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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
How to diagnose/treat renal artery stenosis in a kidney recipient
Flow acceleration at level of stenosis on duplex; PTA with stent
26
Most common cause of external ureter compression in a post-txp patient
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)
27
Kidney txp post-op oliguria is usually 2/2
ATN (hydropic changes; dilation and loss of tubules)
28
Post-op diuresis in a kidney recipient is 2/2
Urea and glucose
29
New proteinuria in a kidney recipient is 22
Renal vein thrombosis
30
Post-op diabetes in a kidney recipient is 2/2
CSA, FK, steroids
31
Treatment CMV, HSV
CMV: ganciclogir HSV: acyclovir
32
S/Sx kidney rejection
Increased Cr, decreased U/O
33
Work-up kidney txp rejection
Duplex: r/o vascular, ureteral obstruction - Empiric decrease in CSA/FK (nephrotoxic) - Empiric pulse steroids - Fluid/Lasix challenge
34
MCC mortality in a kidney txp recipient
Myocardial infarction
35
How many hours can a liver be stored?
24 hours
36
MCC complication in kidney donor
Wound infection
37
Most common cause of death in a living kidney donor
Fatal PE
38
To help prevent re-infection from HBV in a liver recipient
HBIF, lamivudine
39
Is portal vein thrombosis a contraindication to transplantation?
No
40
What percentage of patients will start to drink again after txp?
20%
41
Macrosteatosis is a risk factor for primary non-function
Yes; 50% = 50% primary non-function
42
Number one post-op complication, liver transplant
Bile leak -- ERCP/stent
43
Primary non-function of liver txp
TB >10; bile output < 20 cc/12 hr, elevated INR, renal failure, pulmonary failure; require re-txp
44
For hepatic artery stenosis...
Place a stent
45
MCC early hepatic artery thrombosis
Early vascular complication; increase LFT, decreased bile output, fulminant liver failure; emergent re-transplantation
46
Late hepatic artery thrombosis
Biliary stricture & abscess; not fulminant liver failure
47
IVC stenosis/thrombosis
Edema, ascites, renal failure; thrombolytics and IVC stent
48
PV thrombosis
Early: abdominal pain Late: UGI bleed, ascites, asymptomatic
49
Live donor liver for an adult vs child
Adult: take R lobe Child: L lateral
50
MC indication for pancreas transplant
DM with renal failure
51
What arteries/veins are needed for pancreas txp
Donor celiac and SMA; and donor portal vein
52
Do most panc txps use enteric drainage?
Yes; take second portion of duodenum from donor along with ampulla of Vater and pancreas; anastamosis of donor duodenum to recipient bowel
53
Number one complication of pancreas txp
Venous thrombosis
54
For how long can a heart be stored
6 hours
55
T/F persistent pulmonary hypertension after heart transplantation is a/q early mortality after heart txp
True; Tx: iNOS, ECMO
56
MCC early cardiac graft mortality
Infection
57
MCC of late death heart txp
Chronic allograft vasculopathy
58
Acute rejection, heart txp
Perivascular lymphocytic infiltrate with myocyte inflammation and necrosis
59
Number one cause of early mortality in lung txp
Reperfusion injury (similar to ARDS)
60
Indication for double lung-txp
Cystic fibrosis
61
MCC chronic rejection, lung txp
Bronciolotis obliterans
62
Viral, protozoan, fungal infections in txp recipients
CMV, HSV, VZV PCP Aspergillus, Candida, Cryptococcus
63
Exclusion criteria for lung txp
Aspiration, moderate to large contusion, infiltrate, purulent sputum, PO2 < 350 on 100% FiO2, PEEP 5
64
Graft vs. Host disease is mediated by T cells
True
65
Hyperacute rejection is due to ...
Preformed recipient antibodiesokt3
66
Number one virus post transplant
CMV
67
Azathioprine (Imuran)
6-MP derivative, purine analog, anti-metabolite, decreases DNA synthesis
68
T/F Prednisone blocks IL-1 from macrophages
True
69
Liver transplant 1 year graft survival
70%

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