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Perf Tech 3 > Transplants > Flashcards

Transplants Flashcards

0
Q

First working model of heterotrophic transplant

A

Mann at Mayo clinic 1933
Lasted 4 days
Discovered acute allograft rejection

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1
Q

First heterotrophic transplant of donor heart into neck of a dog

A

1905 Carrel and Guthrie at university of Chicago

Lasted two hours

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2
Q

First heart transplant in dogs with topical hypothermia

A

Lower and Shumway 1960
Survived 6-21 days
Died of rejection

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3
Q

First human heart transplant

A

1967 in South Africa

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4
Q

Postoperative survival of transplants was limited due to what two factors?

A

Lots of opportunistic infection

Graft rejections

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5
Q

Patient parameters for heart transplant

A

End stage CHF (NYHA class 3 or 4)
Unable to manage symptoms with medications, electrophysiology devices, and surgical intervention
LVEF<35%
Cardiogenic shock (acute MI, acute myocarditis)
Ischemic heart disease
Must be able to benefit from transplant

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6
Q

Contraindications to recieving a heart transplant

A
  1. Advanced age (physiologic age should be less than 65)
  2. Irreversible pulmonary hypertension (can cause RV failure in new organ, do not let PA systolic get above 50-60)
  3. Active infection and malignancy
  4. Hepatitis B, C, HIV
  5. Non melanoma cutaneous cancers, primary cardiac rumors restricted to heart, low grade prostate cancers are ok to transplant
  6. Obesity (BMI need be less than 30kg/m2)
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7
Q

Relative contraindications to transplant

A

Diabetes

Pulmonary fibrosis, emphysema, hepatic and renal dysfunction, cerebral vascular disease, peripheral vascular disease

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8
Q

Psychosocial contraindications

A

Substance abuse
Compliance with medications
Social support

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9
Q

5 variables to look at for organ matching

A
  1. ABO blood compatibility
  2. Must be within 20% of body weight
  3. HLA cross match
  4. Priority on UNOS registry
  5. Geographic distance from donor
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10
Q

Status 1a prioritization

A

Mechanical circulatory support (VAD, total artificial heart, IABP, ECMO)
Mechanical ventilation
Continuous infusion of inotropes with continuous monitoring of LV filling pressures
Exceptional Medical urgency

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11
Q

Status 1b prioritization

A

VAD >30 days

Continuous inotrope infusion

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12
Q

Status 2 prioritization

A

Any candidate not meeting 1a or 1b

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13
Q

Order of patients offered organs by status

A

1a–>1b–>status 1 within 500miles–>status 2–> repeat at 1000 mile radius and 1500 mile radius

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14
Q

Technique for procurement

A

Donor heart arrested CPG/preservation
Atria transacted at midatrial level (multiple pulmonary venous connections to LA intact)
Transect aorta and PA just above semilunar valves
Heart cooled topically
Ischemic time: 3-4 hours

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15
Q

Recipient preparation for organ

A

Reanastamosis of midatrial level: start at atrial septum, generous cuff of donor RA included, great vessels connected above semilunar valves
Bicaval technique: donor atria left in tact and anastamosis at SVC, IVC, and pulmonary veins

16
Q

Benefits of bicaval technique

A

Less distortion of aortic valve
Improved atrial and ventricular function
Less AI
Less arrhythmias/heart block

17
Q

Physiology of transplanted heart

A 
Completely denervated
Faster resting heart rate
Slower to increase HR after exercise, slower to recover
No angina with ischemia
No response to parasympathetic drugs
18
Q

First beating heart transplant

A

2007

Use Transmedics Organ Care System

19
Q

Indications for lung transplant

A

Irreversible, progressively disabling, end stage pulmonary disease
Life expectancy less than 18 months

20
Q

5 Evaluation areas for lung transplant

A 
History 
Respiratory exam
Past medical history
Family history
Psychosocial and cultural history
21
Q

Relative contraindications

A 
Osteoporosis 
Musculoskeletal disease
Corticosteroid use (>20mg/day)
Malnutrition (130% ideal body weight)
Substance abuse
Smoking
Psychosocial problems 
Mechanical ventilation
Fungi
Previous thoracotomy, sternotomy, scarring
22
Q

4 categories of lung transplants

A

Single lung
Double lung (En Bloc or Bilateral sequential)
Heart lung block
Ex-vivo lung transplant

23
Q

Indications for single lung transplant

A

Emphysema
Idiopathic interstitial pulmonary fibrosis
Sarcoidosis
Eosinophilia granuloma
Lymphangiolyomyomatosis
Primary pulmonary hypertension
Eisenmengers syndrome with cardiac repair

24
Q

Single lung transplant procedure

A

No CPB usually
Poster plateau thoracotomy through bed of 5th rib
Main PA encircled and clamped (if can’t tolerate, use femoral bypass)
Stay warm
LA clamped, pulmonary veins attached to LA cuff
PA anastamosed
End to end anastamosis of donor and recipient bronchus
Atrial clamp removed

25
Q

Indications for bicaval double lung transplant

A 
Cystic fibrosis
Bronchiectasis
Emphysema
Primary pulmonary hypertension
Eisenmengers syndrome
26
Q

En Bloc double lung transplant

A

Each lung implanted separately through pleural pericardial window
Use clamshell incision

27
Q

Bilateral sequential double lung transplant

A

Like 2 single lung transplants
Ventilate native lung while first one goes in
Ventilate new lung while second goes in

28
Q

First liver transplant

A

1963 Thomas Starz in Denver

29
Q

Variables to evaluate severity of liver disease

A 
Encephalopathy
Ascites
Recurrent GI bleeding
Severe fatigue
Early stage primary liver tumor
30
Q

4 sites where new liver is sewn in

A

Supra hepatic IVC
Infra hepatic IVC
Portal vein
Hepatic artery

31
Q

Patient parameters that must be measured during liver transplant

A 
EKG
HR
Core temp
Pulse Ox
Arterial BP
PA catheter
SvO2
Cardiac output
32
Q

V-V bypass

A

No oxygenator
Flow 1-2LPM
Femoral vein cannulated and advanced to bifurcation of IVC
2nd cannula on portal vein
Centrifugal pump
Return to Axillary vein or internal jugular vein

Perf Tech 3 (9 decks)

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