Week 3: Solid Organ Transplant Flashcards
TEST # 2
**Overview: **
Tranplantation deginition + Benefits
Organization
**Transpaltation: **
* process in which > Tissues/Organs of one human being are > granfted into another human being:
**Purpuse: **
A. Prolong Live
B. Improving Quility of Live
- **United Network for Organ Sharing: (UNOS): **Private,
Non-Profit Organizatio ,
substracted by Federal Goverment
Procurement Organizations:
> Established in US
> Oversee the procurement of organs
**Organ Transplant Waiting List
**1. >120,000
2. Kidney most frequently sought
3. Recipients continues to rise
4. Decreased donors is stagnant for last 10 yrs
Typers of Transpants
Two Types: Deceased and Living Donor
**Deceased Donor: **
> Brain-Dead Donor (no activity EEG) No brain func
> Non-Heart -Beating Donor ( W brain activity but heart on Cardiac Pump Activity heart not suspatble for life )
**Liveing Donor **
> Related (parents, siblings)
> Unrelated (siblings )
> Altruistic (Good heart people
Organ Transplant :
Absolute Contraindications
- Malignancy
- Active Infection
- Active drug,
* tobacco, Illicit Drug substance abuse (Tobacco case by case for **abdominal transplan ok) ** - Inability to comply with medications regiment
Organ Transplant :
**Relative Contraindications **
-
HIV/AIDS (Relative Constraindications case by case) :
> Contraindication for cardiac Patients
.> NOT contraindication for:
> Liver and
> Kidney Transplant
**But pt with HIV need meet Criteria **
CD4 count >2000 at least 6 month
HIV-1-RNA not detercted
on antivroviral therapy at least 2 month
No major infection or neoplastic complications
- Morbid Obesity (Relative Constraindications ) : Case by Case
- **Smoking ** case by case . Abdominal transplan ok
HIV/AIDS
Criteria for Transplant
- CD4 count >2000/ul at least 6 months
- HIV-I RNA is undetectable
- Stable on antiretroviral therapy at least 3 month
- No major infectious or neoplastic complications
Kidney Transplant :
**Indications **
Any conditon leading to
Renal Failure : ERCD
Kidney Trasplant : Complications
- Graft Thrombosis
- Urine Leak
- **Lymphocele **(collection of lymphatic fluid that forms a cyst-like structure in a body retropenial space)
- Bleeding
- Ureteral Obstruction
- Delayed Graft Function
- Rejection
- Infection
Liver Trasplant : Indications
*** Nonchrolestatic Cirrhosis: **
> Post nectrotic cirrhosis from Hep B or C OR
> NASH (Non-Alcoholic Hepatatis )
-
Cholestatic Liver disease: **
> Biliary Cirrhosis Secondary
> PSC: primary Scletosis Coryngitis
.
* Biliary Atresiaz: Blockage in a duct carry bile to golbladder
* Acute Hepatic Failure : **
> Acutely complicated Wilson diasease.
> Willson Disease : genetic Disorger when excessive Cupper in body
* Metabolic Diseases: :
> Alpha-1 Antitrypsin Deficiency OR > Willson disease
> Glycogen Disorders
*** Maligrannt Neoplasms or Binign Turmor : **
> Carcinoma
Liver Trasnplant : Complications
- Hepatic Artery Thrombosis
- Portal Vein Thrombosis
- Biliary Leak
- Anastomotic Stricture
- Primary Graft Dysfunction
- Rejection
- Infection
- Disease recurrence
- **Bile cast Syndrom : **precent of biliary obstruction
Lung Tranplant
Indications
- Pulmonary Hypertension
- Cystic Fibrosis
- COPD
- Sarcoidosis
- IPF(Pulmonary Fibrosis) :
Single Lung transplanted one at the time
Exception is IPF & Pulmonary Hypertension
Lung Tranplant
Complicatiosn
- Bronchial Anastomocic Complications
- Bleeding
- Ischemia-Reperfusion Injury
- Infection/Sepsis
- **Bronchiolitis Obliterans Syndrome (BOS): . **
Immunoattack smal airway effect Fibrotic oclusion
No s/s 2 yrs transplant
Heart Transplant
Indications
- Cardomyopathy
- Cardiac Tumor
- Congenital Defect
- Valvular Heart Disease
Heart Transplant
Complications
- **Bleeding **
- **Rejection **
*** Cardiac allograft Vasculopathy: CAV **( Coronary artery disease extensive form ; Do not responts to menaticpult PNC - **Denervation: **Sympatic effect to heart NO Effect ( Donor heart Complitly Denervated Epinephrie Not going to work )
> Increase Resting Heart RAte
Heart Rate DO Not Respond to
> Do not respond to HypoVolemia
> Vasodilation
Or Exercise
DM cammon Denervatio of Non cardica pts
Cell Mediated Immunity
Activated T Lymphocytes by Cytokant
Humoral Antibody Immunity
Production of Antibodies : B Lymphocytes
Major Histocompatibilty Comlex
- Regulates Immunite System
- HUman Leukocytes Antigens (HLA)
- Identify Compatible or foreign proteins
Donor/Recipient Matching
Paner reactiv Antibody
Panel Reactive Antibody
Measurement of HLA Antibodies
Elevated PRA
Limits Transpantation
( 0 : Not senseitive
8/10 : 80 % getting Rejected )
IMMunospressing
- Pharmacologic Manipulatin of immune system
Preven or suppress Rejection
Initial Therapy
- Before and after Transplant
Delay onset of 1st Rejection Episode 2 wks
Limit Quantity or Calconeurin Inhibitors
Maintaence Therapy
**Calcineuring Inhibors (Cyclosporin; TAcrolymas;
Panrolymas ) : all supresse immune system
* Metabolized by P450 Cytochrome
* Avoid Grapefruit Juice
* Corticteroids
anti-metabilite
Allograft Rejection:
- **Immune System Recognition **
**Gaft is “Non-self” **
**Allograft: **: is type of tissue or organ transplant where the donor and recipient are of the same species but genetically different individuals.
**Complications:
**Local and Systemic Immune Responses: **
> Local inflammation
>Deterrioratio of graft function
> Necrosis
Hyperactue
Rare
Occurs within a mints
Humoral Mediated
Rapid Tissue Necrosis
Accelrated Acute
1 to 5 days postop
Cellular and Humoral mediated
difficult to tx
Acute Cellular Mediated
- Most Common Cause
- 1 st Few Month or any time
**Minumum for TX ** - cellular mediated 90%
Chronic
* Occurs slowly leading to Graf loss
- Cellular mediated/humoral-initeated Injury
Graff lost
**No TX **
Organ Rejection
Diagsosis
Allograft Biopsy
Organ Rejection
Treatment
- High-Dose Corticosteroids
- Optimize Immunosupression regimen
*** Anti-Lymphocyte Therapy (ALT ) : **
* antibodies against T cells **
Trasfer to trasplant center
Help them go guede tx
Organ Transplantation Medical Comlication : Infection
- Leading cause of death
- Highest Risk of Infection (1st 6 month post -transplant)
- Viral, Fungal, Protozoal, Bacerial (Differ according to organ)
Vaccination
Establshed for Reciepient pts
Updated prior to transplant
**No live vaccination **
