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HLA class II antigens
DP DQ DR
-
HLA types used in kidney allocation
A, B, DR
-
most important antigen in donor/recepient matching
DR
-
criteria for cadaveric kidney transplant
-
what is the function of crossmatch
detects recipient preformed antibodies and helps to prevent hyperacute rejection
-
do not require preop crossmatch
- liver
- heart and lung with PRA>10%
- or specific HLA abs are identified preop
-
risk factors for high PRA
- previous transfusions
- pregnancy
- preevious txp
- autoimmune dz
-
immediate vessel thrombosis in transplanted organ
hyperacute rejection, retransplant
-
accelerated rejection caused by
presensitized recipient T cells causing a secondary immune response
-
tx accelerated rejection
increase all immunosuppresion with pulse steroids
-
only definitive treatment for chronic rejection
retransplantation
-
immune response in chronic rejection
- type IV hypersens
- T cells also B cells with antibody production
-
main mechanism of chronic rejection in heart transplant
chronic allograft vasculopathy
-
type of rejection which can occur at anytime
antibiody mediated
-
dx antibody mediated rejection
- HLA Ab levels
- C4d tissue staining of biopys
-
tx options for antibody mediated rejection
- increase immunosuppression
- IVIG
- plasmapharesis
- rituximab
- splenectomy
-
side effects of cyclosporine
- nehprotoxicit
- hepatotoxicity
- HUS
- tremors
- szs
-
why does a biliary drain decrease cyclosporine levels
it undergoes enterohepatic recirculation
-
benefits of sirolimus over tacrolimus
not nephrotoxic
-
difference in action of sirolimus over tacrolimus
sirolimus also inhibits mTOR wich inhibits the response of immune cells to IL-2
-
moa of imuran
inhibits de novo purine synthesis
-
action and use of daclizumab and basilximab
- monoclonal abs to IL-2 receptor abs
- used in induction and decreases acute rejection
-
moa and use of ATG/thymoglobulin
- polyclonals abs to CD2,3,4,8 on t cells
- induction and refractory acute rejection
-
side effects of ATG
- PTLD
- myelosuppression
- cytokine release syndrome
-
2nd mc malignancy following transplant
PTLD
-
highest risk of PTLS
children and Heart
-
mc infxn 2-6 months after transplant
CMV
-
highest risk period of infection following transplant
first month
-
cmv is transmitted by/through
donor leukocytes
-
infections caused by CMV
- PNA
- gastritis
- colitis
- ophthalmitis
- mononucleosis
-
mc manifestation of cmv
febrile mono
-
how long can you store a kidney
48hrs
-
-
MCC of post op diuresis
preop high urea and glucose levels
-
mcc of new proteinuria
renal vein thrombosis
-
mcc of post of diabetes
csa, FK or steroids
-
tx of urine leak
percutaneous drainage and stent
-
mc complication of kidney TXP
urine leak
-
MC time to develop lymphocele
3 weeks
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path of rejection in kidney txp
tubulitis, vasculitis if severe
-
mcc of mortality after kidney txp
MI
-
mgmt of increase Cr and decrease UO post kidney txp
- fluid challenge +/- lasix
- u/s with bx
- empiric pulse steroids and decrease of CSA or FK
-
contraindications for living kidne donation
- cardiovascular dz
- dm
- hiv
- current cocaine
- hep B or C
- concurrent Ca or current infection
-
contraindication for liver txp
- etoh within 6 mo
- acute UC
- severe cardiac or pulm insuf
- poor compliance
- active septic infxn
- CA
-
best overal predictor of primary nonfunction
macrosteatosis
-
liver txp for acute fulminant hepatic failure
- acetaminophen
- pH< 7.3 or PT >100 Cr >3.4 and stage III or IV coma
- all others
- PT>50 or
- any 3:
- age <10 or >40
- halothane, drug or idiopathic
- Jaundice 7 days before encepholapthy
- PT >25
- bilirubin >17.5
-
-
MC complication of liver txp
biliary leak
-
mc early vascular cxs
hepatic artery thrombosis
-
as opposed to early, late hepatic artey thrombosis causes
biliary strictures and abscesses
-
tx of IVC thrombosis
angio with thrombolytics or PTA/stent
-
mcc of hepatic abscess following txp
hepatic artery thrombosis
-
cx acute liver rejection
- increase wbc
- increase LFT
- increase PT
- need bx
-
path of acute liver rejection
- portal vein lymphocytosis
- endothelitis
- bile duct injury
-
path of chronic rejection in liver
disappearing bile ducts
-
biggest RF for chronic rejection in liver
increase acute rejection episodes
-
tx hepatitis B recepient to prevent infxn of new liver
HBIG and lamivudine
-
absolute indication for double lung txp
cystic fibrosis
-
mcc of early and late mortality
- early-reperfusion injury
- late- bronchiolitis obliterans
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