transplantation.txt

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Author:
nsmallwood
ID:
125383
Filename:
transplantation.txt
Updated:
2011-12-30 14:31:53
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Description:
transplantation
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  1. HLA class II antigens
    DP DQ DR
  2. HLA types used in kidney allocation
    A, B, DR
  3. most important antigen in donor/recepient matching
    DR
  4. criteria for cadaveric kidney transplant
    • time on list
    • HLA matching
  5. what is the function of crossmatch
    detects recipient preformed antibodies and helps to prevent hyperacute rejection
  6. do not require preop crossmatch
    • liver
    • heart and lung with PRA>10%
    • or specific HLA abs are identified preop
  7. risk factors for high PRA
    • previous transfusions
    • pregnancy
    • preevious txp
    • autoimmune dz
  8. immediate vessel thrombosis in transplanted organ
    hyperacute rejection, retransplant
  9. accelerated rejection caused by
    presensitized recipient T cells causing a secondary immune response
  10. tx accelerated rejection
    increase all immunosuppresion with pulse steroids
  11. only definitive treatment for chronic rejection
    retransplantation
  12. immune response in chronic rejection
    • type IV hypersens
    • T cells also B cells with antibody production
  13. main mechanism of chronic rejection in heart transplant
    chronic allograft vasculopathy
  14. type of rejection which can occur at anytime
    antibiody mediated
  15. dx antibody mediated rejection
    • HLA Ab levels
    • C4d tissue staining of biopys
  16. tx options for antibody mediated rejection
    • increase immunosuppression
    • IVIG
    • plasmapharesis
    • rituximab
    • splenectomy
  17. side effects of cyclosporine
    • nehprotoxicit
    • hepatotoxicity
    • HUS
    • tremors
    • szs
  18. why does a biliary drain decrease cyclosporine levels
    it undergoes enterohepatic recirculation
  19. benefits of sirolimus over tacrolimus
    not nephrotoxic
  20. difference in action of sirolimus over tacrolimus
    sirolimus also inhibits mTOR wich inhibits the response of immune cells to IL-2
  21. moa of imuran
    inhibits de novo purine synthesis
  22. action and use of daclizumab and basilximab
    • monoclonal abs to IL-2 receptor abs
    • used in induction and decreases acute rejection
  23. moa and use of ATG/thymoglobulin
    • polyclonals abs to CD2,3,4,8 on t cells
    • induction and refractory acute rejection
  24. side effects of ATG
    • PTLD
    • myelosuppression
    • cytokine release syndrome
  25. 2nd mc malignancy following transplant
    PTLD
  26. highest risk of PTLS
    children and Heart
  27. mc infxn 2-6 months after transplant
    CMV
  28. highest risk period of infection following transplant
    first month
  29. cmv is transmitted by/through
    donor leukocytes
  30. infections caused by CMV
    • PNA
    • gastritis
    • colitis
    • ophthalmitis
    • mononucleosis
  31. mc manifestation of cmv
    febrile mono
  32. how long can you store a kidney
    48hrs
  33. mcc of post oliguria
    ATN
  34. MCC of post op diuresis
    preop high urea and glucose levels
  35. mcc of new proteinuria
    renal vein thrombosis
  36. mcc of post of diabetes
    csa, FK or steroids
  37. tx of urine leak
    percutaneous drainage and stent
  38. mc complication of kidney TXP
    urine leak
  39. MC time to develop lymphocele
    3 weeks
  40. path of rejection in kidney txp
    tubulitis, vasculitis if severe
  41. mcc of mortality after kidney txp
    MI
  42. mgmt of increase Cr and decrease UO post kidney txp
    • fluid challenge +/- lasix
    • u/s with bx
    • empiric pulse steroids and decrease of CSA or FK
  43. contraindications for living kidne donation
    • cardiovascular dz
    • dm
    • hiv
    • current cocaine
    • hep B or C
    • concurrent Ca or current infection
  44. contraindication for liver txp
    • etoh within 6 mo
    • acute UC
    • severe cardiac or pulm insuf
    • poor compliance
    • active septic infxn
    • CA
  45. best overal predictor of primary nonfunction
    macrosteatosis
  46. liver txp for acute fulminant hepatic failure
    • acetaminophen
    • pH< 7.3 or PT >100 Cr >3.4 and stage III or IV coma

    • all others
    • PT>50 or
    • any 3:
    • age <10 or >40
    • halothane, drug or idiopathic
    • Jaundice 7 days before encepholapthy
    • PT >25
    • bilirubin >17.5
  47. cutoff MELD
    15
  48. MC complication of liver txp
    biliary leak
  49. mc early vascular cxs
    hepatic artery thrombosis
  50. as opposed to early, late hepatic artey thrombosis causes
    biliary strictures and abscesses
  51. tx of IVC thrombosis
    angio with thrombolytics or PTA/stent
  52. mcc of hepatic abscess following txp
    hepatic artery thrombosis
  53. cx acute liver rejection
    • increase wbc
    • increase LFT
    • increase PT
    • need bx
  54. path of acute liver rejection
    • portal vein lymphocytosis
    • endothelitis
    • bile duct injury
  55. path of chronic rejection in liver
    disappearing bile ducts
  56. biggest RF for chronic rejection in liver
    increase acute rejection episodes
  57. tx hepatitis B recepient to prevent infxn of new liver
    HBIG and lamivudine
  58. absolute indication for double lung txp
    cystic fibrosis
  59. mcc of early and late mortality
    • early-reperfusion injury
    • late- bronchiolitis obliterans

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