Organ Transplantation

Question 1

Selection of donors

Answer 1

Liberalized now to alleviate acute organ shortage, all brain-dead patients, regardless of age. If hepatitis, can be used for pts with same disease. Even donors w/ mets can donate corneas. General rule is all potential donors are referred to harvest teams, will exclude few that can’t be used at all. HIV+ status is only absolute contraindication to organ donation

Question 2

Transplant Rejection

Answer 2

Hyperacute, acute, chronic

Question 3

Hyperacute rejection

Answer 3

Vascular thrombosis occurs within minutes of reestablish blood supply. Caused by preformed abs, prevented by ABO matching + lymphocytotix cross match, so not seen

Question 4

Acute rejction

Answer 4

After first 5 days, in first 3 months, episodes even if pt on maintenance immunosup. Signs of organ dysfn suggest it, biopsy confirms. Liver- more technical problems than immuno rejection, so first rule out biliary obstruction/vascular thromb (ultrasound and doppler). For heart, fn deterioration signs are too late for therapy, so do routine ventric biopsies at set invervals (via jugular, SV, right atrium). First line tx = steroid boluses, otherwise antilymphocyte OKT3 used

Question 5

Chronic rejection

Answer 5

years after transplant, with gradual, insidious loss of organ fn, poorly understood, irreversible, no tx, but pts might have it biopsied to hope its a delayed treatable acute rejection :(