Transplantation Flashcards
(20 cards)
Hyperacute rejection is caused by
Preformed antibodies
- very rapid type of rejection
- graft loss within mintes to hours after organ reperfusion
- HLA or ABO blood group antigens
The Mechanism of action od azathioprine (AZA) is
Interference with DNA synthesis
- antimetabolite
- converted to 6 mercaptopurine and inhibits both de novo purine syntheis and salvage purine salvage synthesis
- Decreases T lymphocyte activity and decreases antibody production
- preferred in the recipients who are considering conceiving a child
Sid effects of cyclosporine
- Hypertension
- nephrotoxicity
- hirsutism
- neurooxicity
- gingival hyperplasia
- hypomagnesemia
- hyperkalemia
Postrenal transplant graft thrombosis usually occurs
within 2 to 3 days
- Risk factors
- hypercoagulability
- severe peripheral vascular disease
- use of en bloc or pediatric donor kidneys
- procurement damage
- intimal dissection
- torsion of vessels
- hyperacute rejection
- acute cessation of urine output
- sudden onset hematuria
- graft pain
- doppler ultasound may help confirm diagnosis
The 1 year graft survival after renal transplant is
92-96.5%
After completion of vascular anastomoses, drainage of a transplanted pancreas is accomplished by anastomosis to________
Bladder or small bowel
- two most common techniques are drainage of the duodenal segment to the bladder or to the small bowel
- For venous drainage, systemic venous drainage is preferred over portal venous drainage
Absolute contraindications in considering a candidate for orthotopic cardiac transplantation
- Active infection
- history of medical noncompliance
- severe pulmonary hypertension
Heart transplant donors and recipients are matched using the following criteria
Status on the UNOS waiting list
Blood type
size
- Evaluation of donor:
- Xray
- serologic testing
- echocardiography
- hemodynamic testing
- coronary artery evaluation are assessed - whether or not the donor’s heart can withstand up to 4 hours of cold ischemic time during procurement transport and surgery
Required laboratory tests in evaluation of a patient under consideration for heart transplantation include all of the following
- psychosocial evaluation
- cardiac cathetirizaion
- dental examniation
- evaluation of undiagnosed malignancies
- liver, kidney, and endocrine function
- mammography
- colonoscopy
- prostate-specific antigen
Immunologic rejection is mediated by the recipients
Lymphocytes
- The main antigens responsible for this process are part of the major histocompatibility coplex
- Antigen coding generes are located in chromosome 6
- Class I antigens (nucleated cells)
- HLA-A
- HLA-B
- HLA-C
- Class II (APC)
- HLA-DR
- HLA-DP
- HLA-DQ
In prevention of graft rejection, cyclosporine
Selectively inhibitss T-cell activation
binds with its cytoplasmic receptor protein, cyclophilin which subsequently inhibits the activity of calcineurin thereby decreasing the expression of several critical T cell activation genes
- the most imporant being IL-2
The most common cause of renal failure in the United states is
Diabetes mellitus
- Diabetes and hypertension
The best method of monitoring the development of acute rejection in a patient after cardiac transplantation
Endomyocardial biopsy
Absolute contraindications to renal transplantation for a patient with chronic renal failure
- Chronic acitive hepatitis
- colorectal cancer
- psychiatric illness
- active infection
- presence of malignany
- active substance abuse
True for living renal transplant
- Donor’s kidneys with multiple renal arteries should be avoided
- there is no medical benefit to the donor
- the intraperitoneal approach is most often used for harvest
- Donor’s left kdiney is preferable due to long vascular pedicle
kidney - most common organ donated
The single most important factor in determining whether to perform a transplant between a specific donor recipient is
ABO blood types of the donor and recipient
- The panel reactive antibody assay
The most common diagnosis leading a heart transplant is
Ischemic dilated cardiomyopathy
- stems from coronary artery disease followed by idiopathic dilated myopathy and congenital heart disease
Side effects of clycosporine administration
- hyperkalemia
- hirsutism
- tremor, headaches, seizures
- hypomagnesemia
- gingival hyperplasia
- nephrotoxic
- constrict the afferent arteriole in a dose-dependent, reversible manner
The metabolism of cyclosporine is via the cytochrome P450 system
True of extracorporeal membrane oxygenation
- minimizes ischemic injury to organs of cardiac death donors
- organs are perfused with warm oxygenated blood after declaration of cardiac death
- cannulation occurs before withdrawal of life support
The most significant ide effect of sirolimus
Hypertriglyceridemia
- resistant to fibrates and statins
- impaired wound healing (immediately post transplant in particular)
- thrombocytopenia
- leukopenia and anemia
- side effects are exacerbated when it is used in c ombination with MMF
