Surgery Marrow Pg 377-386 (Speciality Surgery)
35 Questions
0 Views

Surgery Marrow Pg 377-386 (Speciality Surgery)

Created by
@PremierMetaphor

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which type of graft is taken from the same person?

  • Xenograft
  • Allograft
  • Isograft
  • Autograft (correct)

    • An allograft is a graft between different species.

    False

    What temperature is maintained in static cold storage for organ preservation?

    4°C

    The US solution is primarily used in _______ cold storage for organ preservation.

    <p>static</p> Signup and view all the answers

    Match the types of donors with their definitions:

    <p>Living donors = Individuals who donate organs while still alive Dead donors = Individuals who provide organs after death</p> Signup and view all the answers

    What is the maximum safe cold ischemia time for a kidney?

    <p>36 hours</p> Signup and view all the answers

    Normothermic machine perfusion helps restore organ function ex-vivo and assists in replenishing depleted ATPs.

    <p>True</p> Signup and view all the answers

    Which type of nephropathy is most common in adults?

    <p>Diabetic nephropathy</p> Signup and view all the answers

    A donor who is fit and at least ______ years old can meet the extended donor criteria.

    <p>60</p> Signup and view all the answers

    Match the organ with its safe maximum cold ischemia time:

    <p>Kidney = 36 hours Liver = 12-18 hours Heart = 3-6 hours Lung = 3-8 hours</p> Signup and view all the answers

    Which of the following is NOT part of the King's College Criteria for treatment in acute liver failure?

    <p>Jaundice with encephalopathy &gt;100 days</p> Signup and view all the answers

    Auxiliary Liver Transplant involves the complete removal of the diseased liver.

    <p>False</p> Signup and view all the answers

    What type of transplant involves liver segments being divided and transplanted to different recipients?

    <p>Split and reduced liver transplant</p> Signup and view all the answers

    The presence of prothrombin time greater than ______ seconds is one of the criteria for acetaminophen-induced acute liver failure.

    <p>100</p> Signup and view all the answers

    Match the type of liver transplant with its description:

    <p>Dead donor = Deceased donor Live donor = Living donor Domino Liver Transplant = Transplant from a patient with a systemic disease Paired Exchange Programme = Transplant pair exchange without direct matches</p> Signup and view all the answers

    What is the most common complication following renal transplantation?

    <p>Renal vein thrombosis</p> Signup and view all the answers

    Hyperacute rejection is commonly seen in liver transplantation.

    <p>False</p> Signup and view all the answers

    Name the scoring system used to assess end-stage liver disease in adults.

    <p>MELD Score</p> Signup and view all the answers

    The most common cause of liver transplantation in adults is __________.

    <p>Cirrhosis</p> Signup and view all the answers

    Match the classifications with their corresponding scores:

    <p>Class A = 5-6 Class B = 7-9 Class C = 10-15 MELD Score = Model for end-stage liver disease</p> Signup and view all the answers

    What is the primary difference in the anastomosis type between kidneys from a live donor and a dead donor?

    <p>End-to-side for dead donor, end-to-end for live donor</p> Signup and view all the answers

    The 5-year graft survival rate is higher for dead donor kidneys than for live donor kidneys.

    <p>False</p> Signup and view all the answers

    What are two possible causes of early graft dysfunction?

    <p>Acute rejection and urinary tract infection</p> Signup and view all the answers

    The donor kidney is placed in the ______ fossa during a renal transplant.

    <p>iliac</p> Signup and view all the answers

    Match the following causes of early graft dysfunction with their descriptions:

    <p>Acute allograft dysfunction = Rise of serum creatinine &gt;10% of baseline or &gt;20 µmol/L Calcineurin inhibitor toxicity = Toxicity from immunosuppressive medication Ureteric obstruction = Blockage in the ureter leading to urine buildup Renal vein thrombosis = Clot formation in the renal vein affecting blood flow</p> Signup and view all the answers

    Which of the following is the most common vascular complication after transplant surgery?

    <p>Hepatic artery thrombosis</p> Signup and view all the answers

    Chronic rejection occurs within the first 6 months after transplant surgery.

    <p>False</p> Signup and view all the answers

    Name one disease that can recur after liver transplantation.

    <p>Hepatitis B</p> Signup and view all the answers

    The first step in the sequence of anastomosis during transplant surgery is the ______.

    <p>Suprahepatic IVC</p> Signup and view all the answers

    Match the transplant criteria with the correct condition:

    <p>Impaired left ventricular systolic function = Heart Transplantation Receiving optimal medical therapy = Heart Transplantation Reduced by effective immunosuppression = Acute rejection m/c vascular complication = Hepatic artery thrombosis</p> Signup and view all the answers

    Which of the following is NOT a standard criterion for lung donors?

    <p>Pulmonary function test result &lt; 70%</p> Signup and view all the answers

    A history of smoking less than 20 pack-years can qualify a donor for lung transplantation.

    <p>True</p> Signup and view all the answers

    Name one disease that requires treatment by lung transplantation.

    <p>Emphysema/COPD</p> Signup and view all the answers

    The primary challenge of small bowel transplantation is the large ______ tissue, which increases the risk of rejection.

    <p>lymphoid</p> Signup and view all the answers

    Match the following small bowel transplantation types with their indications:

    <p>Isolated small bowel transplant = Short bowel syndrome requiring TPN Combined small bowel + liver transplant = Liver dysfunction due to long-term TPN Cluster transplants = Multiple organ support</p> Signup and view all the answers

    Study Notes

    King's College Criteria for Acute Liver Failure

    • Patients with acetaminophen-induced liver failure require a prothrombin time greater than 100 seconds OR three of the following:
      • Non-A, non-B viral hepatitis
      • Jaundice with encephalopathy for more than 77 days
      • Age over 40 years
      • Prothrombin time greater than 50 seconds
      • Serum bilirubin greater than 18 mg/dL

    Types of Liver Transplants

    • Deceased donor liver transplant - use of organs from individuals who have passed away
    • Living donor liver transplant - use of organs from living individuals
    • Split and reduced liver transplant - dividing the liver into segments (I-VIII) for transplantation to adults and children

    Extended Donor Criteria

    • Older donors
    • Organ dysfunction
    • Liver infections, such as Hepatitis

    Auxiliary Liver Transplant

    • A type of transplant used in fulminant liver failure
    • The diseased liver is not removed, a healthy liver is attached as a "piggyback" transplant

    Domino Liver Transplant

    • Transplanting a liver from a patient with a systemic disease (amyloidosis, HIV) to another patient

    Paired Exchange Programme

    • Two pairs of donors and recipients
    • Donors and recipients within each pair are incompatible
    • However, the donors and recipients from different pairs are compatible, allowing for exchange of organs

    Transplant Surgery Types of Grafts

    • Autograft: Graft from the same person (e.g., skin graft)
    • Isograft: Graft between identical twins
    • Allograft: Graft among the same species
    • Xenograft: Graft between different species

    Types of Donors

    • Living donors
    • Dead donors

    Maastricht Classification of Dead Donors

    • Class I: Dead on arrival, uncontrolled, heart valves and cornea can be procured
    • Class II: Unsuccessful resuscitation, uncontrolled, kidney, heart valves, and cornea can be procured
    • Class III: Anticipated cardiac arrest, controlled, all organs except the heart can be procured
    • Class IV: Cardiac arrest in brain-dead donor, controlled all organs except the heart can be procured
    • Class V: Unexpected cardiac arrest in a hospital patient, uncontrolled, organs cannot be procured

    Static Cold Storage (UW solution)

    • The organ is stored at 4°C
    • UW solution components:
      • Hydroxyethyl starch (HES)
      • Lactobionic acid (as lactone)
      • Adenosine
      • Allopurinol
      • Glutathione (reduced form)
    • The solution is injected into the donor through the aorta and portal vein
    • Effects:
      • Flushes out blood, preventing thrombosis
      • Cools the organs, reducing oxygen requirement
      • Replaces normal extracellular fluid with preservation fluid

    Renal Transplantation Cold Ischemia Time

    • Kidney: Maximum safe time - 36 hours
    • Liver: 12-18 hours
    • Pancreas: 10-18 hours
    • Small intestine: 4-6 hours
    • Heart: Least safe, 3-6 hours
    • Lung: 3-8 hours

    Normothermic Machine Perfusion

    • Organs are stored at normal temperature
    • Organs: Heart, lung, liver, kidney
    • Advantages:
      • More physiological state
      • Restores ex-vivo function and replenishes depleted ATP's
      • Allows for use of marginal donors
      • Early graft function

    Renal Transplantation Indications

    • Diabetic nephropathy: Most common in adults
    • Glomerulonephritis: Most common in children

    Extended Renal Donor Criteria

    • Fit individuals 60 years or older
    • Individuals 50 years or older with at least two of the following:
      • History of hypertension
      • Stroke as cause of death
      • Serum creatinine greater than 1.5 mg/dL

    Renal Donor Investigations

    • ABO compatibility
    • Rh compatibility
    • HLA compatibility: A, B, DR (most important)
    • Kidney function testing
    • USG KUB: Left kidney is preferred due to longer renal vein

    Dual Kidney Transplantation

    • A procedure involving two kidneys of marginal quality
    • Transplanted to one recipient, in the same iliac fossa
    • Useful for extended criteria donors

    Renal Transplant Diagram

    • The diagram shows a recipient and two donor kidneys
    • One kidney is from a live donor and the other is from a dead donor
    • Vessels (arteries and veins) are labeled to show connections from the recipient to the donor organs

    Recipient vs. Donor Table

    Feature Dead Donor Live Donor
    Renal Arteries External iliac artery Internal iliac artery
    Renal Veins External iliac vein -
    Anastomosis Type End-to-side End-to-end
    Sutures Suture Proline
    Materials Vicryl (PDS)

    Cause of Early Graft Dysfunction

    • Serum creatinine increase greater than 10% of baseline or greater than 20 µmol/L: Acute allograft dysfunction
    • Acute rejection
    • Calcineurin inhibitor toxicity
    • Ureteric obstruction
    • Dehydration
    • Renal vein or artery thrombosis
    • Urinary tract infection or pyelonephritis
    • Sepsis

    Graft Survival

    Status 5-year Graft Survival Rate (%)
    Live 90
    Dead 85

    Improvement Factors

    • Immunosuppression
    • Surgical technique

    Vascular Complications

    • Renal vein thrombosis: Most common complication, leads to decreased graft function, medication: Anticoagulants
    • Renal artery stenosis: Gradual onset, hypertension, decreased graft function, treatment: Balloon dilatation

    Pancreatic Transplant

    • Indications: Diabetic nephropathy, combined kidney + pancreas transplantation
    • Bladder anastomosis: Complications begin in 3-4 years, monitor function using insulin and amylase
    • Enteric anastomosis: Better procedure but difficult monitoring

    Liver Transplantation

    • Most common cause (adults): Cirrhosis (due to Hep B, Hep C, or alcohol)
    • Most common cause (children): Extrahepatic biliary atresia
    • HLA matching: Not important
    • Hyperacute rejection: Not seen

    Assessment

    • Child Pugh Classification*
    Class Score
    A 5-6
    B 7-9
    C 10-15

    • MELD Score (Model for End-stage Liver Disease)*

    • Used in adults

    • PELD Score (Pediatric End-stage Liver Disease)*

    • Milan Criteria (for hepatocellular carcinoma)*

    • Single tumor

    Sequence of Anastomosis

    1. Suprahepatic IVC
    2. Infrahepatic IVC - Proline suture
    3. Portal vein
    4. Hepatic artery
    5. Bile duct

    Complications

    • Rejection:
      • No hyperacute rejection
      • Acute rejection: Reduced by effective immunosuppression
      • Chronic rejection: Most common after 6 months, vanishing duct syndrome on biopsy
    • Vascular:
      • Hepatic artery thrombosis: Most common vascular complication, acute rejection/acute liver failure, treatment: Anticoagulants, Re-transplantation if there is no response
      • Biliary stricture
    • Recurrence of disease:
      • Hepatitis B and C
      • 1º biliary cholangitis
      • Sclerosing cholangitis
      • Autoimmune hepatitis
      • Non-alcoholic fatty liver disease
      • Budd-chiari syndrome
      • Malignant tumors

    Other Transplantations

    Heart transplantation

    • Criteria:
      • Impaired left ventricular systolic function
      • NYHA III
      • Receiving optimal medical therapy
      • Resynchronisation pacing or implantable defibrillator device
      • Poor prognosis

    Lung Transplantation

    • Standard Criteria for Lung Donors:

      • Clear chest radiograph
      • Negative gram stain of bronchial/purulent secretion
      • Arterial O₂ tension > 300 mmHg
      • Age < 55 years
      • Smoking < 20 pack-years
      • No chest trauma, aspiration, pneumonia

    • Diseases requiring treatment:

      • Bilateral cystic fibrosis
      • Interstitial lung disease
      • Emphysema/COPD
      • Pulmonary hypertension
      • Can be combined with heart-lung transplantation if associated with congenital heart disease

    Sequence of Anastomosis

    • Pulmonary vein with cuff of left atrium → Left atrium of recipient
    • Bronchial anastomosis
    • Pulmonary artery

    Small Bowel Transplantation

    • Challenges:

      • Large lymphoid tissue → Increased risk of rejection
      • Graft vs.host reaction

    • Indications:

      • Short bowel syndrome requiring long-term total parenteral nutrition (TPN)
      • Ischemia and rejection → Increased intestinal permeability → Increased risk of bacterial infections
      • Graft rejection, infection → poor outcomes

    • Small Bowel Transplantation Types:

      • Isolated small bowel transplant using jejunum or ileum
      • Combined small bowel + liver transplant: Indication: Liver dysfunction due to long-term TPN
      • Cluster transplants (multivisceral)

    • Sequence of Anastomosis:

      • A diagram is presented showing the different parts of the heart: Left atrium, Right atrium, Pulmonary artery, and Aorta. The labels RA, PA, Ao, LA, are used to identify different parts of the heart.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Explore the critical criteria for diagnosing acute liver failure and the various types of liver transplants. This quiz covers essential topics such as the King's College Criteria, donor types, and extended donor criteria. Test your knowledge of liver health and transplantation practices.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser