Flashcards in Transplantation Deck (47):
transplant between same species
transplant in same individual
transplanted between genetically identical individual
transplanted between different species
graft is divided between two recipients
en bloc transplant
ped donor to adult recipient
2 deceased donor types
DBD: deceased after brain death
DCD: deceased after circulatory death
expanded criteria donors
ex: renal donor with medical complexities
CDC high risk donors
hep b and hep C
signed in 2015 to allow research and standard development for HIV + organ transplantations
United Network for Organ Sharing
holds OPTN contract for the US
Organ Procurement and Transplantation Network
how long can heart, liver, and kidney stay out of body
heart 4-6 hrs
liver 12-24 hrs
kidney 48-72 hrs
6 criteria transplant waiting list build off of
Time on the list
Center, state and regional characteristics
Specific organ requirement
7 criteria for Pre-Transplant Eval
2. No CI
3. Adequate organ fxn
4. Blood type / sensitization risk
5. Psychological barriers
6. social/caregiver support
7. Financial support
How does a recipient get sensitized to HLA of donors?
From.. previous pregnancies, blood transfusions, transplants, or prior viral/bacterial infections
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
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
stop inflammatory cytokine T cells
antiproliferative or antimetabolic meds..
block DNA synthesis and B/T cell activation and proliferation
calcineurin inhbitiors or CNIS...
prevent IL2 and T cell activation, lymphocyte proliferation etc..
mTOR inhibitors...stop what?
IL2 T cell activation and lymphocyte (BT) cell proliferation
deleting antibodies or ALA
deplete T and B cells
sirolimus is a ___med
cyclosporine and tacrolimus are___
calcineurin inhibitors CNI
azathioprine and mycophenolate are__
antiproliferative or antimetabolite meds
prednisone and methylprednisolone are...
what meds are pts put on for maintance of their immunosuppressive state?
corticosteroids, antiproliferative agents, calcineurin inhibiros or mTOR inhibitors
what meds are used for the induction of the immunosuppressive state?
polyclonal ab, monoclonal ab, corticosteroids
how do you reverse a rejection with meds?
high dose corticosteroids (aka pulse steroids), polyclonal/monoclonal ab
what solid tumors indicate need for bone
renal cell carcinoma
what hematologic cancers require bone marrow transplant
hodgin/non Hodgkin leukemias
pts own cells are extracted (apheresis) and stored then re transfused
identical twin (syngenic) or related donor, unrelated or umbilical cord transplant
stem cells than transfused
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
what are ways to prevent post transplant infection?
revaccinate like they are newborns!!
what is a main cause of morbility / mortality in SOT?
sx of CMV syndrome
fever and/or malaise, thrombocytopenia, leukopenia
universal precaution of CMV
all at risk pts get oral or IV gangcyclovir with oral valganciclovir
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
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
infxn 1-6 mo post op
hep c, adenovirus, influenza, tb, etc
infxn over 6 mo
description apophysomyces elegans
irregular branching hyphae with few septations
most common fungal pathogen in HCT
predominantly pulmonary involvement
description of aspergilliosis
hyaline hyphomycete with septate