Transplant Flashcards
all done
what is transplant
the process of transferring an organ or part of an organ from a donor to a recipient
what are the different types of graft
allograft: organ/tissue transplanted from 1 individual to another
autograft: organ/tissue transplanted from 1 part to another of the same individual’s body
xenograft: organ/tissue transplanted from 1 individual to another species
orthotopic graft: graft placed in its normal anatomical site — eg. liver transplant
heterotopic graft: graft placed in site diff to where organ is normally located — eg. kidney transplant
what are the different types of graft rejection, what are they caused by and how is it managed
hyperacute rejection (mins to hrs)
cause: ABO or pre-formed anti-HLA Ab
presentation: interstitial haemorrhage + intravascular thrombosis
acute rejection (1st 6 months)
cause: Ab and/or cell-mediated
Tx: additional immunosuppressive therapy
chronic rejection (after 6 months)
cause: graft failure
prognosis: functional deterioration of graft over months/years
causes of allograft dysfunction
early
primary non-function —- irreversible ischaemic damage
delayed function — reversible ischaemic injury
hyperacute/acute rejection
arterial/venous thrombosis of graft vessels
drug toxicity
infection
mechanical obstruction — eg. ureter/bile duct
late
chronic rejection
arterial stenosis
recurrence of original disease in graft
mechanical obstruction
what is a typical immunosuppressive regimen
steroids + calcineurin inhibitor + anti-proliferative agent
calcineurin inhibitors — tacrolimus, cyclosporin
anti-proliferative agents — azothioprine, mycophenolate
what are the side effects of immunosuppression
increased risk of infections
opportunistic infection
reactivation of latent infections — eg. CMV, HSV
highest risk in 1st 6 months
malignancy
SCC of skin, lymphoproliferative disease
what are the indications of liver transplant
liver cirrhosis/chronic liver failure
acute liver failure — viral vs drug-induced
metabolic liver disease — wilson’s disease
primary hepatic malignancy
what are indications of cardiac transplant
NYHA Class III or IV — despite maximised medical & resynchronisation therapy
recurrent life-threatening LV arrhythmias — despite implantable cardiac defibrillation, anti-arrhythmic therapy or catheter-based ablation
endstage congenital HF + no evi of pulmonary HTN
refractory angina w/o potential medical/surgical intervention
cardiogenic shock requiring continuous IV inotropic therapy
refractory cardiogenic shock requiring intra-aortic balloon pump counter pulsation or PVAD LV assist device
what are C/I to cardiac transplant
systemic illness w life expectancy <2 yrs despite heart transplant
irreversible pulmonary HTN
active substance abuse (incl tobacco)
multiple demonstrations of inability to comply w drug therapy
what is LVAD
stands for LV assist device
implantable longterm mechanical circulatory support device used in advanced HF
indications of LVAD
bridge to transplant
destination therapy – ie refractory HF + arent candidates for transplant
indications of lung transplant
advanced lung disease + clinical status progressively declining despite maximal medical & surgical therapy
such as from
advanced COPD
ILD
CF
emphysema — sec to A1AT deficiency
PAL pulmonary arterial HTN
C/I to lung transplant
uncontrolled/untreatable pulmonary/extrapulmonary infection
active mycobacterium tuberculosis infection
malignancy in last 2 years
sig dysfunction in other vital organs
uncorrectable bleeding diathesis
class II or III obesity — ie BMI >35
active tobacco smoking
active drug/alcohol dependency
unresolved psychosocial problems
noncompliance w medical therapy
causes of ESRD
diabetic nephropathy
glomerulonephritis
renal vascular disease
hypertensive nephrosclerosis
pyelonephritis
PCKD polycystic kidney disease
analgesic nephropathy
obstructive uropathy
SLE
