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Transplant Flashcards

(49 cards)

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1
Q

What are the most important parts of HLA crossmatching?

A

DR and DQ (found on MHC 2/HLA 2)

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2
Q

What induction medication is cytotoxic to T and B cells?

A

thymoglobulin

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3
Q

What induction medication blocks interferon binding sites via monoclonal antibodies?

A

basiliximab

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4
Q

What are the major side effects of tacrolimus?

A

-nephrotoxicity
-neurotoxicity/AMS
-diabetes/hyperglycemia
-hypertension
-hyperlipidemia

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5
Q

What are the major side effects of cyclosporin?

A

-nephrotoxicity
-neurotoxicity

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6
Q

What are the major side effects of mycophenolate?

A

-bone marrow toxicity
-GI disturbances

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7
Q

What type of cells mediate acute rejection?

A

T cells

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8
Q

What mediates hyperacute rejection?

A

preformed antibodies against the graft
-IgG antibodies

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9
Q

What is the treatment for acute rejection?

A

steroids

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10
Q

What is seen on biopsy of acute rejection graft?

A

T-cell infiltrate

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11
Q

What is the chronic rejection syndrome that affects the lungs?

A

bronchiolitis obliterans

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12
Q

What is the chronic rejection syndrome that affects the liver?

A

vanishing bile duct syndrome

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13
Q

What is the chronic rejection syndrome that affects the heart?

A

coronary artery or cardiac allograft vasculopathy

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14
Q

What virus can be associated w/ ureteral stricture in a kidney transplant?

A

polyoma virus

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15
Q

What is the most common infection seen in transplant recipients?

A

Listeria

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16
Q

What infection is an indication of over immunosuppression?

A

Nocardia

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17
Q

What risk factors increase the risk of a pt having a VTE post orthotopic liver transplantation?

A

-DM
-previous VTE
-ESRD
-discharge to rehab facilities
-received factor VII during surgery
-postop PNA

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18
Q

How is pneumocystosis typically diagnosed?

A

90% w/ BAL

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19
Q

What is the treatment for pneumocystosis?

A

bactrim
-if this fails pentamidine isethionate

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20
Q

What is the most common skin tumor seen in transplant recipients?

21
Q

What type of disease process to post-transplant lymphoproliferative disorder (PTLD)?

Study These Flashcards
A

B cell lymphoma

22
Q

Which patient population is PTLD more common in?

Study These Flashcards
A

children more than adults

23
Q

What infection can lead to PTLD and what is the treatment?

Study These Flashcards
A

-EB virus
-ganciclovir

24
Q

When a post-transplant pt has GI symptoms like unexplained diarrhea and intestinal obstruction what process should you be concerned for?

Study These Flashcards
A

PTLD
-get over abundance of gut lymphoid tissue

25
How is PTLD treated?
-reduce or discontinue immunosuppression -ganciclovir if a/w EB virus -may need adjunctive chemotherapy
26
What is the rate of hep B recurrence in 5 years?
50%
27
What is the rate of hep C reccurence in 5-6 years?
100%
28
What hep B markers indicate a higher likelihood of recurrence? How are these treated?
test positive for: -e antigen -HBV DNA treat w/ lamivudine and adefovir
29
What is the most common indication for liver transplant in pediatrics?
biliary atresia
30
What is the most common indication for liver transplant?
hep C
31
Which hepatic tumor requiring liver transplant has the best prognosis?
fibrolamellar carcinoma
32
What acid/base abnormality is actually a sign of a functioning liver?
mild alkalosis
33
What are signs of a successful hepatic transplant?
-golden yellow bile production -resolution of encephalopathy -resolution of acidosis
34
What is the most common cause of early death in liver transplant pts?
-intra abdominal abscess -sepsis
35
What are the options for duodenum drainage in pancreatic transplants?
-urinary bladder -small bowel
36
What are the two more common complications of pancreatic transplants?
-vascular thrombosis (venous thrombosis is most common cause of graft failure) -allograft pancreatitis
37
What is the most common cause of lung transplant complication?
bronchiolitis obliterans
38
What is the limiting long term complication of heart transplant?
atherosclerosis of new heart coronary arteries
39
What occurs in 10% of heart transplant pts leading to bradycardia?
sinus node dysfunction -must use pacer since perfusion depends on heart rate -treatment is mainly isoproterenol if prolonged bradycardia
40
Which type of transplants have the highest rates of invasive fungal disease?
-small bowel -lung -liver
41
What are the most common organisms is post-transplant fungal infections?
-Candida -Aspergillus
42
What is the MOA of calcineurin inhibitors (tracrolimus, cyclosporine)?
-block T-cell activation -bind to specific receptors to block calcineurin, a Ca-dependent phosphatase w/in T-cells
43
How are calcineurin inhibitors (tacrolimus, cyclosporine) metabolized?
P450 CYP3A4 -in both liver and small intestine -clearance is mostly biliary excretion and fecal elimination -any drugs that inhibit CYP3A4 will increase drug concentrations (diltiazem, verapamil, erthyromycin, ketoconazole, fluconazole, ritonavir)
44
What is the MOA of tacrolimus?
binds to FK binding protein-12 and blocks proliferation of calcineurin preventing IL2 expression/production
45
What have been shown to be factors that have a higher mortality after orthotopic liver transplant?
-mechanical ventilation -older age -hyponatremia
46
What are the 3 leading causes of death after transplant?
-CV disease -malignancy -infections
47
What is the most common cause for respiratory failure in the early period following lung transplantation?
ischemia perfusion injury -generally presents within the first 72hrs after transplant
48
What are the immediate objectives of donor optimization for pts w/ non-survivable injuries?
-correct hypovolemia -start vasopressin -wean catecholamine infusions -prompt diagnosis and management of DI -high dose methylprednisolone -application of lung protective ventilation
49
Replacement of which hormone has been shown to have a higher number of procured organs?
thyroid hormone replacement

Transplant (2 decks)

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