HLA Crap

Question 1

How many HLA antigens are looked at for a match?

Answer 1

6

Question 2

The ________ the match, the less likely for _________.

Answer 2

HIgher

Rejection

Question 3

Which two organs require an exact match?

Answer 3

Kidneys and bone marrow

Question 4

What organ requires no HLA match? Why not?

Answer 4

Corneas

Corneas are avascular

Question 5

What is a Positive (+) crossmatch?

Answer 5

Blood from donor 
\+
Blood from recipient
= 
BAD reaction

Question 6

What is a Negative (-) crossmatch?

Answer 6

Blood from donor 
\+
Blood from recipient
= 
No reaction

Question 7

What type of crossmatch is necessary for a transplant?

Answer 7

Negative (-)

Question 8

What are the 3 MAIN components for transplant?

Answer 8

1. Negative crossmatch
2. ABO compatibility
3. HLA match

Question 9

How many types of rejection are there?

Answer 9

3; hyperacute, acute, chronic

Question 10

Hyperacute reaction

When does it occur?
Why is it rejecting?
What organ is more susceptible to this type of reaction?
Treatment?

Answer 10

Almost immediately! Occurs in minutes to hours!

Requires immediate removal of the organ

Rejects due to pre-existing antibodies
- Most likely there was a FALSE negative crossmatch

Most susceptible organ - kidneys

No treatment

Question 11

Acute reaction

When does it occur?
Is it reversible?
Treatments?

Answer 11

Occurs - Usually within 6 months post transplant (can happen up to a year)

The ONLY rejection that is REVERSIBLE

Meds: Immunosuppressants (for life) and corticosteroids

Question 12

Chronic reaction

When does it occur?
Is it reversible?
What are treatments?

Answer 12

Occurs - when the patient has repeated acute rejections. Repeated rejections cause scarring making the organ unable to work.

Non-reversible, organ is scarred (dead) which means no perfusion

TX: Pt will need to be placed back on a transplant list for another transplant - If kidneys, the patient will need to go back on dialysis and most likely need new venous access.
Pt can stop taking immunosuppressants

Question 13

Why don’t we use immunosuppressants for a chronic reaction?

Answer 13

Because the organ is already dead therefore the body cannot reject it

Question 14

Graft Vs. Host Disease

How soon does it occur?
Treatment?

Answer 14

The transplanted ORGAN REJECTS the recipient’s BODY

Happens in 1 - 4 weeks

NO adequate treatment
Focus on prevention:
- Irradiated blood products
- Immunosuppressants
- Corticosteroids

Question 15

3 clinical manifestations of Graft Vs Host

Answer 15

Skin issues (rash)

Liver issues

GI issues

Question 16

What do corticosteroids do?

Answer 16

Suppress the inflammatory response

Question 17

What do calcineurin inhibitors do?

Answer 17

Inhibit B & T cells (WBC)

Question 18

What do cytotoxic drugs do?

Answer 18

Suppress B & T cells

Question 19

What do monoclonal antibodies do?

Answer 19

inhibit T cell function

Question 20

What do polyclonal antibodies do?

Answer 20

Deplete T cells

Question 21

Can a patient with uncontrolled diabetes receive a transplant?

Answer 21

NO

Why? The patient is UNSTABLE

Question 22

Can a patient with managed HIV receive a transplant?

Answer 22

YES

Why? More recently, if HIV is managed PROPERLY the patient is considered STABLE

Question 23

Can a patient with managed Hep C donate and organ to a recipient with managed Hep C?

Answer 23

YES

Why? Both patients are STABLE

Question 24

Can a patient with chronic respiratory infections receive a transplant?

Answer 24

NO

Why, patient is UNSTABLE

Question 25

During the live donor, kidney transplant process, is the procedure more difficult for the donor or the recipient?

Answer 25

The donor Why? When harvesting the kidney it is very invasive for the donor because of where the kidneys are located. For the recipient, the kidney is not transplanted in the same place at it originates. It is placed in a much lower position, and access is easier.

Question 26

What are complications of kidney transplantation?

Answer 26

``` Rejection (most common) Infection Cardiovascular disease Malignancies (cancer) Recurrence of original renal disease Long term corticosteroid-related complications ```

Question 27

Kidneys need a MAP of _____ to fully perfuse

Answer 27

65 or >

Question 28

A patient with end-stage renal disease is being evaluated for possible kidney transplant. The nurse prepares this patient for which testing for this procedure? Select all that apply. ``` ABO typing Electrolytes Cross-matching BUN and creatinine Tissue typing ```

Answer 28

Tissue typing ABO typing Cross-matching

Question 29

After teaching a patient on immunosuppressant therapy after a kidney transplant about the post transplant drug regimen, the nurse determines that additional teaching is needed when the patient says: a. "If I develop an acute rejection episode, I will need to have other types of drugs given IV." b. "I need to be monitored closely because I have a greater chance of developing malignant tumors." c. "After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor." d. "The drugs are given in combination because they inhibit different aspects of transplant rejection."

Answer 29

c. "After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor." The calcineurin inhibitor will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics. DIF: Cognitive Level: Application REF: 230-232

Question 30

A patient who received a bone marrow transplant for treatment of leukemia develops a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication that the: a. donor T cells are attacking the patient's skin cells. b. patient's antibodies are rejecting the donor bone marrow. c. patient is experiencing a delayed hypersensitivity reaction. d. patient will need treatment to prevent hyperacute rejection.

Answer 30

a. donor T cells are attacking the patient's skin cells. The patient's history and symptoms indicate that the patient is experiencing graft-versus-host disease, in which the donated T cells attack the patient's tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity. DIF: Cognitive Level: Comprehension REF: 232 **** I want to say this question or one very similar to it, is on her test *****

Question 31

A patient is admitted to the hospital with acute rejection of a kidney transplant. The nurse will anticipate: a. administration of immunosuppressant medications. b. insertion of an arteriovenous graft for hemodialysis. c. placement of the patient on the transplant waiting list. d. drawing blood for human leukocyte antigen (HLA) and ABO compatibility matching.

Answer 31

a. administration of immunosuppressant medications ANS: A Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing. DIF: Cognitive Level: Application REF: 229-230

Question 32

Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider? a. Patient is Rh positive and donor is Rh negative. b. Six antigen matches are present in HLA typing. c. Results of patient-donor cross matching are positive. d. Panel of reactive antibodies (PRA) percentage is low.

Answer 32

Results of patient-donor cross matching are positive. ANS: C Positive cross matching is an absolute contraindication to kidney transplantation, since hyperacute rejection will occur after the transplant. The other information indicates that the tissue match between the patient and potential donor is acceptable. DIF: Cognitive Level: Application REF: 229

Question 33

When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider? a. Dry lips and oral mucous b. Crackles at both lung bases c. Temperature 100.8° F (38.2° C) d. No bowel movement for 4 days

Answer 33

c. Temperature 100.8° F (38.2° C) ANS: C Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions, but do not indicate a need for urgent action. DIF: Cognitive Level: Application REF: 1088

Question 34

The decision to donate one's organs or tissues can be made by the patient __________ death or by the patient's _________ after death.

Answer 34

BEFORE death | FAMILY after death

Question 35

Patients with a heart transplantation are at rick for which of the following complication in the first year after transplantation? (select all that apply) a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden Cardiac Death

Answer 35

Correct answers: b, c, e b. Infection c. Rejection e. Sudden Cardiac Death Rationale: A variety of complications can occur after heart transplantation. In the first year after transplantation, the major causes of death are acute rejection and infection. Heart transplant recipients also are at risk for sudden cardiac death. Later, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are major causes of death.

Question 36

The nurse plans long-term goals for the patient who has had a heart transplant with the knowledge that a common cause of death in heart transplant patients during the first year is: a. infection b. heart failure. c. embolization d. malignant conditions

Answer 36

a. infection Because of the need for long-term immunosuppressant therapy to prevent rejection, the patient with a transplant is at high risk for infection, a leading cause of death in transplant patients. Acute rejection episodes may also cause death in patients with transplants, but can be successfully treated with augmented immunosuppressive therapy. Malignancies occur in patients with organ transplants after taking immunosuppressants for a number of years.

Question 37

This type of transplant rejection which most commonly occurs with kidney transplant.

Answer 37

Hyperacute

Question 38

Organ must be removed when this type of transplant rejection occurs.

Answer 38

Hyperacute

Question 39

A transplant rejection which Infiltration of the organ with B and T lymphocytes occur.

Answer 39

Chronic

Question 40

A transplant rejection which usually reversible with additional or increased immunosuppressant therapy.

Answer 40

Acute