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SURGICAL CARE > Transplant med > Flashcards

Transplant med Flashcards

1
Q

Transplanted between genetically identical individuals.

A

Isografts

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2
Q

Grafts transplanted between different species

A

Xenografts

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3
Q

Graft divided between two recipients

A

Split Transplant (e.g., split-liver transplant)

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4
Q

Example: kidney transplant
Both pediatric donor kidneys into single adult
recipient

A

“En bloc” Transplant

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5
Q

Transplanted between same species

A

Allograft

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6
Q

What kind of organ donors would the following be considered?

Example: renal transplant donors with “medical complexities”
Deceased or living donors
≥ 60 years
> 50 years + at least 2 of the following: hypertension, serum creatinine > 1.5 mg/dl or death from CV accident

A

“Expanded criteria” Donors

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7
Q

CDC “high risk “ donors

A

Donors w Hep B and C

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8
Q

HOPE act?

A

HIV positive donors can give organs to HIV positive individuals

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9
Q

Role of UNOS?

A

(United Network for Organ Sharing)
Organization that operates the Organ Procurement and Transplantation Network

“Regional” rules

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10
Q

Time heart / lungs can be kept out of body

A

4-6 hours

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11
Q

Time liver can be kept out of body

A

12-24 hours

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12
Q

Time kidney can be kept out of body

A

48-72 hours

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13
Q

Three sets of antigens involved in graft rejection

A

MHC/HLA

mHC

ABO blood groups

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14
Q

Cells mediating the cellular immune response

A

lymphocytes

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15
Q

Cells mediating humoral immune response

A

antibody

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16
Q

Sensitization to HLA occurs due to

A

Pregnancies
Blood transfusions
Prior transplants
Prior viral / bacterial infections

17
Q

3 types of rejection

A

Hyperacute

Acute

Chronic

18
Q

Hyperacute rejections have what kind of immune mediation

A

Humorally mediated (antibodies + compliment) - occur within minutes /hours of transplant

involve pre existing HLA / ABO antibodies to graft

19
Q

Organs most and least susceptible to hyperacute rejections

A

Kidneys most susceptible

Liver least susceptible

20
Q

Acute rejection occurs during ______ and may be cause by _____

A

First 6 months post-transplant

primary acute cellular rejection and/or acute humoral rejection

21
Q

Chronic rejection occurs ________ is mediated by _____ and appears as ______

A

Months to years AFTER ACUTE REJECTION EPISODES

Both cellular and antibody responses

Fibrosis and scarring

22
Q

5 classes of immunosuppressive drugs

A

Corticosteroids

Antiproliferative

Calcineurin inhibitors (CNI’s) (Cyclosporin)

mTOR inhibitors

Depleting antibodies

23
Q

Induction agents (3)

A

Polyclonal antibodies

Monoclonal antibodies

Corticosteroids

24
Q

Maintenance agents (3)

A

Corticosteroids

Antiproliferative agents

Calcineurin / mTOR inhibitors

25
Q

Reversal of established rejection

A

High dose corticosteroids

Polyclonal / monoclonal antibodies

26
Q

Graft vs Host disease

A

Donor T lymphs recognize foreign HLA antigens

Acute or chronic

Affects skin, liver, GI tract,

27
Q

Skin manifestations of acute GVHD

A

Maculopapular rash

may progress to diffuse erythema / bullae

28
Q

Liver manifestations of acute GVHD

A

Elevated LFT’s

29
Q

GI manifestations of acute GVHD

A

loss of appetite
dyspepsia
large volume crampy secretory diarrhea

30
Q

Overall incidence of GVHD

A

40-50% in HLA identical donor

31
Q

First line tx of GVHD

A

Methotrexate, Cyclosporine, Tacrolimus

Prednisone

T cell depletion in vivo

32
Q

fever and/or malaise, thrombocytopenia, leukopenia

A

CMV syndrome

33
Q

Prophylaxis tx for CMV

A

Gancyclovir / valgancyclovir

34
Q

Nosocomial / technical / donor or recipient derived infections typically occur ____ after transplantation

A

< 4 weeks

35
Q

Activation of latent VIRUSES, or other infections, opportunistic infections, occur ____ after transplantation

A

1-6 Months

36
Q

Community acquired infections occur _____ after transplantation

A

> 6 months

SURGICAL CARE (6 decks)

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