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CMV IGG & IGM (-)

✓ Not previously CMV infected

CMV IgG & IgM (+)

✓ Recent CMV infection

CMV IgG (+) & IgM (-)

✓ Past CMV infection, not recent

Blood Type O

✓ Universal Donor - Can receive subtype A2

Blood Type AB

✓ Universal Recipient

Kidney Priority Listing Criteria

✓ If candidate is prior living kidney donor

2) If there are 0 HLA-mismatches

Common causes of HLA Antibody production

✓ Transfusions
2) Pregnancy
3) Previous transplants

Hep C Ab

✓ Exposure to Hepatitis C

Hep B sAg

✓ Infection with hepatitis B

Hep B sAb

✓ Immune to hepatitis B

Hep B Core Antibody

✓ Previous hepatitis B infection or exposure

HLA Haplotypes

✓ A, B, DR

Rejection - Recognition step

✓ AP Cells

Rejection - Stimulation step

✓ T-Cells

Rejection - Defense step

✓ CD8 and B Cells

Immunosuppression balances 3 key factors

✓ Prevent rejection
2) Protect against infection and cancer
3) Guarantee efficacy

What organ is not allocated based on urgency?

✓ Kidney

How does UNOS prioritize?

✓ Medical urgency
2) Biological matching

Liver 1A Criteria includes

✓ Life expectancy <7 days

2) Hepatic artery thrombus

Heart 1A Criteria includes

✓ Mechanical circulatory support for acute hemodynamic decompensation

Lung Allocation Score (LAS) accounts for

✓ Formula estimating urgency and probability of long term survival

2) Pulmonary artery systolic pressure
3) O2 requirement
4) Need for continues mechanical ventilation

Long term risk of kidney donation

✓ HTN

Pre-transplant education should include

 ✓ Treatment options
2) Costs, and immunosuppression
3) Deceased donor criteria

What type of rejection is in first 6 months - likely to respond to increased immunosuppression?

✓ Acute cellular rejection

What urinary symptom is related to kidney transplant rejection?

✓ Decreased UOP

All pre-transplant kidney evals should obtain

✓ Hepatitis serologies

In the small intestine, most absorption occurs in:

✓ Duodenum and jejunum

In early post op period for intestinal transplant, scopes are completed

✓ Twice weekly weeks 1-6.

Nausea and vomiting may be caused by

✓ decreased gastric motility

Which side heart catheterization is required for Lung Allocation Score?

✓ Right heart catheterization

What is not an early complication in lung transplant?

✓ PTLD

Contributors to chronic lung transplant rejection (Bronchiolitis obliterans)

✓ RSV
2) Influenza infection
3) CMV pneumonitis

Covers doctor services for certain organ transplants

✓ Medicare Part B

Covers transplants under certain conditions at Medicare-certified hospitals

✓ Medicare Part A

Pays 80% of physician services, Patient pays 20%

✓ Medicare
How long is Medicare active if obtained solely due to ESRD?

✓ 3 years

Symptoms of CMV (general, outside of tissue invasive disease)

✓ Fever, malaise, arthralgia, leukopenia, thrombocytompenia

Term for chronic rejection in lung transplant

✓ Bronchiolitis obliterans

Leading cause of death in lung transplant beyond the first year

✓ Chronic rejection

Most common bacterial infection after liver transplant

✓ Cryptococcus

Most common organism in Spontaneous Bacterial Peritonitis

✓ Gram neg bacteria (e. Coli)

Normal heart rate post-heart transplant

✓ 100

Which kidney is preferred?

✓ Left

Which VS should be documented for ALL tx patients?

✓ Blood pressure and temperature

Signs and symptoms of intestinal rejection

✓ Intermittent low grade fever and high stoma output

In a heart/lung transplant, which rejects first?

✓ Lung

Cold ischemia time for heart

✓ 4 hours

Cold ischemia time for intestine

✓ 6 hours

Cold ischemia time for lung

✓ 8 hours
Cold ischemia time for liver

✓ 12 hours

Cold ischemia time for kidney

✓ 24 hours

Cold ischemia time for pancreas

✓ 12 hours

If candidate and recipient match one antigen each at HLA-A, B, and DR, this is called

✓ 1-haplotype match

Cramping in the legs associated with peripheral vascular disease

✓ Claudication

Extended criteria donors are at least 50 years old and have two of the following

✓ Stroke as cause of death

2) Hypertension
3) Creatinine greater than 1.5
4) 60 years old +

Best treatment option for HCV

✓ Interferon and ribavirin

Route Interferon is given

✓ SQ

Significant side effect of Interferon

✓ Depression

Which has lower surgical complication rates - BD OR ED Pancreas Transplant?

✓ BD

How often is the PRA tested in a transplant candidate with VAD?

✓ Weekly

High risk behavior criteria must have happened in the last how many years?

✓ 5

Which diagnostic procedure will evaluate CAV?

✓ Left heart cath

Which segment is typically donated in pediatric living donor liver transplant?

✓ Left lateral segment

Used to diagnose if biliary tract is patent has blockage

✓ ERCP

Osteopenia Bone density T-Score

✓ 1-2.5 SD below mean

Osteoporosis Bone density T-Score

✓ >2.5 SD below mean

Most common reported complication after liver donation surgery

✓ Biliary leaks

Signs of biliary leak

✓ New onset fever, leukocytosis, abdominal pain, persistent or increased bile leakage from drain

What indicates acute early rejection in enteric-drained pancreas transplant?

✓ Rise in serum amylase and lipase, graft tenderness

Two or more of the following characteristics are highest risk for cardiac complications

✓ Dialysis >3 years

2) Primary disease with atherosclerotic risk factors
3) Males > 45 years old
4) Ischemic heart disease in first degree relative
5) HTN
6) Current smoker
7) HDL < 35
8) Cholesterol > 200

Most common type of peritransplant fluid collection

✓ Lymphocele

MELD score range

✓ 6-40

At what MELD score do you consider the sodium

✓ MELD >11

MELD score calculated from

 ✓ Serum creatinine, serium bilirubin, INR, serum sodium

Labs that indicate nonfunction in liver

✓ Coags, glucose, potassium, lactate

Cholestatis symptoms

✓ Clay colored stool, dark urine, itching, pain in RUQ, jaundice

T-tube draining should be colored

✓ golden brown

First line test for HCV

✓ EIA

If HCV EIA is positive, use this test next

✓ HCV RNA (NAT)

Liver Listing Status 1A

✓ Fulminant, HAT, or decompensated Wilson's Disease

Liver Listing 1B

✓ Hepatoblastoma, metabolic