Podcast
Questions and Answers
Which type of graft is taken from the same person?
Which type of graft is taken from the same person?
An allograft is a graft between different species.
An allograft is a graft between different species.
False
What temperature is maintained in static cold storage for organ preservation?
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.
The US solution is primarily used in _______ cold storage for organ preservation.
Signup and view all the answers
Match the types of donors with their definitions:
Match the types of donors with their definitions:
Signup and view all the answers
What is the maximum safe cold ischemia time for a kidney?
What is the maximum safe cold ischemia time for a kidney?
Signup and view all the answers
Normothermic machine perfusion helps restore organ function ex-vivo and assists in replenishing depleted ATPs.
Normothermic machine perfusion helps restore organ function ex-vivo and assists in replenishing depleted ATPs.
Signup and view all the answers
Which type of nephropathy is most common in adults?
Which type of nephropathy is most common in adults?
Signup and view all the answers
A donor who is fit and at least ______ years old can meet the extended donor criteria.
A donor who is fit and at least ______ years old can meet the extended donor criteria.
Signup and view all the answers
Match the organ with its safe maximum cold ischemia time:
Match the organ with its safe maximum cold ischemia time:
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?
Which of the following is NOT part of the King's College Criteria for treatment in acute liver failure?
Signup and view all the answers
Auxiliary Liver Transplant involves the complete removal of the diseased liver.
Auxiliary Liver Transplant involves the complete removal of the diseased liver.
Signup and view all the answers
What type of transplant involves liver segments being divided and transplanted to different recipients?
What type of transplant involves liver segments being divided and transplanted to different recipients?
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.
The presence of prothrombin time greater than ______ seconds is one of the criteria for acetaminophen-induced acute liver failure.
Signup and view all the answers
Match the type of liver transplant with its description:
Match the type of liver transplant with its description:
Signup and view all the answers
What is the most common complication following renal transplantation?
What is the most common complication following renal transplantation?
Signup and view all the answers
Hyperacute rejection is commonly seen in liver transplantation.
Hyperacute rejection is commonly seen in liver transplantation.
Signup and view all the answers
Name the scoring system used to assess end-stage liver disease in adults.
Name the scoring system used to assess end-stage liver disease in adults.
Signup and view all the answers
The most common cause of liver transplantation in adults is __________.
The most common cause of liver transplantation in adults is __________.
Signup and view all the answers
Match the classifications with their corresponding scores:
Match the classifications with their corresponding scores:
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?
What is the primary difference in the anastomosis type between kidneys from a live donor and a dead donor?
Signup and view all the answers
The 5-year graft survival rate is higher for dead donor kidneys than for live donor kidneys.
The 5-year graft survival rate is higher for dead donor kidneys than for live donor kidneys.
Signup and view all the answers
What are two possible causes of early graft dysfunction?
What are two possible causes of early graft dysfunction?
Signup and view all the answers
The donor kidney is placed in the ______ fossa during a renal transplant.
The donor kidney is placed in the ______ fossa during a renal transplant.
Signup and view all the answers
Match the following causes of early graft dysfunction with their descriptions:
Match the following causes of early graft dysfunction with their descriptions:
Signup and view all the answers
Which of the following is the most common vascular complication after transplant surgery?
Which of the following is the most common vascular complication after transplant surgery?
Signup and view all the answers
Chronic rejection occurs within the first 6 months after transplant surgery.
Chronic rejection occurs within the first 6 months after transplant surgery.
Signup and view all the answers
Name one disease that can recur after liver transplantation.
Name one disease that can recur after liver transplantation.
Signup and view all the answers
The first step in the sequence of anastomosis during transplant surgery is the ______.
The first step in the sequence of anastomosis during transplant surgery is the ______.
Signup and view all the answers
Match the transplant criteria with the correct condition:
Match the transplant criteria with the correct condition:
Signup and view all the answers
Which of the following is NOT a standard criterion for lung donors?
Which of the following is NOT a standard criterion for lung donors?
Signup and view all the answers
A history of smoking less than 20 pack-years can qualify a donor for lung transplantation.
A history of smoking less than 20 pack-years can qualify a donor for lung transplantation.
Signup and view all the answers
Name one disease that requires treatment by lung transplantation.
Name one disease that requires treatment by lung transplantation.
Signup and view all the answers
The primary challenge of small bowel transplantation is the large ______ tissue, which increases the risk of rejection.
The primary challenge of small bowel transplantation is the large ______ tissue, which increases the risk of rejection.
Signup and view all the answers
Match the following small bowel transplantation types with their indications:
Match the following small bowel transplantation types with their indications:
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
- Suprahepatic IVC
- Infrahepatic IVC - Proline suture
- Portal vein
- Hepatic artery
- 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.
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.
