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ABSITE-TRANSPLANT
absite
42
Science
Post-Graduate
12/10/2012

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Cards

Term
Two main contraindications to cadaveric donation?
Definition
Malignancy and infection (namely HIV)

*recall that + CMV, syphilis, and hepatitis serologies are NOT contraindications for donation*
Term
Criteria for brain death determination?
Definition
1. TWO exams 12 hours apart by neurologist or neurosurg.
2. Loss of cerebral function (no response to pain)
3. Loss of brainstem function (fixed pupils, absence of gag, corneal reflexes)
4. No resp effort after 3 min of PaCO2 greater than or equal t 60
Term
First organ removed in a donor operation?
Definition
Heart
Term
Incision made for donor operation?
Definition
Midline, from suprasternal notch to pubis
Term
Organs which can tolerate the longest ischemic time?
Definition
Kidneys, pancreas (72 hours max)
Term
Most sensitive organs to cold ischemic time?
Definition
Heart and Lung (4 hours max)
Term
Cold ischemic time for liver?
Definition
48 hours (max)
Term
Most common prophylactic antibiotics given to transplant recipients?
Definition
bactrim, nystatin and acyclovir
Term
Incidence of PTLD is greatest in which transplant patients and why?
Definition
Heart and lung (10%--development related to intensity of immunosupression rather than organ itself)
Term
When is risk greatest for development of PTLD?
Definition
within first year after transplant
Term
How is diagnosis of PTLD made?
Definition
Tissue biopsy
Term
Mainstay of treatment for PTLD?
Definition
Decrease level of immunosuppression
Term
PTLD is related to which virus?
Definition
EBV (PTLD is a B cell disease)
Term
Top three indications for renal transplant?
Definition
Diabetes, glomerunephritis, HTN
Term
Graft of choice in a living donor renal transplant?
Definition
LEFT kidney (longer renal vein and easier access to the renal artery)
Term
Donor renal artery site of anastamosis?
Definition
external iliac artery
Term
Cause of sudden anuria in a renal transplant patient?
Definition
vascular thrombosis
Term
Cause of HTN and decreases renal function post transplant?
Definition
Renal transplant artery stenosis
Term
Pathophysiology of tertiary hyperparathyroidism?
Definition
Calcium wasting and poor vit D levels in ESRD patients causing secondary hyperparathyroidism (Low Ca, high phosp). Then, hyperparathyroidism continues post transplant (high calcium, high PTH levels)
Term
Treatment of tertiary hyperparathyroidism?
Definition
parathyroidectomy
Term
Likely cause of graft tenderness, fever, malaise, oliguria post transplant?
Definition
Acute cellular rejection (typically 3 months post transplant)
Term
Indications for liver transplant
Definition
Decompensated cirrhosis or intractable portal HTN
Term
Indications for transplant in patients with HCC?
Definition
1. single lesion < 5cm
2. 1-3 lesions, each less than 3cm diameter
3. No macrovascular invasion, no extrahepatic spread
Term
Components of MELD score?
Definition
INR, Total bilirubin, Creatinine levels
Term
Liver segment utlized for a living related donor to an adult?
Definition
Right lobe
Term
Liver segment utlized for a living related donor to a child?
Definition
Left lateral segment
Term
Why should patients with persistent transfusion requirement post-op from liver transplant go back to OR for hematoms evacuation?
Definition
Clot burden promotes fibrinolysis, causing persistent oozing (usually no frank source of bleeding identified)
Term
Treatment of hepatic artery thrombosis?
Definition
retransplantation
Term
Biliary leak, complete dehiscence of the CBD anastamosis should prompt concern for?
Definition
Hepatic artery thrombosis
Term
Indications for pancreatic transplant?
Definition
Patients with diabetic nephropathy who will also need kidney transplant (and therefore hypERglycemia provoking immunosupression) AND labile diabetics who've had multiple episodes of life threatening hypoglycemia
Term
Placement of transplanted kidney within the recipient abdomen?
Definition
Iliac fossa
Term
Which rejection occurs first in a pancreatic transplant, exocrine or endocrine?
Definition
Exocrine PRECEDES endocrine rejection (so hypERglcyemia indicates late rejection)
Term
Location of pancreatic islet cell transplantation?
Definition
Liver!
Term
Indications for small bowel transplant?
Definition
Short gut syndrome who are TPN dependent and have lost TPN access sites or developed complications of TPN
Term
Why are small bowel transplants so immunogenic?
Definition
Enterocytes express high levels of MHC class II, and the small bowel contains a large amount of lymphoid tissue
Term
Transplant complication more common in small bowel transplants than other transplants?
Definition
graft versus host disease
Term
Structures transplanted for small bowel transplant?
Definition
Entire small bowel and right colon, with SMA origin and origin of portal vein

(reconstruction always includes formation of stoma)
Term
Indications for heart transplant?
Definition
Idiopathic dilated cardiomyopathy and ischemic heart disease
Term
Most common indication for lung transplant?
Definition
COPD (accounts for 45%)
Term
Transplant of which organ has the lowest 5 years survival?
Definition
Lung
Term
Organ transplants where HLA matching not needed?
Definition
Liver, heart (unless high PRA), lung
Term
Primary cause of late mortality and morbidity after lung transplant?
Definition
Bronchiolitis obliterans (sudden and persistent drop in FEV1. acute rejection most importatnt risk factor for development)
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