Transplant/Immunology Flashcards by Nick Ahn

Which antibody is mucosal?

IgA

MucosAAAAAAA

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Which antibody for breast milk?

IgA

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Which antibody signifies past infection?

IgG

These are the OG antibodies who fought in the original war

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Which antibody is produced first to new infection?

IgM

IMMMediate antibodies

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Rx for acute humoral rejection?

Humoral: B cell mediated -> antibodies

Plasmapheresis
IVIg
Rituximab (antiCD20)

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How does chronic rejection manifest in heart?

Vasculopathy + accelerated atherosclerosis

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How does chronic rejection manifest in liver?

Vanishing bile duct syndrome

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How does chronic rejection manifest in lung?

Bronchiolitis obliterans

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How does chronic rejection manifest in kidney?

Interstitial fibrosis and tubular atrophy

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Explain sensitization, PRA (Panel reactive antibody), and DSA (Donor specific antibody) in layman’s terms

Sensitization: pre-formed antibodies. The potential txp recipient already has antibodies (from pregnancy, transfusions, and previous transplants)

PRA: let’s say the potential recipient has antibodies against X. PRA is- what % of the population has the antigen X?

DSA: is how potent is the antibody reaction for those antibodies?

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Which immunosuppressant is classically associated with seizures and tremors?

FK506 (Tacrolimus)

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Immunosuppressant with poor wound healing?

Rapamune&raquo_space; prednisone

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Which immunosuppressant can cause gingival hypertrophy and hirsutism?

Cyclosporine

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What are the old and new clacineurin inhibitors?

New: FK506 (prograf)
old: cyclosporine (hirsutism)

You get levels for both of these remember?

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Old and new antiproliferative immunosuppressant?

Old: azathioprine
New: mycophenolate

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Which immunosuppressant can cause leukopenia?

MMF

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Which immunosuppressant can cause horrible GI toxicity?

MMF

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When is a panc alone txp indicated?

Which one is almost always better pancreas alone or spk?

Hypoglycemic unawareness

Spk is almost always better

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Most common cause of death after liver transplantation?

Infection

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Most common underlying issue for bile duct problems after liver txp?

Issue with the hepatic artery

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What is the official definition of delayed graft function after kidney transplant?

What is the incidence?

Requirement of dialysis in the first week after transplant

15-30% of deceased kidney txp

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What’s the advantage of bladder drainage in pancreas transplant?

You can monitor fx by amylase and stuff

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Virus responsible for post-transplant cervical cancer?

HPV

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Virus responsible for post-transplant lymphoproliferative disorder?

EBV

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Virus responsible for post-transplant liver cancer?

Hep B, hep C

Virus responsible for post-transplant kaposi sarcoma

HSV8

Virus responsible for post-transplant lymphoproliferative disorder?

EBV

PTLD is B or T? Hodgkin or non-hodgkin? 1 or more years post txp? Or less than 1yr? Treatment?

Non-hodgkin B cell Less than 1yr post-txp Rituximab

What % of the liver does the donor need after donating

30%

What is the first line treatment for PTLD? 2nd line?

1st line: reduce IS 2nd line: rituximab Than do CHOP. CD20

Most common cause of death after heart transplant in the first 30 days

Graft failure and infection

Starting one year after cardiac transplant, what is the top cause of mortality?

Cardiac allograft vasculopathy

What is the most common cause of death five years after cardiac transplant?

Malignancy

What is the single most common type of cancer associated with immunosuppression in transplant pts?

Skin and lip (more specifically squamous cell) >> PTLD

Difference in treatment for polyclinal vs monoclonal lymphoma post-transplant?

Polyclonal: decrease IS Monoclonal: require chemo

What is the most common complication for pancreas transplant?

Venous thrombosis

What do you do for a primary graft non-function after liver txp?

Relisted for retransplant. Can't fix this. Lethal

How do you make a firm diagnosis of brain death?

1) reverse reversible causes of coma- hypothermia, neuromuscular blockade, etc 2) clinical criteria- brain stem reflex, apnea test 3) confirmatory test- electroencephalogram, nuclear brain blood flow, four vessel cerebral arteriography

What is the most common long term complication of lung transplant? What% of lung txp pts get this at 10yrs?

Bronchiolitis obliterans Obstruction of the smallest airways of the lungs due to inflammation About 75% of the pts by 10 years

What is the 1yr and 5yr graft survival for living donor renal txp? For cadaveric?

Living: 1yr: 97% 5yr: 85% Cadaveric: 1yr: 93% 5yr: 73%

Which interleukin is involved with allergic reactions?

IL-4 induces production of IgE IL-5 also involved in allergic reactions/asthma

Simultaneous pancreases kidney: what are the inflows and venous drainages for the kidney and the pancreas?

Inflow: Kidney: left external iliac Pancreas: right iliac (common or external) Venous: Typically iliacs but portal through SMV is also appropriate

What is the mechanism of action of tacrolimus?

Prograf. Calcineurin inhibition. Block IL2 expression PREVENTING THE ACTIVATION OF T CELLS, not deactivation of T cells Same as cyclosporin

Mechanism of action of cyclosporine?

Block IL2 expression PREVENTING THE ACTIVATION OF T CELLS, not deactivation of T cells

Most common cause of late death in renal txp pts?

1) cardiovascular disease 2) malignancy 3) infection

Acute rejection: - what % of transplant recipient get it? - T or B cell mediated? - T/F: increases the risk of chronic rejection - treatment can save the graft in what % of cases? - what is the timeframe of acute rejection?

- 10-30% - T cell mediated. Recipient T cells against the graft - true. Increases the risk of chronic rejection - 90-95% can be successfully treated with steroids - 1-6 weeks

What is Pres- posterior reversible encephalopathy syndrome? When do ppl get this?

Tacrolimus side effect. 2mo-1yr

What hormone resuscitation therapy is helpful in organ donors who have been considered brain dead?

Vasopressin for polyuria 80% of brain dead pts experience diabetes insipidus due to exhaustion of ADH

Cardiac allograft vasculopathy is one of the top causes of mortality starting what timeframe after transplant?

1 year

Cardiac allograft vasculopathy is detected in what % of txp recipient at 5 yrs?

50%

What is the treatment for cardiac allograft vasculopathy?

Re-transplant is the only definitive rx

T/F: stroke is the most common cause if mortality in the first 30 days after cardiac transplant

False. Stroke attributes to 7% of deaths in the first 30d Graft failure and infection are the most common cause of death during this period

T/F: technical errors are the most common cause of death in the first 30 days after cardiac. Transplant

False. Infection and graft failure

T/F: malignancy is the most common cause if mortality 1-3 years after cardiac. Transplant.

False. Malignancy is the most common cause of mortality 5 years after cardiac. Transplant.

T/F: epo should be started when hgb < 7 T/F: protein restriction is recommended for children with CKD V

false. Epo when hgb < 10 False. Protein restriction only for adults

Once kidney is harvested, how long can it be stored before they are transplanted?

48 hrs

What does IgA actually do? A. Aids in adherence of bacteria to epithelial cells to facilitate it's destruction B. Activates complements C. Blocks absorption of antigens from the gut D. Enhances opsonization of organisms E. Allows colonization of bacteria in gut

C. Blocks absorption of antigens from the gut. Blocks adherence of bacteria B. IgG activates complements D. IgG

What is a primary lymphoid organ? Are lymph nodes primary or secondary lymphoid organs? Is spleen a primary or secondary lymphoid organ?

Primary lymphoid organs act to generate Lymphocytes and immature cells. Lymph node is a secondary organ Spleen is a secondary organ

For HD access, what is the rule of 3's? Is it used preop or post-op?

There is no rule of 3's. It's the rule of 6's Used to assess the suitability of cannulation. Vein diameter 6mm, depth under the skin no more than 6mm, flow 600 mL/min, 6 weeks after surgery, 6cm in length

What is an acceptable arterial and venous diameter for a fistula creation?

Vein > 3mm | Artery > 2mm

Other than AEIOU, what are the absolute indications for dialysis (3)?

Uremic pericarditis Pleuritis Encephalopathy

What is a positive apnea test for brain death? When do you abort it and what do you do if you abort.

When pCO2 rises to 60 after 8 minutes off ventilator support Abort if SpO2 < 85 for more than 30 seconds or hypotension during the 8 minutes. Abort and do brain scans. CT or MR angio

Most common indication for pancreas transplant?

Type I diabetes, not II

why does hypernatremia of 161 prevent a brain death exam? is being on norepi a contraindication to brain death?

hypernatremia can cause coma. so it should be fixed norepi is okay as long as SBP > 90

you're about to do a liver transplant. you see rounded edges and visual steatosis. what do you do?

1) send for biopsy 2) proceed with transplant if only microvesicular steatosis if macrovesicular steatosis, then stop

treatment for complete pancreatic graft venous thrombosis (21d post-op from transplant)?

transplant graft pancreatectomy

for kidney transplant, what is an advantage of retroperitoneal approach vs intraperitoneal?

- closer to the bladder - easy percutaneous biopsy risk of bleeding and pain is the same