Solid Organ transplantation Flashcards

1
Q

What are the factors complicating pregnancy in transplantation patients

A
  • Preeclmapsia
  • GDM
  • Graft dysfunction
  • Fetal growth restriction
  • Preterm delivery
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2
Q

Prevelnace of renal transplant in UK in child bearing age

A

2-6 / 10000 women

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3
Q

percent of transplant patients get pregnant anually

A

30-40 pregnancies per year

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4
Q

Conception after renal transplant

A

Conception is not advised within the first year following renal transplantation when doses of immunosuppressants are higher and graft stability is more difficult to assess.

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5
Q

how we do pre pregnancy counselling in renal transplant patients

A
  1. Teratogenic meds (ACEI - Mycophenolate - ARB - Warfarin) should be discontinued before preg.
  2. pregnancy planned after 1 year of transplantation
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6
Q

Complaications. that we encounter in transplant patients during pregnancy

A
  • if not taking anti HTN–> needs med. during pregnancy
  • Superimposed PE
  • Proteinuria >1g/day leads to loss of renal function
  • Tacrolimus and prednisone are diabetogenic so high risk for GDM
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7
Q

Effects of renal transplant on pregnancy

A

High creatinine assay with poor outcome like:
* Pregnancy loss
* Perinatal death
* HTN
* PE
* Growth restriction

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8
Q

What si the acute rejection rate in pregnancy

A

4.2%

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9
Q

If there is a rise in creatinine in transplant patients, what is the cause?

A

Preeclampsia

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10
Q

if graft rejection is suspected during pregnancy, what to do?

A
  • Optimization of immunosuppresive drugs
  • Monitoring Cyclosporin, tacrolimus levels in blood
  • Treat DM & HTN
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11
Q

Babies exposed to biological agents in neonatal period, which vaccine should avoid?

A

Live vaccines
1. BCG
2. MMR
3. VZV
4. Typhoid
5. Oral Polio
6. Yellow Fever

During 1st 6 months of life

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12
Q

Where antenatal care should be given

A

Multidiciplinery team
(consultant let with transplant surgeon)

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13
Q

Antenatal tests should be carried out with pt. of transplant

A
  • Midstream Urine for culture
  • Urine for Proteinuria
  • Protein Creatinine ratio or Albumin Creat. ratio
  • RFT - LFT in PE
  • OGTT
  • CBC for anemia or thrombocytopenia
  • 12 & 20 Weeks Scan
  • 1st trimester anomaly screening: double marker
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14
Q

Factors cause proteinuria

A
  • Pre-existing HTN
  • Super emposed PE
  • ACEI - ARB
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15
Q

Effects o proteinuria on patients with transplant

A
  1. Hypercoagulability
  2. Inc. risk of venous thromboembolism
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16
Q

When we can give prophylaxis LMWH in transplant pt.?

A
  • Generalized edema
  • Thromboembolism
  • when P/C ratio >300 mg/dl
  • or Alb./C ratio >180 mg/dl
17
Q

In transplant pt., how often RFT should be done during pregnancy?

A

Monthly

Inc. depending on previous RFTs & clinical picture