transplant Flashcards

1
Q

In which kinds of transplants is HLA antigen matching more (or less) important?

A
  • more important for kidney and pancreas

- less important for heart and liver

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2
Q

What are risk factors for graft vs. host disease?

A

HLA antigen mismatch, old age, donor-host gender disparity, immunosuppression

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3
Q

What are the manifestations of graft vs host disease? Lab/biopsy findings?

A

rash (maculopapular), abd pain, N/V, diarrhea, recurrent infection, bleeds
labs: elevated LFTs, decr. immunoglobulin levels, decr. platelets. biopsy shows inflammation w/ significant cell death

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4
Q

What are treatment options for graft vs host disease?

A

steroids, tacrolimus, mycophenolate acutely; may give thalidomide and hydroxychloroquine in chronic disease

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5
Q

What are complications of graft vs host disease?

A

chronic disease: skin sclerosis, hepatic insufficiency, GI ulcers, pulm fibrosis

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6
Q

What is an acute transplant rejection?

A

6 days to 1 yr post transplant due to antidonor T-cell proliferation in recipient (occasionally due to development of antibodies after transplant). biopsy shows hypercellular lymphocytic infiltrate. often reversible with immunosuppressive agents

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7
Q

What is chronic transplant rejection?

A

months to yrs after transplant, the patient develops multiple cellular and humoral immune rxns to donor tissue

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8
Q

What are the organ specific types of chronic transplant rejection?

A

heart- atherosclerosis
lungs- bronchiolitis obliterans
liver- vanishing bile ducts
kidney- vascular fibrosis, glomerulopathy

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9
Q

How does cyclosporine work? side effects?

A

calcineurin inhibitor that binds cyclophilin and blocks T cell activation by preventing IL-2 transcription. This blocks helper T-cell function. However, it can cause nephrotoxicity, androgenic effects, and HTN

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10
Q

How does tacrolimus work? side effects?

A

calcineurin inhibitor that binds FK506 binding protein and blocks T cell activation by preventing IL-2 transcription.
nephrotoxic, neurotoxic

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11
Q

How does azathioprine work? side effects?

A

antimetabolite precursor of 6-mercaptopurine that prevents lymphocyte production by blocking neucleotide synthesis. causes leukopenia; toxicity increased by allopurinol

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12
Q

What is rapamycin/sirolimus?

A

mTOR inhibitor that prevents IL-2 signal transduction through a different pathway (ie not a calcineurin inhibitor like cyclosporine or tacrolimus), so it is NOT nephrotoxic. may cause thrombocytopenia or hyperlipidemia

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13
Q

mycophenolic acid

A

prevents rejection by inhibition of T cell proliferation, but can cause leukopenia, GI toxicity

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14
Q

When is a pancreas transplant indicated? contraindicated?

A

DM1 with renal failure. not done if age >60, CAD, PVD, obesity, DM2.

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15
Q

What are the indications for lung transplant?

A

COPD, esp if related to alpha 1 antitrypsin deficiency, primary pulmonary HTN, CF, estimated death within 2 yrs. Not done if smoking in past 6 mo, poor function of heart, liver, or kidnies, age >65, HIV
chronic rejection is common, and there is about a 50% 3 yr survival rate

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