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HLA types most important in recipient/donor matching
HLA-A, HLA-B, and HLA-DR**
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Transplant type that does not require ABO blood compatibility
Liver
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Test that detects preformed recipient antibodies by mixing recipient serum with donor lymphocytes
Crossmatch
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Technique identical to crossmatch that detects preformed recipient antibodies using a panel of typing cells
PRA (panel reactive antibody)
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Treatment of mild organ rejection
Steroid pulse
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Treatment of severe or secondary organ rejection
OKT3
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Most common malignancy following transplant
Skin cancer (SCCA)
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Most common non-skin malignancy following transplant
PTLD (post-transplant lymphoproliferative disorder)
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Virus related to most PTLD incidence
EBV
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Transplant drugs that inhibit de novo purine synthesis and thus, T-cells
Azathoiprine, mycophenalate
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Active metabolite of azathioprine
6-mercaptopurine
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transplant drug that binds cyclophilin protein and inhibits cytokine synthesis
cyclosporine
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side effects of cyclosporine (5)
nephrotox, hepatotox, HUS, tremors, seizures
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transplant drug that binds FK binding protein; similar mechanism to cyclosporine but 100X more potent
FK-506 (tacrolimus)
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Side effects of tacrolimus (FK506, Prograf)
Nephrotox, mood change, GI
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Equine polyclonal antibodies directed against antigens on T cells used for transplant induction therapy
ATGAM
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Rabbit polyclonal antibodies directed against antigens on T cells, used for transplant induction therapy
Thymoglobulin
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Monoclonal antibodies that block T cell antigen recognition by binding CD3
OKT3
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Side effects of OKT3
Fever, chills, pulmonary edema, shock
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Human monoclonal antibody against IL-2, used in transplant induction and to prevent rejection
Zenepax
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Rejection caused by preformed antibodies, activating complement cascade and thrombosis of vessels
Hyperacute
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Rejection caused by sensitized T cells to donor antigens
Accelerated rejection
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Rejection caused by T cells (cytotoxic and helper)
Acute rejection
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Treatment of hyperacute rejection
Emergent retransplant
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Treatment of acute and accelerated rejection
Steroids, inc immunosuppression, OKT3
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Rejection caused by antibody formation, type IV hypersensitivity with sensitized T cells
Chronic rejection
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Treatment of chronic rejection
Inc immunosuppression (no real effective treatment)
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Acceptable cold time for a kidney
48 hours
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typing needed for kidney transplant
ABO, crossmatch
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Primary perioperative mortality of kidney transplant
MI, stroke
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Complications of kidney transplant (acute)
Urine leak, renal artery stenosis, lymphocele
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Sign of renal vein thrombosis post-transplant
New proteinuria
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Common posttransplant viral infections of the kidney
CMV, HSV
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5 year kidney graft survival
70% (cadaveric 65%, living donor 75%)
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most common complication of kidney donation
wound infection
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most common cause of death after kidney donation
PE
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Acceptable cold time for a liver
24 hours
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tests needed for liver transplant
crossmatch
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most common reason for liver transplant in US
chronic hepatitis
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criteria for emergent transplant
stupor, coma associated with liver failure
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liver tumors acceptable to transplant
HCC (single tumor <5cm or up to three tumors each <3cm)
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Best predictor of 1-year survival after liver transplant
APACHE score
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Disease most likely to recur in new liver allograft
Hep C
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Method to reduce Hep B reinfection rate
HBIG, lamivudine
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Extracellular fat globules in a liver allograft that can predict primary nonfunction
Macrosteatosis
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Most common arterial anomaly in liver
Right hepatic artery off SMA
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Complications of liver transplant (acute) (6)
Bile leak, primary nonfunction, hepatic artery thrombosis, abscess, IVC stenosis, cholangitis
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Complications associated with microscopic findings of portal lymphocytosis, endothelitis, bile duct injury
Acute rejection
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Complications associated with microscopic findings of disappearing bile ducts, portal fibrosis
Chronic rejection
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Retransplantation rate after liver transplant
20%
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5-year survival rate after liver transplant
70%
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vessels needed with pancreas allograft for hookup
donor celiac, SMA artery, donor portal vein
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most common drainage of pancreatic exocrine secretions
enteric (donor duodenum to recipient bowel)
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complications of pancreas transplant (2)
thrombosis, rejection
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signs of pancreas transplant rejection
inc glucose, amylase, trypsin, fever
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acceptable cold time for hearts
6 hours
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tests needed to determine heart match suitability
ABO, crossmatch
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Most common cause of early mortality following heart transplant
Reperfusion injury
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Indications for double lung transplant
CF
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Pathologic finding associated with acute lung transplant rejection
Perivascular lympocytosis
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Pathologic finding associated with chronic lung transplant rejection
Bronchiolitis obliterans
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Common viral infections post-transplant (3)
HSV, CMV, VZV
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Common protozoal opportunistic infections post-transplant (1)
Pneumocystis jeroveci (P. carnii) pneumonia
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Common fungal opportunistic infections post-transplant (3)
Aspergillus, candida, Cryptococcus
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Reason for bactrim prophylaxis following transplant
Prevent PCP pneumonia
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