Transplant Review Flashcards
Components of MELD Score
- INR
- serum bilirubin
- serum creatinine
- serum sodium (newest addition to algorithm)
components of Child-Pugh Score
- INR
- Bilirubin
- Albumin
- degree of ascites
- degree of encephalopathy
Transplant Criteria for Hepatocellular Carcinoma
Milan Criteria
- one lesion < 5cm or three lesions all <3cm in size
- no extra hepatic manifestation of HCC
- no gross vascular invasion
Transplant Criteria for Intrahepatic Cholangiocarcinoma
- Contraindicated
Transplant Criteria for Extrahepatic Cholangiocarcinoma
- unresectable perihilar cholangiocarcinoma after neoadjuvant chemotherapy
- mass < 3cm after neoadjuvant therapy
- no distant metastesis
- must be at a specialized center ready for vascular reconstruction
patient 8 months post-op from liver transplant presents with fever and right upper quadrant pain. CT scan shows stricture at left hepatic duct…what happened?
hepatic artery thrombosis -> biliary ischemia and subsequent stenosis/obstruction
post-transplant patients are increased risk for what kind of cancer?
non-melanoma skin cancer
- most commonly squamous cell carcinoma
What mediates graft vs host disease?
Donor T cells
Th1 and Th17 are markers for this
Oliguria after kidney transplant, next step?
- flush foley to ensure patency
- get US of graft for vascular or structural reasons of oliguria
- if all negative consider a bolus
Risk factor for BK viral infection in transplant patients?
- high T cell immunosuppression
- pulse steroids for rejection treatment
liver transplant patient 24 hours out from OLT, now has rising bilirubin, coagulopathy, altered mental status, hypotensive with an increased heart rate…what is going on and what do you do next?
- primary graft non-function
- re-transplant
two most common kinds of cancers after transplant?
- nonmelanomatous skin cancers
- post transplant lympho-proliferative disorder associated lymphoma
