Transplantation

Question 1

The only absolute contraindication to being an organ donor

Answer 1

HIV infection

Question 2

3 Modes of transplant rejection

Answer 2

Hyperacute, acute, and chronic

Question 3

What is hyperacute rejection of a transplanted organ

Answer 3

Vascular thrombosis that occurs within minutes of reestablishing blood supply to the organ. Caused by preformed antibodies. Prevented by ABO matching and lymphocytotoxic cross match.

Question 4

What is acute rejection of a transplanted organ

Answer 4

Occurs after the first 5 days, and usually w/in 3 months. Episodes occur even though the patient is on maintenance
immunosuppression. Signs of organ dysfunction suggest it, and biopsy confirms.

Question 5

What is chronic rejection of a transplanted organ?

Answer 5

Seen years after the transplant, with gradual, insidious loss of organ function. It is poorly understood and irreversible.

Question 6

In liver transplantation, what should you consider when the liver starts to deteriorate functionally?

Answer 6

Technical problems are more commonly encountered than immunologic rejection. Thus, signs of deteriorating liver function after transplant (rising g-glutamyltransferase [GGT], alk phos, and bilirubin) may indicate biliary obstruction or vascular thrombosis. Rule out by ultrasound and Doppler.

Question 7

In heart transplantation, what should you do routinely afterward?

Answer 7

Routine ventricular biopsies (by way of the jugular, superior vena cava, and right atrium) are done at set intervals. This is because signs of functional deterioration occur too late to allow effective therapy.

Question 8

First line therapy for acute rejection of transplanted organs

Answer 8

steroid boluses.