transplantation

Question 1

commonalities between diff. organ trans

Answer 1

1. immunosupresive drugs
2. infectious disease
3. metabolic complications
4. psychosocial

Question 2

contraindications to transplant (5)

Answer 2

1. severe non-transplant organ dysfunction (other organ complications)
2. malignancy
3. infection - active or latent
4. psychosocial/adherance
5. recurrent disease in organ
6. age not ABSOLUTE contraindication

Question 3

4 things to assess pre-transplant

Answer 3

1. patient needs
2. short term risks of transplant
3. assess rejection risk
4. long term complication risk

Question 4

issues to take into account in listing (5)

Answer 4

1. allocation scores for various organs
2. waiting time
3. HLA match
4. size
5. medical urgency

Question 5

crit. for living donation

Answer 5

1. good health
2. normal funct. w/out
3. no Hx of disease
4. competent
5. uncoerced
6. unpaid

Question 6

crit. for dead donation

Answer 6

1. brain death - no nerve reflexes

2. physicians not part of transplant team

Question 7

what are two states of ischemia that must be minimized

Answer 7

1. warm - get blood out of organ

2. cold - flush with cooling preservation fluid

Question 8

what is effect of cold ischemia over time

Answer 8

mortality exist up to 10 years post-transplant

Question 9

3 potential immediate problems with graft

Answer 9

1. delayed graft function - hypovolemia, hypotension
2. small for size syndrome
3. graft failure

Question 10

2 locations for transplant

Answer 10

1. heterotopic - in location it belongs

2. orthotopic - in new location

Question 11

what organ has least rejection risk

Answer 11

liver

Question 12

3 aspects that must be balances in immunosupression selcetion

Answer 12

1. acute rejection risk
2. long-term graft loss
3. drug toxicity

Question 13

meds for induction therapy

Answer 13

monoclonal or polyclonal antibody

Question 14

meds for maintenance therapy

Answer 14

1. calcineurin inhib
2. antiproliferative agent
3. steroids

Question 15

what determines doses and changes in meds (3)

Answer 15

1. organ/location
2. time after transplantation
3. change due to side effects or graft problems

Question 16

6 possible post- graft complications

Answer 16

1. acute rejection
2. chronic loss of function
   3 .infecitons
3. recurrence of orig. disease
4. new disease in graft
5. other

Question 17

5 ways to monitor post-graft

Answer 17

1. immunosupression - drug levels, clinical
2. tests of funciton - serum, PFTs
3. signs of organ damage - AST/ALT,
4. imaging
5. tissue examination - biopsy

Question 18

hallmark of acute cellular rejection

Answer 18

leukocyte infiltrate

Question 19

what does treatment of rejection vary on

Answer 19

1. type (cell vs. humoral)

2. severity

Question 20

how have acute and long term rejection changed over time

Answer 20

acute has gotten much better, but chronic has not improved to the same extent

Question 21

what is chronic allograph disease

Answer 21

Gradual process without acute rejection

1. intersitial fibrosis
2. parenchymal atrophy
3. arteriopathy

Question 22

causes of chronic allograft disease

Answer 22

• donor quality
• durations of ischemia
• episodes of acute or subacute rejection
• antibody mediated
• infections
• disease recurrence

Question 23

4 classes of infection that may occur

Answer 23

1. common - bact and virus
2. unusual organism - pneumocyctus- parvovirus, nacardia
3. reactivate latent disease - CMV, TB,
4. recurrent infectious disease - Hep B,C

Question 24

example of common recurrent diease and rare recurrent disease

Answer 24

common - HepC

rare- CF, polycystic kidney

Question 25

what is greatest risk malignancy

Answer 25

virally mediated - cervix, kaposi’s sarcoma, skin

Question 26

treatment of malignancy

Answer 26

1. treat as per usual

2. reduce immunosupression

Question 27

4 metabolic issues

Answer 27

1. hypertension
2. hyperlipidemia
3. DM
4. weight gain

Question 28

4 common causes of renal failure post-transplant

Answer 28

1. intra-op hypotension
2. sepsis
3. nephrotoxic meds
4. volume depletion - low intake or loss

Question 29

what is mortality risk for ckidney disease post transplant

Answer 29

4.55 - better than staying on dialyssis

Question 30

3 bone diseases post transplant

Answer 30

1. osteopenia/porosis
2. avascular necrosis - steroids
3. renal osteodystrophy