ASF - Transplants (Nadig)

Question 1

What stratification tool is used in allocation of kidney or pancreas?

Answer 1

Calculated Panel Reactive Antibody (CPRA)

Tool used in the allocation of kidney, and pancreas

Measures antibody sensitization (% of donors not compatible is secondary to candidates unacceptable antigens)

If >80%, you get 4 extra points

Question 2

How many patients are added to the organ transplant waiting list each day? How many of them die each day?

Answer 2

103 added

18 die

Question 3

What are the biggest barriers to organ donation?

Answer 3

1. DNR orders
2. Early withdrawal of life support
3. Reluctance to support organ donation

Question 4

What is the drug Mycophenolate Mofetil (cellcept) used for?

Answer 4

Used in transplant as an antiproliferative to prevent rejection in renal, liver, and cardiac transplants

Question 5

What are the 5 pre-transplantation requirements?

Answer 5

1. Blood type (ABO; Rh not important in most cases)
2. HLA - antigens on WBCs
3. Cross-match - mix patient and donor blood together to see if reaction occurs
4. Serology - HIV, CMV, hepatitis
5. Cardipulmonary and cancer screening

Question 6

What are the 10 transplantable organs?

Answer 6

1. Liver
2. Kidney
3. Pancreas
4. Heart
5. Lung
6. Intestine
7. Face
8. Bone marrow
9. Cornea
10. Blood

Question 7

What is an allograft/homograft?

Answer 7

Organ transplantation among the same species

Question 8

What are 5 factors that will disqualify a recipient of a potential transplantation?

Answer 8

1. Recent MI
2. Active infection
3. Malignant cancers
4. Substance abuse
5. Limited life expectancy from unrelated disease

Question 9

What is the difference between heterotopic and orthotopic transplantation?

Answer 9

Heterotopic - organ removed from one anatomical region and implanted to a new one (ex: kidney into iliac fossa)

Orthotopic - organ removed from one anatomical position and implanted into the same region in the recipient (ex: heart and lung)

Question 10

True or false: Organs are first offered to patients within the area in which they were donated before being offered to other parts of the country.

Answer 10

True

Exception: if a donor kidney is a perfect match to a recipient not in the area

Question 11

What two organs require the longest wait, on average?

Answer 11

1. Kidney (1121 days)
2. Lungs (1068 days)

Question 12

What are the 2 end stage liver disease tools used to stratify transplant recipients?

Answer 12

1. Model for end stage liver disease (MELD) - for people over the age of 12
   
   1. Creatinine, bilirubin, and INR
2. Pediatric end stage liver disease (PELD) - for children under the age of 12
   
   1. Albumin, bilirubin, INR, growth failure and age

Question 13

What is a lung allocation score (LAS)?

Answer 13

Score used to determine who gets a lung transplant. It reflects the medical status and likelihood of a successful transplant of recipient

Question 14

What is the most common steroid used in transplantation?

Answer 14

Prednisone (solumedrol)

Question 15

What is the term used to describe transplantation between different species?

Answer 15

Xenografting (heterografting)

Question 16

What is the formal, uniform determination of the death act of 1981?

Answer 16

An individual is considered dead if one of the following is true:

1. Irreversible cessation of circulatory or respiratory functions
2. Irreversible cessation of all functions of the entire brain, including brainstem

Must establish the cause that accounts for loss of function.

Question 17

What are the cardiac candidate statuses 1A, 1B, 2 and 7?

Answer 17

1A - admitted to transplant center with one of the following

1. Mechanical ventricular assist device for 30 days with clinical stability (total artificial heart, ECMO, IABP)
2. Mechanical circulatory support with evidence of related complication
3. Continuous mechanical ventilation
4. Continuous infusion of inotrope in addition to continuous hemodynamic monitoring of LV filling pressures

1B - L/R VAD with continuous infusion of inotropes

2 - does not fulfill criteria of 1A/B

7 - currently unsuitable for transplant

Question 18

What is the trend of the number of patients on the organ transplant wait list? What is the trend of deaths of patients on the wait list?

Answer 18

Both rates steadily increase

Question 19

What is an autograft transplanation?

Answer 19

Moving an organ/tissue from the body and putting it elsewhere

Ex: skin graft

Question 20

What are isografts/syngenetic grafts?

Answer 20

Organ transplantation occurring between two identical twins

Question 21

What is the cardiac transplant stratification system?

Answer 21

Candidate status of 1A, 1B, 2 and 7

Question 22

True or False: Patients who irreversibly lack a gag reflex, corneal reflex or pupillary reflex are considered brain dead.

Answer 22

True

Question 23

Organ transplanation between identical twins is called what?

Answer 23

Isograft or syngenetic graft.