ABSITE ch 12 transplant

1. HLA types most important in recipient/donor matching

HLA-A, HLA-B, and HLA-DR**

2. Transplant type that does not require ABO blood compatibility

Liver

3. Test that detects preformed recipient antibodies by mixing recipient serum with
donor lymphocytes

Crossmatch

4. Technique identical to crossmatch that detects preformed recipient antibodies

using a panel of typing cells

PRA (panel reactive antibody)

5. Treatment of mild organ rejection

Steroid pulse

6. Treatment of severe or secondary organ rejection

OKT3

7. Most common malignancy following transplant

Skin cancer (SCCA)

8. Most common non-skin malignancy following transplant

PTLD (post-transplant lymphoproliferative disorder)

9. Virus related to most PTLD incidence

EBV

10. Transplant drugs that inhibit de novo purine synthesis and thus, T-cells

Azathoiprine, mycophenalate
11. Active metabolite of azathioprine

6-mercaptopurine

12. transplant drug that binds cyclophilin protein and inhibits cytokine synthesis

cyclosporine

13. side effects of cyclosporine (5)

nephrotox, hepatotox, HUS, tremors, seizures

14. transplant drug that binds FK binding protein; similar mechanism to cyclosporine
but 100X more potent

FK-506 (tacrolimus)

15. Side effects of tacrolimus (FK506, Prograf)

Nephrotox, mood change, GI

16. Equine polyclonal antibodies directed against antigens on T cells used for
transplant induction therapy

ATGAM

17. Rabbit polyclonal antibodies directed against antigens on T cells, used for
transplant induction therapy

Thymoglobulin

18. Monoclonal antibodies that block T cell antigen recognition by binding CD3

OKT3

19. Side effects of OKT3

Fever, chills, pulmonary edema, shock

20. Human monoclonal antibody against IL-2, used in transplant induction and to
prevent rejection

Zenepax
21. Rejection caused by preformed antibodies, activating complement cascade and
thrombosis of vessels

Hyperacute

22. Rejection caused by sensitized T cells to donor antigens

Accelerated rejection

23. Rejection caused by T cells (cytotoxic and helper)

Acute rejection

24. Treatment of hyperacute rejection

Emergent retransplant

25. Treatment of acute and accelerated rejection

Steroids, inc immunosuppression, OKT3

26. Rejection caused by antibody formation, type IV hypersensitivity with sensitized

T cells

Chronic rejection

27. Treatment of chronic rejection

Inc immunosuppression (no real effective treatment)

28. Acceptable cold time for a kidney

48 hours

29. typing needed for kidney transplant

ABO, crossmatch

30. Primary perioperative mortality of kidney transplant

MI, stroke

31. Complications of kidney transplant (acute)

 Urine leak, renal artery stenosis, lymphocele

32. Sign of renal vein thrombosis post-transplant

New proteinuria

33. Common posttransplant viral infections of the kidney

CMV, HSV

34. 5 year kidney graft survival

70% (cadaveric 65%, living donor 75%)

35. most common complication of kidney donation

wound infection

36. most common cause of death after kidney donation

PE

37. Acceptable cold time for a liver

24 hours

38. tests needed for liver transplant

crossmatch

39. most common reason for liver transplant in US

chronic hepatitis

40. criteria for emergent transplant

stupor, coma associated with liver failure

41. liver tumors acceptable to transplant

HCC (single tumor <5cm or up to three tumors each <3cm)

42. Best predictor of 1-year survival after liver transplant

 APACHE score

43. Disease most likely to recur in new liver allograft

Hep C

44. Method to reduce Hep B reinfection rate

HBIG, lamivudine

45. Extracellular fat globules in a liver allograft that can predict primary nonfunction

Macrosteatosis

46. Most common arterial anomaly in liver

Right hepatic artery off SMA

47. Complications of liver transplant (acute) (6)

Bile leak, primary nonfunction, hepatic artery thrombosis, abscess, IVC

stenosis, cholangitis

48. Complications associated with microscopic findings of portal lymphocytosis,

endothelitis, bile duct injury

Acute rejection

49. Complications associated with microscopic findings of disappearing bile ducts,

portal fibrosis

Chronic rejection

50. Retransplantation rate after liver transplant

20%

51. 5-year survival rate after liver transplant

70%

52. vessels needed with pancreas allograft for hookup

donor celiac, SMA artery, donor portal vein

53. most common drainage of pancreatic exocrine secretions

enteric (donor duodenum to recipient bowel)

54. complications of pancreas transplant (2)

thrombosis, rejection

55. signs of pancreas transplant rejection

inc glucose, amylase, trypsin, fever

56. acceptable cold time for hearts

6 hours

57. tests needed to determine heart match suitability

ABO, crossmatch

58. Most common cause of early mortality following heart transplant

Reperfusion injury

59. Indications for double lung transplant

CF

60. Pathologic finding associated with acute lung transplant rejection

Perivascular lympocytosis

61. Pathologic finding associated with chronic lung transplant rejection

Bronchiolitis obliterans

62. Common viral infections post-transplant (3)

HSV, CMV, VZV

63. Common protozoal opportunistic infections post-transplant (1)

Pneumocystis jeroveci (P. carnii) pneumonia

64. Common fungal opportunistic infections post-transplant (3)

Aspergillus, candida, Cryptococcus

65. Reason for bactrim prophylaxis following transplant

Prevent PCP pneumonia