Transplant

Question 1

What is assessed for donor compatibility?

Answer 1

human leukocyte antigen (HLA)

ABO blood group

Question 2

What is a PRA test?

Answer 2

panel reactive antibody test
gauges whether the recipient is sensitized to foreign proteins
High score = high chance of rejection, recipient must wait for a better matched donor

Question 3

define allograft/homograft

Answer 3

transplant of organ or tissue from one individual to another of the same species

Question 4

define isograft

Answer 4

a transplant from a genetically identical donor (twin)

Question 5

define autograft

Answer 5

transplant within the same patient from one site to another - common in skin grafting

Question 6

what is induction immunosuppression

Answer 6

give before or at time of transplant to prevent acute rejection during early post-transplant period

Question 7

what does induction immunosuppression consist of?

Answer 7

short course of IV biological or monoclonal antibody with or without high dose steroids

Question 8

What is basiliximab

Answer 8

interleukin-2 (IL-2) receptor antagonist - suppresses activation of T-lymphocytes
most common induction drug
NOT a TREATMENT of rejection, only prevention

Question 9

is basiliximab treatment or prevention of rejection?

Answer 9

prevention!

Question 10

what is used in place of basiliximab in patients with higher risk of rejections?

Answer 10

antithymocyte globulin

Question 11

is antithymocyte globulin used for prevention or treatment?

Answer 11

BOTH

Question 12

when is induction immunosuppression not necessary?

Answer 12

when the donor is an identical twin

Question 13

What is the typical combination for maintenance immunosuppression

Answer 13

Tacrolimus (CNI) +
Mycophenolate (antiproliferative agent) (or can use everolimus, siroliumus, belatacept or azathioprine)
with or without steroids (prednisone)

Question 14

why are multiple drug classes used in maintenance immunosuppression?

Answer 14

lower toxicity risk of using an individual immunosuppressant
reduces risk of graft rejection

Question 15

what can mycophenolate decrease the efficacy of?

Answer 15

oral contraceptives

Question 16

what is a genetic concern when it comes to aziothioprine

Answer 16

patients with genetic deficiency of TPMT are at an increased risk of myelosuppression.

Question 17

which medication are we worried about a genetic disorder resulting in increased risk of myelosuppression?

Answer 17

aziothioprine

Question 18

with which immunosuppressants are we worried about container leaching?

Answer 18

cyclosporine and tacrolimus

Question 19

what are some common symptoms of organ rejection?

Answer 19

flu-like symptoms: chills, body aches, nausea, cough, SOB and organ specific symptoms (arrhythmia for heart, or decrease urine output with kidney)

Question 20

what levels are monitored to ensure less toxicity and rejection rates

Answer 20

drug trough levels