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Flashcards in Transplant med Deck (36):
1

Transplanted between genetically identical individuals.

Isografts

2

Grafts transplanted between different species

Xenografts

3

Graft divided between two recipients

Split Transplant (e.g., split-liver transplant)

4

Example: kidney transplant
Both pediatric donor kidneys into single adult
recipient

"En bloc" Transplant

5

Transplanted between same species

Allograft

6

What kind of organ donors would the following be considered?

Example: renal transplant donors with “medical complexities”
Deceased or living donors
≥ 60 years
> 50 years + at least 2 of the following: hypertension, serum creatinine > 1.5 mg/dl or death from CV accident

"Expanded criteria" Donors

7

CDC "high risk " donors

Donors w Hep B and C

8

HOPE act?

HIV positive donors can give organs to HIV positive individuals

9

Role of UNOS?

(United Network for Organ Sharing)
Organization that operates the Organ Procurement and Transplantation Network

"Regional" rules

10

Time heart / lungs can be kept out of body

4-6 hours

11

Time liver can be kept out of body

12-24 hours

12

Time kidney can be kept out of body

48-72 hours

13

Three sets of antigens involved in graft rejection

MHC/HLA

mHC

ABO blood groups

14

Cells mediating the cellular immune response

lymphocytes

15

Cells mediating humoral immune response

antibody

16

Sensitization to HLA occurs due to

Pregnancies
Blood transfusions
Prior transplants
Prior viral / bacterial infections

17

3 types of rejection

Hyperacute

Acute

Chronic

18

Hyperacute rejections have what kind of immune mediation

Humorally mediated (antibodies + compliment) - occur within minutes /hours of transplant

involve pre existing HLA / ABO antibodies to graft

19

Organs most and least susceptible to hyperacute rejections

Kidneys most susceptible

Liver least susceptible

20

Acute rejection occurs during ______ and may be cause by _____

First 6 months post-transplant

primary acute cellular rejection and/or acute humoral rejection

21

Chronic rejection occurs ________ is mediated by _____ and appears as ______

Months to years AFTER ACUTE REJECTION EPISODES

Both cellular and antibody responses

Fibrosis and scarring

22

5 classes of immunosuppressive drugs

Corticosteroids

Antiproliferative

Calcineurin inhibitors (CNI's) (Cyclosporin)

mTOR inhibitors

Depleting antibodies

23

Induction agents (3)

Polyclonal antibodies

Monoclonal antibodies

Corticosteroids

24

Maintenance agents (3)

Corticosteroids

Antiproliferative agents

Calcineurin / mTOR inhibitors

25

Reversal of established rejection

High dose corticosteroids

Polyclonal / monoclonal antibodies

26

Graft vs Host disease

Donor T lymphs recognize foreign HLA antigens

Acute or chronic

Affects skin, liver, GI tract,

27

Skin manifestations of acute GVHD

Maculopapular rash

may progress to diffuse erythema / bullae

28

Liver manifestations of acute GVHD

Elevated LFT's

29

GI manifestations of acute GVHD

loss of appetite
dyspepsia
large volume crampy secretory diarrhea

30

Overall incidence of GVHD

40-50% in HLA identical donor

31

First line tx of GVHD

Methotrexate, Cyclosporine, Tacrolimus

Prednisone

T cell depletion in vivo

32

fever and/or malaise, thrombocytopenia, leukopenia

CMV syndrome

33

Prophylaxis tx for CMV

Gancyclovir / valgancyclovir

34

Nosocomial / technical / donor or recipient derived infections typically occur ____ after transplantation

< 4 weeks

35

Activation of latent VIRUSES, or other infections, opportunistic infections, occur ____ after transplantation

1-6 Months

36

Community acquired infections occur _____ after transplantation

> 6 months