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transplant Flashcards

1
Q

most important HLA for recipient/donor matching?

A

HLA-DR, A and B (on all nucleated cells)
type IV hypersensitivity

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2
Q

what does cross match entail? reagents.

A

recipient serum with donor lymphocytes.
to r/o hyperacute rejection.= type II hypersensitivity

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3
Q

1 and 2 malignancy after transplant

A

squamous skin ca ? PTLD (EBV)

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4
Q

how to tx post-txp EBV

A

reduce immunosuppression; and rule out PTLD

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5
Q

mycophenalate mofetil MOA?

A

inhibit de novo purine synthesis to stop T CELL GROWTH.

adverse: GI mostly, nausea, dyspepsia, diarrhea, bloating, leukopenia, anemia, thrombocytopenia (PANCYTOPENIA!)

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6
Q

cyclosporin MOA?

A

binds cyclophilin to inhibit calcineurin to decrease cytokine (IL-2) synth.
metabolism: LIVER.

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7
Q

tacrolimus MOA?

A

like cyclosporin (calcineurin inhibitor/IL-2) but more potent. via FKBP/p450.
metabolism: less LIVER.

adverse: tremor, HA, seizure, nephrotox, HTN, alopecia, hyperK, hypoMg, GI sx

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8
Q

sirolimus MOA?

A

binds FKBP like tac but inhibits mammalian target of rapamycin (mTOR) to decrease T and B cell response to IL-2.
LESS* NEPHROTOX* compared to tac or cyclosporin.

side effects: hyperTg, impaired wound healing, thrombocytopenia, leukopenia, anemia

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9
Q

sirolimus side effect?

A

interstitial lung dz.

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10
Q

antithymocyte globulin MOA?

A

polyclonal Abs against T cell antigens CD2,3,4.

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11
Q

types of rejection?

A

hyperacute, accelerated, acute cellular, acute humeral, chronic.

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12
Q

hyperacute rejection?

A

min-hrs = preformed Abs Type II (I.e. ABO)
tx: re-transplant

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13
Q

accelerated rejection?

A

<1 wk = sensitized T cells to donor HLA
tx: increase Rx, steroids

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14
Q

acute cellular rejection?

A

after 1 wk.
T cells to HLA Ag
tx: immunosuppresion

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15
Q

acute humeral rejection?

A

after 1 wk.
Abs to donor Ags
tx: steroids, Ab therapy, plasmapharesis.

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16
Q

chronic rejection?

A

mos-years.
Abs formed and T cells sensitized… partially type IV
MC: HLA incompatibility
tx: immunosuppresion, retxp

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17
Q
A
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18
Q

new proteinuria after kidney txp?

A

renal vein thrombosis.

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19
Q

pathology of acute rejection in kidney txp?

A

1-6 mos…
Bx: tubulitis (vasculitis with more severe form), lymphocytic infiltration of the graft… membrane damage… apoptosis of graft cells

sx: fever, chills, malaise, arthralgia, AKI obv

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20
Q

5 yr kidney graft survival?

A

70%.
65 cad, 75 liv

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21
Q

MC cause of death after kidney transplant?

A

MI

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22
Q

how long extended survival after kidney transplant?

A

15 years.

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23
Q

UC and liver txp?

A

cannot txp if active ulcerative colitis.

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24
Q

MC cause of liver txp?

A

HCV.

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25
Q

what MELD has survival benefit after txp?

A

> 15.

26
Q

HBV treatment after liver txp?

A

HBIG and lamivudine to prevent re infection.

27
Q

MC arterial anomaly in liver txp?

A

RHA off SMA

28
Q

early vs late hepatic aa thrombosis sx?

A

early: fulminant hepatic failure.
late: biliary strictures (blood supply from aa) and MC: ABSCESSES

29
Q

acute rejection in liver txp?

A

T cells against blood vessels
path: portal triad lymphocytosis, endothelitis, bile duct injuries

30
Q

chronic rejection in liver txp?

A

disappearing bile ducts (Ab and T cells attack ducts) and get obstruction with portal fibrosis

31
Q

5 yr survival rate liver txp

A

70%.

32
Q

how long does it take for liver to regenerate?

A

6-8 weeks.

33
Q

what is donor hepatectomy in adult vs child?

A

adult: RIGHT lobectomy
child: left lateral (2 + 3)

34
Q

pancreatic txp arterial and venous supply from donor?

A

celiac aa and SMA; portal

35
Q

pancreatic enteric supply from donor?

A

D2 with ampulla and pancreas (anastomose: donor duo to recipient bowel)

36
Q

where does pancreas go to txp?

A

on iliacs.

37
Q

benefits of simult PK txp?

A

fix retinopathy
fix neuropathy
fix nerve conduction slowing
fix autonomic dysfunction (gastroparesis)
fix orthostatic hypotension

38
Q

what will not REVERSE with simult PK txp for DM?

A

microvascular disease.

39
Q

MC complication after PK txp?

A

venous thrombosis (hard to tx).

40
Q

storage of donor organs?

A

heart: 6 hr
lung: 6 hr
liver: 24 hr
kidney: 48 hr

41
Q

what bx to you get routinely after heart txp?

A

RV to assess for rejection.

42
Q

acute rejection path in heart txp?

A

perivascular lymphocytic infiltrate with grades of myocyte inflammation and necrosis

43
Q

cause of early vs late death after heart txp?

A

early: infection
late: chronic rejection = chronic allograft vasculopathy (coronary atherosclerosis)

44
Q

survival increase after heart transplant

A

transplant <1 yr prognosis… get 10 years (median)

45
Q

survival increase after lung transplant

A

transplant < 1 yr prognosis… get 5 years (median)

46
Q

cause of early vs late death after lung txp?

A

early: reperfusion injury like ARDS
late: chronic rejection = chronic bronchiolitis obliterans

47
Q

Merkel cell carcinoma

A

rare cutaneous malignancy that often arises in elderly males and in those with a history of immunosuppression
LOCALLY AGGRESSUCE
RISK OF METS

Tx: WLE 1-2 margin with SLNB
Radiate postop if 1+ cm
No chemotherapy

48
Q

dx of merkels cell carcinoma

A

Bx (IHC)
[negative]: cytokeratin 20 [negative] and TTF-1 (lung), S100 (melanoma)
[positive]: CK and LMW CK markers with paranuclear dot like pattern

49
Q

workup of merkels cell

A

must r/o regional mets before LN resection

50
Q

living donor risk index favorable factors?

A

younger than 40, death due to trauma, cold ischemic time less than 8 hours, local organ procurement, and a whole ***non-DCD organ

51
Q

warm ischemia time

A

cessation of arterial inflow to the kidney to the time of perfusion with preservation solution.

The length of warm ischemia time is particularly important in determining postoperative organ function.

52
Q

cold ischemia time

A

initiation of cold perfusion to the time of reestablishment of arterial inflow in the transplanted kidney

53
Q

how to assess donor kidney function PRECISELY?

A

Isotropic methods, such as a MAG-3 or DTPA renal scans.

measure the glomerular filtration rate (GFR).

54
Q

azathioprine

A

MOA:

adverse: dose related bone marrow suppression (reduce dose, or stop), HEPATOtoxicity, pancreatitis, neoplasia, anemia, pulmonary fibrosis

55
Q

transplant renal artery stenosis

A

<5% cases

75% of all post transplant vascular complication

usually within first 6 mos (can occur whenever tho)

dx: duplex, peak systolic > 200 cm/sec = dx
»» MRA or CTA

tx: perc transluminal angioplasty +/- stent

56
Q

antithymocyte globulin

A

***8polyclonal IgG from rabbit/horse immmunzied with human thymocytes

blocks T cell CD2,3,4

NOT A MAB

57
Q

muromonab-CD3

A

antiCD3 murine mab

binds CD3 associated with T cell receptor, leading to initial activation and cytokine release followed by blockage

58
Q

basiliximab

A

anti-CD25 chimeric mab
bind IL-2R CD25 on activated T cells preventing IL2 mediated activation

59
Q

alemtuzumab

A

anti CD 52 humanized mab

binds to CD52 expressed on most T/B … depletes

60
Q

belatacept

A

CTLA-4 Ig homolob

binds CD80/CD86 and prevents costim through CD28

61
Q

testing hepatic arterial flow

A

if celiac is stenosed, then need to test the SMA-GDA-proper flow before you take the GDA

62
Q
A

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