Transplant stuff Flashcards
donation after cardiac death requires a minimum of ___ but up to ____ minutes of asystole before procurement
2 minutes - 5 minutes
True or false. Confirmation of death should be performed by a physician from the organ procurement team
false
basilizimab and antithymocyte globulin mechanism of action:
induction agents; deplete lymphocyte stores or prevent T cell activation
preventive therapy for Pneumocystis jinroveci
TMP-SMX; more common in transplant patients
true or false. diabetes is an absolute contraindication to being a kidney donor
true
true or false. intrahepatic cholangiocarcinoma is a contraindication to being a kidney donor
true
typical branches of left renal vein:
gonadal (inferior), adrenal (superior), lumbar (posterior)
A MELD-Na score less than ____ is associated with mortality rates less than the mortality rate of undergoing liver transplant
15
a replaced right hepatic artery originates from the____
SMA
a replaced left hepatic artery originates from
left gastric artery
true or false. prolonged cold ischemia time is known in kidney transplant to increase incidence of primary nonfunction and delayed graft function.
true
treatment of arterial thrombosis in renal transplant
anticoagulation and thrombectomy
posttransplant lymphoproliferative disorder (PTLD) is associated with what virus
EBV
what malignancy can PTLD lead to?
lymphoma
presentation of PTLD
fever, lymphadenopathy, bowel obstruction; observed in 20% of small bowel transplants
mechanism and side effects of tacrolimus
bind to FK-binding proteins to inhibit calcineurin and downstream decrease in T cell proliferation; hyperglycemia, nephrotoxicity, neurotoxicity
mechanism & side effects of mycophenolate mofetil (MMF)
inhibitor of inosine monophosphate dehydrogenase which controls synthesis of GMP; causes pancytopenia, GI bleeding, diarrhea
mechanism and side effects of sirolimus
binds rapamycin (mTOR) to prevent cytokine transduction and T cell proliferation; causes poor wound healing, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia
mechanism and side effects of cyclosporine
binds cyclophilin causing NFAT translocation and decreased T cell proliferation; causes vomiting, seizures, and arrhythmias; hypertrichosis, gingival hyperplasia; less nephrotoxic than tacrolimus
study used to measure GFR in potential renal donors
MAG-3 or DTPA renal scans; 24 hr creatinine clearance can be used as an alternative
true or false. liver transplant graft experience rejection less often and require less immunosuppression than other solid organ transplants
true
mainstay immunosuppressive for liver transplant
tacrolimus
most common indication for renal transplant
diabetes
side effect of azathioprine
bone marrow suppression
time frame and mechanism of acute rejection:
occurs in days to weeks (sometimes months) after transplant; classified as T cell mediated (cellular), antibody mediated (humoral), or a combination of both
histology of acute rejection
lymphocytic infiltrate, membrane damage, apoptosis of graft cells on bx, complement deposition, parenchymal necrosis
prevention of acute rejection
initial immunosuppressive T cell depletion
time frame and mechanism of hyperacute rejection
occurs in minutes to hours after graft reperfusion; mediated by preformed antibodies of the recipient to the donor and by complement activation
prevention of hyperacute rejection
preop crossmatching and testing for ABO compatibility
what is tissue typing
testing donors and recipients for HLA-A, HLA-B, and HLA-DR molecule matching; more HLA matches increases the chance of graft survival
true or false. most pancreas transplants are performed as combined kidney-pancreas transplants
true
most common indication for pancreas transplant
type 1 diabetes
cytokine involved in activation of CD4 lymphocytes; casues fevers made by macrophages, monocytes, dendritic cells, and fibroblasts
IL-1
cytokine that activates eosinophils; involved in asthma and allergies
IL-5
cytokine involved in NK and macrphage activation; secreated by helper T cells
interferon gamma
which drugs are the calcineurin inhibitors:
tacrolimus, cyclosporine
which drugs are purine synthesis inhibitors:
MMF, azathioprine
which drugs are inhibitors of NF-KB
steroids
which drugs are mTOR inhibitors
sirolimus, everolimus
which drug is a involved in the co-stimulation blockade
belatacept
treatment of PTLD
rituximab (monoclonal antibody to CD20 that leads to complement and antibody mediated B cell death
where are b lymphocytes derived
pluripotent stem cells in bone marrow
time frame and mechanism of chronic rejection
occurs over months to years; fibrotic process mediated by T and B cels
histology of chronic rejection
parenchymal replacement with fibrous tissue and intimal smooth muscle proliferation leading to vessel occlusion
chronic rejection prevention
avoiding acute rejection episodes and limiting ischemia/reperfusion time at transplant
histology of hyperacute rejection
endothelial damage, inflammation, and thrombosis
most common pulmonary fungal infection in immunosuppressed patients:
aspergillosis
types of aspergillosis infections:
invasive aspergillosis, allergic aspergillosis, and aspergilloma
presentation and treatment of invasive aspergillosis:
presents with cough, pleuritic CP, and fever
presentation and treatment of aspergilloma:
fungal ball in the lung that can invade parenchymal vessels with possible subsequent fatal hemorrhage; tx with lobectomy
