Chapter 23: Transplantation Flashcards
A 30yo woman with ESRD is scheduled for renal transplantation. The donor is her identical twin sister. Which of the following describes the best immunosuppression regiment for this pt after transplantation?
No immunosuppression because of lack of immune reactivity to donor graft isoantigens
A 50yo man develops HTN, tremors, and LFTs while being treated for an episode of acute rejection four months after transplantations of a deceased donor kidney for ESRD as a consequence of Type 1 DM. His maintenance immunosuppression regiment has included tacrolimus, mycophenolate mofetil, and prednisone, and the doses of these have been increased. He has also been treated with OKT3. Which of the following is most likely associated with the onset of HTN, tremors, and LFTs in this pt?
a. Tacrolimus also called FK506
1. Activation of T cell receptor normally increases intracellular Ca, which acts via calmodulin to activate calcineurin. Calcineurin then dephosphorylates the txs factor NF-AT, which moves to nucleus of T cell and increases the activity of genes coding for IL2 and related cytokines.
2. Tacrolimus complexes with FKBP12, and this complex interacts with and inhibits calcineuron, thus inhibiting signal transduction and IL-2 txs.
ii. Orthoclone OKT3 (Muromonab-CD3)
A 52yo man with CHF secondary to ischemic cardiomyopathy is considering heart transplantation. He is not diabetic, and he has no other chronic medical conditions. If he is compliant with his immunosuppressive therapy, what can you predict the 1yr survival rate will be for his cardiac transplantation?
80%
A 20yo man sustained a severe head injury when he fell while rock climbing. He is brain dead and his family has agreed to organ donation. His vital signs are BP 80/40mmHg and pulse 110/min. He is intubated on controlled pressure ventilation. His O2 saturation is 100%. Which of the following drugs is most useful in maintaining his BP until organ donation?
Dopamine
A 30yo man underwent a donor renal transplantation 3mo ago for ESRD secondary to post-streptococcal glomerulonephritis. He has been on CellCept and prednisone for maintenance immunosuppression. A recent episode of rejection was treated with OKT3 and increased dose of prednisone. His azathioprine dose was increased to decrease his steroid dose. His Creatinine has stabilized but he is now leukopenic. What is the most likely cause of his leucopenia?
a. Increased CellCept dose
i. CellCept: Mycophenolate mofetil
1. Inhibits inosine monophosphate dehydrogenase (enzyme that controls rate of syn of GMP in de novo p/w of purine synthesis used in prolif of B and T cells)
2. Usually used in 3 compound regiment: calcineurin inhibitor (ciclosporin or tacrolimus) and prednisone)
A 46yo man is brain dead following a MVC. His family agrees to organ donation and he undergoes multiple organ retrieval. His BP was 110/60 mmHg on dopamine at the time of retrieval. The organ were approx flushed in situ with preservation and removed in an expeditious manner. What is the longest optimum time the liver can be kepton ice without significant ischemic injury?
18 hours
A 46yo woman underwent donor renal transplantation 6mo ago. She cannot tolerate steroids and she is currently maintained on an immunosuppressive regiment of cyclosporine and alemtuzumab (Campath-1H). What is the MOA of alemtuzumab?
Depletes T and B Lymphocytes binds CD52, protein present on surface of mature LCs, but not on stem cells from which these LCs are derived.
A 43 yo man sustained a severe head injury when he crashed his motorcycle into an oncoming car. In the ED his vital signs are BP 110/60 mmHg and pulse 60. He is intubated, and has no spontaneous respirations. ICP is 30 mmHg. DTRs are absent. At the scene, he had decorticate posturing but in the ED he had a decerebrate response to painful stimuli before being intubated. Pupils are fixed at mid positions. CT scan shows severe diffuse edema. Which of the following clinical criteria best determines the cessation of brain function for organ donation in this pt?
Absence of spontaneous respirations
30yo man with chronic RF secondary to T1 DM is being evaluated for simultaneous kidney/pancreas decreased donor transplant. Which of the following is the best immunologic test to detect Ags from the cellular arm of the immune response in this pt?
Mixed lymphocyte culture determines the HLA class II types
A 50yo man has hepatitis C-induced cirrhosis. His total bilirubin is 3.2 mg/dL, his INR is 1.8, and his Cr is 1.4mg/dL. Which of the following pts should have higher place on waiting list compared to this pt?
A 44yo woman with acute liver failure secondary to Wilson’s disease
A 48yo man has severe cardiomyopathy associated with ventricular arrhythmias and cardiac failure secondary to cardiac sarcoidosis. He has an implantable defibrillator that d/cs several times each day b/c of his arrhythmias, despite his multiple medications. He now has severe pulmonary HTN. His chest radiograph shows a large heart and pulmonary vascular congestion. Which of the following conditions would suggest that he is more suitable for a heart lung transplant rather than an isolate heart transplant?
Severe pulmonary hypertension
A 34yo man is found to have elevated fasting blood sugar and an abnormal glucose tolerance test. He recently underwent deceased donor renal transplant for post-streptococcal glomerulonephritis. His maintenance immunosuppressive regiment is tacrolimus, mycophenolate mofetil, and prednisone. The most likely cause of his glucose intolerance is:
Tacrolimus
A 48yo heart transplant recipient maintained on cyclosporine, mycophenolate mofetil, and prednisone is being treated for a fungal infection of his fingers with oral fluconazole (diflucan). The most likely effect will be:
Elevated serum creatinine due to nephrotoxicity
A 24yo woman underwent a double lung transplant for cystic fibrosis one year ago. She has been maintained on an immunosuppressive regimen of tacrolimus, mycophenolate mofetil, and prednisone. Recently she has been experiencing a cough and low-grade fever. A CXR reveals bilateral infiltrates, and further workup and bx shows obliterative bronchiolitis. The most likely dx is:
Chronic rejection
A 8yo boy is scheduled for a kidney transplant from his 18yo brother. Immunologic testing shows a six-antigen match. Which of the following immunosuppression strategies is most appropriate for this recipient?
A combination of agents (i.e. CellCept, tacrolimus, and prednisone)
