38 Questions
Which human leukocyte antigen (HLA) is considered the most important overall in recipient/donor matching?
HLA-DR
What is the primary determinant of organ allocation in the U.S.?
HLA matching
Which blood type is considered the universal donor?
Type O
What type of rejection would likely occur with a positive crossmatch in a transplant?
Hyperacute rejection
What does the Panel reactive antibody (PRA) technique detect in transplant recipients?
Preformed recipient antibodies
What is often a contraindication to transplantation due to the increased risk of hyperacute rejection?
> 50% PRA
What can increase the Panel reactive antibody (PRA) in a transplant recipient?
Transfusions
What is the major histocompatibility complex (MHC) in humans?
HLA-A, B, and DR
What does a positive crossmatch in a transplant indicate?
Recipient antibodies to donor organ are present
Which drug inhibits de novo purine synthesis and is used for preventing rejection, with side effects including GI intolerance and myelosuppression?
Mycophenolate (MMF, CellCept)
Which type of rejection occurs within minutes to hours, is caused by preformed antibodies, and can be diagnosed with emergent retransplant or removal of the organ if kidney?
Hyperacute rejection
Which drug binds FK-binding protein, has similar actions to CSA but is more potent, and has side effects including nephrotoxicity, more GI symptoms, mood changes, and diabetes?
FK-506 (Prograf, tacrolimus)
What is the most common malignancy following transplant, with squamous cell carcinoma being the most common type?
Skin cancer
Which drug is a polyclonal antibody against T-cell antigens, used for induction and acute rejection episodes, and has side effects including cytokine release syndrome, PTLD, and myelosuppression?
Antithymocyte globulin (ATG)
Which type of rejection occurs months to years after transplant, partially caused by a type IV hypersensitivity reaction and antibody formation, leading to graft fibrosis?
Chronic rejection
Which drug binds cyclophilin protein, inhibits calcineurin, and decreases cytokine synthesis, with side effects including nephrotoxicity, hepatotoxicity, tremors, seizures, and hemolytic-uremic syndrome?
Cyclosporin (CSA)
What is the next most common malignancy following transplant, and is Epstein-Barr virus related?
Posttransplant lympho-proliferative disorder (PTLD)
What is the RF for chronic rejection?
Increased number of acute rejection episodes
What are the complications associated with kidney transplantation?
Oliguria
Which of the following is a contraindication to liver transplantation?
Hepatitis B antigenemia
What is the most likely reason for liver transplantation in adults?
Chronic hepatitis C
Which complication is a contraindication to liver transplantation?
Primary nonfunction
What is the recommended treatment for hepatic artery stenosis post liver transplantation?
Stent placement
What is the most common arterial anomaly post liver transplantation?
Right hepatic artery coming off SMA
Which complication is most commonly associated with early mortality after heart transplantation?
Persistent pulmonary hypertension
What is the primary determinant of organ allocation in the U.S. for transplant recipients?
ABO compatibility
What is the recommended method for pancreatic duct drainage in pancreas transplantation?
Enteric drainage
What is the most common indication for pancreas transplantation?
Chronic pancreatitis with end-stage renal disease (ESRD)
What is the primary benefit of successful pancreas/kidney transplantation?
Stabilization of retinopathy
What is the most common cause of early mortality following heart transplantation?
Reperfusion injury
What is the median 10-year survival following lung transplantation?
10 years
Which infection is the reason for Bactrim prophylaxis in lung transplant recipients?
Pneumocystis jiroveci pneumonia
What is the indication for double-lung transplantation?
Cystic fibrosis
What is the exclusion criteria for using lungs in transplantation?
Purulent sputum
What is the most common cause of late death and death overall following heart transplantation?
Chronic allograft vasculopathy
Which virus is commonly associated with lung transplant recipients?
CMV
What is the hierarchy for permission for organ donation from next of kin?
(1) spouse, (2) adult son or daughter, (3) either parent, (4) adult brother or sister, (5) guardian, (6) any other person authorized to dispose of the body
#1 cause of early mortality following lung transplantation is similar to which medical condition?
#1 cause of early mortality following ARDS
Study Notes
- Mild rejection: treated with pulse steroids
- Severe rejection: treated with steroid and antibody therapy (ATG or thymoglobulin)
- Skin cancer is the most common malignancy following transplant, with squamous cell carcinoma being the most common type
- Posttransplant lympho-proliferative disorder (PTLD) is the next most common malignancy following transplant, and is Epstein-Barr virus related
- Mycophenolate (MMF, CellCept) is a drug that inhibits de novo purine synthesis, used for preventing rejection and side effects include GI intolerance and myelosuppression
- Azathioprine is a drug with a similar action to mycophenolate, and side effects include GI intolerance and myelosuppression
- Steroids (prednisone, Solu-Medrol) inhibit inflammatory cells and genes for cytokine synthesis, used for induction, maintenance, and acute rejection episodes, side effects include nephrotoxicity, hepatotoxicity, tremors, seizures, hemolytic-uremic syndrome, and need to keep trough levels between 200–300
- Cyclosporin (CSA) binds cyclophilin protein, inhibiting calcineurin and decreasing cytokine synthesis, used for maintenance therapy, side effects include nephrotoxicity, hepatotoxicity, tremors, seizures, hemolytic-uremic syndrome, and need to keep trough levels between 100–150
- FK-506 (Prograf, tacrolimus) binds FK-binding protein, similar actions to CSA but more potent, less entero-hepatic recirculation compared to CSA, side effects include nephrotoxicity, more GI symptoms, mood changes, and diabetes, need to keep trough levels between 10–15
- Sirolimus (Rapamycin) binds FK-binding protein and inhibits mammalian target of rapamycin, used as maintenance therapy, not nephrotoxic, side effect is interstitial lung disease
- Antithymocyte globulin (ATG) is a polyclonal antibody against T-cell antigens, used for induction and acute rejection episodes, is cytolytic, side effects include cytokine release syndrome, PTLD, and myelosuppression
- Hyperacute rejection occurs within minutes to hours, caused by preformed antibodies, MCC is ABO incompatibility, can be diagnosed with emergent retransplant or removal of organ if kidney, and no effective treatment
- Accelerated rejection occurs within one week, caused by sensitized T cells to donor HLA, treated with ↑ immunosuppression, pulse steroids, and possibly antibody therapy
- Acute cellular rejection occurs after one week, caused by T cells to HLA antigens, treated with ↑ immunosuppression, pulse steroids, and possibly antibody therapy
- Acute humoral rejection occurs after one week, caused by antibodies to donor antigens, treated with pulse steroids, antibody therapy, and plasmapheresis
- Chronic rejection occurs months to years after transplant, partially caused by a type IV hypersensitivity reaction and antibody formation, leads to graft fibrosis, RF is increased number of acute rejection episodes, MCC is HLA incompatibility, and no effective treatment
- Kidney transplantation: can store kidney for 48 hours, need ABO type compatibility and crossmatch, UTI can still be used, 1.0–3.0 increase in creatinine and HIV is not a contraindication, mortality primarily from stroke and MI, attach to iliac vessels, complications include urine leaks, renal artery stenosis, lymphocele, postop oliguria, postop diuresis, new proteinuria, postop diabetes, and viral infections, kidney rejection workup includes ultrasound with duplex and biopsy, and 5-year graft survival overall is 70% (cadaveric 65%, living donors 75%), extends life by 15 years, 1% most common complication is wound infection, most common cause of death is a fatal PE, the remaining kidney hypertrophies.
Test your knowledge on liver transplantation and the criteria for urgent liver transplant. Explore topics like contraindications, MELD score, and indications for urgent transplantation.
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