special pop

Question 1

3 high infxn tmes for transplant

Answer 1

First month after transplant –pre-existing infections (donor or recipient) and post-operative complications
*
1-6 months after transplant –opportunistic infections
*
More than 6-12 months after transplant –community acquired infections

Question 2

CMV presentation: clinical, labs, organ/system

Answer 2

Presents with fever, malaise/fatigue
*
Laboratory findings can include leukopenia or neutropenia, thrombocytopenia, lymphocytosis, and elevation of transaminases
*
Pneumonitis, hepatitis, CNS disease, retinitis can be present

Question 3

cmv trt

Answer 3

valganciclovir (oral) or ganciclovir (IV) while monit viral load, reduction of immunosuppressives may be necessary”

Question 4

dx these dz’s with quantitative PCR

Answer 4

CMV
EBV

Question 5

Treated with reduction of immunosuppression

Answer 5

BK Virus, EBV

Question 6

associated with post transplant lymphoproliferative do

Answer 6

EBV

Question 7

Often asymptomatic or causes a flu-like illness in immunocompetent hosts, can cause brain abscesses, pneumonitis, cardiomyopathy, or disseminated disease in immunosuppressed hosts

Answer 7

toxo gondii

Question 8

vaccines are typically avoided for __-___ months post transplant due to anticipated inadequate response (i_______ _______ vaccine can be given one month post-transplant)

Answer 8

3-6 months,
(inactivated influenza vaccine can be given one month post-transplant)

Question 9

Name the rejection

humoral immune response, manifests within minutes to hours, result of pre-existing antibodies against graft antigens, rare as antigen testing has advanced, treated by removing the graft

Answer 9

hyperacute

Question 10

name the rejection

cell-mediated immune response; T-lymphocytes, macrophages, and NK cell recognition of foreign antigen; presents with worsening organ function and lymphocytic infiltrate on biopsy; treated with pulse steroids and increased immunosuppression

Answer 10

acute

Question 11

name the rejction

long term loss of function of the graft, may be related to fibrosis of graft blood vessels which is called graft vasculopathy

Answer 11

Chronic

Question 12

Lymphoid cell proliferation in the setting of immunosuppression

Answer 12

post transplant proliferative dz (PTLD)

Question 13

Treatment for PTLD

Answer 13

*
Treated with reduction of immunosuppression +/-rituximab (CD20 positive only), chemotherapy, radiation, and occasionally surgery

Question 14

hypomagnesemia can be seen with which 2 immunosuppresive agents

Answer 14

mycophenolate or tacrolimus use

Question 15

Name fxn and SE of immunosup med

Cyclosporine, tacrolimus

Answer 15

Decrease T-cell proliferation
*
Can cause nephrotoxicity, hypomagnesemia, hyperglycemia, elevated liver enzymes

Question 16

*
Block B and T cell activation by cytokines
*
Increased risk of mortality in renal transplant
*
Can cause bone marrow suppression

Answer 16

MTOR inhibitor (sirolimus (rapamycin) and everolimus)

Question 17

MOA: inhibits purine synthesis which decreases lymphocyte proliferation
*SE
Can cause headache, hyperglycemia, hypomagnesemia, and elevated liver enzymes

Answer 17

Mycophenalate (antimetabolite)