Transplant Surgery Flashcards
Delayed graft function is associated w/
Reduced graft function/survival, & increased risk of rejection
Can you match A to B donor-recipient blood group for transplant?
Yes. B/c A has two subtypes: A1 & A2 which differ in the amount of A antigen produced on the surface of the cell. A2 has low amounts of antigen so you can offer A2 to O or A2 to B donations
What malignancies increase post solid organ transplantation?
Squamous cell carcinoma
Cervical cancer
Post-transplant lymphoproliferative disorder
What has been shown to have some efficacy in restoring wound healing function in pts w/ chronic steroid usage?
Vitamin A supplementation
In pts w/ kidney-pancreas transplants, prolonged hyper-insulinemia can be an independent risk factor for which conditions?
Enhanced atherosclerosis –> ischemic heart disease
elevated insulin levels are associated with elevated plasma triglycerids, LDL and HDL levels
Presentation of post-transplant lymphoproliferative disorder (PTLD)?
Abdominal pain + small bowel mass on CT scan +/- GI bleeding (most common)
Could also present as lymphadenopathy & malaise/headaches
What does persistent coagulopathy, prolonged cholestasis, poor bile production, and significant ascites post-liver transplant signify?
Small for size graft syndrome = partial liver graft is unable to meet the functional demand of the recipient ==> EARLY GRAFT DYSFUNCTION
What can a persistent leak post-op in liver transplant pt indicate?
Hepatic artery compromise (thrombosis or stenosis) ==> donor graft provides blood flow to bile duct so leak or stricture/stenosis can occur w/ ischemic changes
Why do you avoid meperidine/demerol in the post-op period of kidney transplant pts?
Metabolites from meperidine are renally excreted and can rise to toxic levels in pts w/ allograft early non-function
Toxicity can lead to seizures
What’s the advantage of living donor vs deceased donor transplantation?
Improved long-term graft survival
When should you consider a donor liver biopsy?
Obese patients w/ BMI greater than or equal to 37
Steatosis is suspected
What are the signs and symptoms of a renal vein thrombosis post renal transplant?
Abrupt pain & drop in UOP + bloody urine
Renal U/S will show thrombosis
Need to return to OR
What are the signs and symptoms of PTLD (post-transplant lymphoproliferative disorder)?
Appears like acute EBV infection - fever, malaise, sweats, cervical lymphadenopathy, enlarged tonsils
Diffuse lymphadenopathy or disseminated organ involvement + small bowel transplant
What is the role of the IgA antibodies?
Found on mucosal surfaces (gut, resp tract) & has secretory form
Found in large quantities in breast milk ==> provides passive immunity to infants w/ developing immune system
What are the risks with trying to biopsy a liver lesion at the dome of segment 7? posterior segment 5? caudate?
Segment 7 - risk of iatrogenic lung puncture & pneumothorax
Segment 5 & caudate - both are close to the IVC
What is the ideal segment of the liver to biopsy?
Segment 6 as there are no major vascular or biliary structures in that area
What’s the pathognomonic CT enhancement pattern of hepatic hemangiomas?
Hypodense in precontrast
Peripheral nodular enhancement on arterial phase
Peripheral to central filling on venous phase…delayed washout
What is Kesselbach-Merrit Syndrome? Sxs?
This is an associated consumptive coagulopathy with hepatic hemangioma’s
Pain, compressive sxs, hemorrhage, inflammation, coagulopathy
Describe the impact of chronic rejection in heart & kidney transplants
Obliterative fibrosis of vessels w/n the graft
Lesions resembling atherosclerosis w/ collagen deposition lead to endothelial injury and intimal thickening
What is Budd-Chiari syndrome?
BCS - constellation of signs/sxs caused by hepatic vein obstruction.
Sxs: Ascites (MC), liver failure, profound coma, sepsis, hepatorenal syndrome
Often 2/2
At what size cutoff should you treat on asymptomatic hepatic adenomas?
4 cm or greater due to the risk of spontaneous rupture & malignant degeneration
Hepatic adenomas grow in high estrogen states, such as OCP usage & pregnancy
What are the radiographic features for a hepatic focal nodular hyperplasia (FNH)?
CENTRAL STELLATE SCAR
Enhancing lesion, well-demarcated border, & central fibrous scar
What are the common sites of metastasis for melanoma?
Commonly will go to lymph nodes and subcutaneous tissues
Can also got lungs, viscera, brain, or liver (though not common)
What is the trade off to improving cold ischemia time with UW solution in Liver transplantation?
While you can increase preservation times to > 12 hrs it increases incidence of biliary tract complications.
