Transplant

Question 1

How is T cell mediated rejection diagnosed?

Answer 1

With biopsy

Question 2

When does hyperacute rejection occur?

Answer 2

Within 24 hours after transplant

Question 3

When does acute rejection occur?

Answer 3

Within first 6 months after transplant

Question 4

When does chronic rejection occur?

Answer 4

Months to years after transplant

Question 5

Glucocorticosteroids is used to treat what kind of rejection?

Answer 5

For acute rejection, and also for induction and maintenance of immunosuppression

Question 6

What is the main class of immunosuppressive med?

Answer 6

Calcineurin inhibitor

Question 7

What is a major side effect of antimetabolites?

Answer 7

Bone marrow suppression

Question 8

Nosocomial infections occur in what time frame?

Answer 8

Within first month

Question 9

Activation of latent infections occurs during what time frame?

Answer 9

1-6 months

Question 10

What are two common viral infections after transplant?

Answer 10

Cytomegalovirus and Epstein-Barr virus

Question 11

What is the most common fungal infection in transplant pts?

Answer 11

Aspergillus

Question 12

What should you maintain hemodynamics at after transplant?

Answer 12

Normal

Question 13

Chronic lung rejection has lasted for how long?

Answer 13

Greater than 3 weeks

Question 14

Donors and recipients are matched based on what?

Answer 14

HLA

Question 15

How is T-cell mediated rejection acute cellular diagnosed?

Answer 15

Biopsy

Question 16

How is T-cell mediated rejection acute cellular treated?

Answer 16

Pulse dose steroids, change the immunosuppressant regimen

Question 17

How is antibody mediated rejection diagnosed?

Answer 17

Biopsy

Question 18

How quickly does hyperacute rejection occur?

Answer 18

Within first 24 hours after transplant

Question 19

In what pts does hyperacute rejection occur?

Answer 19

Those with previous antibodies

Question 20

Previous acute rejection makes what more likely?

Answer 20

Chronic rejection

Question 21

Are glucocorticosteroids used for induction or maintenance of immune suppression?

Answer 21

Both

Question 22

Cyclosporine and tacrolimus are what class of med?

Answer 22

Calcineurin inhibitors

Question 23

What must you do when giving cyclosporine and tacrolimus?

Answer 23

Monitor levels

Question 24

What is the most significant side effect of cyclosporine and tacrolimus?

Answer 24

Nephrotoxicity

Question 25

What is the major side effect of antimetabolites?

Answer 25

Bone marrow suppression

Question 26

Are calcineurin inhibitors used for induction or maintenance of immunosuppression?

Answer 26

Maintenance only

Question 27

When are nosocomial infections most common?

Answer 27

First month after transplant

Question 28

What latent infection is common 1-6 months after transplant?

Answer 28

Cytomegalovirus

Question 29

Community acquired infections occur how long after transplant?

Answer 29

More than 6 months after

Question 30

What does cytomegalovirus do to platelets?

Answer 30

Causes thrombocytopenia

Question 31

How is cytomegalovirus diagnosed?

Answer 31

Biopsy, PCR or culture

Question 32

Bactrim is used for prophylaxis against what?

Answer 32

PCP PNA

Question 33

What two classes of meds interacts often with immunosuppressants?

Answer 33

The -azoles (antifungals) and calcineurin inhibitors

Question 34

Pts with a new transplant should get one drug from each of which 4 categories?

Answer 34

Antibacterial, antiviral, antifungal, PPI/H2 blocker

Question 35

How does primary graft failure in heart transplant present?

Answer 35

Ventricular dysfunction, hypotension and cardiogenic shock

Question 36

How is primary graft failure in heart transplant treated?

Answer 36

With inotropes and mechanical support (ie ECMO)

Question 37

Equilization of pressures after heart transplant indicates what?

Answer 37

Cardiac tamponade

Question 38

Elevated CVP after transplant indicates what?

Answer 38

R ventricular failure

Question 39

Bradycardia or asystole after heart transplant could indicate what?

Answer 39

De-innervation of the vagus nerve

Question 40

How to treat de-innervation of the vagus nerve?

Answer 40

Pacemaker

Question 41

Is atropine effective for de-innervation of the vagus nerve?

Answer 41

No

Question 42

How do you confirm heart transplant rejection?

Answer 42

Biopsy

Question 43

Suspected chronic lung allograft dysfunction must have lasted for how long?

Answer 43

3 or more weeks

Question 44

Suspected chronic lung allograft dysfunction must have FEV1 and/or FVC less than what percent of what it was at baseline?

Answer 44

90%

Question 45

Chronic lung allograft dysfunction must have FEV1 and/or FVC less than what percent of what it was at baseline?

Answer 45

80%

Question 46

FVC is equal to or less than 80% of baseline in which type of chronic lung allograft dysfunction?

Answer 46

Restrictive CLAD

Question 47

FEV1 is equal to or less than 80% of baseline in which type of chronic lung allograft dysfunction?

Answer 47

Obstructive CLAD

Question 48

Primary graft dysfunction occurs how quickly after lung transplant?

Answer 48

Within first 72 hours

Question 49

How is a vascular thrombus diagnosed after liver transplant?

Answer 49

Vascular US

Question 50

What two vessels can thrombose after liver transplant?

Answer 50

Hepatic artery and portal vein

Question 51

How is portal vein thrombus treated after liver transplant?

Answer 51

Thrombectomy and heparin infusion

Question 52

Allograft kidney rejection causes a Cr rise of what percent from baseline?

Answer 52

15%

Question 53

Transplant hydronephrosis could be caused by what?

Answer 53

Lymphocele

Question 54

Ipsilateral lower extremity edema after kidney transplant could be a sign of what?

Answer 54

Lymphocele

Question 55

How is lymphocele diagnosed?

Answer 55

US

Question 56

How is infarct after kidney tx diagnosed?

Answer 56

US or angiography

Question 57

How is infarct after kidney tx treated?

Answer 57

Thrombolysis or return to OR