Podcast
Questions and Answers
What is a deadly complication common in stem cell transplants?
What is a deadly complication common in stem cell transplants?
the graft co-opting the host immune cells and attacking the host tissue
What is one of the risks associated with non-compliance in transplant patients?
What is one of the risks associated with non-compliance in transplant patients?
Youth
What type of treatment is common for graft versus host disease?
What type of treatment is common for graft versus host disease?
steroids, MABs, reducing IS
Which sensory impairment is mentioned as a risk factor for non-compliance?
Which sensory impairment is mentioned as a risk factor for non-compliance?
Signup and view all the answers
What is rejection in organ transplantation?
What is rejection in organ transplantation?
Signup and view all the answers
What is the purpose of immunosuppression in organ transplantation?
What is the purpose of immunosuppression in organ transplantation?
Signup and view all the answers
All transplanted patients will experience rejection after receiving an organ transplant.
All transplanted patients will experience rejection after receiving an organ transplant.
Signup and view all the answers
_______ is the first successful heart transplant.
_______ is the first successful heart transplant.
Signup and view all the answers
Which of the following is a mode of transmission for Hepatitis A?
Which of the following is a mode of transmission for Hepatitis A?
Signup and view all the answers
Match the organ with its 5-year survival rate:
Match the organ with its 5-year survival rate:
Signup and view all the answers
What is the primary method of diagnosis for Hepatitis C?
What is the primary method of diagnosis for Hepatitis C?
Signup and view all the answers
Which of the following is a characteristic of liver inflammation?
Which of the following is a characteristic of liver inflammation?
Signup and view all the answers
What is a risk factor for Hepatitis B transmission?
What is a risk factor for Hepatitis B transmission?
Signup and view all the answers
Which of the following is a prevention method for Hepatitis B?
Which of the following is a prevention method for Hepatitis B?
Signup and view all the answers
What is a common symptom of Hepatitis A, B, and C?
What is a common symptom of Hepatitis A, B, and C?
Signup and view all the answers
What is a characteristic of Hepatitis C?
What is a characteristic of Hepatitis C?
Signup and view all the answers
Which of the following is a mode of transmission for Hepatitis C?
Which of the following is a mode of transmission for Hepatitis C?
Signup and view all the answers
What is a complication of liver inflammation?
What is a complication of liver inflammation?
Signup and view all the answers
Which of the following is a treatment for Hepatitis B?
Which of the following is a treatment for Hepatitis B?
Signup and view all the answers
What is a characteristic of the Icteric Phase in Hepatitis?
What is a characteristic of the Icteric Phase in Hepatitis?
Signup and view all the answers
What does an elevated INR indicate in liver function tests?
What does an elevated INR indicate in liver function tests?
Signup and view all the answers
What is a common symptom of the Viral Prodrome in Hepatitis?
What is a common symptom of the Viral Prodrome in Hepatitis?
Signup and view all the answers
What is a treatment option for Hepatitis C?
What is a treatment option for Hepatitis C?
Signup and view all the answers
What is a complication of liver disease that can occur in Hepatitis C patients?
What is a complication of liver disease that can occur in Hepatitis C patients?
Signup and view all the answers
What is a diagnostic test for Hepatitis C?
What is a diagnostic test for Hepatitis C?
Signup and view all the answers
What is the goal of medical management in patients with liver failure?
What is the goal of medical management in patients with liver failure?
Signup and view all the answers
What is the purpose of paracentesis in patients with liver failure?
What is the purpose of paracentesis in patients with liver failure?
Signup and view all the answers
What is a treatment option for spontaneous bacterial peritonitis?
What is a treatment option for spontaneous bacterial peritonitis?
Signup and view all the answers
What is a benefit of transplant in patients with liver failure?
What is a benefit of transplant in patients with liver failure?
Signup and view all the answers
What is a risk associated with transplant in patients with liver failure?
What is a risk associated with transplant in patients with liver failure?
Signup and view all the answers
What is a complication of liver inflammation?
What is a complication of liver inflammation?
Signup and view all the answers
What is the term for liver inflammation?
What is the term for liver inflammation?
Signup and view all the answers
What type of liver failure develops over a timeframe of greater than 6 months?
What type of liver failure develops over a timeframe of greater than 6 months?
Signup and view all the answers
Which of the following is a common cause of Acute Liver Failure?
Which of the following is a common cause of Acute Liver Failure?
Signup and view all the answers
Which of the following is a cause of Chronic Liver Failure?
Which of the following is a cause of Chronic Liver Failure?
Signup and view all the answers
What is the prevalence of Chronic Liver Disease in the US?
What is the prevalence of Chronic Liver Disease in the US?
Signup and view all the answers
What is the term for scarred non-functional tissue in the liver?
What is the term for scarred non-functional tissue in the liver?
Signup and view all the answers
What is a characteristic of the icteric phase of Hepatitis B?
What is a characteristic of the icteric phase of Hepatitis B?
Signup and view all the answers
What is a common symptom of the viral prodrome of Hepatitis C?
What is a common symptom of the viral prodrome of Hepatitis C?
Signup and view all the answers
Which of the following liver function tests is most specific for liver damage?
Which of the following liver function tests is most specific for liver damage?
Signup and view all the answers
Which of the following is a treatment option for Hepatitis C?
Which of the following is a treatment option for Hepatitis C?
Signup and view all the answers
What is a characteristic of Hepatitis C virus?
What is a characteristic of Hepatitis C virus?
Signup and view all the answers
What is the primary method of diagnosis for Hepatitis C?
What is the primary method of diagnosis for Hepatitis C?
Signup and view all the answers
What is a complication of Hepatitis C infection?
What is a complication of Hepatitis C infection?
Signup and view all the answers
Study Notes
Solid Organ Transplant: The Basics
- Over 42,000 people in the US received some form of transplant in 2022.
- Survival rates of transplanted grafts continue to improve.
- There are over 104,000 people currently on the waitlist for transplants.
- 90% of US adults support organ donation, but only 60% are registered.
Definitions
- Organ transplantation: the removal of organs from one person (donor) and the surgical implantation of those organs into another person (recipient).
- Immunosuppression: required to continue the healthy function of the donor organs, otherwise, the recipient risks rejection.
- Rejection: the activation of the recipient's immune system, targeting the donor organ.
History
- 1954: first successful renal transplant in North America.
- 1963: first lung transplant and first liver transplant.
- 1967: first successful heart transplant and first successful liver transplant.
- 1983: first successful lung transplant.
- 2022: the total number of organ transplants performed in the US reached one million.
What Gets Transplanted
- Organs and other tissues:
- Heart
- Lungs
- Liver
- Kidney
- Intestine
- Bone Marrow
- Blood products
- Corneas
- Vascular Composite Allografts (VCAs):
- Face
- Hands
- Uterus
- Penis
Graft Survival
- Organ Type | 1 Year | 5 Year
- Heart | 91% | 78%
- Lung | 87.75% | 52.5%
- Liver | 93.27% | 72%
- Living Donor Kidney | 98.46% | 85%
- Deceased Donor Kidney | 97.5% | 80%
- Pancreas | 95% | 74.5%
VCA (Vascular Composite Allografts)
- Face: 18 total cranio-facial transplants performed from 2008-2020.
- Uterus: 39 transplants performed.
- Penile: 2 transplants performed.
- Limbs: 19 bilateral upper extremity, 18 unilateral.
Waitlist Stats
- Waitlist additions: 21,000.
- Waitlist mortality increased in 2020 for kidney, lung, and liver.
Who Gets Transplanted?
- Eligibility criteria:
- End-stage organ disease despite best medical management.
- Otherwise healthy.
- Social support in place.
- Medical need.
- Geography.
- Contraindications:
- Active substance use.
- Active infection.
- Active cancer.
- Psycho-social issues.
- Medical instability.
- Obesity/cachexia.
Surgical Overview
- Kidney transplant: available at Mayo Clinic.
- Deceased donor liver transplant: available at Mayo Clinic.
- Living donor liver transplant: available at Mayo Clinic.
- Pancreas transplant: available at Mayo Clinic.
- Heart transplant: available at Mayo Clinic.
- Bilateral lung transplant: available at Emory University.
- Face transplant: available at Cleveland Clinic.
- Hand/arm transplant: available at Johns Hopkins University.
- Uterus transplant: available at Cleveland Clinic.
- Penile transplant: available at Johns Hopkins University.
Post-Surgical Support
- General: ICU vs. IMC, pain management, restore function, rehabilitation.
- Organ-specific:
- Heart: hemodynamic support, pacemaker.
- Lungs: pulmonary support, pulmonary toilet.
- Kidney: fluids and electrolytes, bladder drainage.
- Pancreas: blood glucose, bowel function.
- Liver: LFTs, "other" LFTs, biliary drainage.
Possible Post-Surgical Complications
- Bleeding vs. thrombosis.
- Vascular stenosis.
- Wound infection.
- Interrupted lymphatics.
- Luminal disruption.
- Nerve injuries.
- Ischemia.
- Aspiration.
Medical Management: Immunosuppression
- Three phases:
- Induction: given in the peri-procedural timeframe.
- Maintenance: long-term graft survival.
- Rescue: treating rejection.
Induction
- Goal: massively suppress the immune system and delay recognition of the new organ as foreign.
- Agents:
- Thymoglobulin (T-Cell Ab).
- Campath (T cell Ab).
- Basiliximab (IL 2 interceptor).
- High-dose IV steroids.
Maintenance
- Goal: long-term graft survival.
- Agents:
- Calcineurin inhibitors (tacrolimus, cyclosporin).
- Mycophenolate mofetil (sometimes azathioprine).
- Steroids.
- mTOR inhibitors (rapamune, everolimus).
Prophylaxis
- Post-transplant infections:
- PCP pneumonia.
- Fungal infections.
- CMV.
New and Coming Soon
- Hepatitis C positive donors.
- HIV positive donors.
- New immunosuppressive agents.
Rejection
- All transplanted patients will have some episode of rejection.
- Signs and symptoms:
- Pain over graft site.
- Lab abnormalities.
- Failure to thrive.
- Biopsy is the gold standard for diagnosis.
- Treatment:
- Steroids.
- Thymoglobulin.
- Plasmapheresis.
- Gamunex.
Other Complications
- Malignancy: 3-4 times increase in all types of cancer.
- PTLD (Post-Transplant Lymphoproliferative Disorder).
- Graft vs. Host.
- Non-compliance.
References
- List of sources cited in the original text, including journal articles, books, and online resources.
Hepatitis Overview
- Hepatitis is an inflammation of the liver, which can be caused by viral infections, autoimmune disorders, or exposure to toxins.
- It can be acute or chronic, and may lead to liver failure or cirrhosis.
Hepatitis A
- Caused by the Hepatitis A virus (HAV), which is transmitted through the fecal-oral route, contaminated food and water.
- Symptoms include fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and jaundice.
- Diagnosis is made through serological tests for IgM and IgG anti-HAV antibodies.
- Treatment is supportive care, with no specific antiviral treatment.
- Prevention is possible through vaccination, proper hygiene, and sanitation.
Hepatitis B
- Caused by the Hepatitis B virus (HBV), which is transmitted through blood, semen, and other bodily fluids.
- Symptoms are similar to Hepatitis A, but can be more severe.
- Diagnosis is made through serological tests for HBsAg, anti-HBs, and anti-HBc antibodies.
- Treatment includes antiviral medications and interferon therapy.
- Prevention is possible through vaccination, safe sex practices, and screening of blood and organ donors.
Hepatitis C
- Caused by the Hepatitis C virus (HCV), which is transmitted through blood, organ transplantation, and vertical transmission.
- Symptoms are often asymptomatic, but can cause fatigue, loss of appetite, and nausea.
- Diagnosis is made through serological tests for anti-HCV antibodies and PCR for HCV RNA.
- Treatment includes antiviral medications, direct-acting antivirals (DAAs).
- There is no vaccine available, and prevention is through screening of blood and organ donors.
Liver Inflammation
- Characterized by liver cell necrosis, inflammation, and fibrosis.
- Causes include viral infections, autoimmune disorders, toxins, and metabolic disorders.
- Symptoms include fatigue, loss of appetite, nausea, vomiting, and abdominal pain.
- Diagnosis is made through liver function tests, imaging studies, and liver biopsy.
Viral Transmission
- Modes of transmission include fecal-oral, blood, and vertical transmission.
- Risk factors include unsafe sex, shared needles, tattooing, and piercing.
- Prevention is possible through vaccination, safe sex practices, screening of blood and organ donors, and proper hygiene.
Solid Organ Transplant
- Risk of transmission of Hepatitis B and C viruses through organ transplantation.
- Prevention is possible through screening of organ donors and antiviral prophylaxis.
Immunosuppression Therapy
- Increases risk of Hepatitis B and C reactivation.
- Prevention is possible through antiviral prophylaxis, monitoring of liver function and viral load.
Liver Failure
- Characterized by severe liver dysfunction, coagulopathy, and hepatic encephalopathy.
- Causes include acute liver inflammation, chronic liver disease, and cirrhosis.
- Symptoms include jaundice, fatigue, confusion, and bleeding.
- Treatment is supportive care, with liver transplantation as an option.
Cirrhosis
- Characterized by irreversible liver scarring, liver dysfunction, and portal hypertension.
- Causes include chronic liver disease, Hepatitis B and C, and alcohol abuse.
- Symptoms include fatigue, loss of appetite, nausea, vomiting, and abdominal pain.
- Treatment is liver transplantation, with management of complications such as portal hypertension and ascites.
Liver Failure
- Liver failure can be caused by various factors, including toxic agents, infections, mechanical injuries, and autoimmune diseases.
- Acute liver failure can develop in days to weeks, while chronic liver failure develops over a longer period of time (more than 6 months).
- Hepatitis is another word for liver inflammation, which can progress to fibrosis (scarring), cirrhosis (non-functional tissue), and eventually liver failure.
Diagnosis and Treatment
- Diagnosis involves laboratory tests, imaging studies, and liver biopsy.
- Laboratory tests include CBC, CMP, INR, and hepatitis serologies.
- Imaging studies include ultrasound, CT, and MRI liver protocols.
- Treatment involves supportive care, medications, and potential liver transplantation.
- Supportive care includes monitoring of INR, CBC, bilirubin, and liver function tests.
- Medications used to treat liver failure include lactulose, rifaximin, diuretics, midodrine, propranolol, and octreotide.
Prophylaxis
- Pantoprazole is used for GI prophylaxis.
- Cipro or other antibiotics are used for spontaneous bacterial peritonitis (SBP) prophylaxis.
Procedures
- Paracentesis is used to remove excess fluid from the abdomen and can help with breathing and patient comfort.
- Thoracentesis is used to remove excess fluid from the chest cavity.
- TIPS (transjugular intrahepatic portosystemic shunt) is a procedure used to create a shunt between the hepatic vein and the portal vein.
- ERCP (endoscopic retrograde cholangiopancreatography) and EGD (esophagogastroduodenoscopy) are used to diagnose and treat gastrointestinal disorders.
- Biopsy is used to diagnose liver disease.
- Transplant is a life-sustaining therapy that requires lifelong immunosuppression and has potential complications, such as cancer and cardiac disease.
Common Causes of Liver Failure
- Acute liver failure can be caused by medications, toxins, hepatitis A, B, and E, and other factors.
- Chronic liver failure can be caused by ETOH, NAFLD/NASH, chronic viral hepatitis, AIH, and other factors.
Epidemiology
- According to the CDC, approximately 4.5 million people in the US have chronic liver disease.
- Hepatitis C is the leading cause of liver disease, followed by ETOH, NAFLD/NASH, and hepatitis B.
Viral Prodrome
- Viral prodrome is a symptom complex that includes malaise, myalgia, arthralgia, fatigue, anorexia, nausea, vomiting, diarrhea, and fever.
- It can occur in patients with hepatitis B and other viral infections.
Icteric Phase
- The icteric phase is characterized by dark urine, clay-colored stool, and jaundice.
- It can occur in patients with liver disease and can be accompanied by other symptoms, such as fever, anorexia, and nausea.
Physical Findings
- Physical findings in patients with liver disease can include jaundice, ascites, vascular cephalization, caput medusae, and other signs of liver dysfunction.
- The "grimace" body habitus is a characteristic physical finding in patients with liver disease.
Hepatic Encephalopathy
- Hepatic encephalopathy is a complication of liver disease that can cause confusion, altered mental status, and other neurological symptoms.
- It can be graded from I to IV and can be provoked by various factors, including GI bleeding, electrolyte abnormalities, and dehydration.
Associated Pathophysiology
- Liver disease can be associated with various pathophysiological processes, including cardiovascular, respiratory, infectious, gastrointestinal, renal, hematological, oncological, endocrine, neurological, and dermatological disorders.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the fundamentals of solid organ transplantation, including statistics on transplants, survival rates, and organ donation. It's a great resource for medical professionals and students. Learn about the current state of organ transplantation in the US.
