Transplantation - Cariello 2017

Question 1

What is the highest expected survival rate at 5 years amongst solid organ transplants?

Answer 1

Kidney (90%)

Question 2

What are the 5 major classes of immunosuppressive drugs?

Answer 2

1-Calcineurin inhibitors
2-mTOR inhibitors
3-Antiproliferative agents
4-Antibodies
5-Corticosteroids

Question 3

What are the two stages of host versus graft reaction?

Answer 3

1-Sensitization stage (recognition of alloantigens with T cells)
2-Effector stage (inflammatory response by B cells and other inflammatory cells)

Question 4

What are the 3 post Hematopoetic Stem Cell Transplant (HSCT) phases (factors for infection risk of transplant)?

Answer 4

1-Phase 1 (pre engraftment day 0-30, prolonged neutropenia/mucocutaneous damage)
2-Phase 2 (post engraftment day 31-100, impaired immunity,m GVHD)
3-Phase 3 (late day>100 immunosuppression)

Question 5

What is the most common infection complication after transplants?

Answer 5

Candadiasis (C. albicans)

Question 6

What is the most frequent complication of bone marrow transplant patients? Where does this happen in the oral cavity?

Answer 6

Mucositis

*nonkeratinized mucosal surfaces

Question 7

GVHD have oral manifestations in >______% of cases

Answer 7

50

Question 8

Peak immunosuppression takes place during what period of post-transplant care?

Answer 8

3-6 months

*elective procedures should be postponed to 6-12 months post transplant

Question 9

What condition is caused by use of cyclosporine, is worsened if used with calcium channel blockers?

Answer 9

Gingival hyperplasia

*develops 1-3 months after starting drugs, epithelium invaded by candida hyphae

Question 10

Induction of CD8 responses against tumors requires what?

Answer 10

Cross-priming antigen presentation

Question 11

T/F Immunosuppressed Transplant patients (all transplant patients are immunosuppressed) should avoid flossing because of the risk of infection and bleeding

Answer 11

True

Question 12

What family of viruses are we worried about causing complications after a transplant?

Answer 12

HSV

Question 13

What are some oral signs of GVHD currently happening in a patient?

Answer 13

xerosotmia
ulceration
mucosal lichenoid

Question 14

Sirolimus/Everolimus are immunosuppressant drugs. What 3 side effects do they cause?

Answer 14

mucositis
oral ulcers
poor wound healing

Question 15

Azathiprine is an immunosuppressant drug. What side effect does it cause?

Answer 15

thrombocytopenia

Question 16

Cyclophosphamide is an immunosuppressant drug. What side effect does it cause?

Answer 16

coagulopathy

Question 17

T/F we must immediately remove dentures or orthodontic appliances after transplant

Answer 17

True

Question 18

T/F for the first 3-6 months after a transplant a patient is at peak immunosuppression so we as dentists should do emergency treatment only and only in a hospital environment.

Answer 18

True