Term
| most important antigen overall for txp matching? |
|
Definition
HLA-DR
(human leukocyte antigen, = MHC in humans)
*A, B, and DR are 3 most important* |
|
|
Term
| Txp that does not need ABO match? |
|
Definition
|
|
Term
|
Definition
|
|
Term
Function of cross match?
-how is it performed? |
|
Definition
detect preformed recipient anti-bodies to donor organ
-mixes recipient serum w/donor lymphocytes |
|
|
Term
|
Definition
>50% = contraindication to Txp
-risk of hyper-acute rejection
(gives % of cells that the recipient serum reacts with) |
|
|
Term
| what factors increase PRA? |
|
Definition
transfusion
preg
hx txp
AI DZ |
|
|
Term
|
Definition
skin cancer
(squamous cell = #1) |
|
|
Term
PTLD
-def
-epidemiology
-pphys |
|
Definition
-post-txp lympho-proliferative disorder
-2nd MC malig after txp (skin = 1st)
-EBV related |
|
|
Term
|
Definition
-SBO, mass, adenopathy
-RF = cytolytic drugs
-Tx = withdrawal of imm-supp, ritux, +/- chemo/xrt |
|
|
Term
Mycophenolate
-mech
-SE
-Use |
|
Definition
-inhib purine synth = inhib T cell growth
-SE = GI intoleratnce #1, myelosupp
-Maintenance therapy.
*keep WBC>3*
(AKA cellcept) |
|
|
Term
|
Definition
inhibit INFLAMM cells
inhibit CYTOKINE synthesis (IL-2 most imp) |
|
|
Term
|
Definition
| -bind cyclophilin protein = inhib calcineurin = dec cytokine synth |
|
|
Term
|
Definition
nephro, hepatotox
tremors
seizures
hemolytic-uremic syndrome |
|
|
Term
|
Definition
hepatic metab
biliary excretion w/re-ab in gut |
|
|
Term
|
Definition
prograf, tacrolimus
-FK binding protein inhibs cytokine synth
-more potent that cyclosporin |
|
|
Term
|
Definition
|
|
Term
|
Definition
-Rapamycin
-FK protein binding agent that inhibs mTOR-->inhib B/T cell response to IL-2 |
|
|
Term
| advantage of sirolimus vs cyclosoprin/prograf? |
|
Definition
Sirolimus (rapamycin) is not nephrotoixic
SE = interstitial lung dz |
|
|
Term
Anti-thymocyte globulin
-mech
-use
-se |
|
Definition
-cytolytic (complement dependent) polyclonal Ab vs T cell antigens (CD2/3/4)
-induction and acute rejection episodes
-SE = cytokine release synrdrome |
|
|
Term
| prevention of cytokine release syndrome |
|
Definition
steroids and benadryl before use
-p/w fevers, chils, pulm edema, shock |
|
|
Term
|
Definition
-hyperacute
-Accelerated (< 1 wk)
-acute (<1 mo)
-chronic (mo to years) |
|
|
Term
Hyperacute rejection
-pphys
-MCC
-tx |
|
Definition
-preformed ab (type 2 hypersense) activate the complement cascade -->vessel thrombosis
*min to hours*
-MCC ABO incompat
-emergent re-txp/removal |
|
|
Term
Accelerated rejection
-pphys |
|
Definition
< 1 week
-sensitized T cells to donor HLA |
|
|
Term
|
Definition
*1wk to 1 mo*
-T cells to HLA antigens (cell mediated immune system) |
|
|
Term
|
Definition
-mo to years
-type 4 hypersense to sensitized T cells (but Ab formation also plays a role)
-->graft fibrosis |
|
|
Term
|
Definition
increased + of acute rejection episodes
-MCC HLA incompat |
|
|
Term
| Common issues with kidney txp that are NOT contraindications to txp |
|
Definition
UTI
Acute inc in creatinine
HIV |
|
|
Term
| vessel targets for kidney txp |
|
Definition
|
|
Term
|
Definition
urine leaks
-drain and stent |
|
|
Term
|
Definition
|
|
Term
Kidney txp C: lymphocele
-timing
-tx |
|
Definition
3 weeks post txp (is MCC external ureter compression)
-perc drain = first
-2nd line = peritoneal window (fluid is reab in peritoneum) |
|
|
Term
Kidney txp Cx: post op oliguria
-MCC |
|
Definition
|
|
Term
Kidney txp Cx: Post op diuresis
-cause |
|
Definition
|
|
Term
sp renal txp with new proteinuria
-mcc |
|
Definition
|
|
Term
renal txp
-viral infections MC/tx |
|
Definition
CMV
-ganciclovir
HSV
-acyclovir |
|
|
Term
kidney txp
acute rejection histo-path |
|
Definition
tubulitis
-vasculitis with severe forms |
|
|
Term
|
Definition
1. US / bx
2. empiric decrease in Cyclosporin or FK (nephrotoxic agents)
3. Empiric pulse steroids
4. Empiric fluid/lasix challenge |
|
|
Term
| Graft survival rate @ kidney txp |
|
Definition
70% overall
-cadaveric = 65%
-living donor = 75% |
|
|
Term
mortality benefit of kidney txp
mcc mortality |
|
Definition
-extends life by 15 years
-MCC mort = MI |
|
|
Term
living kidney donors
-MCCx
-MC death |
|
Definition
MCCx = wound infxn (1%)
MC death = fatal PE |
|
|
Term
storage time for
kidney vs liver vs heart/lung |
|
Definition
Kidney = 48 hrs
Liver = 24 hrs
heart/lung = 6 hrs |
|
|
Term
| Contraindications to liver txp |
|
Definition
Active EtOH/drug abuse
Active UC |
|
|
Term
| MELD cutoff for liver txp benefit? |
|
Definition
| > 15 = benefits of TXP outweigh surgical risks |
|
|
Term
| Urgent TXP liver indications |
|
Definition
|
|
Term
| Meds for pts with hep B after txp? |
|
Definition
HepB IG
Lamivudine (protease inhibitor) |
|
|
Term
Liver txp
-Hep B vs C graft infection rates? |
|
Definition
Heb B = 20% w/meds
Hep C = infects nearly all new livers |
|
|
Term
EtOH -->cirrhosis -->txp
-recidivism rate? |
|
Definition
|
|
Term
liver txp
-macrosteatosis significance? |
|
Definition
extra-cellular fat globules in liver
= RF for primary non function |
|
|
Term
| Preferred liver txp anastomosis |
|
Definition
duct to duct
*hepaticoJ in kids* |
|
|
Term
Liver txp Cx
-MC overall
-MC early vascular |
|
Definition
-bile leak (drain + ERCP/stent)
-early hepatic artery thrombosis (fulm hepatic failure) |
|
|
Term
| MCC abscess after liver txp |
|
Definition
| late (chronic) hepatic artery thrombosis |
|
|
Term
| pres w/early vs late hepatic artery thrombosis |
|
Definition
early = fulm hepatic failure
late = biliary strictures, abscess formation |
|
|
Term
| tx portal vein thrombosis after liver txp |
|
Definition
| if early..re-op thrombectomy and revision of anastomosis |
|
|
Term
Liver txp acute rejection
-pres
pphys/timing |
|
Definition
-fever/J, dec bile output
-path: portal triad lymphocytosis, endotheliitis, bile duct injury
-1 to 2 months |
|
|
Term
| chronic liver txp rejection |
|
Definition
unusual..
-ab/cellular attack on bile ducts |
|
|
Term
liver txp
-re-transplantation rate
-5YSR |
|
Definition
|
|
Term
Living donor txp
-adult vs child |
|
Definition
-right lobe in adults
-left lateral in kids (seg 2+3) |
|
|
Term
|
Definition
|
|
Term
Panc txp
-art supply needed |
|
Definition
donor celiac and SMA
donor portal for drainage |
|
|
Term
Panc txp
-how is panc duct drained? |
|
Definition
enteric drainage
-take 2nd portion of duod w/panc and vater etc
-then anast donor duod to recip bowel |
|
|
Term
| benefits of kidney/panc txp |
|
Definition
-stabilizes retinopathy
-dec neuropathy (inc conduction velocity)
-dec autonomic dysfunction
-dec orthostatic hypoTN
*DOES NOT REVERSE VASCULAR DZ* |
|
|
Term
|
Definition
|
|
Term
Heart txp
-associated RF for early mortality |
|
Definition
persistent pulm HTN
-a/w early mortality |
|
|
Term
Heart txp
-acute rejection findings |
|
Definition
1. perivascular lymphocytic infiltrate
2. myocyte inflamm and necrosis |
|
|
Term
Heart txp
MCC early vs late mortality |
|
Definition
early = infection
late = chronic allograft vasculopathy = progressive diffuse coronary atherosclerosis
*also MCC death overall* |
|
|
Term
| MCC death overall @ heart txp |
|
Definition
chronic allograft vasculopathy
= progressive diffuse coronary athero
*occurs late* |
|
|
Term
| median heart Txp survivial |
|
Definition
|
|
Term
Lung txp
-MCC early mortality |
|
Definition
repurfusion injury
-pphys similar to ARDS |
|
|
Term
| Indication for double lung txp |
|
Definition
|
|
Term
| Exclusion criteria for using lung for txp |
|
Definition
Aspiration
Large contusion
Purulent sputum
PO2 < 350 on 100% FiO2 + PEEP 5 |
|
|
Term
Lung txp
-acute vs chronic rejection findings |
|
Definition
acute = perivascular lymphocytosis
chronic = bronchiolitis obliterans |
|
|
Term
| MCC early vs late vs overall death after lung Txp |
|
Definition
early = repurfision injury (ARDS like)
late = chronic rejection (bronchiolitis obliterans)
overall = chronic reject |
|
|
Term
| median survival after lung txp |
|
Definition
|
|
Term
| reason for bactrim prophy after txp? |
|
Definition
| Pneumocystis Jiroveci pneumonia |
|
|
Term
| opportunistic infections after tpx |
|
Definition
viral (CMV, HSV, VZV)
protozoan (PJP)
fungal (aspergillus, candida, cryptococcus |
|
|
Term
| hierarchy for permission for organ donation from next of kin |
|
Definition
1 = spouse
2 = adult child
3 = either parent
4 = adult sibling
5 = guardian
6 = any other person authorized |
|
|
Term
post transplant infection
-highest vs lowest risk period |
|
Definition
1st month = highest
>6 mo = lowest
*bacteria MC @ 1st month*
*CMV MC @ month 2-6* |
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