ABSITE Review - Transplantation

Question 1

What is the most important overall marker in transplant?

Answer 1

HLA-DR

Question 2

What is the only organ which does not need ABO blood compatibility?

Answer 2

Liver

Question 3

The crossmatch is performed to detect …

Answer 3

Preformed recipient antibodies by mixing recipient serum with donor lymphocytes –> would generally cause hyperacute rejection (except liver)

Question 4

What is the #1 malignancy following any transplant?

Answer 4

Skin Cancer - Squamous cell CA

Question 5

What is the next MC CA following a transplant? What is the virus related? What is the treatment?

Answer 5

Posttransplant Lymphoproliferative disorder (PTLD)
EBV
Tx: withdrawal of immunosuppression, may need chem and XRT for aggressive tumor

Question 6

What is the MOA and side effects of Azathioprine (Imuran)?

Answer 6

Inhibits de novo synthesis, which inhibits T cells

SEs: myelosuppression

Question 7

What is the MOA and side effects of Cyclosporin (CSA)?

Answer 7

Binds cyclophilin protein and inhibits genes for cytokine synthesis (IL-2, IL-3, IL-4, INF-gamma)
SEs: nephrotoxicity, hepatotoxicity, HUS, tremors, seizures

Question 8

What is the MOA and side effects of FK-506 (Prograf)?

Answer 8

Binds FK-binding protein, MOA similar to CSA but more potent

SEs: nephrotoxicity, mood changes

Question 9

What is the MOA of ATGAM?

Answer 9

Equine polyclonal antibodies directed against antigens on T cells, used for induction therapy

Question 10

What is the MOA and side effects of OKT3?

Answer 10

Monoclonal antibodies that block antigen recognition function of T cells by binding CD3, inhibiting T cell receptor complex; interferes with both class I and II MHC; causes CD3 opsonization
SEs: fever, chills, pulm edema, shock

Question 11

Describe the timeframe and cause of Hyperacute rejection. What is the treatment?

Answer 11

Occurs within minutes to hours
Caused by preformed antibodies that should have been picked up by crossmatch
Activates the complement cascade and thrombosis of vessel occurs
Tx: emergent retransplant

Question 12

Describe the timeframe and cause of Accelerated rejection. What is the treatment?

Answer 12

Occurs <1week
Caused by sensitized T cells to donor antigens
Tx: increase immunosuppression, pulse steroids and possibly OKT3

Question 13

Describe the timeframe and cause of Acute rejection. What is the treatment?

Answer 13

Occurs 1 week to 1 month
Caused by T cells (cytotoxic and helper T cells)
Tx: increase immunosuppression, pulse steroids and possibly OKT3

Question 14

Describe the timeframe and cause of Chronic rejection. What is the treatment?

Answer 14

Occurs month to years
A type IV herpersensitivity reaction (sensitized T cells)
Leads to graft fibrosis and vascular damage
Tx: increase immunosuppression or OKT3 - no really effective

Question 15

How long a kidney can be stored and where it is attach?

Answer 15

Can store a kidney for 48 hours

Attach to iliac vessels

Question 16

What is the #1 complication of a renal transplant? What is the treatment?

Answer 16

Urine leak

Tx: drainage and stenting

Question 17

What is the MCC of external compression after a kidney transplant?

Answer 17

Lymphocele

Tx: 1st percutaneous drainage; if that fails then need intraperitoneal marsupialization

Question 18

What suggest new proteinuria after a kidney transplant?

Answer 18

renal vein thrombosis

Question 19

What should include a kidney rejection workup?

Answer 19

Ultrasound with duplex (to rule out vascular problem and ureteral obstruction) and biopsy

Question 20

How long a liver can be stored?

Answer 20

Can store liver for 24 hours

Question 21

What contraindications to liver transplant?

Answer 21

current ETOH abuse, acute UC

Question 22

What is the best predictor of 1-year survival after a liver transplant?

Answer 22

APACHE score

Question 23

How is the duct anastomosis performed?

Answer 23

Duct-to-duct anastomosis

Hepaticojejunostomy in kids

Question 24

What drains are left in place?

Answer 24

Right subhepatic, right and left subdiaphragmatic drains

Question 25

What is the MC arterial anomaly in the liver?

Answer 25

Right hepatic coming off SMA

Question 26

What is the #1 complication of a liver transplant? What is the treatment?

Answer 26

Bile leak

Tx: PTC tube and stent

Question 27

What is the treatment for hepatic artery thrombosis?

Answer 27

Angio, surgery, retransplantation

Question 28

What is the cause and pathology of acute liver rejection?

Answer 28

T cell mediated against blood vessels

Pathology - shows portal lymphocytosis, endotheliitis and bile duct injury

Question 29

What is the pathology of chronic liver rejection?

Answer 29

Disappearing bile ducts (antibody and cellular attack on bile ducts)

Question 30

For pancreas tranplant, what is used for arterial supply and venous drainage?

Answer 30

Need donor celiac and SMA for arterial supply

Need donor portal vein for venous drainage

Question 31

How is attach the pancreas?

Answer 31

Attach to iliac vessels

Enteric drainage attaching donor duodenum to recipient bowel

Question 32

What clinical effects a succesful pancreas/kidney transplatn will cause?

Answer 32

Stabilization of retinopathy, decrease neuropathy, increase nerve conduction velocity, decrease autonomic dysfunction (gastroparesis), decrease orthostatic hypotension

Question 33

How long a heart can be stored?

Answer 33

6 hours

Question 34

What is the #1 cause of early mortality after a lung transplant?

Answer 34

Reperfusion injury

Question 35

What is an indication for double-lung transplant?

Answer 35

Cystic fibrosis

Question 36

What is characteristic of a chronic lung rejection?

Answer 36

Bronchiolitis obliterans