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Summer 2017-Oral Medicine Final > Transplantation and Tissue Regeneration > Flashcards

Transplantation and Tissue Regeneration Flashcards

1
Q

Autograft

A

from the same person (CABG, skin graft, blood)

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2
Q

Allograft

A

from a closely matched individual (close relative or donor)

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3
Q

Isograft

A

from a genetically identical individual (identical twin)

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4
Q

Hematopoietic stem cell transplant

A

autologous or allogenic

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5
Q

Solid Organ Sources

A
  1. live donor
  2. cadaveric donor (mostly)
  3. “brain dead” donor
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6
Q

Transplant Outcomes

A
  1. all transplant recipients have a weakened immune system (EXCEPT isografts)
  2. barriers to success: immunologic rejection, failure to take immuno-suppressive drugs
  3. immunosuppresion
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7
Q

Immunosuppression

A
  1. Induction phase: immediately after transplant, want to make sure transplant tissue has a chance
  2. Maintenance phase: patient will be immunosuppressed until death
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8
Q

Infections and Transplantation

A
  1. may need antibiotic prophylaxis

2. may need to discontinue medication

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9
Q

Malignancies and Transplantation

A
  1. cutaneous squamous cell carcinomas (20X)
  2. virally-induced cancers (HPV, KSHV, EBV)
  3. post-transplant lymphoproliferative disorders (EBV-induced B cell lesion)
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10
Q

What should be done prior to transplants?

A
  1. comprehensive exam
  2. treat active disease
  3. extract non-restorable teeth
  4. oral hygiene instruction
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11
Q

What should be done after transplants?

A
  1. defer elective care for three months
  2. consider antibioitc/antivral prophylaxis
  3. chlorhexidine??
  4. watch for infections, bleeding, medication side-effects, adrenal crisis
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12
Q

Hematopoietic Stem-Cell (Bone Marrow) Transplantation

A
  1. autologous or allogenic stem cells

2. Usually HLA-matched siblings

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13
Q

Management of Hematopoietic Stem-Cell (Bone Marrow) Transplantation

A
  1. must be immunosuppressed (drugs and total body irradiation)
  2. donor cells infused
  3. recipient not immunocompressent until donor tissue starts working
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14
Q

Dental Aspects-Bone Marrow Transplant

A
  1. oral mucositis (30-50% of pts)
  2. oral infections, pain, bleeding, gingival hyperplasia, graft-versus-host disease, xerostomia, malignancies
  3. defer elective dental care for 6 months
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15
Q

Graft-Versus Host Disease

A
  1. usually after bone marrow stem cell transfer
  2. transplanted T-cells recognized HLA antigen–>releases cytokines and TNFa–>destroy tissues (skin, liver, gut)
  3. chronic –> greater than 100 days
  4. survival rates drop 42% –> 10%
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16
Q

Acute Graft-Versus Host Disease

A
  1. <100 days
  2. initial skin rash
  3. liver dysfunction
  4. gut sloughing
17
Q

Chronic Graft-Versus Host Disease

A
  1. > 100 days
  2. lichenoid lesions
  3. sclerodermatous thickening
  4. hyposalivation
  5. stomatodynia
  6. dysphagia
  7. xeropthalmia
  8. COPD symptoms
  9. neuromuscular symptoms
18
Q

Current Management of Chronic Graft-Versus Host Disease

A
  1. no prevention strategies

2. corticosteroids may help chronic GVHD

19
Q

Craniofacial Transplantation

A
  1. Teeth: auto-transplantation, 6 year survival
    2 Salivary gland: 70% long-term survival
  2. Jaws: 2004-created from bone stem cells
  3. Face: replant and transplant
20
Q

Chronic Graft Versus Host Disease - Dental Aspects

A
  1. mucositis
  2. stomatodynia
  3. hyposalivation
  4. increased caries
  5. dysgeusia
  6. candidiasis
  7. herpetic infection
  8. lichenoid lesions
  9. Scleroderma-like changes
  10. oral cancer
  11. bleeding tendency
  12. adverse drug effects
    * *adrenal suppression
    * *gingival hyperplasia
21
Q

20X increased risk of cutaneous squamous cell carcinoma

A

Transplantation

22
Q

Increased risk of virally-induced cancers (HPV, KSHV, EBV)

A

Transplantation

23
Q

Elective care should be deferred for __ (time) for transplant patients

A

three months

24
Q

Elective care should be deferred for __ (time) for bone marrow transplant recipients

A

six months

Summer 2017-Oral Medicine Final (17 decks)

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