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CJA > Transplant > Flashcards

Transplant Flashcards

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

A

-cells are specially processed and reinfused into the patient

20
Q

Syngeneic

A

from an identical twin

21
Q

myeloablative

A

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

22
Q

nonmyeloablative

A

(mini-transplants) bone arrow not completely destroyed

23
Q

candidates for heart transplant

A

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

24
Q

most common procedure for cardiac transplantation

A

orthotropic transplantation with implantation of the donor heart with intact atria at the vena cava and pulmonary veins

25
Q

liver transplants

A

-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
Q

kidney transplants

A

-become the treatment choice for most ESRD patients
-should be evaluated early-before starting dialysis
-GFR <20mL to be on the list

27
Q

when do kidney transplants have the best outcomes?

A

before dialysis or minimal dialysis time

28
Q

preoperative care for transplant

A

-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
Q

pre-op teaching

A

-pain
-dietary restrictions
-IV
-foley catheter
-early ambulation
-pulmonary care
-anxiety
-possible rejection
-treatment adherence

30
Q

pre-op labs

A

-BMP
-CMP
-CBC
-coags
-urine culture
-blood type and crossmatch

31
Q

pre-op medications

A

antibiotics & immunosuppressive therapy

32
Q

caring for deceased donor

A

-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
Q

surgery for kidney transplant

A

-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
Q

post op kidney transplant care

A

-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
Q

hyper acute transplant rejection

A

-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
Q

acute transplant rejection

A

-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
Q

chronic transplant rejection

A

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
Q

assessing for kidney rejection

A

-oliguria
-edema
-fever
-hypertension
-increased BUN & creatinine
-weight gain
-swelling or tenderness over transplant site

39
Q

complications of kidney rejection

A

-bleeding, hypovolemic shock
-presence of uremia
-GI ulceration
-interventions – platelets, blood, Epogen & IV fluids
-fluid & electrolyte imbalances
-infection

40
Q

patient teaching

A

-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
Q

immunosuppressive medications

A

-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
Q

risk associated with immunosuppressive meds

A

-nephrotoxicity
-hypertension
-hyperlipidemia
-hirsutism
-tremors
-blood dyscrasias
-cataracts
-gingival hyperplasia
-several types of cancer

43
Q

what do calcineurin inhibitors do?

A

bind to & inhibit calcineurin and decrease T-cell activation and proliferation

44
Q

Tacrolimus

A

-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
Q

mycophenolate mofetil

A

pregnancy category D
do not crush

46
Q

Sirolimus

A

-do not chew or crush tablets
-avoid grapefruit juice
-limit exposure to light

47
Q

adverse effects of glucocorticosteroids

A

-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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