Pediatric Lung Transplant Flashcards

1
Q

MC indication for lung transplant among children aged 1-5 yo

A

Pulmonary HP

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2
Q

Absolute contraindications in pedia lung transplant

A

HIV
Hepa B and C

TB
Malignancy

B cenocepacia colonizatiij

liver, renal or left vent failure

psych

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3
Q

relative contraindication in Lung transplant

A
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4
Q

this relative contraindication is associated with high mortality and may prolong ischemic time

A

prior pleurodesis

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5
Q

bridge to transplant

A

ECMO

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6
Q

PFT of px post transplant with acute rejection

A

obstructive

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7
Q

onset of acute rejection

A

earliest 1 week after
to 2 to 3 yrs later

MC 2 weeks-12 weeks

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8
Q

histologic pattern in acute rejection

A

perivascular lymphocytic infiltrates +- airway inflammation

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9
Q

most frequent problem in 1st post transplant week

A

primary graft dysfunction

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10
Q

complication of Primary graft dysfunction

A

non cardiogenic edema

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11
Q

histology of primary graft dysfunction

A

DAD

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12
Q

hyperacute rejection mechanistm

A

binding of recipient antibodies to donor human HLA molecules leading to ischemia

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13
Q

tx for acute rejection

A

methylpred 10mg/kg for 3 days

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14
Q

In early phase (1-6 months), allo antibody response or anti HLA antibodies comes from

A

the donor

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15
Q

Antibody-mediated rejection (AMR) in Early phase , can develop in response to self antigens (AUTO antibody response) such as

A

collagen V
k alpha 1 tubulin

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16
Q

Clinical manifestation of acute rejection

A

dyspnea, infiltrates, dec lung function

17
Q

tx of early phase acute rejection

A

steroids
plasmapharesis
ivig
b cell reduction

18
Q

risk of infection is highest at this phase

A

early phase

19
Q

leading cause of death after the 1st yr post transplant

A

Bronchiolitis obliterans

20
Q

medication side effects of CSS

A

hpn
nephropathy

21
Q

csa based immunosup

A

hirsutisim, gingival hyperplasia

22
Q

tacrolimus

A

DM

23
Q

most common malignancy after lung transplant

A

post transplant lymphoproliferative disease (EBV driven lymphoma)

24
Q

most common site of PTLD

A

allograft

25
Q

histologic fx of PTLD

A

monomorphous histologic pattern (worse prognosis)

cd20 positive tumors

26
Q

mainstay of tx

A

reduction in. immunosuppresiib

27
Q

lung function of px with chronic lung allograft dysfunctiin

A

unexplained fall jn fev1 >20% (diagnosis)

obstructive
progressively restrictive (dec tlc)

28
Q

worse prognosis in CLAD

A

restrictive allograft syndrome

29
Q

greatest obstacle to long term success

A

CLAD

30
Q

survival

A

5 yrs

31
Q

cause of death 1 yr after

A

graft failure

infection

32
Q

first 30 days
cause of death

A

surgical complications

33
Q

after 30 days
before a year

A

infection

34
Q

by 1-3 yrs after

A

BO