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ABSITE > Transplantation > Flashcards

Transplantation Flashcards

1
Q

Most important HLA’s for recipient/donor matching. Which is the most important overall?

A

HLA-A, B, DR

HLA-DR

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2
Q

ABO blood compatibility is not required for which type of transplant

A

Liver

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3
Q

Universal donor blood type

A

O

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4
Q

Universal recipient blood type

A

AB

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5
Q

What is a cross match?

A

It detects preformed recipient antibodies to the donor by mixing RECIPIENT serum with DONOR lymphocytes
* If positive cross-match –> hyperacute rejection

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6
Q

What is Panel Reactive Antibody

A

Similar to cross-match: detects preformed recipient antibodies using a panel of HLA typing cells. A high PRA means highly sensitized

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7
Q

What increases panel reactive antibody?

A

Transfusion, pregnancy, previous transplant, autoimmune disease

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8
Q

Treatment for mild –> severe rejection

A

Mild: pulse steroids
Severe: steroids and antibody therapy (ATG, thymo)

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9
Q

Number one @ two malignancy following any transplant

A
  1. Squamous cell skin cancer

2. PTLD / related to EBV

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10
Q

Signs/symptoms of PTLD

A

SBO, mass, adenopathy
RF: Cytolytic drugs
Treatment: Withdrawal IS, ritux (anti-CD20), CTX/RT

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11
Q

Risks of long-term immunosupression

A

Cancer, cardiovascular disease, infection, osteopenia

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12
Q

Myocphenolate/MMF/CellCept

  • Mechanism
  • AE
A

Inhibits de novo purine synthesis (which inhibits growth of T cells)
AE: GI intolerance (N/v/d), myelosuppression – need to keep WBC > 3; used as maintenace therapy; Azathioprine (Imuran) has similar MOA

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13
Q

Steroids

- Mechanism

A

Inhibit inflammatory cells (macrophages) and genes for cytokine synthesis (IL-2 most important)

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14
Q

Cyclosporin MOA

A

Binds cyclophilin protein; complex inhibits calcinuerin; decreased cytokine synthesisof IL-2, 4).
AE: nephrotoxicity, hepatotoxicity, tremor, seizure, HUS (trough 200-300); hepatic metabolism, biliary excretion

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15
Q

FK-506, Prograf, Tacrolimus

A

Binds FK-binding protein; more potent than CsA
AE: Nephro, GI sx, mood changes, DM
Trough 10-15

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16
Q

Sirolimus/Rapamycin

A

Inhibits mTOR, inhibits T and B cell response to IL-2

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17
Q

ATG (anti-thymocyte globulin)

A

Equine or rabbit (Thymo) polyclonal antibodies against T cell antigens (CD2, 3, 4)
- Induction, acute rejection, cytolytic
- Depends on complement
AE: cytokine release syndrome – give steroids and benadryl (fever, chills, pulmonary edema, shock); also PTLD, myelosuppression

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18
Q

Hyperacute rejection

A

Caused by pre-formed antibodies that should have been picked up by cross-match (T2 hypersensitivity); MCC-ABO incompatibility

  • Activates compliment cascade and thrombosis of vessesls
  • Emergent re-txp or explant
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19
Q

Accelerated rejection

A

Sensitized T cells to donor HLA (IS, pulse steroids, possible Antibody treatment)

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20
Q

Acute rejection

A

Occurs 1 week to 1 month

- Caused by T cells (cytotoxic and helper T cells) to HLA antigens

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21
Q

Chronic rejection

A

Type IV hypersensitivity (sensitized T cells); antibody formation; graft fibrosis
RF: increased acute rejection episodes

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22
Q

How long can a kidney be stored cold?

A

48 hours

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23
Q

Major cause of mortality in kidney transplant recipients

A

Stroke, MI

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24
Q

Number one complication of kidney transplant operation

A

Urine leak; drain/stent

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25
Q

How to diagnose/treat renal artery stenosis in a kidney recipient

A

Flow acceleration at level of stenosis on duplex; PTA with stent

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26
Q

Most common cause of external ureter compression in a post-txp patient

A

Lymphocele; 3 weeks after TXP (late decreased urine output with hydro adn fluid collection)
- Try perc drainage; peritoneal window (hole into peritoneum, lymph fluid is re-absorbed)

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27
Q

Kidney txp post-op oliguria is usually 2/2

A

ATN (hydropic changes; dilation and loss of tubules)

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28
Q

Post-op diuresis in a kidney recipient is 2/2

A

Urea and glucose

29
Q

New proteinuria in a kidney recipient is 22

A

Renal vein thrombosis

30
Q

Post-op diabetes in a kidney recipient is 2/2

A

CSA, FK, steroids

31
Q

Treatment CMV, HSV

A

CMV: ganciclogir
HSV: acyclovir

32
Q

S/Sx kidney rejection

A

Increased Cr, decreased U/O

33
Q

Work-up kidney txp rejection

A

Duplex: r/o vascular, ureteral obstruction

  • Empiric decrease in CSA/FK (nephrotoxic)
  • Empiric pulse steroids
  • Fluid/Lasix challenge
34
Q

MCC mortality in a kidney txp recipient

A

Myocardial infarction

35
Q

How many hours can a liver be stored?

A

24 hours

36
Q

MCC complication in kidney donor

A

Wound infection

37
Q

Most common cause of death in a living kidney donor

A

Fatal PE

38
Q

To help prevent re-infection from HBV in a liver recipient

A

HBIF, lamivudine

39
Q

Is portal vein thrombosis a contraindication to transplantation?

A

No

40
Q

What percentage of patients will start to drink again after txp?

A

20%

41
Q

Macrosteatosis is a risk factor for primary non-function

A

Yes; 50% = 50% primary non-function

42
Q

Number one post-op complication, liver transplant

A

Bile leak – ERCP/stent

43
Q

Primary non-function of liver txp

A

TB >10; bile output < 20 cc/12 hr, elevated INR, renal failure, pulmonary failure; require re-txp

44
Q

For hepatic artery stenosis…

A

Place a stent

45
Q

MCC early hepatic artery thrombosis

A

Early vascular complication; increase LFT, decreased bile output, fulminant liver failure; emergent re-transplantation

46
Q

Late hepatic artery thrombosis

A

Biliary stricture & abscess; not fulminant liver failure

47
Q

IVC stenosis/thrombosis

A

Edema, ascites, renal failure; thrombolytics and IVC stent

48
Q

PV thrombosis

A

Early: abdominal pain
Late: UGI bleed, ascites, asymptomatic

49
Q

Live donor liver for an adult vs child

A

Adult: take R lobe
Child: L lateral

50
Q

MC indication for pancreas transplant

A

DM with renal failure

51
Q

What arteries/veins are needed for pancreas txp

A

Donor celiac and SMA; and donor portal vein

52
Q

Do most panc txps use enteric drainage?

A

Yes; take second portion of duodenum from donor along with ampulla of Vater and pancreas; anastamosis of donor duodenum to recipient bowel

53
Q

Number one complication of pancreas txp

A

Venous thrombosis

54
Q

For how long can a heart be stored

A

6 hours

55
Q

T/F persistent pulmonary hypertension after heart transplantation is a/q early mortality after heart txp

A

True; Tx: iNOS, ECMO

56
Q

MCC early cardiac graft mortality

A

Infection

57
Q

MCC of late death heart txp

A

Chronic allograft vasculopathy

58
Q

Acute rejection, heart txp

A

Perivascular lymphocytic infiltrate with myocyte inflammation and necrosis

59
Q

Number one cause of early mortality in lung txp

A

Reperfusion injury (similar to ARDS)

60
Q

Indication for double lung-txp

A

Cystic fibrosis

61
Q

MCC chronic rejection, lung txp

A

Bronciolotis obliterans

62
Q

Viral, protozoan, fungal infections in txp recipients

A

CMV, HSV, VZV
PCP
Aspergillus, Candida, Cryptococcus

63
Q

Exclusion criteria for lung txp

A

Aspiration, moderate to large contusion, infiltrate, purulent sputum, PO2 < 350 on 100% FiO2, PEEP 5

64
Q

Graft vs. Host disease is mediated by T cells

A

True

65
Q

Hyperacute rejection is due to …

A

Preformed recipient antibodiesokt3

66
Q

Number one virus post transplant

A

CMV

67
Q

Azathioprine (Imuran)

A

6-MP derivative, purine analog, anti-metabolite, decreases DNA synthesis

68
Q

T/F Prednisone blocks IL-1 from macrophages

A

True

69
Q

Liver transplant 1 year graft survival

A

70%

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