Transplant Flashcards
Most important recipient/donor matching
HLA - A; B; DR
Most important HLA
HLA - DR
Most important determinants of organ allocation
Time on waitlist / HLA- compatibility
ABO universal donor
Type O
ABO universal recipient
Type AB
What does cross matching involve
Mix recipient serum with donor lymphocytes
See if there are recipient ABs to donor organs
What kind of rejection does a positive cross match predict?
Hyperacute rejection
What do you give for mild rejection
Pulse steroids
What do you give for severe rejection
Steroids + Antibodies (ATG or thyroglobulin)
Most common malignancy in txp pt
Skin cancer - Squamous cell cancer
2nd most common maliganacy in txp pt
PTLD (post transplant lymphoproliferative disorder)
S/Sx; RF; Tx of PTLD
Sx: SBO, mass, adenopathy
RFs: Cytolytic drugs
Tx: Stop immunosuppresion; rituximab (anti-CD20, decreases B cells); may need chemo and XRT
Immunosuppresion risks
CA, CVD, infection, osteopenia
Mycophenolate (cellcept)
MOA:
Side effects:
Info:
MOA: inhibits de novo purine synthesis -> inhibits T cell growth
SE: GI intolerance (N/V/D), myelosuppression
Info: Keep WBC > 3; used for maintenance to prevent rejection; similar MOA to Azathioprine (imuran)
Steroids (prednisone, solumedrol)
MOA:
Use:
MOA: Inhibit inflammation (macrophages), genes for cytokine synthesis (IL-2)
Use: For induction after txp, maintenacne, acute rejection episodes
Cyclosporin (CSA)
MOA:
Side Effects:
Info:
MOA: Inhibits calcineurin (do not use with CCB diphenhydromine / verapimil) -> decrease cytokine synthesis (IL-2, IL-4)
Use: Maintenance therapy
SE: Nephro, Hepato, tremors/seizures, HUS
Info: Keep trough 200-300, Hepatic metabolism and biliary excretion (reabsorbed in gut -> enterohepatic recirculation)
FK-506 (Tacrolimus - prograf)
MOA:
Side Effects:
Info:
MOA: Similar to CSA but more potent
SE: Nephro, GI Sxs, mood changes, DMs (less entero-hepatic recirculation)
Info: Fewer rejection episodes in kidneys than CSA; keep trough 10-15
Sirolimus (Rapamycin) MOA: Uses: SE: Info:
MOA: Similar to FK-506; binds FK-binding protein but inhibits mTOR -> Inhibits T cell/B cell response to IL-2
Uses: Maintenance therapy
SE: ILD
Info: NOT nephrotoxic
Antithymocyte globulin MOA: Uses: Side Effects: Info:
MOA: polyclonal abs (equine or rabbit) against T cell antigens (CD 2,3,4)
Uses: For induction and/or acute rejection
SE: Cytokine release syndrome (F/C, pulm edema, shock); PTLD; myelosuppresion
Info: Give steroids/benadryl prior to prevent cytokine release syndrome; Keep WBCs > 3
Acute rejection When: Cause: Mechanism: Tx:
When: Minutes to Hours
Cause: MCC - ABO incompatibility
Mechanism: Preformed abs (should have been picked up on cross match - Type II hypersensitivity rxn) activate complement cascade and cause thrombosis of vessels
Tx: Emergent re-transplantation
