Sabto and transplant stuff

Question 1

PML is an absolute contraindication to organ donation? T/F

Answer 1

TRUE
(tissues and organs)

Question 2

HEV is a contraindiaction to organ and tissue donation T/F

Answer 2

FALSE

Screen donors to establish monitoring in recipient

Question 3

Influenza is a CI to organ donation

Answer 3

FALSE
-accept lung, if they died of flu, don’t use the lung, and if they died WITH flu, high risk but not a reject

Question 4

Mandatory tests for a solid organ donor

Answer 4

HBV- surface and core
HCV
HIV

Question 5

mandatory tests for a gamete donor

Answer 5

HBV- surface and core
HCV
HIV
HTLV
Syphilis

Question 6

Mandatory tests for Stem cell donor

Answer 6

HIV
HBV- core and surface antibody
CV
Syph
HTLV

Question 7

Absolute contra-indications to solid organ donation

Answer 7

TSE
Confirmed HHV-8 infection
Confirmed PML (JC virus)
MERS and SARS-1
Rabies
Yellow fever
Acute illness with MPox
VHF

When COVID-19 was the cause of death

Those which say “contra-indication but not Absolute”

Known Dengue virus infection
13.18.4.1 Is a contraindication to donation of Solid Organs for
Transplantation.

Known Chikungunya virus infection
13.19.5.1 Is a contraindication to donation of Solid Organs for
Transplantation

Donation may be considered 6 months after recovery from infection with
Chikungunya virus. same for dengue

Known Zika virus infection
13.20.6.1 Is a contraindication to donation of Solid Organs for
Transplantation except in exceptional circumstance.
13.20.6.2 Is a contraindication to tissue donation.
13.20.7 Donation may be considered 6 months after recovery from infection with
Zika virus.

Known West Nile virus infection
13.21.3.1 Is a contraindication to donation of Solid Organs for
Transplantation.

MMR
Acute disease is an absolute contraindication to donation of tissues
unless life preserving

Acute illness with MPOX

Question 8

An organ donor has MPOX- can you accept

Answer 8

Theoretical risk of transmission if the donor was viraemic
with asymptomatic infection or contact with MPX in the previous 21 days.
Acute illness,-> absolute contraindication to donation of
tissues and solid organs for transplantation

Donation can be accepted following exposure to Mpox more than 21 days
before, with no signs or symptoms of Mpox

Donation can be accepted after complete recovery from Mpox at least 14 days previously

Question 9

Donor has COVID- can they donate?

Answer 9

Thus far, transmission has only been described through transplantation of lungs
where was subsequently
shown to be strongly positive for SARS-CoV-2 RNA

where COVID-19 is felt to
contribute to the cause of death, are currently not being considered for deceased organ donation.

Where positive screening results are compatible with recent, resolving, or current infection in the upper
and/or lower respiratory tract, evidence thus far indicates that transmission of SARS-CoV-2 through the transplantation of (non-lung) organs leading to COVID-19 in the recipient is unlikely. Non-lung organs
from these donors will now be offered.

Question 10

What percentage of renal transplant patients develop BK reactivation?

Answer 10

15%
Half will go on to develop BK nephropathy
Typically occurs in first 12 months

Question 11

Presentation of BK disease in HSCT patients

Question 12

Causes of haemorrhagic cystitis post transplant (HSCT and solid)

Answer 12

Cyclophosphomide- AKA acreolin associated. Usually occurs early, and within 72 hours of agent given
Infectious. MESNA is used to help prevent, but not always effective

BK
Adeno
?CMV

Question 13

Monitoring of BK post renal transplant

Answer 13

Blood PCR monthly for 9 months, then three monthly until 2 years
- also do if deteriorating renal function, and at time of a biopdy if they are having one

Plasma BKPyV loads >4 log10 c/mL are associated with an increased rate of biopsy‐proven PyVAN, whereby plasma BKPyV loads peaking above 6 log10 c/mL are seen in cases with extensive PyVAN pathology

FIrst repeat sample, consider RIS, consider biopsy

Question 14

Histological findings of BK nephrophathy

Answer 14

SV40 immunohistochemistry positive

Decoy cells in urine

Question 15

Management options for BK nephropathy

Answer 15

RIS- calciunuerin inhibitors, and antiproliferative drugs
Reducs steroids

Additional strategies have been switching from tacrolimus to low‐ dose cyclosporine‐A, or switching from the calcineurin inhibitors to sirolimus, or switching from mycophenolic acid to low‐dose sirolimus, or from mycophenolic acid to leflunomide

Question 16

Pathogenesis of HLH

Answer 16

Primary or secondary

Primary: genetic mutation of NK and CTLs, leads to unregulated immune response

Secondary: triggering event
Immune dysregulation (dysfunction.of cytotoxic t cells and NK cells)
Cytokine storm
Macrophage activation and haemophagocytosis of bone marrow
Also leads to organ malfunction

Question 17

Renal transplant patient has BK viral load in blood of 200. Could they have BK nephropathy?

Answer 17

No idea….way to ask that

BKV PCR of plasma > 4.1 l0g1 copies/mL
(100% sensitivity, 90% specificity)

BKV PC of urine > 2.5 x 107 copies/mL
(100% sensitivity, 92% specificity)