Term
| Two main contraindications to cadaveric donation? |
|
Definition
Malignancy and infection (namely HIV)
*recall that + CMV, syphilis, and hepatitis serologies are NOT contraindications for donation* |
|
|
Term
| Criteria for brain death determination? |
|
Definition
1. TWO exams 12 hours apart by neurologist or neurosurg.
2. Loss of cerebral function (no response to pain)
3. Loss of brainstem function (fixed pupils, absence of gag, corneal reflexes)
4. No resp effort after 3 min of PaCO2 greater than or equal t 60 |
|
|
Term
| First organ removed in a donor operation? |
|
Definition
|
|
Term
| Incision made for donor operation? |
|
Definition
| Midline, from suprasternal notch to pubis |
|
|
Term
| Organs which can tolerate the longest ischemic time? |
|
Definition
| Kidneys, pancreas (72 hours max) |
|
|
Term
| Most sensitive organs to cold ischemic time? |
|
Definition
| Heart and Lung (4 hours max) |
|
|
Term
| Cold ischemic time for liver? |
|
Definition
|
|
Term
| Most common prophylactic antibiotics given to transplant recipients? |
|
Definition
| bactrim, nystatin and acyclovir |
|
|
Term
| Incidence of PTLD is greatest in which transplant patients and why? |
|
Definition
| Heart and lung (10%--development related to intensity of immunosupression rather than organ itself) |
|
|
Term
| When is risk greatest for development of PTLD? |
|
Definition
| within first year after transplant |
|
|
Term
| How is diagnosis of PTLD made? |
|
Definition
|
|
Term
| Mainstay of treatment for PTLD? |
|
Definition
| Decrease level of immunosuppression |
|
|
Term
| PTLD is related to which virus? |
|
Definition
| EBV (PTLD is a B cell disease) |
|
|
Term
| Top three indications for renal transplant? |
|
Definition
| Diabetes, glomerunephritis, HTN |
|
|
Term
| Graft of choice in a living donor renal transplant? |
|
Definition
| LEFT kidney (longer renal vein and easier access to the renal artery) |
|
|
Term
| Donor renal artery site of anastamosis? |
|
Definition
|
|
Term
| Cause of sudden anuria in a renal transplant patient? |
|
Definition
|
|
Term
| Cause of HTN and decreases renal function post transplant? |
|
Definition
| Renal transplant artery stenosis |
|
|
Term
| Pathophysiology of tertiary hyperparathyroidism? |
|
Definition
| Calcium wasting and poor vit D levels in ESRD patients causing secondary hyperparathyroidism (Low Ca, high phosp). Then, hyperparathyroidism continues post transplant (high calcium, high PTH levels) |
|
|
Term
| Treatment of tertiary hyperparathyroidism? |
|
Definition
|
|
Term
| Likely cause of graft tenderness, fever, malaise, oliguria post transplant? |
|
Definition
| Acute cellular rejection (typically 3 months post transplant) |
|
|
Term
| Indications for liver transplant |
|
Definition
| Decompensated cirrhosis or intractable portal HTN |
|
|
Term
| Indications for transplant in patients with HCC? |
|
Definition
1. single lesion < 5cm
2. 1-3 lesions, each less than 3cm diameter
3. No macrovascular invasion, no extrahepatic spread |
|
|
Term
| Components of MELD score? |
|
Definition
| INR, Total bilirubin, Creatinine levels |
|
|
Term
| Liver segment utlized for a living related donor to an adult? |
|
Definition
|
|
Term
| Liver segment utlized for a living related donor to a child? |
|
Definition
|
|
Term
| Why should patients with persistent transfusion requirement post-op from liver transplant go back to OR for hematoms evacuation? |
|
Definition
| Clot burden promotes fibrinolysis, causing persistent oozing (usually no frank source of bleeding identified) |
|
|
Term
| Treatment of hepatic artery thrombosis? |
|
Definition
|
|
Term
| Biliary leak, complete dehiscence of the CBD anastamosis should prompt concern for? |
|
Definition
| Hepatic artery thrombosis |
|
|
Term
| Indications for pancreatic transplant? |
|
Definition
| Patients with diabetic nephropathy who will also need kidney transplant (and therefore hypERglycemia provoking immunosupression) AND labile diabetics who've had multiple episodes of life threatening hypoglycemia |
|
|
Term
| Placement of transplanted kidney within the recipient abdomen? |
|
Definition
|
|
Term
| Which rejection occurs first in a pancreatic transplant, exocrine or endocrine? |
|
Definition
| Exocrine PRECEDES endocrine rejection (so hypERglcyemia indicates late rejection) |
|
|
Term
| Location of pancreatic islet cell transplantation? |
|
Definition
|
|
Term
| Indications for small bowel transplant? |
|
Definition
| Short gut syndrome who are TPN dependent and have lost TPN access sites or developed complications of TPN |
|
|
Term
| Why are small bowel transplants so immunogenic? |
|
Definition
| Enterocytes express high levels of MHC class II, and the small bowel contains a large amount of lymphoid tissue |
|
|
Term
| Transplant complication more common in small bowel transplants than other transplants? |
|
Definition
| graft versus host disease |
|
|
Term
| Structures transplanted for small bowel transplant? |
|
Definition
Entire small bowel and right colon, with SMA origin and origin of portal vein
(reconstruction always includes formation of stoma) |
|
|
Term
| Indications for heart transplant? |
|
Definition
| Idiopathic dilated cardiomyopathy and ischemic heart disease |
|
|
Term
| Most common indication for lung transplant? |
|
Definition
|
|
Term
| Transplant of which organ has the lowest 5 years survival? |
|
Definition
|
|
Term
| Organ transplants where HLA matching not needed? |
|
Definition
| Liver, heart (unless high PRA), lung |
|
|
Term
| Primary cause of late mortality and morbidity after lung transplant? |
|
Definition
| Bronchiolitis obliterans (sudden and persistent drop in FEV1. acute rejection most importatnt risk factor for development) |
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