Organ transplant Flashcards
What is a heterograft?
transplantation of tissues between two different species
What is an isograft?
transplantation of tissues between identical twins
What is an allograft?
tissue that is transplanted between members of the same species
What are the 3 topics that need to be assessed in order to determine brain death?
ensure the cause of unresponsiveness is not reversible
absence of metabolic central nervous system depression (which must be fixed first)
Absence of toxic cns depression (sedatives, alcohol, neuromuscular blockade)
Can an EEG be used to determine brain death?
no
If a person has brain death, will they be positive or negative for the doll’s eye test?
negative
What criteria need to be met in order for a person to be a donor?
no active bacterial, viral, or severe fungal infections
No active systemic cancers
Assessment of high risk behaviors (IV drug use, etc.)
Absence of hyper/hypotension
Diabetes may or may not be an issue
Corneas less stringent (avascular)
What are the 5 major goals for physiologic management of a donor?
maintain hemodynamic stability
maintain optimal oxygenation
maintain normothermia
maintain fluid and electrolyte balance
prevent infectiosn
What is the golden hour for organ donation?
the organs must be procured from the donor within an hour after the death of the patient
Which hospitals in arizona perform organ transplants?
banner UMC (Tucson)
Mayo clinic (Scottsdale)
St. Joe’s (Phx)
AZ GS Banner UMC
When can an organ be re-transplanted?
if the original recipient died from something other than transplant related
How long can a heart be out of a body and on ice before it must be transplanted?
4-6 hours
What is different about an ECG for a patient that has had a heart transplant?
it will have 2 p waves
What is one of the major complications of receiving a denervated donor heart?
The patient may not experience angina, and since they cannot feel pain, the patient may have silent MIs
What are common signs and symptoms of a heart transplant rejection?
fatigue/weakness
fever 100.5 or greater
General malaise
SOB
Tachycardia/dysrhythmia
Edema/sudden weight gain
Hypotension
What is a major sign that rejection of a heart transplant is occurring?
dysrhythmias
What are the clinical indications for a lung transplant?
irreversible end stage lung disease, expected to die in 1-2 years
Why would a patient need a single lung transplant?
COPD, Alpha-1 Antitrypsin Deficiency
Why would a patient need a double lung transplant?
CF or bronchiectasis
why would a patient need a heart/lung transplant?
pulmonary HTN or Elsenmenger’s
What is the cold time for a lung transplant?
4-6 hours
What are the common signs/symptoms of rejection?
Malaise
Non-productive cough
Dyspnea
Decreased O2 sats
Abnormal pulmonary function test
Indications for a liver transplant
Primary Biliary Cirrhosis
Other Cirrhosis (non-alcoholic)
Post necrotic, Cryptogenic, TPN induced, Laennec’s
Alcoholic Liver Disease
Chronic Active Hepatitis
Hepatocellular Cancer
Biliary Atresia
What is the cold time for a liver transplant?
less than 12 hours
What is the cold time for a kidney transplant?
less than 30 hours
What is the test used for kidney rejection diagnosis?
ultrasound or biopsy
When is a kidney/pancreas transplant indicated?
type I diabetes
When does hyperacute rejection occur?
immediately in the post-op period
What needs to be done if a hyperacute rejection occurs?
re-transplant or life sustaining treatment
When does acute rejection occur?
1st 3-6 months after transplant
What happens with chronic organ transplant rejection?
Chronic inflammation with diffuse scarring and stenosis of the vasculature of the organ
This causes lack of blood supply and ischemia to the organ
Side effects of long term corticosteroid use
increase in blood sugar, weight gain (increase in appetite), bone disorders (softening), moon face, vision changes, stomach irritation, etc
What is the life-long triple therapy that transplant patients do?
CSA, Tracrolimus or Rapamune
Prednisone
Imuran or Cellcept
