transplants clinical correlation

Question 1

first organ to be transplanted

Answer 1

kidney in 1936

Question 2

function of UNOS

Answer 2

oversees and makes policies for transplantation in US

Question 3

function of SRTR

Answer 3

tacks transplant outcomes

Question 4

function of CMS

Answer 4

major payor for kidney transplants

certifies programs, provides oversight

Question 5

what are reasons why pts may have anti-HLA antibodies? (3)

Answer 5

previous pregnancies, transfusions, other transplants

Question 6

2 m/c indications for adult liver transplant

Answer 6

etOH, HCV

Question 7

what are the biochemical markers to assess for need of liver transplant?

Answer 7

bili level
albumin level
INR

Question 8

what is the MELD score?

Answer 8

used in liver transplant work-up
“medical urgency status”
bili, INR, Cr

Question 9

best liver tx outcomes? worst?

Answer 9

best- cholestatic or metabolic etiology

worst- malignant

Question 10

what are the most clinically important HLAs in terms of transplantation?

Answer 10

HLA-A
HLA-B
HLA-DR

Question 11

phases of immunosuppression (3)

Answer 11

desensitization
induction
maintenance

Question 12

goal of desensitization, meds

Answer 12

goal= reduce pre-formed antibodies

tx: plasma exchange/IVIG, rituximab, bortiezomib

Question 13

goal of induction, meds

Answer 13

goal= reduce risk of early rejection

tx: steroids, thymoglobulin, alemtuzumab (anti-CD25)

Question 14

rituximab

Answer 14

anti-CD20 (b cell)

Question 15

bortiezomib

Answer 15

protease inhibitor for plasma cells

Question 16

alemtuzumab

Answer 16

anti-CD25 (high affinity IL-2 receptor)

Question 17

belatacept

Answer 17

costimulation blocker- blocks CD28 from binding B7 = T cells cannot be activated by APCs

Question 18

in which transplanted organ is there screening for donor specific antibodies?

Answer 18

kidney

Question 19

factors that make a pt high risk for rejection

Answer 19

• poor HLA matching
• deceased donor
• prolonged cold ischemia time
• previous transplant
• donor specific antibody
• high panel reactive antibody
• african american

Question 20

clinical picture of post-transplant lymphoproliferative disease (4)

Answer 20

acute EBV infection (mono)
single or multiple tumors
allograft dysfunction
fulminant disease

Question 21

which malignancies are NOT assoc with increased risk after transplant?

Answer 21

colon, prostate, breast

Question 22

which organ has longest wait?

Answer 22

kidney

Question 23

1* means of organ recovery

Answer 23

death by neurologic disease

Question 24

1* means of tissue recovery

Answer 24

death by cardiopulmonary disease