Transplant

Question 1

1 malignancy following any transplant; #2?

Answer 1

1 squamous cell skin Ca; #2 = post transplant lymphoproliferative disorder (PTLD – EBV related)

Question 2

mechanism of cellcept; main side effect

Answer 2

mycophenolate – inhibits T cell growth; can cause myelosuppression, similar to azathioprine (imuran)

Question 3

mechanism of cyclosporine? main side effects

Answer 3

binds cyclophilin protein, inhibits genes for cytokine synthesis (IL2, IL4 etc.), side effect = nephrotoxicitiy, hepatotoxicity, tremors, seizures, HUS – need careful pharma monitoring

Question 4

mechanism of FK-506? main side effects

Answer 4

prograf/tacrolimus – finds FK binding protein, similar to cyclosporine, inhibits genes for cytokine synthesis; side effects = nephrotoxicity, more GI symptoms/ mood changes than cyclosporine – less rejection episodes in kidney TXPs w/ tac vs CSA

Question 5

causes of hyperacute rejection

Answer 5

caused by preformed antibodies that should have been picked up by cross match, activates complement cascade and thrombosis of vessels occur

Question 6

cause of accelerated rejection <1 wk

Answer 6

caused by sensitized T cells to DONOR antigens – tx w/ increasing immunosuppression and pulse steroids, possible antibody tx

Question 7

cause of acute rejection (1 wk to 1 month)

Answer 7

caused by T cells – cytotoxic/helper T cells; tx w/ increasing immunosuppression, pulse steroids, possible antibody tx

Question 8

cause of chronic rejection (>1 month)

Answer 8

type 4 hypersensitivity reaction (T cell mediated), plus antibody formation – leads to graft fibrosis; tx w/ increased immunosuppression

Question 9

indication for pancreas transplant

Answer 9

1) diabetic pt w/ imminent or established ESRD who have or plan to have kidney txp; OR 2) pt meeting all 3 criteria – frequent episodes of metabolic complication related to diabetes, emotional problems w/ insulin therapy, and conssistnet failure of insulin based management to prevent complications

Question 10

most significant factor independently associated with death amongst pt awaiting kidney transplant?

Answer 10

COPD > smoker status > nonambulatory status > CAD

Question 11

most common cause of death postop for kidney donors

Answer 11

pulmonary emboli

Question 12

most common complication for kidney donors postop

Answer 12

wound infection

Question 13

contraindications to organ donation

Answer 13

HIV/hepatitis (unless to HIV/hepatitis recipients), cirrhosis, active system infection w/ +blood cultures – cancer often contraindication, depends on the tumor (low grade CNS tumors are often OK

Question 14

most common cause of postop oliguria after kidney txp

Answer 14

acute tubular necrosis – presents w/ gradual decrease in UOP, usually fluid responsive – if sudden drop in UOP, concern for graft thrombosis

Question 15

most common cause of extrinsic compression of ureter after kidney txp

Answer 15

lymphocele -if asymptomatic do nothing, if symptomatic need image guided drainage or surgical drainage

Question 16

Post transplant lymphoproliferative disorder: most common type of cell origin? most common after which transplant? Relation to EBV / CMV status?

Answer 16

most commonly monoclonal B cell origin, most common after heart/lung transplant vs liver/kidney, EBV negative pt higher risk than EBV positive, CMV negative patients are at increased risk once they seroconvert