Fiser Chapter 12 TRANSPLANTATION Flashcards Preview

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Flashcards in Fiser Chapter 12 TRANSPLANTATION Deck (73)
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1

Mycophenolate (MMF, CellCept)
- MOA
- Side effects
- Use
- Drug with similar action

- Inhibits de novo purine synthesis, which inhibits growth of T cells
- Side effects: myelosuppression, need to keep WBC > 3
- Used as maintenance therapy to prevent rejection
- Azathioprine (Imuran) has similar action

2

Mild rejection tx

pulse steroids

3

Biliary system (ducts, etc.) depends on _____ artery blood supply.

hepatic

4

1) What kind of biliary anastomosis is performed in adults during liver TXP?
2) What kind of biliary anastomosis is performed in children during liver TXP?

1) duct-to-duct
2) hepaticojejunostomy

5

ABO Blood compatibility

generally required for all transplants (except liver)

6

Disease most likely to recur in new liver allograft?

Hepatitis C; reinfects essentially all grafts

7

Is ____ a contraindication for liver TXP?
1) hepatocellular CA
2) portal vein thrombosis

1) if no vascular invasion or mets cans till consider TXP
2) not a contraindication to liver TXP

8

Can you use kidney with...
a) UTI?
b) acute increase in Cr (1.0-3.0)

a) yes, can still use kidney
b) yes, can still use kidney

9

Cross-match

detects preformed recipient antibodies to the donor organ by mixing recipient serum with donor lymphocytes --> if these antibodies are present, it is termed a positive cross-match and hyperacute rejection would be likely to occur with TXP

10

Liver TXP complications:
Late hepatic artery thrombosis
- sequelae

results in biliary strictures and abscesses (NOT fulminant hepatic failure)

11

- 2nd most common malignancy following transplant
- related virus
- treatment

- Post-transplant lymphoproliferative disorder (PTLD)
- Epstein-Barr virus related
- Tx: withdrawal of immunosuppression; may need chemo and XRT for aggressive tumor

12

Acute kidney rejection:
- timing
- pathology

- Timing: usually occurs in first 6 months
- Pathology: tubulitis (vasculitis with more severe form)

13

Kidney TXP complications:
Renal artery stenosis
- Dx
- Tx

- diagnose with ultrasound
- Tx: PTA with stent

14

Sirolimus (Rapamycin)
- MOA
- Use

- Binds FK-binding protein like FK-506 but inhibits mammalian target of rapamycin (mTOR); result is inhibition of T and B cell response to IL-2
- Used as maintenance therapy

15

Living kidney donors
1) most common complications?
2) most common cause of death?
3) what happens to remaining kidney?

1) wound infection (1%)
2) fatal PE
3) remaining kidney hypertrophies

16

MELD Score
1) components
2) use
3) what MELD score predicts usefulness

1) Creatinine, INR, bilirubin
2) Predicts if patient with cirrhosis will benefit more from liver TXP than from medical therapy
3) MELD > 15 benefits from liver TXP

17

Zenapax (daclizumab)
- MOA
- Use

- human monoclonal antibody against IL-2 receptors; not cytolytic
- Used for induction and acute rejection episodes

18

Cyclosporine (CSA)
- MOA
- Side effects
- Use
- Metabolism

- binds cyclophilin protein and inhibits genes for cytokine synthesis (IL-2, IL-4, etc.)
- Side effects: nephrotoxicity, hepatotoxicity, tremors, seizures, hemolytic-uremic syndrome
- Used for maintenance therapy
- need to keep trough 200-300
- Hepatic metabolism and biliary excretion (reabsorbed in the gut, get entero-hepatic recirculation)

19

#1 complication with liver TXP and the treatment

- bile leak
- Tx: place drain, then ERCP with stent across leak

20

Liver TXP complications:
Primary nonfunction
1) clinical/lab signs in first 24 hrs
2) clinical signs after 96 hrs
3) Tx

1) 1st 24 hrs: total bilirubin > 10, bile output , 20 cc/12h, elevated PT and PTT
2) after 96 hrs: mental status changes, rising LFTs, renal failure, repiratory failure
3) Tx: usually requires re-transplantation

21

Kidney TXP complications:
1) Usual cause of post-op oliguria and pathology
2) Usual cause of post-op diuresis
3) New proteinuria
4) Postop diabetes

1) usually due to ATN (pathology shows hydrophobic changes)
2) usually due to urea and glucose
3) suggestive of renal vein thrombosis
4) side effect of CSA, FK, steroids

22

Anti-thymocyte globulin (ATG)
- MOA
- Use
- Side-effects

- Equine (ATGAM) or rabbit (Thymoglobulin) polyclonal antibodies against T cell antigens (CD2, CD3, CD4); is cytolytic (complement dependent)
- Used for induction and acute rejection episodes
- Need to keep WBC > 3
- Side effects: cytokine release syndrome (fever, chills, pulmonary edema, shock); give steroids before giving drug to try and prevent this

23

5-year graft survival overall (kidneys)

70% (65% cadaveric, 75% living donors)

24

Pancreas TXP complications:
Most common is...

venous thrombosis; hard to treat

25

Persistent pulm HTN after heart TXP:
- prognostic implications
- Tx

- associated with early mortality after heart TXP
- inhaled nitric oxide, ECMO if severe

26

Chronic liver rejection
- pathology/presentation

- unusual after liver TXP
- disappearing bile ducts (antibody and cellular attacks on bile ducts)
- gradually get bile duct obstruction with increase in alkaline phosphatase, portal fibrosis

27

Kidney TXP complications:
Two most common viral infections and their respective treatments

1) CMV - Tx: ganciclovir
2) HSV - Tx: acyclovir

28

Two primary causes of mortality with kidney TXP?

stroke and MI

29

Liver TXP complications:
Abscesses- most common cause

late (chronic) hepatic artery thrombosis

30

#1 cause of early mortality after lung TXP and treatment

- reperfusion injury
- Tx: similar to ARDS