Transplant med

Question 1

Transplanted between genetically identical individuals.

Answer 1

Isografts

Question 2

Grafts transplanted between different species

Answer 2

Xenografts

Question 3

Graft divided between two recipients

Answer 3

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

Question 4

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

Answer 4

“En bloc” Transplant

Question 5

Transplanted between same species

Answer 5

Allograft

Question 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

Answer 6

“Expanded criteria” Donors

Question 7

CDC “high risk “ donors

Answer 7

Donors w Hep B and C

Question 8

HOPE act?

Answer 8

HIV positive donors can give organs to HIV positive individuals

Question 9

Role of UNOS?

Answer 9

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

“Regional” rules

Question 10

Time heart / lungs can be kept out of body

Answer 10

4-6 hours

Question 11

Time liver can be kept out of body

Answer 11

12-24 hours

Question 12

Time kidney can be kept out of body

Answer 12

48-72 hours

Question 13

Three sets of antigens involved in graft rejection

Answer 13

MHC/HLA

mHC

ABO blood groups

Question 14

Cells mediating the cellular immune response

Answer 14

lymphocytes

Question 15

Cells mediating humoral immune response

Answer 15

antibody

Question 16

Sensitization to HLA occurs due to

Answer 16

Pregnancies
Blood transfusions
Prior transplants
Prior viral / bacterial infections

Question 17

3 types of rejection

Answer 17

Hyperacute

Acute

Chronic

Question 18

Hyperacute rejections have what kind of immune mediation

Answer 18

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

involve pre existing HLA / ABO antibodies to graft

Question 19

Organs most and least susceptible to hyperacute rejections

Answer 19

Kidneys most susceptible

Liver least susceptible

Question 20

Acute rejection occurs during ______ and may be cause by _____

Answer 20

First 6 months post-transplant

primary acute cellular rejection and/or acute humoral rejection

Question 21

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

Answer 21

Months to years AFTER ACUTE REJECTION EPISODES

Both cellular and antibody responses

Fibrosis and scarring

Question 22

5 classes of immunosuppressive drugs

Answer 22

Corticosteroids

Antiproliferative

Calcineurin inhibitors (CNI’s) (Cyclosporin)

mTOR inhibitors

Depleting antibodies

Question 23

Induction agents (3)

Answer 23

Polyclonal antibodies

Monoclonal antibodies

Corticosteroids

Question 24

Maintenance agents (3)

Answer 24

Corticosteroids

Antiproliferative agents

Calcineurin / mTOR inhibitors

Question 25

Reversal of established rejection

Answer 25

High dose corticosteroids Polyclonal / monoclonal antibodies

Question 26

Graft vs Host disease

Answer 26

Donor T lymphs recognize foreign HLA antigens Acute or chronic Affects skin, liver, GI tract,

Question 27

Skin manifestations of acute GVHD

Answer 27

Maculopapular rash may progress to diffuse erythema / bullae

Question 28

Liver manifestations of acute GVHD

Answer 28

Elevated LFT's

Question 29

GI manifestations of acute GVHD

Answer 29

loss of appetite dyspepsia large volume crampy secretory diarrhea

Question 30

Overall incidence of GVHD

Answer 30

40-50% in HLA identical donor

Question 31

First line tx of GVHD

Answer 31

Methotrexate, Cyclosporine, Tacrolimus Prednisone T cell depletion in vivo

Question 32

fever and/or malaise, thrombocytopenia, leukopenia

Answer 32

CMV syndrome

Question 33

Prophylaxis tx for CMV

Answer 33

Gancyclovir / valgancyclovir

Question 34

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

Answer 34

< 4 weeks

Question 35

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

Answer 35

1-6 Months

Question 36

Community acquired infections occur _____ after transplantation

Answer 36

> 6 months