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Rosalynn's ABSITE > Transplant > Flashcards

Transplant Flashcards

1
Q

ABO blood compatibility is necessary for all transplants except?

A

liver

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2
Q

Which HLA are most important for compatibility?

A

HLA A
HLA B
HLA DR (most important overall)

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3
Q

Hyperacute rejection

A

result of preformed anti-HLA antibodies that bind the allograft endothelium leading to vascular thrombosis and ischemic necrosis

Remove allograft immediately

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4
Q

accelerated rejection

A

sensitized T cells that produce a secondary immune response

usually within 1 week of transplant

treat with pulse steroids and muromonab-CD3 (OKT3)

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5
Q

acute cellular rejection

A

cell mediated and involves T lymphocytes (cytotoxic and helper)

usually at 1 week to 1 month after transplant

treat with high dose methylprednisolone

or

treat with anti lymphocyte preparation

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6
Q

Chronic rejection

A

fibrotic process mediated by T and B cells

weeks to years after transplant

suggest humeral immune response

treat w/plasmapharesis, IVIG, rituximab to treat antibody mediated rejection

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7
Q

immunosuppression therapy usually has

A

a calcineurin inhibitor
anti proliferative agent
steroids

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8
Q

corticosteroids

A

dampen immune response by preventing lymphocytes from proliferating and neutrophils from migrating

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9
Q

anti proliferative agent/anti metabolite

A

azathrioprine

mycophenolic acid

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10
Q

azathioprine

A

purine analog that alters DNA and RNA synthesis inhibiting T and B lymphocyte proliferation

used for maintenance therapy

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11
Q

mycophenolate (Cell cept)

A

selectively inhibits lymphocyte proliferation and suppresses T and B lymphocytes

maintenance therapy

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12
Q

Calcineurin inhibitors

A

cyclosporine

tacrolimus

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13
Q

mTOR inhibitors

A

sirolimus

everolimus

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14
Q

cyclosporine

A

inhibits IL-2 production preventing initiation of T cell proliferation

maintenance therapy

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15
Q

tacrolimus

A

10-100 times stronger than cyclosporine

inhibits IL-2

maintenance therapy

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16
Q

sirolimus

A

anti-T cell agent that inhibits mTOR molecule
blocks T cell signal transduction

maintenance therapy

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17
Q

everolimus

A

mechanism and toxicity similar to sirolimus but with great bioavailability

maintenance therapy

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18
Q

CMV

A

can happen at any time but MC 1-4 months post transplant in the absence of prophylaxis

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19
Q

dx CMV by

A

peripheral blood PCR or serologic assays

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20
Q

tx of CMV

A

decreasing immunosuppression

ganciclovir (inhibits DNA synthesis)

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21
Q

EBV

A

can infect B cells at any time after transplant and can be associated with developing PTLD (type of lymphoma usually of monoclonal B cell origin)

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22
Q

dx of EBV

A

physical exam
EBV serology
CT head/chest/abdomen to look for lymph nodes, biopsy

23
Q

tx of EBV

A

reducing or withdrawing immunosuppression

24
Q

HSV

A

for renal transplant patients if not on ganciclovir, are given ppl dose of acyclovir

active infections treated with decreasing immunosuppression and acyclovir

25
Q

BK virus

A

member or polyoma virus family
about 90% are seropositive
develops in 30% of kidney transplant
persistent viremia leads to BK nephropathy which occurs in 10% of transplants in first year

no effective tx

26
Q

oral candidiasis

A

prevented or tx with oral nystatin or fluconazole

27
Q

esophageal candidiasis

A

treated w/short course of IV amphotericin B or fluconazole

28
Q

serious fungal infections

A

tx with amphotericin B

can also consider capsofungin and anidulafungin (less nephrotoxic)

29
Q

cancers that arise in transplant patients at higher frequencies

A 
squamous cell carcinoma
basal cell carcinoma
kaposi sarcoma
lymphomas 
hepatobiliary carcinoma
cervical carcinoma
30
Q

Liver allocation is based on

A

MELD score which predicts 3 month mortality in patients with liver disease

given to patients with the highest MELD score

31
Q

MELD score includes

A

bilirubin
creatinine
INR

ranges from 6-40

32
Q

brain death

A

absence of pupillary, corneal, vestibule-ocular, and gag reflexes

can also do blood flow scan, arteriography, apnea test

33
Q

cold ischemia time for livers

A

less than 6 hours

34
Q

cold ischemia time for kidneys

A

less than 24 hours

35
Q

donor livers can be preserved up to

A

12 hours

36
Q

donor kidneys can be preserved up to

A

40 hours

37
Q

Early poor function of transplanted kidney

A

reversible ATN

must get renal doppler U/S of tech 99 scan to show good vascular patency

38
Q

lymphocele

A

lymphatic leak into retroperitoneum after kidney transplant

occur 1-2 weeks after

Dx with U/S

Tx symptomatic lymphocytes with drainage into peritoneum via lap or open

39
Q

renal artery/vein thrombosis

A

occur first 1-3 days after transplant

if transplant kidneys works then stops all of the sudden suspect thrombosis

rapid rise in Cr, graft swelling, local pain

Dx with tech 99 renal scan or doppler U/S

must repair immediately or graft will be lost and transplant nephrectomy will be needed

40
Q

urine leak

A

anastomotic leak or ureteral sloughing secondary to ureteral blood supply disruption

pain, increase Cr, possibly urine draining from the wound

get renal scan showing radioisotope outside the urinary tract

treat with foley to reduce intravesical pressure and subsequent surgical exploration

41
Q

kidney rejection

A

inversely correlated with degree of HLA matching

treat with pulse steroids

42
Q

cyclosporin is associated with

A

gallstone formation (tacrolimus too)
hirsutism
gingival hyperplasia
thrombocytopenia

43
Q

which meds are associated with diarrhea, anemia, leukopenia, and neutropenia?

A

mycophenolate and azathioprine

44
Q

impaired wound healing, thrombocytopenia, mouth ulcers, delayed graft function, interstitial lung disease

A

mTOR inhibitor (sirolimus and everolimus)

45
Q

MCC of OPSI

A

pneumococcus (even if had vaccine)

46
Q

biliary strictures

A

late hepatic artery thrombosis

initially treat non op but retransplant is typically needed eventually to avoid infectious complications

47
Q

MC incision used for liver transplant

A

bilateral subcostal incision with midline extension to xiphoid process

48
Q

MC methods used for recipient hepatectomy during orthotropic liver transplant

A

bicaval technique
piggyback technique
cavocavostomy (side to side caval technique)

49
Q

benefit of cavocavostomy anastomosis with liver transplant

A

shorter vena caval clamping time
minimal changes to HD as the clamp is placed longitudinally
only clamping anterior third of vena cava up to 1/2 lumen, lower incidence of caval stenosis

lower risk for hepatic vein outflow complications d/t larger anastomosis

50
Q

benefit of piggbag method for liver transplant

A

requires single vena caval anastomosis which limits warm ischemic time

51
Q

Treatment for post transplant lymphoproliferative disorder

A

rituximab monoclonal antibody to CD20

leads to complement and antibody mediated B cell death

52
Q

absolute contraindications for liver transplant

A

recent intracranial hemorrhage
elevated intracranial pressures
active substance or alcohol abuse
current or recent extra hepatic malignancy
uncontrolled sepsis
inadequate social and financial support
prohibitive cardiopulmonary disease including right heart failure

53
Q

cardiac allograft rejection commonly presents

A

asymptomatically
Dx with perc biopsy
steroids are main treatment

Rosalynn's ABSITE (33 decks)

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