Quiz 12 Flashcards
This is the unit all on transplantation
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1) What is transplantation
1A) What are examples of organs that can receive a transplant:
2) What are the 6 different types of transplants:
3) When would someone need an organ transplant?
4) Can anyone become an organ donor? Who can’t? What’s the criteria?
4A) T or F: A 100% match would be your identical twin?
- Meaning what?
4B) Complications from an organ donation
4C) Why are organ donations UP right now?
5) How are the organs that get donated distributed to people needing them?
- T or F: The people with most urgent medical need, and who will benefit most, will get first choice of a donated organ
5A) So what is the 2 main criteria for someone getting a donation.
6) T or F: There is TONS of research being done in this area of donations / transplantation
7) What is Transplant Conditioning:
1) Taking an organ or living tissue and implanting it in another part of the body, or in another body. Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). Transplantation is necessary because the recipient’s organ has failed or has been damaged by disease or injury.
1A) ANY organ: heart, lungs, liver, kidney, bladder, pancreas, bone, bone marrow, skin, heart valves, blood, etc.
2)
- Allograft: between 2 people (same species)
- Allogenic: between 2 people, diff. genes
- Autologous: Within same person (skin or bone graft)
- Xenogenic: between diff. species (pig to human)
- Heterotopic: Taking a kidney from someone else (donor) and placing it in a different part of body into receipient.
- Synegeneic/isograft: transplant between identical twins
3)
- Organ fails
- Graft failure / rejection
- Continued disease leading to mortality issues
4) Basically anyone can yes.
- You can’t have cancer, systemic issue, HIV, Hep B, etc. No malignant systemic issue.
- Have same blood type
- Typically donors are under the age of 50-60, and within about 20% of ideal BMI. ***
- Left ventricular ejection fracture of >40% for a heart donor.
- Usually can NOT accept donations from children, prisoners, pregnant women
- No selling organs on dark web
4A) True
- You’ll never get 100% exact match, but can get very close.
4B) Rejection of the tissue/donation
4C) Because of the overdose opioid epidemic going on, many people are donating (or families donating) from these people who overdose.
5) UNOS. U.S. is divided into 11 regions, each region has an organ procurement organization (OPO) that administers the waiting list in that region.
- True
5A) Based on urgent medical need, and chance for success.
6) True
7) IT IS NOT EXERCISE. It is conditioning / preparing the individuals body to receive the transplant. So high doses of chemo for 72 hours before to kill old cells. They typically leave hospital with no WBC’s.
1) What is the United Network for Organ Sharing (UNOS):
*** There will be a ? on the test on this
1) UNOS administers the national organ waiting list, allocates organs throughout the US, tracks outcomes, provides public education.
UNOS is involved in many aspects of the organ transplant and donation process … Managing the national transplant waiting list, matching donors to recipients. Maintaining the database that contains all organ transplant data for every transplant event that occurs in the U.S. Educating and providing assistance donors and professionals.
THIS IS NOT ABOUT Transplantation:
1) What is a Gleason Score
(how to remember)
2) What is pre-eclampsia
(How to remember)
3) What is chimerism
(How to remember)
1) The Gleason Score is the grading system used to determine the aggressiveness of prostate cancer. This grading system can be used to choose appropriate treatment options.
(remember: Ryan Gleason had prostate cancer)
The Gleason Score ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue (lower score) or abnormal tissue (higher score). Most cancers score a grade of 3 or higher.
2) A potentially dangerous pregnancy complication characterized by high blood pressure.
(Have to use a clamp in some pregnancy when it is high risk / complicated = high blood pressure)
3) Chimerism, meaning a person has two sets of DNA, each with the genetic code to make a separate person. YOU are your OWN TWIN. It occurs when two eggs (ova) are each fertilized by a separate sperm (spermatozoa). Then, the fertilized eggs, called zygotes, fuse to create a single organism with two genetically distinct types of DNA.
(Chim chim-ery. Two chim’s = twins)
2) Syngeneic
3) Autologous
9) Autograft
10) Allograft
6) Allogeneic
7) Xenogeneic-
8) Heterograft
1) Heterologous
4) Orthotopic
5) Homologous
11) Heterotopic
2) Between individuals with identical genes
3) Donation within same individual
9) Donation from one point to another of the same individual’s body.
10) Donate tissue/organ from individuals of same species
6) Donation between Individuals of same species, DIFFERENT genes (HLA matched donor)
7) Between individuals of different species (pig to human)
8) tissue/organ between individuals of different species
1) Transplant derived from a different species
4) Transplant grafted into its normal anatomic position
5) Corresponding in structure, position, origin
11) From one part of a donor’s body to another area of the recipient’s body (placing a kidney in a different area than normal)
Organ Retransplantation
- Immediately or years down the road. Can occur due to graft rejection, mechanical failure, or recurrence of primary disease.
- Ethical concerns - is the recipient moved up on the list or are they moved back?
- Lower success rate than first time transplants, higher morbidity and mortality rates.
Organ retransplantation is:
Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.
Organ Procurement and Allocation
- *** - United Network for Organ Sharing (UNOS) is responsible for administering allocations of donations throughout the US, tracks outcomes, and provides public education.
- There is a waitlist and allocation is done through specific calculations based on the patient’s functional status (diagnosis, age, lab values, etc). The calculators are organ specific.
- You can donate while you are living or after you are deceased. You can choose who you donate to (direct) or donated to whoever needs one (indirect).
Organ Procurement and Transplantation Network (OPTN) directs the allocation of organs to the sickest patients first without regard to a host of medical, geographic, and social factors that members of the transplant
Criteria for Organ Candidates
- No presence of other illness/contraindicated diseases that would cause transplant to not work
- History of noncompliance with medical therapy, ongoing alcohol/drug dependence, cigarette smoking, or psychological instability
- Make sure donor and recipient have matched blood type
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Medications
- Calcineurin inhibitor (Ex. Tacrolimus and Cyclosporine)–inhibit growth and differentiation of T cells
- Antimetabolite–suppresses the bone marrow and inflammatory response by inhibiting the replication of DNA and RNA in lymphocytes
- Corticosteroids (Ex: Prednisone)– immuno-suppressors. Blocks formation of macrophages, B cells, and T cells.
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Immunosuppression
- People are immunosuppressed (meaning stops the immune system from working) leading up to transplant to ensure the donation does NOT get rejected by body.
- Can be deliberately induced with drugs as in preparation for a transplant, or can result from certain diseases like AIDS or lymphoma
- In relation to transplants: Side effects can include cancer, accelerated hyperlipidemia, osteoporosis, neurotoxic reactions
- PTs need to focus on wound healing and identifying and reducing risk factors for patients who are immunosuppressed. Immunosuppression puts patient at risk for infection and decreases patient exercise tolerance.
What is immunosuppression:
The partial or complete suppression of the immune response of an individual. It is induced to help the survival of an organ after a transplant operation.
Exercise, Activity and Sports
- No contact sports or swimming pools
- Pretransplant: exercise program with the goal to promote functional mobility, strength, and endurance before you do proceedure.
- Posttransplant: exercise enhances QOL, lowers risk for CV disease and diabetes, but especially important in transplant patients because immunosuppressive drugs can be atherogenic and diabetogenic
- PT should begin 1 day post-op since the pt will have a decrease in VO2 max
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Ischemic Reperfusion Injury
- Posttransplant complication of the donated organ
- Damage to the internal lining epithelial cells of the organ when perfusion of blood is returned to the organ after transplantation
Can be due to a change of blood pressure from donor
to recipient - Commonly seen in heart and lungs and generally heals within 3-5 days. Or can get worse and lead to organ rejection from the host.
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Graft Rejection
Hyperacute rejection
- Occurs within MINUTES of the transplantation due to antibodies in the organ recipients blood stream that react with the new organ and result in organ failure within the first hours after transplant
- Dominantly mediated by HUMORAL responses of immune system and activation of coagulation factors - blood type incompatibility
- Rare if antibody screening was done prior
Acute or late acute rejection
- Days to months after transplant, combines both humoral and cell-mediated responses. The humoral (antiBody) rejection happens in first few days/weeks as donor and recipient cell antigens interact.
- Symptoms are fever, graft tenderness, fatigue.
Chronic rejection
- Months to years after the transplant takes place
- Slow failure of the organ over time
- Thickening and fibrosis of graft vessels and organ atrophy
- Typically caused by problems with the antibodies and/or lymphocytes
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Bone Marrow Transplant
- Used following high dose chemo and radiation to treat diseases most commonly cancer (leukemia, multiple myeloma, lymphoma, renal cancer, testicular cancer, and periodically breast cancer).
- Typically an allogenic process meaning transplant from a different person in same species.
- The phases of transplantation include: conditioning, marrow infusion, induction phase, and engraftment
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What is Transplant Conditioning: IT IS NOT EXERCISE. It is conditioning the individuals body to receive the transplant. So high doses of chemo for 72 hours before to kill old cells. They typically leave hospital with no WBC’s.
Hematopoietic Stem Cell Transplantation
- Transplantation of blood or marrow derived hematopoietic stem cells
- Cell Source: bone marrow, peripheral blood, placental/umbilical cord blood
- Can be syngeneic (between individuals with identical genes), autologous (within same individual), and allogeneic (same species, different genes, HLA match)
A dangerous procedure reserved for patients with life threatening diseases beyond cancer, such as autoimmune diseases and skeletal dysplasias.
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Kidney Transplantation
- Treatment choice for kidney failure, ESRD (End Stage Renal Disease) rather than lifetime dialysis
- You only need 1 kidney to replace 2 malfunctioning kidneys
- Old diseased kidneys are left in and new kidney is placed inferomedially in abdomen off external iliac artery, below the old kidneys (Heterotopic transplant)
Old only taken out if they are causing high BP, kidney
stones; the surgery to remove old is too invasive - Requirements to find match:
—- Similar blood type
—- Tissue typing (genetic markers are a match)
—-Crossmatching (mixing small sample of patient
blood and donor blood to see if the antibodies of
patient will react with antigens of the donor - Treatments:
—- On non-rejection (immunosupressant) medication
for life
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Multiple Organ Transplants:
- Used to treat several failing or diseased organs by replacing them with healthy ones
- Individuals are considered for this procedure when all other therapies and treatments have been unsuccessful in improving their condition
- A common cause of multiple organ failure is a multisystem disease called AMYLOIDOSIS. This condition can lead to a buildup of abnormal proteins in organs such as the kidneys, heart, or liver.
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This is a last option … there is huge risk. Plus it is hard enough to find one matching / willing organ donated, and to get many is very very hard.
Usually though multiple organs donated come from the same donor.
You’d get a liver transplant but often get Hep B because of it.
You’d get a pancreas transplant for people typically with diabetes.
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