Organ Transplant Flashcards
organ transplant
can provide long-term survival outcomes in otherwise fatal disease
which organs can only be harvested from a deceased donor?
heart and intestines
which organs can be harvested from an alive donor?
- kidney
- liver
- pancreas
- bone marrow
principles of organ transplantation
- immunology underlying proper donor and recipient matching
- immunosuppression for prevention and management of graft rejection
why are recipients for transplants significantly immunocompromised?
- decrease ability of host to mount response and destroy new organ
- pancytopenia
- increased risk for infection (WBCs)
- increased risk for bleeding (platelets)
immunosuppressive agents used
- corticosteroids
- antimetabolites
- calcineurin inhibitors
- mTOR inhibitors
complications of organ transplantation
- graft rejection
- problems related to chronic immunosuppressive therapy
- problems specific to the transplanted organ
what are some problems related to chronic immunosuppressive therapy in organ transplantation?
block T and B-cell activity as well as innate immunity
pre-transplant management
- significant immunosuppression to get body ready for transplant
- require comprehensive dental screening and clearance to reduce infection risk
bone marrow transplant pts have to undergo what before transplantation?
total body radiation in addition to chemotherapy
pre-transplant dental considerations
- dental exam to diagnose and treat active or potential disease
- work with managing transplant team to optimize pt for the needed dental procedures
- continue preventive care throughout transplant phases
what type of dental txtments can organ transplant pts have the first 6 months post-transplant?
emergency only
how should active or potential disease be treated in pts pre-transplant?
expeditiously and aggressively
most common type of transplant?
kidney
dental concerns for pts w/ HF?
stress
dental concerns for pts w/ ESRD?
dialysis concerns and altered drug metabolism
dental concerns for pts w/ liver failure?
drug metabolism and coagulation
dental concerns for pts w/ severe diabetes?
insulin rxns and infection risk
organ transplant pts need prophylactic antibiotics to prevent infection?
- there’s no standard of care for these pts so consults with transplant managing team
- Dr. Kennedy would prescribe prophylactic antibiotics though
can you provide routine dentistry to organ transplant pts during the stable period (>6 months post-transplant)?
yes but pt’s immune system is suppressed for life so let managing team advise txtment
which type of pts need dental clearance first before starting txtment?
- pts with heart valve replacement
- pts on anti-resorptive drugs
- pts that are going to undergo radiation therapy to head and neck
- pts that are undergoing chemotherapy
how long should a pt wait from an extraction to receive radiation therapy?
at least 2 wks
*for epithelium to heal over socket
