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CJA > Transplant > Flashcards

Transplant Flashcards

(48 cards)

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1
Q

most common transplant?

A

kidney

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2
Q

what can be transplanted?

A

-organs
-tissues
-corneas
-stem cells
-bone marrow

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3
Q

xenotransplant

A

-donor is an animal, recipient is human

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4
Q

allotransplant

A

donor and recipient are same species

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5
Q

isotransplant

A

donor and recipient are identical twins

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6
Q

autotransplant

A

-donor and recipient are self
-bone, skin, ligaments, blood vessels, stem cells

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7
Q

living donor

A

-patient survival rate and graft survival is better with the donor living
-surgery happens at the same time and organ is transplanted sooner
-wait time is 2-4 months
-lower rate of delayed graft function

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8
Q

deceased donor

A

-wait time is 1-3 years
-increased rate of delayed graft function
-standard brain dead donor
-donation after circulatory death
-if organ becomes available from a donor with high risk criteria, recipient is notified and can decline transplant

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9
Q

Human Leukocyte Antigens (HLA)

A

-gene clusters that mostly exist on the surface of our cells
-use uniqueness to distinguish self from non-self
-responsible for the presentation of “forge in” peptides (antigens) to the immune competent cells
-T lymphocytes recognize foreign antigens when it combines with HLA molecules
-a close match between donor’s and patient’s HLA markers is essential for successful transplant outcome
-HLA matching promotes the growth and development of new healthy blood cells and reduce CVHD disease

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10
Q

Graft-versus-host disease (GVHD)

A

-a major cause of morbidity and mortality in 30-50% of allogenic transplant population
-occurs when the donor lymphocytes initiate an immune response against the recipient’s tissues during the beginning of engraftment

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10
Q

when does acute GVHD occur?

A

within first 100 days after transplant

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11
Q

when does chronic GCHD occur?

A

after the first 100 days post transplant

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12
Q

clinical manifestations of acute GVHD

A

-diffuse rash that progresses to blisters and desquamation (like 2nd degree burn)

-mucosal inflammation of eyes and GI tract with severe diarrhea

-biliary stasis (bile slows down), abdominal pain, hepatomegaly, elevated liver enzymes

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13
Q

treatment of GVHD

A

immunosuppressant drugs
-cyclosporine
-methotrexate
-tacrolimus
-mycophenolate mofetil

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14
Q

what does the success of a transplant depend on?

A

-general health of recipient (renal diet, mask, exercise)
-degree of histocompatibility with donor (HLSA, ABO, & Rh)
-degree of the recipient’s end organ disease
-how well immunologic response is managed

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15
Q

contraindications for recipient

A

-recent malignancy
-active or chronic infection
-severe irreversible other disease
-class II obesity
-current substance use disorder
-inability to give informed consent
-active psychiatric disease
-history of nonadherence with treatment regimens

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16
Q

contraindications of donor

A
  • same as any condition that is determined to have an impact on the remaining organ
    -example: kidney transplant with hypertension & diabetes
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17
Q

transplant criteria

A

-ABO, Rh, HLA compatibility
-body sizes of donor and potential recipient
-age, severity of illness, and length of time on waiting list
-geographic location (some organs need to be implanted within certain time frames)

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18
Q

Hematopoietic Stem Cell Transplant (HSCT)

A

-used to treat severe malignant and nonmalignant diseases
-most transplants obtained from peripheral blood cell collection through aphaeresis
-also can come from umbilical cord blood from newborn placenta at birth

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19
Q

apheresis

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A

-cells are specially processed and reinfused into the patient

20
Q

Syngeneic

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A

from an identical twin

21
Q

myeloablative

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A

patient is given high dose of chemo and sometimes total-body irradiation

22
Q

nonmyeloablative

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A

(mini-transplants) bone arrow not completely destroyed

23
Q

candidates for heart transplant

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A

patients who have severe uncontrolled by medical therapy, no other surgical options and a prognosis of less than 1-2 years

24
most common procedure for cardiac transplantation
orthotropic transplantation with implantation of the donor heart with intact atria at the vena cava and pulmonary veins
25
liver transplants
-have good patient outcomes -candidates with cancer must net strict selection criteria diseases liver removed and replaced with a healthy liver - 4 years survival rates 85%
26
kidney transplants
-become the treatment choice for most ESRD patients -should be evaluated early-before starting dialysis -GFR <20mL to be on the list
27
when do kidney transplants have the best outcomes?
before dialysis or minimal dialysis time
28
preoperative care for transplant
-proper diet -dialysis within 24 hours of surgery -complete physical exam on recipient and donor -blood from living kidney donor often transfused into recipient -psychological eval for recipient and donor
29
pre-op teaching
-pain -dietary restrictions -IV -foley catheter -early ambulation -pulmonary care -anxiety -possible rejection -treatment adherence
30
pre-op labs
-BMP -CMP -CBC -coags -urine culture -blood type and crossmatch
31
pre-op medications
antibiotics & immunosuppressive therapy
32
caring for deceased donor
-an intensive care setting -goal is to preserve function of the organs through maintaining hemodynamic stability, decreasing risk of infection, and monitoring lab values -once pronounces brain dead the patient may need additional; tests and procedures to check for organ function and quality -provide dignified care to donor and family
33
surgery for kidney transplant
-2-3 hour surgery -places in the patient's iliac fossa anterior to the iliac crest -allows easier access to the blood supply -ureter is sutured to the bladder -3-4 day hospital stay
34
post op kidney transplant care
-goal is to maintain homeostasis until the kidney is transplanted is functioning -more favorable prognosis when kidney functions immediately -donor usually has more pain & requires more medication -monitor fluid, electrolyte, & hemodynamic closely in both donor and recipient
35
hyper acute transplant rejection
-within 3 days of transplant -causes immediate destruction and necrosis of organ -requires immediate removal of organ -s/s - fever, hypertension, pain at transplant site
36
acute transplant rejection
-occurs within 3-14 days or suddenly later -requires early detection and increased immunosuppression treatment to prevent further damage -s/sx- oliguria, anuria, fever, graft site tenderness, lethargy, fluid retention, azotemia (BUN & creatinine) -treatment - increase immunosuppressive meds
37
chronic transplant rejection
occurs gradually over months to years -often result of immune-mediated ischemic damage over time -s/sx - progressing organ failure, fluid retention, electrolyte imbalance, azotemia returns -treatment - monitor and continue meds until dialysis is needed
38
assessing for kidney rejection
-oliguria -edema -fever -hypertension -increased BUN & creatinine -weight gain -swelling or tenderness over transplant site
39
complications of kidney rejection
-bleeding, hypovolemic shock -presence of uremia -GI ulceration -interventions -- platelets, blood, Epogen & IV fluids -fluid & electrolyte imbalances -infection
40
patient teaching
-coping -lifelong proces -monitor for complications and signs of rejection -diet (low fat, high fiber, increased protein, low sodium, avoid sugary foods & carbs, adequate electrolytes) -avoid contact sports -medication adherence -avoid infection -cancer screenings
41
immunosuppressive medications
-goal: to suppress the immune system enough to prevent rejection but not too much to allow infections or cancers -start immediately after transplant to get to therapeutic level asap -combination of corticosteroids and medications -avoid grapefruit juice with most meds
42
risk associated with immunosuppressive meds
-nephrotoxicity -hypertension -hyperlipidemia -hirsutism -tremors -blood dyscrasias -cataracts -gingival hyperplasia -several types of cancer
43
what do calcineurin inhibitors do?
bind to & inhibit calcineurin and decrease T-cell activation and proliferation
44
Tacrolimus
-given oral or IV -adverse effects: nephrotoxic, hypertension, insomnia, asthenia, photosensitivity, GI upset, electrolyte imbalances -monitor trough levels -best taken on empty stomach at same time of day -avoid grape fruit juice
45
mycophenolate mofetil
pregnancy category D do not crush
46
Sirolimus
-do not chew or crush tablets -avoid grapefruit juice -limit exposure to light
47
adverse effects of glucocorticosteroids
-peptic ulcers -increased appetite -fluid restriction -weight gain -hyperglycemia -impaired wound healing -muscle weakness -osteoporosis -irregular menses -insominia -pyschosis

CJA (31 decks)

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