Organ Transplantation

Question 1

Define isoimmune response

Answer 1

• body rejects donor tissue as it is recognized as non-self & destroys

Question 2

What leads to a successful grafting/transplantation

Answer 2

• HLA protein matching of donor & recipient
• better chance with syngeneic (same genes) or autologous (from yourself) transplants
• recipients immune system does not react to graft

Question 3

Define autograft

Answer 3

• graft of 1 site to another of same individual

Question 4

Define isograft

Answer 4

• graft of tissue between 2 individuals who are genetically identical

Question 5

Define homograft

Answer 5

• tissue graft from a donor of the same species as the recipient, but different genetics

Question 6

Define histocompatibility

Answer 6

• have same blood group

Question 7

Define allogenic

Answer 7

• possible family member

Question 8

Define xenograft

Answer 8

• tissue graft or organ transplant from a donor of a different species from the recipient

Question 9

Describe the possible needs for a re-transplantation

Answer 9

• due to acute/chronic graft failure, rejection, or return of primary disease
• clinical picture of rejection occurs over time
• as survival following transplantation increases so does the need for re-transplantation
• immunosuppressive medication is no longer able to suppress response

Question 10

What are the guidelines for donor candidates

Answer 10

• no evidence of malignancy, HIV, hepatitis B virus, or sepsis
• hepatitis C virus if present is considered a precaution
• body weight must be within 20% of the ideal
• fully informed of risks with clear & altruistic intentions
• testing of donor organ

Question 11

How long can hearts be preserved for outside of the body

Answer 11

• up to 6 hours

Question 12

How long can livers be preserved for outside of the body

Answer 12

• up to 24 hours

Question 13

How long can kidneys be preserved for outside of the body

Answer 13

• up to 72 hours

Question 14

How long can lungs be preserved for outside of the body

Answer 14

• lungs cannot be preserved outside of the body for any extended period of time

Question 15

What determines preference between organ candidates

Answer 15

• preference is given to candidate in critical status from the same geographical location as time is critical

Question 16

What can exclude an organ candidate

Answer 16

• problematic behavior or psychosocial risk

Question 17

How are predictor values for rejection evaluated

Answer 17

• panel reactive antibodies
• epstein-barr virus
• herpes simplex virus
• hepatitis

Question 18

Why is histocompatibility important

Answer 18

• it can determine if antibodies incompatible with donor have been formed by the candidate (positive cross-match)
• if there is a positive cross-match, the transplant will fail

Question 19

Define haplotype

Answer 19

• HLA antigens that are inherited

Question 20

Define HLA proteins

Answer 20

• they are surface cells that signal to the immune system whether a cell is part of the self or an invading organism

Question 21

What are some complications of transplants

Answer 21

• procurement & surgical procedure
• transplantation
• immunosuppressive agents to prevent rejection
• infections & rejection

Question 22

What are immunological reasons for graft rejection

Answer 22

• residual blood from transplanted organ enters host general circulation
• host recognizes transplanted tissue as foreign & begins immune response with antibodies

Question 23

What are non-immunological reasons for graft rejection

Answer 23

• ischemic injury: when normal blood is stopped at time of organ harvest from donor
• repercussion injury: when blood flow is restored after transplantation

Question 24

Describe hyperacute rejection

Answer 24

• it’s immediate from minutes to 48 hours
• rare due to pre antibody & tissue typing
• recipient has antibodies to donors antigens & the organ must be removed

Question 25

Describe acute or late rejection

Answer 25

• develops in 3 months
• all recipients have some amount of acute rejection
• sudden onset of organ related symptoms: fever, graft tenderness, fatigue, decreased tolerance, or asymptomatic

Question 26

Describe chronic rejection

Answer 26

• develops within months to years
• slow progressive organ failure due to aggregate sum or irreversible immunological & non-immunologic injuries to graft over time

Question 27

Describe graft versus host reaction

Answer 27

• mediated by donor’s T lymphocytes
• most often complication of bone marrow transplantation
• if white blood cell inflammation markers are elevated it signifies rejection
• donor’s transplanted lymphocytes respond to the antigens of recipient’s tissues

Question 28

Define immunosuppressive therapy

Answer 28

• medications to block transplanted recipient’s reactivity to donor organ while sparing other responses

Question 29

What are the side effects of immunosuppressive therapy

Answer 29

• organ recipients have increased risk of CA
• accelerated hyperlipidemia
• decreased bone density
• myopathies
• neurotoxic reactions: tremor & paresthesia
• increased time for wound healing

Question 30

Pre-transplant activity & exercise

Answer 30

• limited activity prior = limited tolerance post transplant
• strengthening proximal muscles to support function & accessory respiratory efficiency
• people who participate in an exercise program before transplantation are like to recover more rapidly afterwards

Question 31

Post-transplant activity & exercise

Answer 31

• extent of recovery depends on function of transplanted organ
• PT begins post operation day (POD) 1
• exercise can decrease cardiovascular disease (CVD), hypertension (HTN), & diabetes (DM)
• the goal is to mobilize the patient out of bed (OOB) as soon as possible

Question 32

Activity guidelines

Answer 32

• goal is 30 minutes at moderate intensity 4-5 times a week
• monitor minimal dyspnea, mild fatigue, stable vital signs, O2 saturation >90%, & client response

Question 33

When should you terminate activity

Answer 33

• respiratory rate (RR) >40 breaths per minute
• 3/10 on Borg scale
• decrease in rate pressure product (RRP)
• O2 saturation <90%
• change in mental status, pallor, or client request