Transplant Flashcards
How is T cell mediated rejection diagnosed?
With biopsy
When does hyperacute rejection occur?
Within 24 hours after transplant
When does acute rejection occur?
Within first 6 months after transplant
When does chronic rejection occur?
Months to years after transplant
Glucocorticosteroids is used to treat what kind of rejection?
For acute rejection, and also for induction and maintenance of immunosuppression
What is the main class of immunosuppressive med?
Calcineurin inhibitor
What is a major side effect of antimetabolites?
Bone marrow suppression
Nosocomial infections occur in what time frame?
Within first month
Activation of latent infections occurs during what time frame?
1-6 months
What are two common viral infections after transplant?
Cytomegalovirus and Epstein-Barr virus
What is the most common fungal infection in transplant pts?
Aspergillus
What should you maintain hemodynamics at after transplant?
Normal
Chronic lung rejection has lasted for how long?
Greater than 3 weeks
Donors and recipients are matched based on what?
HLA
How is T-cell mediated rejection acute cellular diagnosed?
Biopsy
How is T-cell mediated rejection acute cellular treated?
Pulse dose steroids, change the immunosuppressant regimen
How is antibody mediated rejection diagnosed?
Biopsy
How quickly does hyperacute rejection occur?
Within first 24 hours after transplant
In what pts does hyperacute rejection occur?
Those with previous antibodies
Previous acute rejection makes what more likely?
Chronic rejection
Are glucocorticosteroids used for induction or maintenance of immune suppression?
Both
Cyclosporine and tacrolimus are what class of med?
Calcineurin inhibitors
What must you do when giving cyclosporine and tacrolimus?
Monitor levels
What is the most significant side effect of cyclosporine and tacrolimus?
Nephrotoxicity
What is the major side effect of antimetabolites?
Bone marrow suppression
Are calcineurin inhibitors used for induction or maintenance of immunosuppression?
Maintenance only
When are nosocomial infections most common?
First month after transplant
What latent infection is common 1-6 months after transplant?
Cytomegalovirus
Community acquired infections occur how long after transplant?
More than 6 months after
What does cytomegalovirus do to platelets?
Causes thrombocytopenia
How is cytomegalovirus diagnosed?
Biopsy, PCR or culture
Bactrim is used for prophylaxis against what?
PCP PNA
What two classes of meds interacts often with immunosuppressants?
The -azoles (antifungals) and calcineurin inhibitors
Pts with a new transplant should get one drug from each of which 4 categories?
Antibacterial, antiviral, antifungal, PPI/H2 blocker
How does primary graft failure in heart transplant present?
Ventricular dysfunction, hypotension and cardiogenic shock
How is primary graft failure in heart transplant treated?
With inotropes and mechanical support (ie ECMO)
Equilization of pressures after heart transplant indicates what?
Cardiac tamponade
Elevated CVP after transplant indicates what?
R ventricular failure
Bradycardia or asystole after heart transplant could indicate what?
De-innervation of the vagus nerve
How to treat de-innervation of the vagus nerve?
Pacemaker
Is atropine effective for de-innervation of the vagus nerve?
No
How do you confirm heart transplant rejection?
Biopsy
Suspected chronic lung allograft dysfunction must have lasted for how long?
3 or more weeks
Suspected chronic lung allograft dysfunction must have FEV1 and/or FVC less than what percent of what it was at baseline?
90%
Chronic lung allograft dysfunction must have FEV1 and/or FVC less than what percent of what it was at baseline?
80%
FVC is equal to or less than 80% of baseline in which type of chronic lung allograft dysfunction?
Restrictive CLAD
FEV1 is equal to or less than 80% of baseline in which type of chronic lung allograft dysfunction?
Obstructive CLAD
Primary graft dysfunction occurs how quickly after lung transplant?
Within first 72 hours
How is a vascular thrombus diagnosed after liver transplant?
Vascular US
What two vessels can thrombose after liver transplant?
Hepatic artery and portal vein
How is portal vein thrombus treated after liver transplant?
Thrombectomy and heparin infusion
Allograft kidney rejection causes a Cr rise of what percent from baseline?
15%
Transplant hydronephrosis could be caused by what?
Lymphocele
Ipsilateral lower extremity edema after kidney transplant could be a sign of what?
Lymphocele
How is lymphocele diagnosed?
US
How is infarct after kidney tx diagnosed?
US or angiography
How is infarct after kidney tx treated?
Thrombolysis or return to OR
