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Flashcards in Transplantation Deck (47):
1

allograft transplant

transplant between same species

2

autograft transplant

transplant in same individual

3

isograft transplant

transplanted between genetically identical individual

4

xenograft transplant

transplanted between different species

5

split transplant

graft is divided between two recipients

6

en bloc transplant

ped donor to adult recipient

7

2 deceased donor types

DBD: deceased after brain death
DCD: deceased after circulatory death

8

ECD

expanded criteria donors
ex: renal donor with medical complexities

9

CDC high risk donors

hep b and hep C

10

Hope act

signed in 2015 to allow research and standard development for HIV + organ transplantations

11

UNOS purpose

United Network for Organ Sharing

holds OPTN contract for the US

12

OPTN

Organ Procurement and Transplantation Network

13

how long can heart, liver, and kidney stay out of body

heart 4-6 hrs
liver 12-24 hrs
kidney 48-72 hrs

14

6 criteria transplant waiting list build off of

ABO/HLA type
Candidate height/weight
Medical urgency
Time on the list

Center, state and regional characteristics

Specific organ requirement

15

7 criteria for Pre-Transplant Eval

1. Indication
2. No CI
3. Adequate organ fxn
4. Blood type / sensitization risk
5. Psychological barriers
6. social/caregiver support
7. Financial support

16

How does a recipient get sensitized to HLA of donors?

From.. previous pregnancies, blood transfusions, transplants, or prior viral/bacterial infections

17

CPRA

calculated panel reactive antibodies:
pts are sera tested against cells from a panel of HLA-typed donors or against solubilized HLA antigens attached to solid supports

18

what is considered a high CPRA or PRA level? and what does that mean?

over 80% is high

means high chance recipient will have a graft rejection because they are having a sensitive reaction against 80% of the HLA that was tested

19

corticosteriods

stop inflammatory cytokine T cells

20

antiproliferative or antimetabolic meds..

block DNA synthesis and B/T cell activation and proliferation

21

calcineurin inhbitiors or CNIS...

prevent IL2 and T cell activation, lymphocyte proliferation etc..

22

mTOR inhibitors...stop what?

IL2 T cell activation and lymphocyte (BT) cell proliferation

23

deleting antibodies or ALA

deplete T and B cells

24

sirolimus is a ___med

mTOR inhibitor

25

cyclosporine and tacrolimus are___

calcineurin inhibitors CNI

26

azathioprine and mycophenolate are__

antiproliferative or antimetabolite meds

27

prednisone and methylprednisolone are...

corticosteroids

28

what meds are pts put on for maintance of their immunosuppressive state?

corticosteroids, antiproliferative agents, calcineurin inhibiros or mTOR inhibitors

29

what meds are used for the induction of the immunosuppressive state?

polyclonal ab, monoclonal ab, corticosteroids

30

how do you reverse a rejection with meds?

high dose corticosteroids (aka pulse steroids), polyclonal/monoclonal ab

31

what solid tumors indicate need for bone

renal cell carcinoma
Ewig sarcoma
neuroblastoma
breast/colon/ovarian/pancreatic

32

what hematologic cancers require bone marrow transplant

acute/chronic leukemia
myeloma
hodgin/non Hodgkin leukemias

33

autologous hct

pts own cells are extracted (apheresis) and stored then re transfused

34

allogenic hct

identical twin (syngenic) or related donor, unrelated or umbilical cord transplant

stem cells than transfused

35

why do peripheral blood progenitor cells have a higher risk for GVHD?

they contain more of the donors T cells
but used more often instead of BM cells because of ease of collection

36

what are ways to prevent post transplant infection?

revaccinate like they are newborns!!

37

what is a main cause of morbility / mortality in SOT?

CMV

38

sx of CMV syndrome

fever and/or malaise, thrombocytopenia, leukopenia

39

universal precaution of CMV

all at risk pts get oral or IV gangcyclovir with oral valganciclovir

40

high risk pt for CMV def and tx

def: donor was +, recipient was -
6 mo post transplant universal precaution
plus prophylaxis 1 mo post ALA for rejection

41

common infections less than 4 wk post op

Think from the procedure: aspiration, line infxn, wound infxn, C. diff colitis, anstamotic leaks

Donor: HSV, LCMV, rabies, west nile

42

infxn 1-6 mo post op

hep c, adenovirus, influenza, tb, etc

43

infxn over 6 mo

hepatitis, HSV,

44

description apophysomyces elegans

mold
irregular branching hyphae with few septations

45

most common fungal pathogen in HCT

invasive aspergilliosis

predominantly pulmonary involvement

46

description of aspergilliosis

hyaline hyphomycete with septate

47

aspergilliosis infection are more common in ___ transplants than autologous

allogenic (esp day 40-180)