhibits de novo purine synthesis, inhibits growth of T cells s/e: GI intolerance, myelosuppression keep WBC >3 maintenance therapy to prevent rejection |
| Steroids with transplants MoA When to use it | prednisone, Solu-Medrol inhibit inflammatory cells and genes for cytokine synthesis (IL-2 most important) used for induction after TXP, maintenance and acute rejection episodes |
| Cyclosporin MoA Uses | binds cyclophilin protein, inhibits calcineurin decreasing cytokine synthesis (IL-2, IL-4) used for maintenance therapy after TXP |
| Cyclosporin side effects | Nephrotoxicity, Hepatotoxicity, Tremor, Seizures, HUS |
| Trough to keep cyclosporin at | 200-300 |
| How is Cyclosporin Metabolized and Excreted? | hepatic metabolism biliary excretion |
| FK-506 MoA Side effects Patient Population | Prograf, Tacrolimus binds FK-binding protein s/e: nephrotoxicity, GI sxs, mood changes, diabetes Kidney transplants |
| Target Trough for FK-506 | 10-15 |
| Sirolimus MoA | AKA: Rapamycin binds FK-binding protein and inhibits mammalian target of rapamycin (mTOR) inhibits T & B cell response to IL-2 |
| How is Sirolimus different from CYclosporin and Tacrolimus? | It is not nephrotoxic |
| Side effect of Sirolimus | Interstitial Lung Disease |
| Anti-thymocyte Glubulin (ATG) MoA and when to use it | Equine or Rabbit polyclonal antibodies against T cell antigens (CD2, CD3, CD4) For induction and acute rejection episodes |
| Side Effects of Anti-thymocyte globulin | cytokine release syndrome (fever, chills, pulmonary edema, shock) |
| What is Hyperacute Rejection? | within minutes to hours from preformed antibodies Type 2 hypersensitivity activates complement cascade and thrombosis of vessels occurs |
| MCC of hyperacute rejection | ABO incompatibility |
| Treatment for Hyperacute Rejection | Emergent Re-transplant |
| What is Accelerated Rejection? | Occurs in <1week caused by sensitized T cells to donor HLA |
| Treatment for Accelerated Rejection | Increase immunosuppression, pulse steroids, and possibly antibody treatment |
| What is acute rejection? | occurs in 1week to 1 month caused by T cells (cell-mediated) to HLA antigens |
| Treatment of acute rejection | increase immunosuppression, pulse steroids, and possibly antibody treatment |
| What is chronic rejection? | months to years partially type 4 hypersensitivity sensitized T cells, antibody formation leads to graft fibrosis |
| MCC of chronic rejection | HLA incompatibility |
| Treatment of chronic rejection | increased immunosuppression, no really effective treatment; re-transplant |
| How long can a kidney be stored? | 48 hours |
| Testing required because kidney transplant | ABO type compatibility and cross match |
| MCC of mortality s/p kidney transplant | stroke or MI |
| MC complication after kidney transplant and its treatment | urine leaks drain and stent |
| Complication after kidney transplant: RAS how to diagnose and treat | use ultrasound (flow accel @ level of stenosis) Tx: PTA w/ stent |
| MCC of external ureter compression s/p kidney transplant | lymphocele |
| Postop Oliguria s/p Kidney transplant main cause and pathology | ATN path: hydrophobic changes, dilation and loss of tubules |
| Time frame in which lymphoceles present themselves after kidney transplant | 3 weeks |
| Treatment of lymphoceles | 1st: percutaneous drainage if fails, peritoneal window - hole in peritoneum for lymphatic fluid to drain into |
| Cause of post renal transplant diuresis | urea and glucose |
| s/p renal transplant, new proteinuria suggests: | renal vein thrombosis |
| Possible cause of post renal transplant diabetes | side effect from cyclosporin (CSA), FK, steroids |
| Treatment for CMV s/p transplant | Ganciclovir |
| Treatment for HSV s/p transplant | Acyclovir |
| Pathology in acute rejection s/p kidney transplant | tubulitis (vasculitis in more severe form) |
| Kidney Rejection Workup | US with duplex, Biopsy empiric decrease in CSA or FK, give pulse steroids, fluids/lasix |
| 5-year kidney transplant survival cadaveric vs living donors | Cadaveric - 65% Living Donor - 75% |
| MC complication in living kidney donors | wound infection |
| MC cause of death in living kidney donors | Pulmonary Embolism |
| How long can a liver be stored for? | 24hours |
| Contraindications for liver transplant | Current ETOH abuse Acute Ulcerative Colitis |
| MCC liver transplant in adults | Chronic Hep C |
| MELD Score | Uses Cr, INR, and bilirubin to predict if patients with cirrhosis with benefit from liver TXP MELD >15 benefits from TXP |
| Criteria for urgent transplant | fulminant hepatic failure (encephalopathy - stupor, coma) |
| When can you do a liver transplant in someone with hepatocellular carcinoma? | if NO vascular invasion or mets |
| Liver Transplantation Macrosteatosis | extracellular fat globule in liver allograft RF for primary non-funtion |
| Liver transplant anastomosis in adults vs kids | Adult: Duct-to-duct Kids: Hepaticojejunostomy |
| Drains place s/p Liver TXP | Right subhepatic, right and left subdiaphragmatic drains |
| MC arterial anomaly associated with liver transplants | Right hepatic coming off SMA |
| #1 Complication associated with Liver Transplants and treatment | Bile Leak Tx: place drain, then ERCP with stent across leak |
| What is primary nonfunction after liver transplant? | 1st 24hrs - total bili >10, bile output <20cc/12hr, elevated PT amd PTT After 96hrs: mental status change, increased LFTs, renal failure, resp failure Requires retransplantation |
| What to do in a patient who develops hepatic artery stenosis s/p Liver TXP | place stent |
| Early hepatic artery thrombosis what happens? | MC early vascular complication of liver TXP increased LFTs, decreased bile output fulminant hepatic failure |
| Treatment for early hepatic artery thrombosis s/p liver TXP | emergent re-transplantation for ensuing fulminant hepatic failure (can try to stent or revise anastomosis) |
| Late Hepatic Artery Thrombosis s/p Liver Transplant | biliary strictures and abscesses |
| Effects of IVC Stenosis/Thrombosis s/p Liver Transplant & treatment | its a complication causes edema, ascites, renal insufficiency Tx: Thrombolytics and stents |
| Sxs associated with Portal Vein Thrombosis s/p Liver TXP | early: abdominal pain late: UGI bleed, ascites, asx |
| Treatment for portal vein thrombosis s/p liver TXP | if early, re-op thrombectomy and revise anstomosis |
| Pathology associated with Acute Rejection w/ Liver Transplant | portal triad lymphocytosis, endothelitis (mixed infiltrate), bile duct injury will see fever, jaundice and decrease biliary output |
| What do you see in liver transplant chronic rejection? | this is unusual get disappearing bile ducts gradually get bile duct obstruction with increase in alkaline phosphatase, portal fibrosis |
| Retransplantation rate s/p liver transplant | 20% |
| 5 year survival rate s/p liver transplant | 70% |
| Which lobe to take in a living donor for adult liver transplant | Right Lobe |
| Which lobe to take in an living donor for child liver TXP | Left Lateral Lobe (segments 2+3) |
| MC indication for pancreas transplant | DM with renal failure |
| what vessels do you need for pancreas transplant? | donor celiac artery and SMA donor portal vein |
| Where do you attach vessels during a pancreas transplant? | attach to iliac vessels |
| part of bowel to take from donor during pancreas transplant | 2nd part of duodenum with ampulla of Vater, perform an anastomosis of donor duodenum to recipient bowel |
| What results point towards a successful pancreas/kidney transplant? | stabilization of retinopathy, decreased neuropathy, orthostatic HoTN, autonomic dysfxn (gastroparesis), increased nerve conduction velocity |
| MC complication s/p pancreas transplant | venous thrombosis |
| How long can you store a heart? | 6hrs |
| What testing do you need prior to a heart transplant? | ABO compatibility and crossmatch |
| Treatment for persistent pulmonary HTN s/p heart TXP | inhaled nitric oxide ECMO if severe |
| Pathology of acute rejection associated with heart transplant | perivascular lymphocytic infiltrate with varying myocyte inflammation and necrosis |
| MCC of early mortality associated with heart transplant | infection |
| MCC of late death and death overall following heart TXP | chronic allograft vasculopathy, progressive diffuse coronary atherosclerosis |
| How long can you store Lungs? | 6hours |
| Life expectancy before Heart or Lung Transplant | <1 year |
| #1 cause for early mortality s/p lung transplant | reperfusion injury |
| indication for double lung TXP | Cystic Fibrosis |
| Exclusion criteria for using lungs | aspiration, moderate to large contusion, infiltrate, purulent sputum, PO2 <350 on 100% FiO2 and PEEP5 |
| Pathology of acute rejection s/p lung transplant | perivascular lymphocytosis |
| MCC of late death and death overall following lung transplant | chronic rejection, bronchiolitis obliterans |
| Median survival s/p lung transplant | 5 years |
| Viral Opportunitistic Infections s/p transplants | CMV, HSV, VZV |
| Opportunistic Protozoan Infections s/p transplantation | Pneumocystis jiroveci pneumonia (reason for bactrim ppx) |
| Opportunistic Fungal Infections s/p transplants | Aspergillus, Candida, Cryptococcus |
| Hierarchy for Permission for Organ Donation from Next of Kin | Spouse, Adult son/Daughter, Either Parent, Adult brother/sister, Guardian, any other person authorized to dispose of body |
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