Transplant stuff

Question 1

donation after cardiac death requires a minimum of ___ but up to ____ minutes of asystole before procurement

Answer 1

2 minutes - 5 minutes

Question 2

True or false. Confirmation of death should be performed by a physician from the organ procurement team

Answer 2

false

Question 3

basilizimab and antithymocyte globulin mechanism of action:

Answer 3

induction agents; deplete lymphocyte stores or prevent T cell activation

Question 4

preventive therapy for Pneumocystis jinroveci

Answer 4

TMP-SMX; more common in transplant patients

Question 5

true or false. diabetes is an absolute contraindication to being a kidney donor

Answer 5

true

Question 6

true or false. intrahepatic cholangiocarcinoma is a contraindication to being a kidney donor

Answer 6

true

Question 7

typical branches of left renal vein:

Answer 7

gonadal (inferior), adrenal (superior), lumbar (posterior)

Question 8

A MELD-Na score less than ____ is associated with mortality rates less than the mortality rate of undergoing liver transplant

Answer 8

15

Question 9

a replaced right hepatic artery originates from the____

Answer 9

SMA

Question 10

a replaced left hepatic artery originates from

Answer 10

left gastric artery

Question 11

true or false. prolonged cold ischemia time is known in kidney transplant to increase incidence of primary nonfunction and delayed graft function.

Answer 11

true

Question 12

treatment of arterial thrombosis in renal transplant

Answer 12

anticoagulation and thrombectomy

Question 13

posttransplant lymphoproliferative disorder (PTLD) is associated with what virus

Answer 13

EBV

Question 14

what malignancy can PTLD lead to?

Answer 14

lymphoma

Question 15

presentation of PTLD

Answer 15

fever, lymphadenopathy, bowel obstruction; observed in 20% of small bowel transplants

Question 16

mechanism and side effects of tacrolimus

Answer 16

bind to FK-binding proteins to inhibit calcineurin and downstream decrease in T cell proliferation; hyperglycemia, nephrotoxicity, neurotoxicity

Question 17

mechanism & side effects of mycophenolate mofetil (MMF)

Answer 17

inhibitor of inosine monophosphate dehydrogenase which controls synthesis of GMP; causes pancytopenia, GI bleeding, diarrhea

Question 18

mechanism and side effects of sirolimus

Answer 18

binds rapamycin (mTOR) to prevent cytokine transduction and T cell proliferation; causes poor wound healing, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia

Question 19

mechanism and side effects of cyclosporine

Answer 19

binds cyclophilin causing NFAT translocation and decreased T cell proliferation; causes vomiting, seizures, and arrhythmias; hypertrichosis, gingival hyperplasia; less nephrotoxic than tacrolimus

Question 20

study used to measure GFR in potential renal donors

Answer 20

MAG-3 or DTPA renal scans; 24 hr creatinine clearance can be used as an alternative

Question 21

true or false. liver transplant graft experience rejection less often and require less immunosuppression than other solid organ transplants

Answer 21

true

Question 22

mainstay immunosuppressive for liver transplant

Answer 22

tacrolimus

Question 23

most common indication for renal transplant

Answer 23

diabetes

Question 24

side effect of azathioprine

Answer 24

bone marrow suppression

Question 25

time frame and mechanism of acute rejection:

Answer 25

occurs in days to weeks (sometimes months) after transplant; classified as T cell mediated (cellular), antibody mediated (humoral), or a combination of both

Question 26

histology of acute rejection

Answer 26

lymphocytic infiltrate, membrane damage, apoptosis of graft cells on bx, complement deposition, parenchymal necrosis

Question 27

prevention of acute rejection

Answer 27

initial immunosuppressive T cell depletion

Question 28

time frame and mechanism of hyperacute rejection

Answer 28

occurs in minutes to hours after graft reperfusion; mediated by preformed antibodies of the recipient to the donor and by complement activation

Question 29

prevention of hyperacute rejection

Answer 29

preop crossmatching and testing for ABO compatibility

Question 30

what is tissue typing

Answer 30

testing donors and recipients for HLA-A, HLA-B, and HLA-DR molecule matching; more HLA matches increases the chance of graft survival

Question 31

true or false. most pancreas transplants are performed as combined kidney-pancreas transplants

Answer 31

true

Question 32

most common indication for pancreas transplant

Answer 32

type 1 diabetes

Question 33

cytokine involved in activation of CD4 lymphocytes; casues fevers made by macrophages, monocytes, dendritic cells, and fibroblasts

Answer 33

IL-1

Question 34

cytokine that activates eosinophils; involved in asthma and allergies

Answer 34

IL-5

Question 35

cytokine involved in NK and macrphage activation; secreated by helper T cells

Answer 35

interferon gamma

Question 36

which drugs are the calcineurin inhibitors:

Answer 36

tacrolimus, cyclosporine

Question 37

which drugs are purine synthesis inhibitors:

Answer 37

MMF, azathioprine

Question 38

which drugs are inhibitors of NF-KB

Answer 38

steroids

Question 39

which drugs are mTOR inhibitors

Answer 39

sirolimus, everolimus

Question 40

which drug is a involved in the co-stimulation blockade

Answer 40

belatacept

Question 41

treatment of PTLD

Answer 41

rituximab (monoclonal antibody to CD20 that leads to complement and antibody mediated B cell death

Question 42

where are b lymphocytes derived

Answer 42

pluripotent stem cells in bone marrow

Question 43

time frame and mechanism of chronic rejection

Answer 43

occurs over months to years; fibrotic process mediated by T and B cels

Question 44

histology of chronic rejection

Answer 44

parenchymal replacement with fibrous tissue and intimal smooth muscle proliferation leading to vessel occlusion

Question 45

chronic rejection prevention

Answer 45

avoiding acute rejection episodes and limiting ischemia/reperfusion time at transplant

Question 46

histology of hyperacute rejection

Answer 46

endothelial damage, inflammation, and thrombosis

Question 47

most common pulmonary fungal infection in immunosuppressed patients:

Answer 47

aspergillosis

Question 48

types of aspergillosis infections:

Answer 48

invasive aspergillosis, allergic aspergillosis, and aspergilloma

Question 49

presentation and treatment of invasive aspergillosis:

Answer 49

presents with cough, pleuritic CP, and fever

Question 50

presentation and treatment of aspergilloma:

Answer 50

fungal ball in the lung that can invade parenchymal vessels with possible subsequent fatal hemorrhage; tx with lobectomy