Organ Transplantation

Question 1

Who is eligible as an organ donor?

Answer 1

-Virtually all brain-dead patients, regardless of age

Question 2

What can be done with donors who have specific infections?

Answer 2

-Their organs can be given to a recipient with a similar infection (for example: hepatitis)

Question 3

What is the general rule for physicians regarding donor eligibility?

Answer 3

-Potential donors are referred to harvesting teams and they will exclude the few that cannot be used at all

Question 4

Which is the one absolute contraindication to organ donation?

Answer 4

-HIV positive status

Question 5

What are the ways in which transplant rejection can happen?

Answer 5

• Hyperacute
• Acute
• Chronic

Question 6

What is hyperacute rejection?

Answer 6

• Vascular thrombosis within minutes of reestablishing blood supply to the organ
• Caused by preformed antibodies
• Prevented by ABO matching and lymphocytotoxic crossmatch (Not sen clinically)

Question 7

What is acute rejection?

Answer 7

• Occurs after first five days and usually within the first 3 months
• Episodes occur even if patient is on immunosuppressives
• Suggested by signs of organ dysfunction
• Confirmed by biopsy

Question 8

What is the most common cause of liver transplant rejection?

Answer 8

-Technical problems (not immunologic)

Question 9

What are the signs of liver transplant failure?

Answer 9

-Rising gamma-glutamyltransferase (GGT), alkaline phosphatase, and bilirubin

Question 10

What should be done first when liver function deteriorates after a transplant?

Answer 10

-R/o biliary obstruction by US and vascular thrombosis by doppler

Question 11

What is important to keep in mind regarding heart transplant rejection?

Answer 11

-Signs of functional deterioration occur too late to allow for effective therapy
-Routine ventricular biopsies (via jugular, SVC and right atrium) are done at intervals
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Question 12

What is the first line therapy for rejection?

Answer 12

-Steroid boluses

Question 13

What other treatments are available for acute rejection if first line treatment fails?

Answer 13

• Antilymphocyte agents (OKT3), but have higher toxicity

- Antithymocyte serum is tolerated better

Question 14

What is chronic rejection?

Answer 14

• Seen years after a transplant w gradual, insidious loss of organ function
• Poorly understood and irreversible

Question 15

How is chronic rejection managed?

Answer 15

• There is no treatment

- Patients undergo biopsies in the hope that it may be a delayed and treatable case of acute rejection.