Transplant Flashcards
Signs of Chronic rejection in : Heart Lung Liver Kidney
Heart - allograft vasculopathy - accelerated coronary athlerosclerosis
Lung - bronchiolitis obliterans
Liver - disappearing bile ducts, portal fibrosis, increased Alk phos
Kidney - interstitial fibrosis and tubular atrophy
Mechanism of Hyperacute rejection
IgG antibodies against Class 1 MHC receptors
Treatment of Diabetes insipidus in post-transplant patients?
give exogenous vasopressin (ADH)
CKD stages
Stage 1 - anatomic evidence of kidney disease but normal renal function Stage 2 - GFR 60 to 90 Stage 3 - GFR 30 to 60 Stage 4 - GFR 15 to 30 Stage 5 - GFR < 15 or on dialysis
When does most of the preservation injury to transplanted organs occur?
During organ reperfusion and is referred to as ischemia reperfusion injury (IRI)
Not during periods of cold ischemia or warm ischemia
Contraindications to TXP
Kidney living donor GFR < 80ml/min
Liver living donor age > 55 yo
Panel reactive antibody, PRA, > 50%
What does Cross-match actually mix together?
Recipient serum + donor lymphocytes
MC indication for pancreas transplant?
MC indication is diabetic with renal failure
MC indication in diabetic patient without renal failure is hypoglycemic unawareness, life-threatening
Pancreas AND kidney transplant
Simultaneous pancreas-kidney transplant has SAME one-year patient survival rate of 90% - which is the same patient survival for sequential.
However, the pancreas GRAFT survival rates are higher for simultaneous transplant.
Liver transplant post-op MCC of death
Infection
Living donor kidney MCC of death
Pulmonary embolism
Delayed graft function is associated with what?
Reduced graft function and survival, and increased risk of rejection.
Unlike the general population, what type of cancer is more common the post-transplant population.?
squamous cell is more common than basal cell carcinoma in the post-transplant population.
Establishing donation after cardiac death recommendations
Period of 5 minutes of asystole following cardiac arrest
Confirmation of death by a physician not associated with the transplant
Organ procurement team should not be in the OR until after time of death is established
How are liver transplant recipients different compared to patients receiving other solid organ transplants?
It is not completely understood why, but liver transplant recipients overall require less immunosuppression in the long-term compared to patients receiving other solid organ transplants, and graft loss from rejection is rare.
