transplantation

Question 1

scd

ecd

dcd

Answer 1

• SCD – standard criteria donors
• ECD (extended criteria donors) – presence of variables that increased the risk for graft failure by 70% (relative hazard ratio 1.7); half of added-life years compared to SCD
• DCD – deceased cardiac death; donor who does not meet the criteria for brain death but in whole cardiac standstill or cessation of cardiac failure occurred before organs were procured

Question 2

KAS

Answer 2

Kidney allocation score
based on:
o 1. Dialysis Time (DT): Time spent on dialysis allows candidates to gain priority
o 2. Life Years from Transplant (LYFT): yrs gained d/t transplant versus remaining on dialysis; a measure of utility.
o 3. Donor Profile Index (DPI): Provides a continuous measure of organ quality

Question 3

EPTS score

Answer 3

Estimated Post Transplant Survival (EPTS score)

o Uses four factors: age, history of diabetes, length of time on dialysis, and history of prior transplant

Question 4

a successful kidney transplant surgery does the following

Answer 4

o Don’t sew vessel shut or they will clot
o Sew the vessels all the way around or they will leak
o Sew fast, nephrons are dying
o Rules apply to ureter too

Question 5

buzz words associated with T cells?

Answer 5

thymus
t cell receptor
calcineurin
IL-2
cellular rejection

Question 6

buzzwords associated with B cells

Answer 6

antibodies
crossmatch
humoral rejection

Question 7

hyperacute rejection syndrome

Answer 7

antibody, complement, crossmatch

rapid and irreversible

Question 8

acute rejection is

Answer 8

t cells

biopsy and rescuable

Question 9

chronic rejection

Answer 9

accumulating damage, multifactoral, fibrosis and r=nonreversible

Question 10

T cells selection

signal 1 and 2 –>
signal 1 only –>
2 only –>

Answer 10

1/2 – activation and expansion of that T cell
1 – anergy or apoptosis
2 - no response

Question 11

CTLA4 receptor

Answer 11

negative receptor of T cell proliferation

Question 12

induction immunosuppression meds

Answer 12

via Lymphocyte Depletion
o Thymoglobulin — a Polyclonal Anti body
o Alemtuzumab– Monoclonal Ab (Anti-CD52)

via Anti-IL2R
o basiliximab or dacliximab

Glucocorticosteroids

Question 13

maintenance immunosuppression

Answer 13

Calcineurin Inhibitors – Cyclosporine or Tacrolimus

Antimetabolites – Azathioprine or Mycophenolate mofetil

Glucocorticsteroids

TOR inhibitors – Sirloimus or Everolimus

Costimulation – Belatacept (CTLA-4) or Abatacept (CTLA-4)

Question 14

rituximab

Answer 14

humoral (Ab mediated) rescue immunosuppression

antiCD20

Question 15

what can be used for all categories of immunosuppression?

Answer 15

glucocorticosteroids

Question 16

two drugs that stimulate CTLA-4?

Answer 16

belatacept or abatacept

ctla4 allows negative regulation of T cell proliferation