Organ transplants

Question 1

Antibodies in hyperacute rejection

Answer 1

IgG

Question 2

What analgesia should be avoided in renal transplant

Answer 2

NSAIDs

Question 3

Most important HLA to match

Answer 3

DR

Question 4

Which HLA cause the hyper acute rejections

Answer 4

Type 1

Question 5

Fever, fatigue 6 weeks following transplant

Answer 5

CMV

Primary infection with CMV typically occurs 6 weeks post transplantation in a seronegative individual who receives an organ from a seropositive donor. Symptoms may occur as early as 20 days but can occur up to 6 months post transplant .

Question 6

Tx of CMV post transplant

Answer 6

Ganciclovir

Question 7

Sudden loss of urine post transplant

Answer 7

Usually blocked catheter
If not then arterial thrombosis

Question 8

Corticosteroids actions

Answer 8

Suppression of macrophage activation
Reduction in MHC antigens on grsaft
Reduce proliferation of lymphocytes and induce apoptoiss
Reduction of endothelial cell adhesion molecules

Question 9

Types of Organ rejection

Answer 9

Hyperacute. This occurs immediately through presence of pre formed antibodies (such as ABO incompatibility).
Acute. Occurs during the first 6 months and is usually T cell mediated. Usually tissue infiltrates and vascular lesions.
Chronic. Occurs after the first 6 months. Vascular changes predominate.

Question 10

Giving another person a graft- name?

Answer 10

Allograft

Question 11

Patient develop HTN and low renal function months post renal transplant

Answer 11

RAS

Most cases can be assessed using duplex scanning and managed with angioplasty.

Question 12

Type of hypersensitivity in chronic rejection

Answer 12

Type 4
T lymphocytes

Question 13

Which is most susceptible to HLA mismatches

Answer 13

Renal transplant

Question 14

Cold ischameia time for organs

Answer 14

4-6 hours for heart, < 12 hours for liver and pancreas, and < 24 hours for kidney

Question 15

8 months post renal transplant, jaundice, widespread lymphadenopathy and hepatomegaly

Answer 15

EBV

EBV: post transplant lymphoproliferative disease. > 6 months post transplant

Question 16

MOA and SE of cyclosporin

Answer 16

Inhibits calcineurin, a phosphatase involved in T cell activation
Nephrotoxic
Monitor levels

Question 17

MAO and SE of azathioprine

Answer 17

Metabolised to form 6 mercaptopurine which inhibits DNA synthesis and cell division
Side effects include myelosupression, alopecia and nausea

Question 18

MAO and SE of tacrolimus

Answer 18

Inhibits calcineurin, a phosphatase involved in T cell activation

Lower incidence of acute rejection compared to ciclosporin
Also less hypertension and hyperlipidaemia
However, high incidence of impaired glucose tolerance and diabetes

Question 19

Mycophenolate MOA and SE

Answer 19

Blocks purine synthesis by inhibition of IMPDH
Therefore inhibits proliferation of B and T cells
Side-effects: GI and marrow suppression

Question 20

Donating an organ to a identical twin

Answer 20

Isograft

Question 21

Kidney in LIF- which vessel to anastomose

Answer 21

External iliac and vein

Question 22

Patient has normal renal function but a swollen area over graft

Answer 22

Lymphocele

Symptoms usually occur as a result of mass effect with compression of adjacent structures. These include the vessels supplying both the graft, with deterioration in graft function, the ureter, with alteration in urine output and the recipients lower limb vessels, with development of leg swelling. Creation of a laparoscopic or open peritoneal window is a favored treatment.

Question 23

What should you avoid with tacrolismus

Answer 23

P450 inhibitors