Transplant Flashcards
Leading COD >1 yr after lung transplant
Chronic lung allograft dysfunction (CLAD)
Bronchiolitis obliterates syndrome, restrictive allograft syndrome
Leading COD b/w 30 days - 1 year from lung transplant
Non-CMV infections
Leading COD w/in 30 days from lung transplant
Graft failure
Cardiac allograft rejection
Greatest RF for rejection: grafts from young female donors
MC presentation: asxs
2/2 host immune response against non-self Ags, predominantly T-cell mediated.
Dx: perc myocardial Bx. Tx: steroids
Post-transplant lymphoproliferative disorder
EBV-positive B cell proliferation in setting of immunosuppressive tx. MC w/in 1st year of transplant. MC in setting of multi organ and intestinal transplants
2nd MC malignancy after solid organ transplant
P/w: b sxs (fever, night sweats, weight loss), lymphadenopathy, extra nodal masses involving GI tract, lungs, liver, CNS or transplanted organ
labs: anemia, thrombocytopenia, leukopenia
Cytotoxic T cells (decreased w/ immunosuppression) don’t check EBV infected B cells.
Tx: decrease immunosuppression, rituximab (against CD 20 -> complement and Ab-mediated B cell death)
Greatest likelihood of functioning transplanted kidney with what diagnosis?
Cystic kidney disease - highest 5 year graft survival >85%
DM, HTN, Glomerulonephritis, Lupus are all not cured with transplant so they continue to impact transplanted kidney
Highest risk of what malignancy post transplant?
squamous cell carcinoma (nonmelanoma of skin)
% of biliary complications after liver transplant
15% deceased donor livers
30% living donors
Biliary strictures post liver transplant
occurs in 13% liver transplants
Early stricture (w/in 2 months) -> technical
Late stricture (after 2 months) -> ischemia, fibrosis
20% of postop bile leaks -> stricture
nonanastomotic strictures can occur d/t hepatic artery thrombosis or recurrence of underlying dz (PSC)
Tx: ERCP, stent
