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Oncology / Organ Transplant > Transplant > Flashcards

Transplant Flashcards

0
Q

CI to donating organs

A 
70 CHIMPS
70+ years old
CKD
HIV+, Hep B SA+, Severe HTN
IVDA (current user)
Metastatic Malignancy (potential)
Prolonged warm ischemia
Sepsis (untreated, bacterial)
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1
Q

CI to receiving organs

A 
COUSINS or COPS SIN
Cancer/Malignancy
Obesity (BMI above 35)
Uncontrolled Psych Disorder
Social Support Absent
Infection (uncontrolled)
Noncompliance 
Substance Abuse
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2
Q

List induction agents

A

Basiliximab
ATGAM (equine)/ATG (rabbit)
Methylprednisolone IVPB
Mycophenolate (MMF)

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3
Q

Basiliximab MOA

A

Blocks IL-2 receptor on ACTIVATED T-Lymphocytes

Signal 3 blocker

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4
Q

Dosing for basiliximab

A

20mg IVPB on

POD0 and POD4

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5
Q

Basiliximab ADEs

A
  • Fewer and less than polyclonal antibodies

- No cytokine release syndrome

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6
Q

Cytokine Release Syndrome

A

Fever, chills, malaise
ADE of ATG

-Can minimize CRS by premedicating with:
Methylprednisolone, APAP, and diphenhydramine

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7
Q

ATG ADEs

A

Cytokine Release Syndrome
Leukopenia, Thrombocytopenia
Skin rash, serum sickness

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8
Q

Monitoring for polyclonal antibodies

A

ATG/ATGAM:
CBC with diff and vitals during admin
Everybody Appreciates Toilet Paper

Efficacy - ALC (lymphs,auto% x WBC)
Less than 50 - Hold
50-100 decrease dose by 1/2

Toxicity - Platelets
Less than 50,000 - Hold
50k-100k - decrease dose by 1/2

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9
Q

A transplant of tissue from one to oneself

A

Autograft

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10
Q

A transplant from a genetically non-identical member of the same species

A

Allograft

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11
Q

Organs or tissues are transplanted from a donor to a genetically identical recipient (identical twin)

A

Isograft (Syngenic transplant)

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12
Q

A transplant of organs or tissues from one species to another

A

Xenograft (Xenogenic transplant)

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13
Q

Organization that writes all the rules for transplants (governing recovery, matching, distribution, translation, data collection, and waiting list)

A

Organ Procurement and Transplantation Network (OPTN)

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14
Q

Non-profit that carries out regulations regarding transplants

A

United Network for Organ Sharing (UNOS)

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15
Q

OPO for Arkansas

A

Arkansas Regional Organ Recovery Agency (ARORA)

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16
Q

Order of writing to governing organ transplants in Arkansas

A

OPTN - write regulations
UNOS - carries out regulations and monitor OPOs
ARORA - training, management, community involvement

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17
Q

Types of solid organ transplants

A 
Kidney
Liver
Pancreas
Heart - deceased
Small Bowel
Lungs - deceased
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18
Q

A chain of donors created to swap organs for a loved one

Usually all at the same time

A

Paired donation

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19
Q

Donation just to be nice

A

Altruistic donor

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20
Q

Common causes of kidney organ failure

A

Diabetic nephropathy
Hypertension
Glomerulonephritis
Polycystic Kidney Disease

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21
Q

Common causes of liver organ failure

A 
Alcoholic Liver Disease
Hepatitis B & C
Hepatic Tumors
Metabolic Disorders
Cryptogenic cirrhosis
Polycystic Liver Disease
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22
Q

Common causes of pancreas organ failure

A

Diabetes

Pancreatic tumor

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23
Q

Common causes of heart organ failure

A

Cardiomyopathy
Coronary Artery Disease
Congenital Disease

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24
Q

Common causes of small bowel organ failure

A

Small Bowel Syndrome

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25
Q

Common causes of lungs organ failure

A

Cystic Fibrosis
Idiopathic Pulmonary Fibrosis
Primary Pulmonary Hypertension
COPD, emphysema

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26
Q

The organ transplant waiting list is ____ compared to the number of donors

A

3-5 times higher

27
Q

Allograft rejection depends on:

A

Antigen recognition
Activation of T-Cells
Proliferation of T-Cells

28
Q

Complement mediated and occurs immediately

upon revascularization of the transplanted organ

A

Hyperacute Reaction

29
Q

Caused by infiltration of the allograft by T cells
which causes inflammatory and cytotoxic effects on
the graft

A

Acute Rejection

-relatively easy to treat

30
Q

Caused by antibodies directed against the vascular

endothelium of the transplanted organ

A

Vascular Rejection (Humoral Rejection)
-more difficult to treat than cellular rejection, but is
usually responsive

31
Q

Caused by complex interactions of cytokines, cellular

interactions, CD4+ and CD8+ T cells, and B cells

A

Chronic Rejection

-difficult to treat and will ultimately result in graft loss

32
Q

Rejection Process

A

-Recognition of donor Major Histocompatibility
Complex (MHC) differences by the recipients
immune system

  • Recruitment of activated lymphocytes
  • Initiation of immune effector process
  • Graft destruction
33
Q

Occurs when preformed donor-specific antibodies are present in the recipient’s blood at the time of transplant.
Recipient IgG antibodies bind to donor vascular endothelium

Tissue damage occurs through
1. antibody-dependent cytotoxicity
2. complement cascade

Ischemic damage to microvasculature rapidly produces tissue necrosis

A

Hyper acute rejection

34
Q

Metabolic disorders cause what type of organ failure?

A

Liver

35
Q

HTN causes what type of organ failure?

A

Kidney

36
Q

Diabetes causes what type of organ failure?

A

Pancreas

37
Q

Chronic rejection is caused by

A

Caused by complex interactions of cytokines, cellular interactions, CD4+ and CD8+ T cells, and B cells

38
Q

Prevention of hyperacute rejection

A
  1. ABO Blood Testing x2
  2. HLA (MHC) Matching (Kidney only)
  3. Final Crossmatching
  4. Panel Reactive AntiB (Kidney only)
39
Q

Type A blood is compatible with…
B…
AB…
O…

A

A and O
B and O
A, B, AB, and O
O only

40
Q

How does final cross matching work

A

Donor and recipient blood are mixed.
If anticoag occurs, crossmatch is positive.
-means hyperacute rejection would occur
-transplant cancelled

41
Q

How does PRA work

A 
Panel Reactive AntiB represents the percentage of population that the recipients blood has antiBs to and will react with.
Pts develop anti-HLA antiBs through:
1. Pregnancy
2. Other transplants
3. Blood Transfusions
42
Q

High PRA protocol

A 
If current PRA is 30+ or history of 50+,
Induce with ATG 2mg/kg d0, d1, and d3
Alternatives:
 -Rituximab
 -IVIG
 -Immunoadsorption columns
 -Bortezomib
43
Q

Tx of acute rejection

A

Corticosteroids
-Methylprednisolone 500 IV x3 days
-followed by PO prednisone taper
Stops immune mediated attack of tissues

Second line ATG/ATGAM for steroid resistant

44
Q

Tx of chronic rejection

A

None

Not reversible

45
Q

Second line tx for acute rejection

A

Polyclonal antiBs (ATG or ATGAM)
for steroid resistant rejection
Premedicate with CCS, Tylenol and Benadryl

46
Q

Tx for vascular (humoral) rejection

A 
Plasmapheresis with IVIG
Plasmapheresis alone
High-dose IVPB Methylprednisolone
Antithymocyte globulin
Cyclophosphamide
Rituximab
Bortezomib
47
Q

Four Types of Rejection

A 
Hyperacute Rejection 
  - PREFORMED antibodies
  - no tx, must prev
Acute Cellular Rejection
  - easy tx
Vascular/Humoral Rejection
Chronic Rejection
  - slow prog, no tx
48
Q

Universal recipient

Universal donor

A

Type AB

Type O

49
Q

Which HLAs do we look at for kidney transplants?

A

HLA-A
HLA-B
HLA-DR

50
Q

Ideal HLA matching

A

Zero mismatches

51
Q

How many HLA matches do you need to transplant?

A

A two antigen match is enough to transplant. Six would be best (zero mismatches)

52
Q

How many antigens does each HLA have?

A

Each HLA-A has
2 antigens per donor and recipient
Each HLA-B has 2 each
Each HLA-DR has 2 each

53
Q

Order or prevention steps for hyperacute rejection

A
  1. ABO Typing x2
  2. HLA (MHC) matching in kidneys
    Then, right before transplant…
  3. Final Crossmatch
  4. Panel Reactive Antibody (PRA) x2
54
Q

HLA matching occurs only in

A

Kidney transplants only

55
Q

What is the big test to prevent hyperacute rejection?

A

Final Crossmatch
Between T and B cells
Expressed as + or -
If coagulase, then + and rejection

56
Q

What does a PRA of 40 tell you?

A

A pt has antibodies to 40% of tissue types expressed in a given population (donor pool).
It also tells you that the pt has a 40% chance of rejection.

57
Q

How does PRA go up?

A

Previous transplants
Blood transfusions
Pregnancy
(PRA can fluctuate over time)

58
Q

Most common form of rejection

A

Acute rejection

T-lymphocytes attack the allograft

59
Q

Role of T helper cells

A

Recruit other immune cells

CD-8 and B cells

60
Q

Second line tx of acute rejection

A

ATG or ATGAM for steroid resistance

-big guns that actually kills T cells instead of inhibiting them

61
Q

Acute Rejection vs. Drug Toxicity

A

Acute Rejection

  • within 4 weeks
  • fever
  • graft swelling/pain
  • rapid rise in SrCr
  • Normal CSA or TAC conc.
  • Decreased urine output

Drug Toxicity
-good urine output, afebrile,elevated drug conc, greater than 6 weeks

62
Q

Rejection driven by MHC II

A

Humoral or Vascular or Antibody Mediated Rejection

63
Q

Tx for humoral/vascular/antibody mediated rejection

A 
Plasmapheresis w IVIG
Methylprednisolone
Cyclophosphamide 
Rituximab
Bortezomib
64
Q

Other names for vascular rejection

A

Humoral Rejection

Antibody Mediated Rejection

65
Q

Antibody Mediated Rejection usually occurs… (time)

A

Within 3 months

Oncology / Organ Transplant (12 decks)

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