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Flashcards

Transplantation - Absite

Jennifer Huber Surgery - Absite Review Inglês 102 flashcards

Flashcards do conjunto (102)

  1. 1Most important recipient/donor matching human leukocyte antigensHLA-A, HLA-B, and HLA-DR
    (DR is more important overall)
  2. 2Universal Donor Blood TypeType O
  3. 3Universal Recipient Blood TypeType AB
  4. 4Cross-matchingdetects preformed recipient antibodies to the donor organ by mixing recipient serum with donor lymphocytes
    if positive, expect hyperacute rejection
  5. 5Panel Reactive Antibodydetects preformed recipient antibodie using a panel of HLA typing cells
    if high (>50%) TXP is contraindicated
  6. 6Management for mild rejectionpulse steroids
  7. 7management of severe rejectionsteroid and antibody therapy
    (ATG or thymoglobulin)
  8. 8#1 malignancy following any transplantskin cancer, squamous cell
  9. 9Post-transplant lympho-proliferative disorder & treatment2nd MC malignancy following transplant
    EBV related
    causes SBO, mass, adenopathy
    Tx: w/draw immunosuppression, rituximab, may need chemo and XRT
  10. 10Rituximab MoAanti-CD20, decreased B cells
  11. 11Risks associated with long term immunosuppressioncancer, cardiovascular disease, infection, osteopenia
  12. 12Mycophenolate MoA side effects usesinhibits de novo purine synthesis, inhibits growth of T cells
    s/e: GI intolerance, myelosuppression
    keep WBC >3
    maintenance therapy to prevent rejection
  13. 13Steroids with transplants MoA When to use itprednisone, Solu-Medrol
    inhibit inflammatory cells and genes for cytokine synthesis (IL-2 most important)
    used for induction after TXP, maintenance and acute rejection episodes
  14. 14Cyclosporin MoA Usesbinds cyclophilin protein, inhibits calcineurin decreasing cytokine synthesis (IL-2, IL-4)
    used for maintenance therapy after TXP
  15. 15Cyclosporin side effectsNephrotoxicity, Hepatotoxicity, Tremor, Seizures, HUS
  16. 16Trough to keep cyclosporin at200-300
  17. 17How is Cyclosporin Metabolized and Excreted?hepatic metabolism
    biliary excretion
  18. 18FK-506 MoA Side effects Patient PopulationPrograf, Tacrolimus
    binds FK-binding protein
    s/e: nephrotoxicity, GI sxs, mood changes, diabetes
    Kidney transplants
  19. 19Target Trough for FK-50610-15
  20. 20Sirolimus MoAAKA: Rapamycin
    binds FK-binding protein and inhibits mammalian target of rapamycin (mTOR)
    inhibits T & B cell response to IL-2
  21. 21How is Sirolimus different from CYclosporin and Tacrolimus?It is not nephrotoxic
  22. 22Side effect of SirolimusInterstitial Lung Disease
  23. 23Anti-thymocyte Glubulin (ATG) MoA and when to use itEquine or Rabbit polyclonal antibodies against T cell antigens
    (CD2, CD3, CD4)
    For induction and acute rejection episodes
  24. 24Side Effects of Anti-thymocyte globulincytokine release syndrome (fever, chills, pulmonary edema, shock)
  25. 25What is Hyperacute Rejection?within minutes to hours
    from preformed antibodies
    Type 2 hypersensitivity
    activates complement cascade and thrombosis of vessels occurs
  26. 26MCC of hyperacute rejectionABO incompatibility
  27. 27Treatment for Hyperacute RejectionEmergent Re-transplant
  28. 28What is Accelerated Rejection?Occurs in <1week
    caused by sensitized T cells to donor HLA
  29. 29Treatment for Accelerated RejectionIncrease immunosuppression, pulse steroids, and possibly antibody treatment
  30. 30What is acute rejection?occurs in 1week to 1 month
    caused by T cells (cell-mediated) to HLA antigens
  31. 31Treatment of acute rejectionincrease immunosuppression, pulse steroids, and possibly antibody treatment
  32. 32What is chronic rejection?months to years
    partially type 4 hypersensitivity
    sensitized T cells, antibody formation
    leads to graft fibrosis
  33. 33MCC of chronic rejectionHLA incompatibility
  34. 34Treatment of chronic rejectionincreased immunosuppression, no really effective treatment; re-transplant
  35. 35How long can a kidney be stored?48 hours
  36. 36Testing required because kidney transplantABO type compatibility and cross match
  37. 37MCC of mortality s/p kidney transplantstroke or MI
  38. 38MC complication after kidney transplant and its treatmenturine leaks
    drain and stent
  39. 39Complication after kidney transplant: RAS how to diagnose and treatuse ultrasound (flow accel @ level of stenosis)
    Tx: PTA w/ stent
  40. 40MCC of external ureter compression s/p kidney transplantlymphocele
  41. 41Postop Oliguria s/p Kidney transplant main cause and pathologyATN
    path: hydrophobic changes, dilation and loss of tubules
  42. 42Time frame in which lymphoceles present themselves after kidney transplant3 weeks
  43. 43Treatment of lymphoceles1st: percutaneous drainage
    if fails, peritoneal window - hole in peritoneum for lymphatic fluid to drain into
  44. 44Cause of post renal transplant diuresisurea and glucose
  45. 45s/p renal transplant, new proteinuria suggests:renal vein thrombosis
  46. 46Possible cause of post renal transplant diabetesside effect from cyclosporin (CSA), FK, steroids
  47. 47Treatment for CMV s/p transplantGanciclovir
  48. 48Treatment for HSV s/p transplantAcyclovir
  49. 49Pathology in acute rejection s/p kidney transplanttubulitis (vasculitis in more severe form)
  50. 50Kidney Rejection WorkupUS with duplex, Biopsy
    empiric decrease in CSA or FK,
    give pulse steroids, fluids/lasix
  51. 515-year kidney transplant survival cadaveric vs living donorsCadaveric - 65%
    Living Donor - 75%
  52. 52MC complication in living kidney donorswound infection
  53. 53MC cause of death in living kidney donorsPulmonary Embolism
  54. 54How long can a liver be stored for?24hours
  55. 55Contraindications for liver transplantCurrent ETOH abuse
    Acute Ulcerative Colitis
  56. 56MCC liver transplant in adultsChronic Hep C
  57. 57MELD ScoreUses Cr, INR, and bilirubin to predict if patients with cirrhosis with benefit from liver TXP
    MELD >15 benefits from TXP
  58. 58Criteria for urgent transplantfulminant hepatic failure
    (encephalopathy - stupor, coma)
  59. 59When can you do a liver transplant in someone with hepatocellular carcinoma?if NO vascular invasion or mets
  60. 60Liver Transplantation Macrosteatosisextracellular fat globule in liver allograft
    RF for primary non-funtion
  61. 61Liver transplant anastomosis in adults vs kidsAdult: Duct-to-duct
    Kids: Hepaticojejunostomy
  62. 62Drains place s/p Liver TXPRight subhepatic, right and left subdiaphragmatic drains
  63. 63MC arterial anomaly associated with liver transplantsRight hepatic coming off SMA
  64. 64#1 Complication associated with Liver Transplants and treatmentBile Leak
    Tx: place drain, then ERCP with stent across leak
  65. 65What is primary nonfunction after liver transplant?1st 24hrs - total bili >10, bile output <20cc/12hr, elevated PT amd PTT
    After 96hrs: mental status change, increased LFTs, renal failure, resp failure
    Requires retransplantation
  66. 66What to do in a patient who develops hepatic artery stenosis s/p Liver TXPplace stent
  67. 67Early hepatic artery thrombosis what happens?MC early vascular complication of liver TXP
    increased LFTs, decreased bile output
    fulminant hepatic failure
  68. 68Treatment for early hepatic artery thrombosis s/p liver TXPemergent re-transplantation for ensuing fulminant hepatic failure
    (can try to stent or revise anastomosis)
  69. 69Late Hepatic Artery Thrombosis s/p Liver Transplantbiliary strictures and abscesses
  70. 70Effects of IVC Stenosis/Thrombosis s/p Liver Transplant & treatmentits a complication
    causes edema, ascites, renal insufficiency
    Tx: Thrombolytics and stents
  71. 71Sxs associated with Portal Vein Thrombosis s/p Liver TXPearly: abdominal pain
    late: UGI bleed, ascites, asx
  72. 72Treatment for portal vein thrombosis s/p liver TXPif early, re-op thrombectomy and revise anstomosis
  73. 73Pathology associated with Acute Rejection w/ Liver Transplantportal triad lymphocytosis, endothelitis (mixed infiltrate), bile duct injury
    will see fever, jaundice and decrease biliary output
  74. 74What do you see in liver transplant chronic rejection?this is unusual
    get disappearing bile ducts
    gradually get bile duct obstruction with increase in alkaline phosphatase, portal fibrosis
  75. 75Retransplantation rate s/p liver transplant20%
  76. 765 year survival rate s/p liver transplant70%
  77. 77Which lobe to take in a living donor for adult liver transplantRight Lobe
  78. 78Which lobe to take in an living donor for child liver TXPLeft Lateral Lobe (segments 2+3)
  79. 79MC indication for pancreas transplantDM with renal failure
  80. 80what vessels do you need for pancreas transplant?donor celiac artery and SMA
    donor portal vein
  81. 81Where do you attach vessels during a pancreas transplant?attach to iliac vessels
  82. 82part of bowel to take from donor during pancreas transplant2nd part of duodenum with ampulla of Vater, perform an anastomosis of donor duodenum to recipient bowel
  83. 83What results point towards a successful pancreas/kidney transplant?stabilization of retinopathy,
    decreased neuropathy, orthostatic HoTN, autonomic dysfxn (gastroparesis),
    increased nerve conduction velocity
  84. 84MC complication s/p pancreas transplantvenous thrombosis
  85. 85How long can you store a heart?6hrs
  86. 86What testing do you need prior to a heart transplant?ABO compatibility and crossmatch
  87. 87Treatment for persistent pulmonary HTN s/p heart TXPinhaled nitric oxide
    ECMO if severe
  88. 88Pathology of acute rejection associated with heart transplantperivascular lymphocytic infiltrate with varying myocyte inflammation and necrosis
  89. 89MCC of early mortality associated with heart transplantinfection
  90. 90MCC of late death and death overall following heart TXPchronic allograft vasculopathy, progressive diffuse coronary atherosclerosis
  91. 91How long can you store Lungs?6hours
  92. 92Life expectancy before Heart or Lung Transplant<1 year
  93. 93#1 cause for early mortality s/p lung transplantreperfusion injury
  94. 94indication for double lung TXPCystic Fibrosis
  95. 95Exclusion criteria for using lungsaspiration, moderate to large contusion, infiltrate, purulent sputum, PO2 <350 on 100% FiO2 and PEEP5
  96. 96Pathology of acute rejection s/p lung transplantperivascular lymphocytosis
  97. 97MCC of late death and death overall following lung transplantchronic rejection, bronchiolitis obliterans
  98. 98Median survival s/p lung transplant5 years
  99. 99Viral Opportunitistic Infections s/p transplantsCMV, HSV, VZV
  100. 100Opportunistic Protozoan Infections s/p transplantationPneumocystis jiroveci pneumonia
    (reason for bactrim ppx)
  101. 101Opportunistic Fungal Infections s/p transplantsAspergillus, Candida, Cryptococcus
  102. 102Hierarchy for Permission for Organ Donation from Next of KinSpouse, Adult son/Daughter, Either Parent, Adult brother/sister, Guardian, any other person authorized to dispose of body

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Surgery - Absite Review FlashCards sobre Transplantation - Absite, criado por Jennifer Huber em 11-06-2018.
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Jennifer Huber
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