Solid Organ Transplants Key Concepts Flashcards
Eligibility for kidney transplant is usually…
Referral for evaluation prior to dialysis
GFR < 20 mL/min
Common indications = diabetes, HTN, glomerulonephritis, polycystic kidney disease
In general, kidney transplant use this immunosuppression regimen:
Biologic therapy for induction + maintenance triple therapy
Rejection monitoring for kidney transplants is via…
Routine bloodwork - SCr, urea, lytes, and drug levels
Acute kidney rejection symptoms may manifest as…
Fever
Weight gain
Edema, pain over kidney
Abrupt increase in SCr, >30% from baseline
Decreased urine output
HTN
Chronic kidney rejection symptoms may manifest as…
HTN
Proteinuria
Progressive decline in renal function
Delayed graft function in kidney transplants refers to…
No urine output after transplant - need for dialysis in first week post transplant
An important factor to consider post-kidney transplant is…
Original cause of renal failure: diabetes, HTN
A major cause of graft loss is ____, which is associated with increased levels of…
Not adherence, but…
BK virus/polyoma virus - opportunistic infection associated with increased levels of immunosuppression
The liver is the ____ immunogenic organ, which means…
Least immunogenic - often possible to taper to one agent over time
Immunosuppression regimens with liver transplants usually are as follows…
Induction and triple therapy initially - then wean off steroid, then anti-proliferative
Patients eligible for liver transplant include…
Patients with advanced, impaired, non-reversible liver disease
Decompensated cirrhosis
Monitoring for liver transplant is done via…
Routine bloodwork - liver enzyme tests help monitor for rejection
Acute liver rejection may manifest as the following symptoms…
Increases in billirubin, liver enzymes
Leukocytosis
Chronic liver rejection may manifest as…
“Vanishing bile duct syndrome”
Increased liver enzymes
Increased bilirubin leading to jaundice
Itching
Recurrence of disease after liver transplant is possible with some conditions because….
They are autoimmune - ex: hepatitis B&C
Patients eligible for heart transplant include…
Advanced heart failure - non-responsive to medical therapy, but otherwise healthy
Cardiomyopathy, congenital defect, severe CAD with scar tissue
Needs to be in relatively critical condition - is it worth all the surgical procedure, immunosuppression?
In general, immunosuppression for heart transplants…
Follow standard regimen of biologic induction + maintenance triple therapy
Similar to kidneys but prednisone is eventually often tapered
Heart transplants are unique in that, with monitoring…
There is no great way to monitor for rejection - labs are NOT helpful
Biopsies are scheduled depending on time post-transplant
Acute heart rejection symptoms may manifest as…
Majority are asymptomatic
Symptoms may include fever, malaise, decreased, hypotension (CHF sx’s)
Chronic heart rejection symptoms may include…
“Coronary graft vasculopathy” - similar to atherosclerosis
Specific pathology unique to transplanted vessels
Transplanted hearts are denervated, which means…
Increased resting heart rate, decreased ability to rise quickly with exercise
MI may be asymptomatic
Altered response to drugs that work via autonomic nervous system
All patients should have a statin + ACEI/ARB
Patients who are eligible for lung transplant include…
Healthy, younger patients with chronic end-stage lung disease who are failing maximal medical therapy
Patients should be well informed, demonstrate adequate health behaviour, + willingness to adhere to guidelines
Immunosuppression for lung transplant compared to other solid organ transplants…
Needs high levels of immunosuppressants to prevent rejection
Induction + triple maintenance tx is almost always necessary (sometimes quadruple tx)
Monitoring for lung transplant is done via…
Routine pulmonary function tests to monitor for rejection
Routine bloodwork to help monitor for toxicity
Acute lung rejection symptoms may manifest as…
Fever
Flu-like symptoms
Chestpain
Cough, SOB
Decreased pulmonary function tests
Increase/decrease in body weight
Similar to pneumonia
Chronic lung rejection symptoms may manifest as…
“Chronic lung allograft dysfunction” - persistent drop in lung function
This could potentially be used in chronic lung rejection…
Azithromycin 250mg every other day
Lung transplants have additional susceptibility compared to other organ, because of…
Exposure via direct inhalation
High immunosuppression load
Denervation - inhibits cough reflex
