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Transplant > Transplant stuff > Flashcards

Transplant stuff Flashcards

1
Q

donation after cardiac death requires a minimum of ___ but up to ____ minutes of asystole before procurement

A

2 minutes - 5 minutes

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2
Q

True or false. Confirmation of death should be performed by a physician from the organ procurement team

A

false

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3
Q

basilizimab and antithymocyte globulin mechanism of action:

A

induction agents; deplete lymphocyte stores or prevent T cell activation

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4
Q

preventive therapy for Pneumocystis jinroveci

A

TMP-SMX; more common in transplant patients

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5
Q

true or false. diabetes is an absolute contraindication to being a kidney donor

A

true

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6
Q

true or false. intrahepatic cholangiocarcinoma is a contraindication to being a kidney donor

A

true

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7
Q

typical branches of left renal vein:

A

gonadal (inferior), adrenal (superior), lumbar (posterior)

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8
Q

A MELD-Na score less than ____ is associated with mortality rates less than the mortality rate of undergoing liver transplant

A

15

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9
Q

a replaced right hepatic artery originates from the____

A

SMA

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10
Q

a replaced left hepatic artery originates from

A

left gastric artery

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11
Q

true or false. prolonged cold ischemia time is known in kidney transplant to increase incidence of primary nonfunction and delayed graft function.

A

true

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12
Q

treatment of arterial thrombosis in renal transplant

A

anticoagulation and thrombectomy

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13
Q

posttransplant lymphoproliferative disorder (PTLD) is associated with what virus

A

EBV

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14
Q

what malignancy can PTLD lead to?

A

lymphoma

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15
Q

presentation of PTLD

A

fever, lymphadenopathy, bowel obstruction; observed in 20% of small bowel transplants

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16
Q

mechanism and side effects of tacrolimus

A

bind to FK-binding proteins to inhibit calcineurin and downstream decrease in T cell proliferation; hyperglycemia, nephrotoxicity, neurotoxicity

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17
Q

mechanism & side effects of mycophenolate mofetil (MMF)

A

inhibitor of inosine monophosphate dehydrogenase which controls synthesis of GMP; causes pancytopenia, GI bleeding, diarrhea

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18
Q

mechanism and side effects of sirolimus

A

binds rapamycin (mTOR) to prevent cytokine transduction and T cell proliferation; causes poor wound healing, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia

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19
Q

mechanism and side effects of cyclosporine

A

binds cyclophilin causing NFAT translocation and decreased T cell proliferation; causes vomiting, seizures, and arrhythmias; hypertrichosis, gingival hyperplasia; less nephrotoxic than tacrolimus

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20
Q

study used to measure GFR in potential renal donors

A

MAG-3 or DTPA renal scans; 24 hr creatinine clearance can be used as an alternative

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21
Q

true or false. liver transplant graft experience rejection less often and require less immunosuppression than other solid organ transplants

A

true

22
Q

mainstay immunosuppressive for liver transplant

A

tacrolimus

23
Q

most common indication for renal transplant

A

diabetes

24
Q

side effect of azathioprine

A

bone marrow suppression

25
Q

time frame and mechanism of acute rejection:

A

occurs in days to weeks (sometimes months) after transplant; classified as T cell mediated (cellular), antibody mediated (humoral), or a combination of both

26
Q

histology of acute rejection

A

lymphocytic infiltrate, membrane damage, apoptosis of graft cells on bx, complement deposition, parenchymal necrosis

27
Q

prevention of acute rejection

A

initial immunosuppressive T cell depletion

28
Q

time frame and mechanism of hyperacute rejection

A

occurs in minutes to hours after graft reperfusion; mediated by preformed antibodies of the recipient to the donor and by complement activation

29
Q

prevention of hyperacute rejection

A

preop crossmatching and testing for ABO compatibility

30
Q

what is tissue typing

A

testing donors and recipients for HLA-A, HLA-B, and HLA-DR molecule matching; more HLA matches increases the chance of graft survival

31
Q

true or false. most pancreas transplants are performed as combined kidney-pancreas transplants

A

true

32
Q

most common indication for pancreas transplant

A

type 1 diabetes

33
Q

cytokine involved in activation of CD4 lymphocytes; casues fevers made by macrophages, monocytes, dendritic cells, and fibroblasts

A

IL-1

34
Q

cytokine that activates eosinophils; involved in asthma and allergies

A

IL-5

35
Q

cytokine involved in NK and macrphage activation; secreated by helper T cells

A

interferon gamma

36
Q

which drugs are the calcineurin inhibitors:

A

tacrolimus, cyclosporine

37
Q

which drugs are purine synthesis inhibitors:

A

MMF, azathioprine

38
Q

which drugs are inhibitors of NF-KB

A

steroids

39
Q

which drugs are mTOR inhibitors

A

sirolimus, everolimus

40
Q

which drug is a involved in the co-stimulation blockade

A

belatacept

41
Q

treatment of PTLD

A

rituximab (monoclonal antibody to CD20 that leads to complement and antibody mediated B cell death

42
Q

where are b lymphocytes derived

A

pluripotent stem cells in bone marrow

43
Q

time frame and mechanism of chronic rejection

A

occurs over months to years; fibrotic process mediated by T and B cels

44
Q

histology of chronic rejection

A

parenchymal replacement with fibrous tissue and intimal smooth muscle proliferation leading to vessel occlusion

45
Q

chronic rejection prevention

A

avoiding acute rejection episodes and limiting ischemia/reperfusion time at transplant

46
Q

histology of hyperacute rejection

A

endothelial damage, inflammation, and thrombosis

47
Q

most common pulmonary fungal infection in immunosuppressed patients:

A

aspergillosis

48
Q

types of aspergillosis infections:

A

invasive aspergillosis, allergic aspergillosis, and aspergilloma

49
Q

presentation and treatment of invasive aspergillosis:

A

presents with cough, pleuritic CP, and fever

50
Q

presentation and treatment of aspergilloma:

A

fungal ball in the lung that can invade parenchymal vessels with possible subsequent fatal hemorrhage; tx with lobectomy

Transplant (1 decks)

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