ABSITE Review - Transplantation Flashcards
What is the most important overall marker in transplant?
HLA-DR
What is the only organ which does not need ABO blood compatibility?
Liver
The crossmatch is performed to detect …
Preformed recipient antibodies by mixing recipient serum with donor lymphocytes –> would generally cause hyperacute rejection (except liver)
What is the #1 malignancy following any transplant?
Skin Cancer - Squamous cell CA
What is the next MC CA following a transplant? What is the virus related? What is the treatment?
Posttransplant Lymphoproliferative disorder (PTLD)
EBV
Tx: withdrawal of immunosuppression, may need chem and XRT for aggressive tumor
What is the MOA and side effects of Azathioprine (Imuran)?
Inhibits de novo synthesis, which inhibits T cells
SEs: myelosuppression
What is the MOA and side effects of Cyclosporin (CSA)?
Binds cyclophilin protein and inhibits genes for cytokine synthesis (IL-2, IL-3, IL-4, INF-gamma)
SEs: nephrotoxicity, hepatotoxicity, HUS, tremors, seizures
What is the MOA and side effects of FK-506 (Prograf)?
Binds FK-binding protein, MOA similar to CSA but more potent
SEs: nephrotoxicity, mood changes
What is the MOA of ATGAM?
Equine polyclonal antibodies directed against antigens on T cells, used for induction therapy
What is the MOA and side effects of OKT3?
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
Describe the timeframe and cause of Hyperacute rejection. What is the treatment?
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
Describe the timeframe and cause of Accelerated rejection. What is the treatment?
Occurs <1week
Caused by sensitized T cells to donor antigens
Tx: increase immunosuppression, pulse steroids and possibly OKT3
Describe the timeframe and cause of Acute rejection. What is the treatment?
Occurs 1 week to 1 month
Caused by T cells (cytotoxic and helper T cells)
Tx: increase immunosuppression, pulse steroids and possibly OKT3
Describe the timeframe and cause of Chronic rejection. What is the treatment?
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
How long a kidney can be stored and where it is attach?
Can store a kidney for 48 hours
Attach to iliac vessels
What is the #1 complication of a renal transplant? What is the treatment?
Urine leak
Tx: drainage and stenting
What is the MCC of external compression after a kidney transplant?
Lymphocele
Tx: 1st percutaneous drainage; if that fails then need intraperitoneal marsupialization
What suggest new proteinuria after a kidney transplant?
renal vein thrombosis
What should include a kidney rejection workup?
Ultrasound with duplex (to rule out vascular problem and ureteral obstruction) and biopsy
How long a liver can be stored?
Can store liver for 24 hours
What contraindications to liver transplant?
current ETOH abuse, acute UC
What is the best predictor of 1-year survival after a liver transplant?
APACHE score
How is the duct anastomosis performed?
Duct-to-duct anastomosis
Hepaticojejunostomy in kids
What drains are left in place?
Right subhepatic, right and left subdiaphragmatic drains
What is the MC arterial anomaly in the liver?
Right hepatic coming off SMA
What is the #1 complication of a liver transplant? What is the treatment?
Bile leak
Tx: PTC tube and stent
What is the treatment for hepatic artery thrombosis?
Angio, surgery, retransplantation
What is the cause and pathology of acute liver rejection?
T cell mediated against blood vessels
Pathology - shows portal lymphocytosis, endotheliitis and bile duct injury
What is the pathology of chronic liver rejection?
Disappearing bile ducts (antibody and cellular attack on bile ducts)
For pancreas tranplant, what is used for arterial supply and venous drainage?
Need donor celiac and SMA for arterial supply
Need donor portal vein for venous drainage
How is attach the pancreas?
Attach to iliac vessels
Enteric drainage attaching donor duodenum to recipient bowel
What clinical effects a succesful pancreas/kidney transplatn will cause?
Stabilization of retinopathy, decrease neuropathy, increase nerve conduction velocity, decrease autonomic dysfunction (gastroparesis), decrease orthostatic hypotension
How long a heart can be stored?
6 hours
What is the #1 cause of early mortality after a lung transplant?
Reperfusion injury
What is an indication for double-lung transplant?
Cystic fibrosis
What is characteristic of a chronic lung rejection?
Bronchiolitis obliterans
