Transplant Flashcards
(113 cards)
1
Q
Most common transplant organ?
A
kidney
2
Q
What is a autograft?
A
from self ie skin graft
3
Q
What is allograft/
A
from same speciesq
4
Q
What is a xenograft?
A
different species
5
Q
What is isograft?
A
from twin
6
Q
Why can you get less immunosuppression for liver transplants?
A
can regain so better at transplanting
7
Q
What organ needs ALOT of immunosuppression?
A
lung
8
Q
What is MHC/ HLA? Where are they found?
A
distinguishes self from non self
on antigen presenting cells (B cell, macrophage
9
Q
What do APC’s do?
A
present antigen to T cells
10
Q
What do CD4 or t helper cells do?
A
recog MHC class2 and stims B cells and t cells
11
Q
What do CD8 or cytotoxic T cells do?
A
recog MHC class 1 and kill infected cells
12
Q
What do B cells do?
A
forms antibodies
13
Q
What do histocompatibility antigens do?
A
bind peptides and present them on cell surface for inspection of t cells
14
Q
Why do we match HLA and not MHC?
A
HLA is more specific for human
15
Q
What chromosome is HLA on?
A
Chromosome 6
16
Q
What cells have HLA class 1?
A
most cells and platlets
17
Q
What cells have class 2?
A
immune cells
18
Q
What cells have class 3?
A
don’t worry no role in grafts
19
Q
What is inheriting from haplotype mean? What’s the odds of being the same?
A
HLA genes are given as a group
1/4 siblings have the same
20
Q
If perfect HLA match is there still a chance of rejection?
A
yes
21
Q
What does signal 1 do?
A
recognition of MCH 2 and begin activation calcineurin pathway to make IL-2
22
Q
What does signal 2 do?
A
Acitvate T cells by timing CD80 and 86 and 28
23
Q
What does signal 3 do?
A
IL-2 released and binds on T cell for proliferation
24
Q
Why are the signals of T cell an important target?
A
causes graft destruction
and activates calcineurin which is targeted
25
Do B cells play a role in matching?
yes by creating donor specific antibodies (DSA)
if due to this called humeral rejection
26
What is a PRA?
cross match blood sample with donors to see how much HLA antigens are present
27
What does a high PRA percentage mean?
bad because there is broad sensitization
28
Con of PRA?
doesn't know strength of reaction
29
What is a lymphocyte cross match test mean?
directly tests reactivity between patient and donor cells if positive= BAD
30
What is the importance of ABO blood matching?
stops hyper acute reaction and destruction of the graft
31
Treatment of chronic rejection?
none hope immunosuppressants stop the beginning of process
32
What causes acute cellular rejection? When does this occur?
by t lymphocytes
can happen anytime
33
How long does induction therapy last?
1-3 months
34
What drugs must be given for induction?
Basiliximab OR Antithymocyte globulin
AND
corticosteroid
AND
Azathiprine OR Mycophenolate
AND
cyclosporine OR tacrolimus
35
How does basiliximab work?
Il-2 receptor antagonist
36
S/e of basiliximab?
hypersensitivity but VERY well tolerated
37
General dosing info on basiliximab?
everyone gets same dose
38
How does anti-thymocyte globulin work?
this antibody binds to T cells and depletes them
39
Main difference between basiliximab and antithymocyte?
Antithymocyet is a polyclonal antibody so binds more
40
S/e of antithymocyte?
bone marrow suppression, anaphylaxis, hepatic issues
41
Which agent can be used if rejection is happening?
antithymocyte
42
Short term s/e of corticosteroids and long term?
Short= insomnia, Gi, glucose, poor wound healing
long= osteoporosis, cataracts, moon face
43
Does CS cause hypo or hyper kalmia?
hypokalemia
44
How can we prevent osteoporosis?
routine bone tests, calcium, vitamin D, bisphosphonates
45
What other agent besides CS causes hyperglycaemia?
tacrolimus
46
MOA of azathioprine?
purine analoge that suppresses T and. B cells
47
Main DI with azathioprine?
allopurinol- people often get gout
CAUSES MYELIN SUPPRESSION
48
S/e of azathiprine?
alopecia, bone marrow suppression, skin lesion
49
MOA of mychophenolic acid derivatives?
more specific ability than AZA to suppress B cells and T cells
50
General dosing of MPA?
everyone gets the same dose
51
Do you need blood tests for MPA?
NO
52
S/e of MPA?
Gi is bad, neutropenia
teratogen for both males and females
53
DI of MPA?
iron and calcium and other agents that cause neutropenia
54
Can you give MPA with food?
yes to help with Gi just slows absorption NOT extent
55
is it a good idea to divide doses of MPA foo help with gi?
helps but lowers adherence
56
What agent causes bad neutropenia with MPA?
Valganciclovir
57
If neutropenia happens with MPA what can we do?
filgrastim/GCSF to cause WBC proliferation
58
How do cyclosporin and tacrolimus work?
binds calcineurin which stops T cell activation
59
What is important about dosing with cyclosporin and tacrolimus?
narrow TI which is gets serum levels right
60
What metabolizes cyclosporin/ tacrolimus?
CYP 34A
61
How does the neural formulation of cyclosporin improve the drug?
less variable and improved BA
62
How do you do blood levels of cyclosporin? Which method is better?
trough or 2 hour post dose
2 hours post is better for AUC but must be within 15 minutes of the 2 hours
63
True or false Advagraf and prograf are bio equivalent?
FALSE prograf is BID and advagraft is ER
64
How do you do blood levels of tacrolimus?
trough needs to be within 30 minutes of C0
65
S/e of the calcineurin inhibitors?
nephrotoxicity, neurotoxicity- headache, fatigue
electrolytes issues (K increase)
gi
hepatic
66
Which calcineurin inhibitors has worse gi?
tacrolimus, especially with MPA
67
Unique s/e of tacrolimus?
alopecia
68
unique s/e of cyclosporin?
more limipds and uricemia, acne, facial hair, gingival hyperplasia
69
How to help with lipid s/e of cyclosporin?
statin BUT lowest dose due to DI causing more muscle pain
70
DI with calcineurin inhibitors?
macrolide (NOT azithro), diltiazem, verapamil, fluconazole, grapfruit, other nephrotoxic agents
71
MOA of sirolimus?
Macrolide antibiotic similar to tacrolimus that binds to FKBP and engages TOR which lowers proliferation
72
Important PK info of sirolimus?
LOOOOONG half life (60 hours)
same DI as tacrolimus
73
When would we use sirolimus?
to replace calcineurin agents due to low renal function, anti malignancy properties, add on
74
S/e of sirolimus?
BAD hyper lipids, rash, mouth sores, edema, proteinuria, anemia
75
What side effect must you stop siroliimus?
proteinuria
76
Patient comes in complaining of edema and is on sirolimus. What agent can we give?
DIURETICS DO NOT WORK
77
How to treat acute rejection?
HIGH dose CS
antithymocyte
78
How to treat humeral rejection?
plasmapheresis (dialysis for antibodies), CS, antithymocyte, rituximab, tocilzumab, bortezomib
79
How frequent is blood work for transplant patients?
minimum monthly forever
80
How frequent is blood work for heart transplants?
prob q3 months due to no good biomarkers if stable
81
Which drugs need level monitoring?
CNI, Sirolimus
82
Should we use generic immunosuppressants?
Cheaper so yeah but LOTS more monitoring when switching so patient must be made aware
83
Who is eligible for kidney transplant?
when GFR under 20
84
What other transplant is common with kidney?
pancreas
85
Signs of acute and chronic kidney rejection?
acute= abrupt >30% increase in SCr, low urine production, pain by kidney
Chronic= HTN, proteinuria and low renal function
86
When do we need delayed graft function? and why?
if no pee after transplant need dialysis to kickstart kidney
87
What is a common opportunistic infection with kidney grafts?
BK virus/polyoma virus due to so high immunosuppression
88
Who is eligible for liver transplant? And what conditions are common?
advanced, nonreversible decompensated liver disease
causes= Hep C+B, PBC,PSC, alcohol
89
How is immunosuppression different in Liver grafts?
can eventually taper off CS first then MPA after a year
90
Signs of acute and chronic liver rejection?
Acute= increase in enzymes and bilirubin
chronic= LFTs, jaundice and itching
91
What conditions can cause recurrent disease in liver?
Hep B and c, PBC and PSC
92
Who is eligible for heart transplant?
advanced heart failure, non responsive to therapy, otherwise HEALTHY, but survival about 1 year
93
How is immunosuppression different in heart grafts?
prednisone is eventually tapered off
94
Issues with heart grafts?
higher resting rate, can't tolerate exercise, MI can be asymptomatic
95
If heart transplant what meds MUST be on board?
statin, ASA, ACE
96
Signs of acute and chronic rejection of heart grafts?
Acute= mostly asymptomatic, heart failure sx
chronic= vasculopathy (plaque in grafted vessels
97
Who is eligible of lung transplants?
HEALTHY,YOUNGER, end stage and failing max therapy, able to adhere
98
Difference in immunosuppression in lung grafts?
possibly quad therapy
99
signs of chronic rejection of lung graft?
CLAD- happens a lot after 5 years give azithro
100
What is CMV and what is therapy?
most common virus and risk is highest with D+R-
give valganciclovir and screening with CMV PCR
101
What is PJP prophylaxis?
SMX-TMP perhaps always if lung
sulpha allergy give dapsone or inhaled pentamadine
102
What can we do for herpes simplex reactivation?
valganciclovir some help but usually therapy
103
Why is Epstein Barr virus so bad?
can cause PTLD which is cancer and need prophylaxis and monitoring if D+R-
104
How can we minimize malignancy risk?
sunscreen, pap and colonoscopy, term exams
105
Who is most at risk of PTLD?
kids
106
How do we treat PTLD?
lower immunosuppression or rituximab
107
If bad gi issues on meds what can we do?
PPI
108
What is blood pressure target for graft patients?
Lower is better but as tolerated
109
Which is worse for renal grafts, ACE or diuretics?
diuretics
110
Is CCB good for BP in graft patients?
use amlodipine but worse peripheral edema, gingival hyperplasia
111
What can we do if anemia?
EPO dugh
112
What drug is worse for gout in transplant therapy?
Cyclosporin
113
What is paired exchange and altruistic donor?
Paired= if want to donate but no match go on registry for later
altruistic= stagner donating
