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NU 737 > Week 3: Solid Organ Transplant > Flashcards

Week 3: Solid Organ Transplant Flashcards

TEST # 2

1
Q

**Overview: **
Tranplantation deginition + Benefits
Organization

A

**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

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2
Q

Typers of Transpants

A

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

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3
Q

Organ Transplant :

Absolute Contraindications

A
  • Malignancy
  • Active Infection
  • Active drug, tobacco, Illicit Drug substance abuse (Tobacco case by case for abdominal transplan ok)
  • Inability to comply with medications regiment
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4
Q

Organ Transplant :
**Relative Contraindications **

A
  • 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
  • Morbid Obesity (Relative Constraindications ) : Case by Case
  • **Smoking ** ( Relative Constraindications)
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5
Q

HIV/AIDS
Criteria for Transplant

A
  • 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
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6
Q

Kidney Transplant :
**Indications **

A

Any conditon leading to
Renal Failure : ERCD

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7
Q

Kidney Trasplant : Complications

A
  • 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
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8
Q

Liver Trasplant : Indications

A
  • 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 a body

* Metabolic Diseases: :
> Alpha-1 Antitrypsin Deficiency OR > Willson disease
> Glycogen Disorders

*** Maligrannt Neoplasms or Binign Turmor : **
> Carcinoma

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9
Q

Liver Trasnplant : Complications

A
  • Hepatic Artery Thrombosis
  • Portal Vein Thrombosis
  • Biliary Leak
  • Anastomotic Stricture
  • Primary Graft Dysfunction
  • Rejection
  • Infection
  • Disease recurrence
  • Bile cast Syndrom : precent of biliary obstruction
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10
Q

Lung Tranplant
Indications

A
  • Pulmonary Hypertension
  • Cystic Fibrosis
  • COPD
  • Sarcoidosis
  • IPF(Pulmonary Fibrosis) :

Single Lung transplanted one at the time
Exception is IPF & Pulmonary Hypertension

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11
Q

Lung Tranplant
Complicatiosn

A
  • 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
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12
Q

Heart Transplant
Indications

A
  • Cardomyopathy
  • Cardiac Tumor
  • Congenital Defect
  • Valvular Heart Disease
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13
Q

Heart Transplant
Complications

A
  • **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

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14
Q

Cell Mediated Immunity

A

Activated T Lymphocytes by Cytokant

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15
Q

Humoral Antibody Immunity

A

Production of Antibodies : B Lymphocytes

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16
Q

Major Histocompatibilty Comlex

A

Regulates Immunite System
HUman Leukocytes Antigens (HLA)
Identify Compatible or foreign proteins

17
Q

Donor/Recipient Matching

A

Paner reactiv Antibody

18
Q

Panel Reactive Antibody

A

Measurement of HLA Antibodies
Elevated PRA
Limits Transpantation
( 0 : Not senseitive
8/10 : 80 % getting Rejected )

19
Q

IMMunospressing

A
  • Pharmacologic Manipulatin of immune system
    Preven or suppress Rejection
20
Q

Initial Therapy

A
  • Before and after Transplant
    Delay onset of 1st Rejection Episode
    Limit Quantity or Calconeurin Inhibitors
21
Q

Maintaence Therapy

A

Calcineuring Inhibors (Cyclosporin; TAcrolymas; Panrolymas ) : all supresse immune system
* Metabolized by P450 Cytochrome
* Avoid Grapefruit Juice
* Corticteroids
anti-metabilite

22
Q

Allograft Rejection:

A
  • **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

23
Q

Hyperactue

A

Rare
Occurs within a mints
Humoral Mediated
Rapid Tissue Necrosis

24
Q

Accelrated Acute

A

1 to 5 days postop
Cellular and Humoral mediated
difficult to tx

25
Q

Acute Cellular Mediated

A
  • Most Common Cause
  • 1 st Few Month or any time
    **Minumum for TX **
  • cellular mediated 90%
26
Q

Chronic

A
  • Occurs slowly leading to Graf loss
  • Cellular mediated/humoral-initeated Injury

**No TX **

27
Q

Organ Rejection
Diagsosis

A

Allograft Biopsy

28
Q

Organ Rejection
Treatment

A
  • High-Dose Corticosteroids
  • Optimize Immunosupression regimen
  • Anti-Lymphocyte Therapy (ALT ) :
    antibodies against T cells
    Trasfer to trasplant center
    Help them go guede tx
29
Q

Organ Transplantation Medical Comlication : Infection

A
  • Leading cause of death
  • Highest Risk of Infection (1st 6 month post -transplant)
  • Viral, Fungal, Protozoal, Bacerial (Differ according to organ)
30
Q

Vaccination

A

Establshed for Reciepient pts
Updated prior to transplant
**No live vaccination **

NU 737 (8 decks)

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