Translplant Flashcards
Lung Transplant: Acute Cellular Rejection
T-cells
RF: infections, acid reflux, nonadherence to IS regimen
TX; IV solumedrol, ATGAM, Campath
Lung Transplant:
Antibody-mediated
B-cells/ HLA
DSAs found in blood labs.
Dx: Transbronchial biopsy (TBBX)
TX: plasmapheresis (remove antibodies), IVIG, rituximab, bortezomib
CLAD
Persistent inflammation from immune system - leads to scaring (fibrosis of small airways)
RF: - prior acute rejections, recurrent infections, GERD, nonadherance, aspiration
Treatment of CLAD
Prevention of rejection
Azithromycin (prophyl)
Montelukast
Phonophoresis
Monoclonial antibodies
S/S of acute and chronic lung rejection
dyspnea, fatigue, cough, hypoxemia, pleural effusions, pulmonary infiltrates, declining PFTs
What are the 2 types of chronic lung rejection
1) Obstructive - BOS
2) Restrictive - CLAD
Bronchiolitis obliterans syndrome
progressive obstructive ventilatory defect w/ air trapping.
FALL IN FEV1 AND RISE IN FVC
Do you use high dose STEROIDS for chronic lung?
NO
CLAD -> RCLAD
Progressive restrictive ventilatory defect w/ air trapping
FEV1 and FVC simultaneously decrease but ratio stays the same
Renal Transplant Complications
-Bleeding
-ATN (ischemic injury leads to low UO and increase BUN/Creat)
-Hyperkalemia
-Urine leaks
-Ureteral obstruction
-Graft thrombosis (sudden cessation of urine output, graft swelling, gross hematuria)
-Lymphocele (iliac vessels, clear protein containing fluid)
What is the most common Infection/UTI in transplanted pts
BK type polyoma virus
-elevated serum creat and hematuria
-TX: IV CIDOFOVIR and/or reduce IS regimen
Cause of death in post transplant pts
CV EVENTS - AMI, CVA, CHF
-prevent CV disease
S/S of acute kindney transplant rejection
Pyrexia, tenderness over graft site, oliguria, acute renal failure, increasing BUN/Creat, weight gain, HTN, edema, general malaise
Liver Transplant: How to assess for rejection
bile production, coagulation factors, LFTs (initally elevtated then decrease), ammonia
Is pancreatic transplant associated with renal transplant
Yes
Pancreas Transplant S/S of rejection
-urinary amylase levels reflect rejection
-HYPERGLYCEMIA IS A LATE SIGN AND WHEN EVIDENT, REJECTION IS IRREVERSIBLE
-Sepsis
-Abd pain
-increase lipase/amylase
Complications of Intestinal transplant
-rejection: abd pain, n/v, change in stools, infection, biliary leaks, perforations, bleeding, ascites, bowel obstruct
-HYPERMOTILITY SEEN EARLY POST-TRANSPLANT - ATTRIBUTED TO DENERVATION
Complications of stem cell transplant
-Infection - Neutropenia and immunocompromised
-VENO-OCCLUSIVE DISEASE OF THE LIVER: hyperbilirubiemia, rapid weight gain, ascites, RUQ pain, hepato/splenomegaly, Jaundice
-Graft vs Host: SKIN RASH, GI ENTERITIS, LIVER DYSFUNCTION
-Rejection: PANCYTOPENIA
Do immunospression drugs alter inflammatory response
YES
-many may NOT present w/ typical fever and leukocytosis even if an infection taking place
What does fever in transplantation mean?
Infection or rejection
CMV in transplant pts!
-Can lead to infection + rejection
-Can be systemic involving eyes, brain, GI tract, blood, lungs
-Encephalopathy
-TX: ganciclovir IV or PO valcyte therapy
Are viral infections in TP patients concerning?
YES
high incidence in morbidity and mortality > can occur new or reactivation of latent infection
-Herpes is high risk in these pts > test HSV-PCR > can spread to brain, empiric cyclovir
Tuberculosis
4 drug tx for 1 year:
-IHN
-Rifampin
-Ethanmbutol
-Pyrazinamide
What do you treat listeria with?
Ampicillin IV
