Transplant Flashcards

1
Q

Blocks IL-2R

A

Anti-CD 25

Basiliximab
Daclizumab

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2
Q

Blocks RNA/DNA synthesis

A

Azathioprine (pro-drug of 6-mercaptopurine)

Mycophenolate motefil

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3
Q

Inhibits T Cells

A

Tacrolimus

Mycophenalate

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4
Q

mTOR inhibitor

A

Rapamycin

Blocks T cell cycle

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5
Q

Severe myelosuppression causing neutropaenia and GI side effects

A

Azathioprine

Blocks purine synthesis

Pro-drug for 6-mercaptopurine
Need to test for presence of Thiopurine methyltransferase (TPMT)

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6
Q

Thrombocytopaenia, Anaemia, Leucopaenia, GI disturbances

A

Mycophenalate motefil

Inhibits DNA formation

Has replaced azathioprine in Renal Transplants

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7
Q

Nephrotoxicity, hypertension, hyperlipidaemia, hyperglycaemia

A

Cyclosporin

Calcineurin inhibitor, now replaced by 2nd gen tacrolimus

Inhibits IL-2 production

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8
Q

Nephrotoxicity, neurotoxicity, alopaecia, diabetes

A

Tacrolimus

Calcineurin inhibitor (2nd gen)

Forms mainstay of immunosuppresion for liver and renal

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9
Q

Contraindications for a liver donor

A

Acute hepatitis AST >1000

Cirrhosis

Portal vein thrombosis

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10
Q

Contraindications for a kidney donor

A

Chronic kidney disease eGFR <45 / Stage 3B

Long-term dialysis

Any Hx of renal malignancy

Previous kidney transplant

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11
Q

Contraindications for a pancreas donor

A

Insulin dependent diabetes

Hx of pancreatic malignancy

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12
Q

UW Solution

A

Liver and pancreas

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13
Q

Marshall’s solution

A

Kidney

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14
Q

Contraindications of living kidney donor

A

Diabetes

Uncontrolled HTN

BMI >30

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15
Q

Contrindications to recieveing kidney donation

A

Absolute
-Malignancy
-Active infection

Relative
-Severe cardiovascular disease
-Advanced age
-Non-compliance

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16
Q

Delayed graft function Mx

A

Ensure good CVP and fluid replacement

At Day 5, if DGF still present – > renal biopsy for ?acute rejection

17
Q

MELD score

A

Predicts short term outcome in pateints awaiting liver transplant
Based on bilirubin, INR, creatinine, and cause

3.8 loge (bilirubin mg/dl)
+ 11.2 loge (International Normalized Ratio)
+ 9.6 loge (creatinine mg/dl)
+ 6.4 (aetiology: 0 if cholestatic or alcoholic, 1 if otherwise)

18
Q

Criteria for liver transplant in acute liver failure

A

Paracetamol
-pH <7.3
-PT >100s, Creatinine >300, encephalopathy

Non-Paracetamol
-PT >100s with encephalopathy

Any three of the following:
-Age <10, Age >40
-Non-A, Non-B Hepatitis
-Drug reaction or halothane hepatitis
-Jaunice for >7 days prior to encephalopathy
-PT > 50s
-Bilirubin >300

19
Q

Indications for simultaneous pancreas kindey transplant

A

Inadequate glucose control by medical management
alone

Hypoglycaemic unawareness and ‘brittle diabetes’ - extremely high or low blood glucose levels are precipitated by minor dietary modifications.

20
Q

Monitoring for heart and lung rejection

A

Differs from kidney as biopsies are taken regularly to monitor for signs

21
Q

Monitoring in heart transplant recipient

A

Regular right ventricular biopsies initially

Anually angio: won’t get angina as rate is limited

22
Q

Heart and lung transplant ischaemic time

A

Ischamic time effects outcome far more importantly vs intra-abdominal organs