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Transplant > Transplant > Flashcards

Transplant Flashcards

1
Q

What are the most important parts of HLA crossmatching?

A

DR and DQ (found on MHC 2/HLA 2)

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2
Q

What induction medication is cytotoxic to T and B cells?

A

thymoglobulin

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3
Q

What induction medication blocks interferon binding sites via monoclonal antibodies?

A

basiliximab

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4
Q

What are the major side effects of tacrolimus?

A

-nephrotoxicity
-neurotoxicity/AMS
-diabetes/hyperglycemia
-hypertension
-hyperlipidemia

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5
Q

What are the major side effects of cyclosporin?

A

-nephrotoxicity
-neurotoxicity

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6
Q

What are the major side effects of mycophenolate?

A

-bone marrow toxicity
-GI disturbances

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7
Q

What type of cells mediate acute rejection?

A

T cells

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8
Q

What mediates hyperacute rejection?

A

preformed antibodies against the graft
-IgG antibodies

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9
Q

What is the treatment for acute rejection?

A

steroids

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10
Q

What is seen on biopsy of acute rejection graft?

A

T-cell infiltrate

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11
Q

What is the chronic rejection syndrome that affects the lungs?

A

bronchiolitis obliterans

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12
Q

What is the chronic rejection syndrome that affects the liver?

A

vanishing bile duct syndrome

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13
Q

What is the chronic rejection syndrome that affects the heart?

A

coronary artery or cardiac allograft vasculopathy

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14
Q

What virus can be associated w/ ureteral stricture in a kidney transplant?

A

polyoma virus

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15
Q

What is the most common infection seen in transplant recipients?

A

Listeria

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16
Q

What infection is an indication of over immunosuppression?

A

Nocardia

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17
Q

What risk factors increase the risk of a pt having a VTE post orthotopic liver transplantation?

A

-DM
-previous VTE
-ESRD
-discharge to rehab facilities
-received factor VII during surgery
-postop PNA

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18
Q

How is pneumocystosis typically diagnosed?

A

90% w/ BAL

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19
Q

What is the treatment for pneumocystosis?

A

bactrim
-if this fails pentamidine isethionate

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20
Q

What is the most common skin tumor seen in transplant recipients?

A

SCC then BCC

21
Q

What type of disease process to post-transplant lymphoproliferative disorder (PTLD)?

A

B cell lymphoma

22
Q

Which patient population is PTLD more common in?

A

children more than adults

23
Q

What infection can lead to PTLD and what is the treatment?

A

-EB virus
-ganciclovir

24
Q

When a post-transplant pt has GI symptoms like unexplained diarrhea and intestinal obstruction what process should you be concerned for?

A

PTLD
-get over abundance of gut lymphoid tissue

25
Q

How is PTLD treated?

A

-reduce or discontinue immunosuppression
-ganciclovir if a/w EB virus
-may need adjunctive chemotherapy

26
Q

What is the rate of hep B recurrence in 5 years?

A

50%

27
Q

What is the rate of hep C reccurence in 5-6 years?

A

100%

28
Q

What hep B markers indicate a higher likelihood of recurrence? How are these treated?

A

test positive for:
-e antigen
-HBV DNA

treat w/ lamivudine and adefovir

29
Q

What is the most common indication for liver transplant in pediatrics?

A

biliary atresia

30
Q

What is the most common indication for liver transplant?

A

hep C

31
Q

Which hepatic tumor requiring liver transplant has the best prognosis?

A

fibrolamellar carcinoma

32
Q

What acid/base abnormality is actually a sign of a functioning liver?

A

mild alkalosis

33
Q

What are signs of a successful hepatic transplant?

A

-golden yellow bile production
-resolution of encephalopathy
-resolution of acidosis

34
Q

What is the most common cause of early death in liver transplant pts?

A

-intra abdominal abscess
-sepsis

35
Q

What are the options for duodenum drainage in pancreatic transplants?

A

-urinary bladder
-small bowel

36
Q

What are the two more common complications of pancreatic transplants?

A

-vascular thrombosis (venous thrombosis is most common cause of graft failure)
-allograft pancreatitis

37
Q

What is the most common cause of lung transplant complication?

A

bronchiolitis obliterans

38
Q

What is the limiting long term complication of heart transplant?

A

atherosclerosis of new heart coronary arteries

39
Q

What occurs in 10% of heart transplant pts leading to bradycardia?

A

sinus node dysfunction
-must use pacer since perfusion depends on heart rate
-treatment is mainly isoproterenol if prolonged bradycardia

40
Q

Which type of transplants have the highest rates of invasive fungal disease?

A

-small bowel
-lung
-liver

41
Q

What are the most common organisms is post-transplant fungal infections?

A

-Candida
-Aspergillus

42
Q

What is the MOA of calcineurin inhibitors (tracrolimus, cyclosporine)?

A

-block T-cell activation
-bind to specific receptors to block calcineurin, a Ca-dependent phosphatase w/in T-cells

43
Q

How are calcineurin inhibitors (tacrolimus, cyclosporine) metabolized?

A

P450 CYP3A4
-in both liver and small intestine
-clearance is mostly biliary excretion and fecal elimination
-any drugs that inhibit CYP3A4 will increase drug concentrations (diltiazem, verapamil, erthyromycin, ketoconazole, fluconazole, ritonavir)

44
Q

What is the MOA of tacrolimus?

A

binds to FK binding protein-12 and blocks proliferation of calcineurin preventing IL2 expression/production

45
Q

What have been shown to be factors that have a higher mortality after orthotopic liver transplant?

A

-mechanical ventilation
-older age
-hyponatremia

46
Q

What are the 3 leading causes of death after transplant?

A

-CV disease
-malignancy
-infections

47
Q

What is the most common cause for respiratory failure in the early period following lung transplantation?

A

ischemia perfusion injury
-generally presents within the first 72hrs after transplant

48
Q

What are the immediate objectives of donor optimization for pts w/ non-survivable injuries?

A

-correct hypovolemia
-start vasopressin
-wean catecholamine infusions
-prompt diagnosis and management of DI
-high dose methylprednisolone
-application of lung protective ventilation

49
Q

Replacement of which hormone has been shown to have a higher number of procured organs?

A

thyroid hormone replacement

Transplant (2 decks)

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