Transplant

Question 1

Blocks IL-2R

Answer 1

Anti-CD 25

Basiliximab
Daclizumab

Question 2

Blocks RNA/DNA synthesis

Answer 2

Azathioprine (pro-drug of 6-mercaptopurine)

Mycophenolate motefil

Question 3

Inhibits T Cells

Answer 3

Tacrolimus

Mycophenalate

Question 4

mTOR inhibitor

Answer 4

Rapamycin

Blocks T cell cycle

Question 5

Severe myelosuppression causing neutropaenia and GI side effects

Answer 5

Azathioprine

Blocks purine synthesis

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

Question 6

Thrombocytopaenia, Anaemia, Leucopaenia, GI disturbances

Answer 6

Mycophenalate motefil

Inhibits DNA formation

Has replaced azathioprine in Renal Transplants

Question 7

Nephrotoxicity, hypertension, hyperlipidaemia, hyperglycaemia

Answer 7

Cyclosporin

Calcineurin inhibitor, now replaced by 2nd gen tacrolimus

Inhibits IL-2 production

Question 8

Nephrotoxicity, neurotoxicity, alopaecia, diabetes

Answer 8

Tacrolimus

Calcineurin inhibitor (2nd gen)

Forms mainstay of immunosuppresion for liver and renal

Question 9

Contraindications for a liver donor

Answer 9

Acute hepatitis AST >1000

Cirrhosis

Portal vein thrombosis

Question 10

Contraindications for a kidney donor

Answer 10

Chronic kidney disease eGFR <45 / Stage 3B

Long-term dialysis

Any Hx of renal malignancy

Previous kidney transplant

Question 11

Contraindications for a pancreas donor

Answer 11

Insulin dependent diabetes

Hx of pancreatic malignancy

Question 12

UW Solution

Answer 12

Liver and pancreas

Question 13

Marshall’s solution

Answer 13

Kidney

Question 14

Contraindications of living kidney donor

Answer 14

Diabetes

Uncontrolled HTN

BMI >30

Question 15

Contrindications to recieveing kidney donation

Answer 15

Absolute

• Malignancy
• Active infection

Relative

• Severe cardiovascular disease
• Advanced age
• Non-compliance

Question 16

Delayed graft function Mx

Answer 16

Ensure good CVP and fluid replacement

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

Question 17

MELD score

Answer 17

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)

Question 18

Criteria for liver transplant in acute liver failure

Answer 18

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

Question 19

Indications for simultaneous pancreas kindey transplant

Answer 19

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.

Question 20

Monitoring for heart and lung rejection

Answer 20

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

Question 21

Monitoring in heart transplant recipient

Answer 21

Regular right ventricular biopsies initially

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

Question 22

Heart and lung transplant ischaemic time

Answer 22

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