Transplant

Question 1

Most important recipient/donor matching

Answer 1

HLA - A; B; DR

Question 2

Most important HLA

Answer 2

HLA - DR

Question 3

Most important determinants of organ allocation

Answer 3

Time on waitlist / HLA- compatibility

Question 4

ABO universal donor

Answer 4

Type O

Question 5

ABO universal recipient

Answer 5

Type AB

Question 6

What does cross matching involve

Answer 6

Mix recipient serum with donor lymphocytes

See if there are recipient ABs to donor organs

Question 7

What kind of rejection does a positive cross match predict?

Answer 7

Hyperacute rejection

Question 8

What do you give for mild rejection

Answer 8

Pulse steroids

Question 9

What do you give for severe rejection

Answer 9

Steroids + Antibodies (ATG or thyroglobulin)

Question 10

Most common malignancy in txp pt

Answer 10

Skin cancer - Squamous cell cancer

Question 11

2nd most common maliganacy in txp pt

Answer 11

PTLD (post transplant lymphoproliferative disorder)

Question 12

S/Sx; RF; Tx of PTLD

Answer 12

Sx: SBO, mass, adenopathy
RFs: Cytolytic drugs
Tx: Stop immunosuppresion; rituximab (anti-CD20, decreases B cells); may need chemo and XRT

Question 13

Immunosuppresion risks

Answer 13

CA, CVD, infection, osteopenia

Question 14

Mycophenolate (cellcept)
MOA:
Side effects:
Info:

Answer 14

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)

Question 15

Steroids (prednisone, solumedrol)
MOA:
Use:

Answer 15

MOA: Inhibit inflammation (macrophages), genes for cytokine synthesis (IL-2)
Use: For induction after txp, maintenacne, acute rejection episodes

Question 16

Cyclosporin (CSA)
MOA:
Side Effects:
Info:

Answer 16

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)

Question 17

FK-506 (Tacrolimus - prograf)
MOA:
Side Effects:
Info:

Answer 17

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

Question 18

Sirolimus (Rapamycin)
MOA:
Uses:
SE:
Info:

Answer 18

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

Question 19

Antithymocyte globulin
MOA:
Uses:
Side Effects:
Info:

Answer 19

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

Question 20

Acute rejection
When:
Cause:
Mechanism:
Tx:

Answer 20

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