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Surgery > Fiser ABSITE Ch. 12 Transplant > Flashcards

Fiser ABSITE Ch. 12 Transplant Flashcards

1
Q

Three most important HLAs for recipientdonor matching?

Most important overall?

A

HLA-A, -B, -DR

-DR

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2
Q

ABO blood compatibility required for all transplants except ___

A

liver

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3
Q

Crossmatch detects preformed recipient antibodies by mixing recipient serum with donor lymphocytes that would generally cause ___ (except liver)

A

hyperacute rejection

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4
Q

Technique identical to crossmatch; detects preformed recipient antibodies using a panel of typing cells. Transfusions, pregnancy, pervious transplant, and autoimmune diseases can all increase.

A

Panel reactive antibody (PRA)

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5
Q

Tx for mild rejection.

A

Pulse steroids

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6
Q

What is the number one malignancy following any transplant?

A

skin CA (squamous cell CA #1)

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7
Q

What is the second most common malignancy following transplant?

A

Posttransplant lymphoproliferative disorder (PTLD)

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8
Q

What virus is associated with Posttransplant lymphoproliferative disorder (PTLD)?

A

epstein-barr

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9
Q

What is the tx for posttransplant lymphoproliferative disorder (PTLD)?

A

Withdrawal of immunosuppression; may need chemotherapy and XRT for aggressive tumor

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10
Q

Antirejection drug that inhibits de novo purine synthesis, which inhibits T cells. 6-Mercaptopurine is the active metabolite (formed in the liver). Side effects: myelosuppression. Keeps WBCs > 3.
Also, there is another drug with similar action.

A

Azathioprine (Imuran)

Mycophenolate

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11
Q

What antirejection drug works by inhibiting genes for cytokine synthesis (IL-1, IL-6) and macrophages.

A

steroids

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12
Q

What antirejection drug works by binding cyclophilin protein and inhibits genes for cytokine synthesis (IL-2, IL-3, IL-4, INF-gamma).

A

Cyclosporin (CSA)

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13
Q

What is the route of metabolism and excretion of cyclosporin?

A

hepatic metabolism and biliary excretion

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14
Q

What antirejection drug binds FK-binding protein; actions similar to CSA but 10-100x more potent. Side effects include: nephrotoxicity, mood changes, more GI and neurologic changes than CSA

A

FK-506 (Prograf)

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15
Q

What antirejection drug is equine polyclonal antibodies direct against antigens on T cells (CD2, CD3, CD4, CD8, CD1118). Used for induction therapy. Complement dependent. Keeps peripheral T-cell count >3?
Also there is another drug that has similar action but is rabbit polyclonal antibodies.

A

ATGAM

Thymoglobulin

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16
Q

What type of rejection occurs within minutes to hours?

A

Hyperacute rejection

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17
Q

What is hyperacute rejection caused by?

A

preformed antibodies that should have been picked up on crossmatch

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18
Q

What is the tx for hyperacute rejection.

A

Emergent retransplant

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19
Q

What type of rejection occurs less than 1 week?

A

accelerated rejection

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20
Q

What is accelerated rejection caused by?

A

sensitized T cells to donor antigens

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21
Q

What is the tx for accelerated rejection?

A

increase immunosuppression, pulse steroids, and possibly OKT3

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22
Q

What type of rejection occurs in 1 week to 1 month?

A

acute rejection

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23
Q

What is acute rejection caused by?

A

cytotoxic and helper T cells

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24
Q

What is the treatment for acute rejection?

A

increase immunosuppression, pulse steroids and possibly OKT3

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25
Q

What type of rejection occurs in months to years?

A

chronic rejection

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26
Q

What type of hypersensitivity reaction is chronic rejection? (Antibodies, monocytes and cytotoxic t cells also play a role)

A

Type IV

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27
Q

What is the tx for chronic rejection?

A

increase immunosuppression or OKT3 - no really effective tx

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28
Q

How long can you store a kidney?

A

48 hours

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29
Q

Can you still use a kidney with UTI or acute increase in Cr (1.0-3.0)

A

yes

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30
Q

2 main causes of mortality in kidney transplant?

A

stroke and MI

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31
Q

What vessels are donor kidney attached to?

A

external iliac

32
Q

Number one complication of kidney transplant? tx?

A

urine leaks;

drainage and stenting; may need reoperation

33
Q

Most common cause of external compression after kidney transplant? Tx 1st and if that fails

A

lymphocele

percutaneous drainage, intraperitoneal marsupialization (90% successful)

34
Q

After kidney transplant, postop oliguria is usually due to ___ (pathology shows hyrophobic changes)

A

ATN

35
Q

After kidney transplant, postop diuresis is usually due to ___ and ___

A

urea and glucose

36
Q

New proteinuria after kidney transplant is usually suggestive of what?

A

renal vein thrombosis

37
Q

Postop diabetes after kidney transplant is usually due to what?

A

side effects of rejection meds: CSA, FK, steroids

38
Q

Kidney rejection workup (usually for increase in Cr): ___ to rule out vascular problem and ureteral obstruction; bx; empiric decrease in CSA or FK because they can be nephrotoxic; what tx?

A

US with duplex;

pulse steroids

39
Q

What is the 5-year graft survival for kidney transplant?

A

70% (65 cadaveric, 75 living)

40
Q

Living kidney donors: most common complication? most common cause of death?

A 
wound infection (1%);
fatal PE
41
Q

How long can you store a liver for transplantation?

A

24 hours

42
Q

2 contraindications to liver TXP

A

current ETOH abuse, acute ulcerative colitis

43
Q

What is the most common reason for liver TXP in adults?

A

chronic hepatitis

44
Q

Criteria for emergent liver TXP - stage III (___), stage IV (___)

A

stupor, coma

45
Q

What are two postoperative tx for pts with Hep B after TXP?

A

HBIG (hep B immunoglobulin) and lamivudine (protease inhibitor)

46
Q

What are the tumor size limitations on considering TXP with hepatocellular carcinoma

A

single tumor less than 5 cm;

3 tumors each less than 3 cm

47
Q

Is portal vein thrombosis a contraindication to liver TXP?

A

no

48
Q

What is the best predictor of 1 year survival after liver TXP?

A

APACHE score

49
Q

What is more likely to occur in liver allograft, Hep B or C

A

Hep C (Hep B reduced to 20% with the use of HBIG)

50
Q

What percentage of liver TXP pts will start drinking again?

A

20%

51
Q

What is the #1 predictor of primary nonfunction in liver TXP?

A

Macrosteatosis (extracellular fat globules in allograft); (if 50% of cross section is macrosteatatic, there is 50% chance of primary nonfunction)

52
Q

What is the difference in liver TXP procedure in adults vs. kids?

A

Duct-to-Duct in adults

Hepatico jejunostomy in kids

53
Q

Location of drains after liver TXP

A

Right subhepatic, Right and Left subdiaphragmatic

54
Q

What is the most common hepatic arterial anomaly?

A

right hepatic coming off SMA

55
Q

1 complication of liver TXP? Tx?

A

Bile leak; PTC tube and stent

56
Q

What are the signs and sx of primary nonfunction after liver TXP in the 1st 24 hrs

A

total bilirubin > 10, bile output less than 20 cc/12h, PT and PTT 1.5x normal

57
Q

What are the signs and sx of primary nonfunction after liver TXP after 96 hours?

A

hyperkalemia, mental status changes, increased LFTs, renal failure, respiratory failure

58
Q

What is the tx of primary nonfunction after liver TXP?

A

usually requires retransplantation

59
Q

Most common cause of liver abscesses after TXP?

A

chronic hepatic artery thrombosis

60
Q

Tx for hepatic artery thrombosis after liver TXP?

A

angio, surgery, retransplantation

61
Q

Edema, acites, renal insufficiency after liver TXP could be due to what?

A

IVC stenosis

62
Q

After liver TXP: fever, jaundice, decreased bile output, change in bile consistency. leukocytosis, eosinophilia, increased LFTs, total bilirubin, PT. Pathology shows portal lymphocytosis, endotheliitis, bile duct injury. Dx?

A

acute rejection

63
Q

After liver TXP: disappearing bile ducts, gradual bile obstruction with increased alk phos, portal fibrosis. Dx?

A

chronic rejection

64
Q

What is the most common predictor of chronic rejection in liver TXP?

A

acute rejection

65
Q

Liver TXP retransplantation rate?

A

20%

66
Q

LIver TXP 5 year survival rate?

A

70%

67
Q

How long can a heart for TXP be stored?

A

6 hours

68
Q

What is the life expectancy needed for a heart TXP?

A

Less than 1 year

69
Q

What is the tx for persistant pulmonary hypertension after heart transplant?

A

Flolan (PGI2); inhaled nitric oxide, ECMO if severe

70
Q

After heart TXP: perivascular infiltrate with increasing grades of myocyte inflammation and necrosis. Dx?

A

acute rejection

71
Q

After heart TXP: progressive diffuse coronary atherosclerosis. Dx?

A

Chronic rejection

72
Q

How long can a lung for transplantation be stored?

A

6 hours

73
Q

What is the life expectancy needed for a lung TXP?

A

Less than 1 year

74
Q

What is the number one cause of early mortality after lung TXP?

A

reperfusion injury

75
Q

What is the indication for double-lung TXP?

A

cystic fibrosis

76
Q

Exclusion criteria for using lungs for TXP includes: aspiration, moderate to large contusion, infiltrate, purulent sputum, PO2

A

350

77
Q

What is the sign of acute lung rejection? chronic?

A

perivasculare lymphocytosis

bronchiolitis obliterans

Surgery (33 decks)

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