Transplant

Question 1

MOA of cyclosporine?

Answer 1

Calcineurin inhibition; leads to decreased IL-2 activation and T-cell suppression

Question 2

SE of cyclosporine?

Answer 2

Nephrotoxicity

Question 3

SE of sirolimus and other mTOR inhibitors?

Answer 3

Wound complications

Lymphocele formation

Question 4

MOA of sirolimus?

Answer 4

MTOR inhibitor

Question 5

SE of mycophenolate mofetil?

Answer 5

GI sxs; diarrhea, nausea

Question 6

MELD scoring will give pts with HCC how many points?

Answer 6

22 if they have HCC; or else they end up lower on the list

Question 7

What MELD score is usually used as a cutoff for referral to a transplant center;

Answer 7

> 15

Question 8

MILAn criteria for liver tx?

Answer 8

1 lesions less than or equal to 5 cm

And/or 3 separate lesions, none larger than 3 cm

Question 9

Med approved for palliative treatment of unresectable liver cancer:

Answer 9

Sorafenib (tyrosine kinase inhibitor)

Question 10

What is graft v host dx?

Answer 10

WBCS from donor marrow, attack the recipients cells
Involves both B/T cells

Question 11

Sxs of graft v host dx?

Answer 11

Skin; maculopapular rash

Intestines; diarrhea/vomiting

Liver; abnormal LFTs

Question 12

What does bx of graft v host dx show?

Answer 12

Denuded mucosa

Crypt gland destruction

Enterocyte apoptosis

Question 13

Owls eyes inclusions?

Answer 13

Cytoplasmic nuclear inclusions seen in CMV enteritis

Question 14

MC indication for renal transplant in the US?

Answer 14

Diabetes

HTN

Cystic kidney dx

RCC

Question 15

MOA of tacrolimus;

Answer 15

Inhibits T-cell function by preventing IL-2 and other cytokines synthesis

Question 16

Rituximab?

Answer 16

Monoclonal antibody to CD 20

Leads to complement and antibody mediated cell death of B cells

After reducing immunosuppression, it is first line treatment for PTLD

Question 17

PTLD?

Answer 17

Happens in setting of immunosuppression

EBV-positive B cell proliferation occurs

Question 18

Hyperacute rejection;

Answer 18

Occurs mins to hrs after tx

Due to recipient preformed antibodies to donor antigens
‘
complement system is activated and you get intravascular thrombosis and graft necrosis

Question 19

SE of mycophenolate mofetil?

Answer 19

Leukopenia
Diarrhea

Question 20

Hypertrichosis and gigival hyperplasia seen with what drug?

Answer 20

Cyclosporine

Question 21

MOA of cyclosporine;

Answer 21

Calcineurin inhibitor

Binds cyclophilin, which binds Calcineurin, (a tyrosine phosphatase)

End goal of all of this is to block IL-2 gene transcription

Question 22

Polyclonal antibody directed at the signal transduction unit on CD3 cells;

Answer 22

Thymoglobulin

Question 23

MOA of tacrolimus/prograf?

Answer 23

Binds to FK binding protein; blocks expression of IL-2 receptors

Question 24

MOA of mycophenolate/cellcept?

Answer 24

Blocks purine synthesis

Question 25

Transplant renal artery stenosis?

Answer 25

See refractory HTN and allograft dysfunction
Usually occurs within 6 months of transplant

Dx made with US showing peak systolic velocities >200 cm/second

Percutaneous transluminal angioplasty is tx of choice, possibly with stent placement

Question 26

When do we transfuse cryoprecipitate;

Answer 26

If fibrinogen <100

Decreased K time, alpha angle

Question 27

If max amplitude on TEG is depressed we give?

Answer 27

Plts

Question 28

If R time is elevated;

Answer 28

FFP

Question 29

LOW MA you can give?

Answer 29

Platelets or desmopressin

Question 30

Macrophages and wound healing?

Answer 30

Predominant cells days 3-5. Peak day 7

Important for growth factor release helping immune cells proliferate, important for angiogenesis

Question 31

What skin cell performs immune function?

Answer 31

Dendrocytes