Organ Transplant

Question 1

organ transplant

Answer 1

can provide long-term survival outcomes in otherwise fatal disease

Question 2

which organs can only be harvested from a deceased donor?

Answer 2

heart and intestines

Question 3

which organs can be harvested from an alive donor?

Answer 3

• kidney
• liver
• pancreas
• bone marrow

Question 4

principles of organ transplantation

Answer 4

• immunology underlying proper donor and recipient matching

- immunosuppression for prevention and management of graft rejection

Question 5

why are recipients for transplants significantly immunocompromised?

Answer 5

• decrease ability of host to mount response and destroy new organ
• pancytopenia
• increased risk for infection (WBCs)
• increased risk for bleeding (platelets)

Question 6

immunosuppressive agents used

Answer 6

• corticosteroids
• antimetabolites
• calcineurin inhibitors
• mTOR inhibitors

Question 7

complications of organ transplantation

Answer 7

• graft rejection
• problems related to chronic immunosuppressive therapy
• problems specific to the transplanted organ

Question 8

what are some problems related to chronic immunosuppressive therapy in organ transplantation?

Answer 8

block T and B-cell activity as well as innate immunity

Question 9

pre-transplant management

Answer 9

• significant immunosuppression to get body ready for transplant
• require comprehensive dental screening and clearance to reduce infection risk

Question 10

bone marrow transplant pts have to undergo what before transplantation?

Answer 10

total body radiation in addition to chemotherapy

Question 11

pre-transplant dental considerations

Answer 11

• dental exam to diagnose and treat active or potential disease
• work with managing transplant team to optimize pt for the needed dental procedures
• continue preventive care throughout transplant phases

Question 12

what type of dental txtments can organ transplant pts have the first 6 months post-transplant?

Answer 12

emergency only

Question 13

how should active or potential disease be treated in pts pre-transplant?

Answer 13

expeditiously and aggressively

Question 14

most common type of transplant?

Answer 14

kidney

Question 15

dental concerns for pts w/ HF?

Answer 15

stress

Question 16

dental concerns for pts w/ ESRD?

Answer 16

dialysis concerns and altered drug metabolism

Question 17

dental concerns for pts w/ liver failure?

Answer 17

drug metabolism and coagulation

Question 18

dental concerns for pts w/ severe diabetes?

Answer 18

insulin rxns and infection risk

Question 19

organ transplant pts need prophylactic antibiotics to prevent infection?

Answer 19

• there’s no standard of care for these pts so consults with transplant managing team
• Dr. Kennedy would prescribe prophylactic antibiotics though

Question 20

can you provide routine dentistry to organ transplant pts during the stable period (>6 months post-transplant)?

Answer 20

yes but pt’s immune system is suppressed for life so let managing team advise txtment

Question 21

which type of pts need dental clearance first before starting txtment?

Answer 21

• pts with heart valve replacement
• pts on anti-resorptive drugs
• pts that are going to undergo radiation therapy to head and neck
• pts that are undergoing chemotherapy

Question 22

how long should a pt wait from an extraction to receive radiation therapy?

Answer 22

at least 2 wks

*for epithelium to heal over socket