Transplant surgery

Question 1

Liver MELD cutoff?

Answer 1

> 20

Question 2

when to consider TIPS instead of transplant?

Answer 2

MELD <18

Question 3

post op complications of liver transplant?

Answer 3

thrombosis, PV thrombosis, Leak, graft failure

Question 4

post op labs to monitor in liver transplant?

Answer 4

bilirubin, lactate, transaminases

Question 5

Lab value to be elevated if concerned for rejection?

Answer 5

lactate

Question 6

Hepatic artery thrombosis post transplant management? 2nd line? 3rd?

Answer 6

perc angio with stent/thrombectomy/retransplant

Question 7

absolute CI to donor heart?

Answer 7

MI, CAD, hypokinesis, ventricular arrythmia, CO poisoning, metastatic CA

Question 8

CI to heart retransplantation?

Answer 8

ECMO bridge

Question 9

Post transplant lymphoproliferative disease?

Answer 9

B cell lymphoma induced by EBV- will have increased LDH and monoclonal spike, PET positive

Question 10

prevention of CMV with donor CMV positive?

Answer 10

tx with ganciclovir and CMV Ig

Question 11

immediate complications post LT?

Answer 11

PGD, volume overload, anastomotic issues

Question 12

PGD timing?

Answer 12

hours to 3 days

Question 13

MOA of PGD?

Answer 13

ischemia reperfusion

Question 14

PGD sx?

Answer 14

new infiltrates, decreased complaince, inc PVR, poor gas exchange

Question 15

tx for PGD?

Answer 15

diuretics LPV, possible ECMO

Question 16

oncologic CI to transplant?

Answer 16

history of melanoma or active malignancy

Question 17

post pneumonectomy BP fistula mgmt?

Answer 17

if acute and large >5mm needs reexploration

chornic ones with empyema consider OWT

if small consider bronchoscopic interventions

if after lobectomy consider a pneumonectomy

Question 18

C4D staining seen in what? tx?

Answer 18

ab mediated rejection, IVIG

Question 19

post transplant lymphoproliferative disorder? tx?

Answer 19

HSM, fever, generalized lymphadenopathy caused by EBV

reduce immunosuppression and give rituximab

Question 20

CMV infection post transplant presentation?

Answer 20

diarrhea and hepatits

Question 21

polyoma BK virus presentation?

Answer 21

increased Cr, interstitial nephritis

Question 22

post lung transplant with new stroke and infiltrates?

Answer 22

pulmonary vein thrombosis

Question 23

treatment for pulmonary vein thrombosis?

Answer 23

AC or thrombolysis

Question 24

MC complication in iniital post op lung transplant period?

Answer 24

PGD

Question 25

Hyperacute AMR timing?

Answer 25

in first 24h

Question 26

MOA of hyperacute AMR?

Answer 26

patients have preformed ab that develop donor specific ab

Question 27

anastomotic dehiscence post LT is most commonly caused by what?

Answer 27

ischemia

Question 28

management of anastamotic dehiscense?

Answer 28

bronch first- watch and abx
then can move to stent
still no recovery think about reexploration

Question 29

risk factors for LT PGD?

Answer 29

smoking, obesity, preop sarcoid, PAH, use of cardiopulmonary bypass

Question 30

acute cellular rejection timing post transplant?

Answer 30

2-12 weeks

Question 31

tx for hyperacute AMR?

Answer 31

pharesis, steroids, IVIG, rituxan