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BCTXP > Evaluation of donor & recipients & Allocation > Flashcards

Evaluation of donor & recipients & Allocation Flashcards

1
Q

Acceptable GFR for kidney donation

A

Acceptable: GFR > 90

May use: GFR 60 – 89

Contraindicated: GFR < 60

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2
Q

Acceptable BP for kidney donation

A

< 140/90 on 1 or 2 antihypertensive rx w/o evidence of end-organ damage

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3
Q

Acceptable DM status for kidney donation

A

T1DM cannot donate, T2DM or pre-diabetics on case by case basis

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4
Q

Acceptable albuminuria for kidney donation

A

Acceptable: Urine AER less than 30 mg/d

Contraindicated: > 100 mg/d

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5
Q

Kidney txp: when to refer for evaluation

A

GFR < 30 and expected to reach ESRD

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6
Q

Absolute C/I to kidney transplant

A
  • Reversible renal failure
  • Severe irreversible extrarenal dz
  • Active infxn
  • Active or untreatable malignancy
  • Primary oxalosis
  • Life expectancy <2 years
  • Limited irreversible rehabilitative potential
  • Poorly controlled psych illness
  • Active illicit drug abuse
  • Ongoing nonadherence
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7
Q

Frailty assessment tools

A

Liver txp: Liver Frailty Index

Geriatric populations: Fried Frailty Phenotype

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8
Q

Liver txp: indications for listing

A

Severe acute liver dz or ESLD w/ exhaustion of medication therapies + index complication (ascites, HE, etc)

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9
Q

Absolute C/I to liver transplant

A
  • MELD < 15
  • Severe cardiac/pulmonary dz
  • Fulminant hepatic failure with sustain ICP > 50 or CPP < 40
  • Active extrahepatic malignancy
  • Intrahepatic cholangiocarcinoma
  • Active, controlled infxn outside HB system
  • Active substance abuse
  • Technical/anastomical barriers
  • Lack of adequate social support
  • Persistant noncompliance
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10
Q

Panc txp: indications for listing

A
  • T1DM or T2DM (no longer req to meet C peptide or BMI criteria)
  • Pancreatic exocrine insufficiency (pancreatectomy, CF)
  • Req of procurement of txp for part of mult-organ txp for technical reasons
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11
Q

Kidney-Panc txp: indications for listing

A
  1. DM or pancreatic exocrine insuff

2. GFR < 20

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12
Q

Intestinal txp: who to refer for evaluation

A

PN Failure:
- Impending or apparently liver failure 2/2 PN
- CVC-related thrombosis of 2 central veins
- Frequent central line sepsis: 2 episodes/year of systemic sepsis OR single episode of fungemia/septic shock/ARDS
- Frequent episodes of severe dehydration despite IVF
Desmoid tumors
Congenital mucosal disorders
Ultrashort bowel syndrome
Intestinal failure with high morbidity or inability to function
Patient unwillingness to accept long-term PN

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13
Q

Heart txp: indications for listing

A

Refractory AHA Stage D or NYHA Class III-IV Heart Failure

Malignancy ventricular arrhythmias unresponsive to standard therapies

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14
Q

Absolute C/I to heart transplant

A
  • Irreversible pulm HTN
  • Chronic noncardiac illness that compromisess urvival
  • Severe PAD
  • Active or recent malignancy
  • Active infection
  • Ongoing substance abuse
  • Noncompliance
  • Psych instability
  • Poor DM control
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15
Q

Lung txp: indications for listing

A
  • Obstructive dz: COPD, emphysema, bronchiectasis
  • Pulm vascular dz : pulm HTN
  • CF or immunodeficiency disorders
  • Restrictive lung dz: IPF, retransplant
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16
Q

Absolute C/I to lung transplant

A
  • Malignancy in the last 5 years (or 2 years if low risk)
  • Multi-organ dysfunction
  • Uncorrected atherosclerotic dz with end organ ischemia or CAD
  • Acute medical instability: infxn or otherwise
  • Uncorrectable bleeding diathesis
  • Chronic infxn with highly virulent microbes
  • Active TB infxn
  • Significant chest wall or spinal deformity
  • Current or hx of nonadherence
  • Psych instability
  • Lack social support
  • Severe limited functional status
  • Substance abuse
17
Q

Kidney Txp: Dual antiplatelet therapy recommendations

A

Rec’d to delay txp for the mandated period
of treatment with DAPT when the risk of stopping medication (eg, stent thrombosis) or operating while on treatment (eg, surgical bleeding)
exceeds the anticipated benefit of transplantation

IF living donor: antiplatelets should be stopped 5 days prior to txp

18
Q

Kidney Txp: Time to wait after stroke/TIA

A

Stroke: 6 mo
TIA: 3 mo

19
Q

Kidney Txp: When to hold warfarin pre-txp

A

Living donor: 5 days

20
Q

Islet cell txp candidates

A
  • T1DM c/b hypoglycemia unawareness, severe hypoglycemia episodes, or glycemia liability
  • Chronic pancreatitis with total pancreatectomy
21
Q

Patients who should not be considered for islet cell

A
  • T1DM <5 years
  • Age 18+
  • BMI > 30
  • Weight > 90 Kg
  • Daily insulin req >1 u/kg
22
Q

Intestinal Organ Allocation Statuses

A

Status 1: LFT abnormalities, loss of vascular access, or urgent need
Status 2: all others

BCTXP (11 decks)

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