4/24/17 Transplantation PALOMA FINAL TEST Flashcards
What are indications for needing a bone marrow transplant?
- Leukemia
- Lymphoma
- Multiple Myeloma
What type of transplant is COPD, Cystic Fibrosis, Idiopathic pulmonary fibrosis an indication for?
-Lungs
What are indications for needing liver transplants?
- Viral Hepatitis
- Overdose
- Alcohol
What type of transplant has the highest expected survival at 5 years?
-Kidney
What type of transplant has the lowest expected survival at 5 years?
-Lungs
What are the five major drug classes used during a transplant?
- Calcineurin inhibitors
- mTOR inhibitors
- Antiproliferative agents
- Antibodies
- Corticosteroids
What type of immune response occurs in transplantation?
-Adaptive response
What is the major target during transplantation?
-allo-MHC on surface of donor cells
What are the two stages of rejection: host versus graft?
- Sensitization stage
- Effector stage
What is the direct pathway of the sensitization stage?
-Host T cells recognize allo-MHC molecules as non-self
What is the indirect pathway of the sensitization stage?
-T cells recognize processed alloantigen presented by self APCs
What is the effector stage in rejection?
- Inflammatory response to injury
- B cell activation with Ab production
- Further cell recruiting, NKs, apoptosis
SOT (Solid Organ) transplant has four stages, what are they?
- Induction
- Acute post-transplant
- Maintenance
- Rejection treatment
What are the four stages of HSCT (Stem cell transplant)?
- Induction/conditioning
- Consolidation/Intensification
- Maintenance
- GVHD treatment
What phase of post HSCT occurs during 0-30 days?
-Phase I
What occurs in phase I of post HSCT?
- Prolonged neutropenia
- Damage to mucocutaneous barriers
What occurs in phase II (31-100 days) of post HSCT?
- Impaired cell-mediated immunity
- GVHD
What occurs in phase III (Day > 100) of post HSCT?
-Depends on immunosupression
If a patients is going to receive a transplant when should dental prophylaxis and active disease be treated?
-Pre-transplant
If a patient is going to receive a transplant when should you remove all non-restorable teeth?
-Pre-transplant
What are four indications (if they can’t be fixed otherwise) for tooth extractions when considering transplant patients?
- Teeth mobility (periodontal pocket > 5-6)
- Teeth with endo-perio problem
- Teeth with periapical lesions
- Teeth with very deep or extensive caries
What are the cumulative effects of transplants?
- Poor dental health
- Untreated dental disease
- Increased susceptibility to infections
If a person has sever leukopenia and thrombocytopenia what should a transplant patients avoid that is dentally related?
-Flossing
If a person has dentures and is receiving a transplant what should be done?
-Make sure they disinfect dentures before each use and rinse before placing back in mouth
What are the effects of radiation and chemotherapy?
- Xerostomia
- Mouth ulcers
T/F Topical therapy with infectious complication dealing with transplant patients is efficacious alone
False
-It is not sufficient alone
What is the most frequent complication of post Bone marrow transplant?
-Mucositis
When does mucositis peak after organ transplant?
-5-7 days
When a person is taking cyclosporine for a transplant what may be a dentally related side effect?
-Gingival hyperplasia
T/F Gingival hyperplasia is more common is men than women
True
T/F Gingival hyperplasia is higher (more prevalent) in children
True
Gingival hyperplasia from cyclosporine is worse if combined with what other drugs?
-Calcium-channel blockers
How long after starting immunosuppressive drugs does gingival hyperplasia occur?
-1-3 months after starting drugs
When location does gingival hyperplasia begin?
-Interdental papillae
what immunosuppressive drug causes mucositis, oral ulcers, and poor wound healing?
-Sirolimus/Everolimus
What immunosuppressive drug causes thrombocytopenia?
-Azathioprine
What immunosuppressive drug causes stomatitis?
-Cyclosphamide
When is the peak immunosuppression for transplant patients?
3-6 months
How long after a transplant should you wait to treat a patient?
-6 months
T/F Antibiotics should be considered for invasive procedures
True
When treating a person with a heart transplant what should you avoid when using anesthesia?
-Epinephrine
When treating a person with a lung transplant what should you avoid when prescribing drugs?
-Narcotics
