transplantation Flashcards
commonalities between diff. organ trans
- immunosupresive drugs
- infectious disease
- metabolic complications
- psychosocial
contraindications to transplant (5)
- severe non-transplant organ dysfunction (other organ complications)
- malignancy
- infection - active or latent
- psychosocial/adherance
- recurrent disease in organ
- age not ABSOLUTE contraindication
4 things to assess pre-transplant
- patient needs
- short term risks of transplant
- assess rejection risk
- long term complication risk
issues to take into account in listing (5)
- allocation scores for various organs
- waiting time
- HLA match
- size
- medical urgency
crit. for living donation
- good health
- normal funct. w/out
- no Hx of disease
- competent
- uncoerced
- unpaid
crit. for dead donation
- brain death - no nerve reflexes
2. physicians not part of transplant team
what are two states of ischemia that must be minimized
- warm - get blood out of organ
2. cold - flush with cooling preservation fluid
what is effect of cold ischemia over time
mortality exist up to 10 years post-transplant
3 potential immediate problems with graft
- delayed graft function - hypovolemia, hypotension
- small for size syndrome
- graft failure
2 locations for transplant
- heterotopic - in location it belongs
2. orthotopic - in new location
what organ has least rejection risk
liver
3 aspects that must be balances in immunosupression selcetion
- acute rejection risk
- long-term graft loss
- drug toxicity
meds for induction therapy
monoclonal or polyclonal antibody
meds for maintenance therapy
- calcineurin inhib
- antiproliferative agent
- steroids
what determines doses and changes in meds (3)
- organ/location
- time after transplantation
- change due to side effects or graft problems
6 possible post- graft complications
- acute rejection
- chronic loss of function
3 .infecitons - recurrence of orig. disease
- new disease in graft
- other
5 ways to monitor post-graft
- immunosupression - drug levels, clinical
- tests of funciton - serum, PFTs
- signs of organ damage - AST/ALT,
- imaging
- tissue examination - biopsy
hallmark of acute cellular rejection
leukocyte infiltrate
what does treatment of rejection vary on
- type (cell vs. humoral)
2. severity
how have acute and long term rejection changed over time
acute has gotten much better, but chronic has not improved to the same extent
what is chronic allograph disease
Gradual process without acute rejection
- intersitial fibrosis
- parenchymal atrophy
- arteriopathy
causes of chronic allograft disease
- donor quality
- durations of ischemia
- episodes of acute or subacute rejection
- antibody mediated
- infections
- disease recurrence
4 classes of infection that may occur
- common - bact and virus
- unusual organism - pneumocyctus- parvovirus, nacardia
- reactivate latent disease - CMV, TB,
- recurrent infectious disease - Hep B,C
example of common recurrent diease and rare recurrent disease
common - HepC
rare- CF, polycystic kidney
what is greatest risk malignancy
virally mediated - cervix, kaposi’s sarcoma, skin
treatment of malignancy
- treat as per usual
2. reduce immunosupression
4 metabolic issues
- hypertension
- hyperlipidemia
- DM
- weight gain
4 common causes of renal failure post-transplant
- intra-op hypotension
- sepsis
- nephrotoxic meds
- volume depletion - low intake or loss
what is mortality risk for ckidney disease post transplant
4.55 - better than staying on dialyssis
3 bone diseases post transplant
- osteopenia/porosis
- avascular necrosis - steroids
- renal osteodystrophy
