Chapter 20 Transplant Flashcards
The most common reason for liver transplant in US
Cirrhosis, due to chronic hep C and alcohol abuse
Scoring system for assessing the severity of chronic liver disease
MELD— Model for End-stage Liver Disease
Cadaveric liver donation connections:
-pretty much the same connections as the native liver
Living donor donation usually donates the ___ lobe
Right
The _________ are not routinely included in the native liver exam, but they are very important to image in transplanted patient
Hepatic arteries
A low RI can indicate
Proximal stenosis
High RI can indicate:
Rejection or hepatic venous congestion
Hepatic artery flow through out diastole: _____ resistance
Low resistance
Hepatic arteries velocities should be below:
200 cm/s
A normal RI in the hepatic artery is:
.5-.7
The most common cause for liver transplant failure is _____
Rejection
Acute rejection occurs within the first _____
10 days
Thrombosis and stenosis most commonly occurs at the ____ sites
Anastomosis sites
Hepatic vein/IVC thrombosis and stenosis color Doppler will show:
Aliasing, turbulence, tripling of the spectral Doppler waveform
Hepatic artery stenosis: ______ waveform
Tardus parvus
Hepatic artery stenosis velocity:
Greater than 200 cm/s
Hepatic artery stenosis RI:
Less than .5
The most common vascular complication of liver transplantation is:
Hepatic artery(HA) thrombosis
_____ is the only vascular supply to the bile ducts
Hepatic artery (HA)
Biliary complications usually occur within the first ______ months after transplantation
3 months
Most common biliary complication:
Obstruction
Hematomas are most common along the ____ spaces near the vascular and biliary anastomoses sites
Perihepatic
Recurrence of HCC is seen in about ___% of patients after their liver transplant
40%
The most common site of HCC recurrence is:
Lung, and then the liver
Portal venous gas is a common finding on ultrasound during the _____ period following transplantation
Early postoperative
Post-Transplant Lymphoproliferative Disorder appears:
hypoechoic soft tissue mass and may encase hepatic hilum
Transjugular Intrahepatic Portal-Systemic Shunt(TIPS) is placed:
Between right hepatic vein and right portal vein
A widely patant TIPS, the RPV and LPV will demonstrate _____- flow
hepatofugal
TIPS is placed by using ____ access
Jugular
TIPS is placed to:
Lower portal pressure(portal HTN)
TIPS malfunction: velocity
<50cm/s or >190cm/s
TIPS malfunction: _____ flow of LPV or RPV
Hepatopetal
The most common cause for needing a renal transplant is:
chronic end-stage renal disease or renal failure
Most common cause of renal disease leading to kidney transplant
Diabetes
Renal transplant is usually placed into the:
Right iliac fossa
In cadaveric renal transplants, the donors MAIN RENAL ARTERY is harvested with a portion of the AORTA which is then anastomosed to:
The side of recipient external iliac artery
Live donor transplants involve a direct anastomosis of _____ to the _______
Renal arterial graft to the external or internal iliac artery
The main renal vein is almost always grafted to the recipient ______ in a ___ to side manner
External iliac vein in an end to side manner
Renal: low RI indicates
Proximal stenosis
Renal: high RI indicates
Rejection, renal venous congestion
Normal renal transplant sonographic findings: ______ flow
Continuous diastolic flow
Normal renal transplant sonographic findings: _____ resistance wave form
Low resistance
Normal renal transplant sonographic findings: velocities should be:
Below 250cm/s
Normal renal transplant sonographic findings: RI in the arcuate artery:
.6-.7
Most common biopsy complication:
Bleeding
Causes of draft dysfunction or failure(renal):
- rejection
- acute tubular necrosis
- pyelonephritis
- drug nephrotoxicity
Renal graft dysfunction/failure: pyelonephritis occurs in ___% of patients in the first year
80%
The most common complications immediately postoperative and within the first year of transplantation are: _______ and ______
- Acute rejection
- Acute Tubular Necrosis
Renal graft complications: arterial flow RI:
> .8
In early stages following transplantation, the most common cause of hypertension is ______
Acute rejection
Urinary obstruction & stones: The most common site of obstruction is—
At the site of ureteral implantation into the bladder
(Renal) echogenic foci with shadowing or “twinkle” artifact on color Doppler:
Stones
Early ultrasound findings of renal vein stenosis and thrombosis:
Renal enlargement, hypoechoic cortex(edema)
Late ultrasound findings of renal vein stenosis and thrombosis:
-decreasing size and increased echogenicity
Renal artery thrombosis or stenosis: peak systolic velocity:
Greater than or equal to 250cm/s
Renal artery thrombosis or stenosis: velocity difference between pre and post stenotic segments ____
2:1
Renal artery thrombosis or stenosis: _____ waveform distal to stenosis
Tardus parvus
Renal artery thrombosis or stenosis: Renal artery/Aorta Ratio(RAR)
> 3.5
Most common peri-transplant fluid collection
Lymphoceles
Lymphoceles are typically found ____ to the transplant
Medial
Most common fluid collection that causes hydronephrosis
Lymphocele
Most severe complication found in solid organ as well as stem cell transplantation:
Post-Transplant Lymphoproliferative Disorder(PTLD)
