Transplantation Surgery
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| Drug that revolutionized transplantation | Cyclosporine
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| What percentage of donor candidates/families are approached regarding willingness to be a transplant donor? | 84% approached, 44% yes
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| Antigen | a molecule that can interact with the immune system
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| Antibody | peptides produced by B lymphocytes that attach to foreign material and aid in removing it from the body
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| Antigen presenting complex (APC) | - is a cell that displays foreign antigen complexed with MHC on its surface. T-cells may recognize this complex using their T-cell receptor (TCR)
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| Major Histocompatibility complex (MHC) | genes expressed on the surface of cells which display fragments of molecules from invading microbes to a T cell that has the ability to kill or coordinate the killing of the microbe
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| Human Leukocyte Antigens (HLA) | are encoded by the MHC genes (another name for MHC)
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| Cytokines | Circulation peptides that influence behavior of the immune system (IL-2, IL-6, TNF-alpha)
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| T-cell receptor | a protein complex of T lymphocytes that can identify MHC molecules
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| CD4 lymphocytes | Interact with APC MHC II molecules via the TCR to release cytokines (primarily IL-2)
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| CD8 T lymphocytes | Interact with MHC class I molecules (that contain foreign peptides) and can directly kill the foreign cell
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| Allogeneic | "of the same species"
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| Crossmatch | a test for determining tissue compatibility between a transplant donor and a recipient prior to transplantation using recipient's serum and donor lymphoctyes (or other donor cells)
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| Panel Reactive Antibodies (PRA) | Preexisting antibodies that will react against HLA antigens in the serum of a potential allograft recipient
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| Tolerance | A state of immune acceptance without immunosuppression. Immune system is actually regulating itself.
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| MHC I binds with | CD8 T cell
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| MHC II binds with | CD4 T cells
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| MHC Class I antigens are found on | nearly all cells. Class II antigens found primarily on APC's
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| How many pathways are there of allogeneic recognition? | 2. Direct and Indirect
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| Direct Pathway | T-cells and their receptors identify allogeneic major histocompatibility complex (MCH) molecules. This generates CD8 T Cells which cause attack an organ and cause rejection
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| Indirect Pathway | CD4 T cells recognize donor MHC peptides after presentation by APC’s (APC’s pick up peptides shed from transplanted organs)
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| Main foreign substances | blood type antigens, HLA
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| Intracellular pathways that create immune response | Just teh T cell receptor interacting alone doesn't affect the immune system enough to get a huge immune response. Have to have costimulation
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| Three types of rejection | Hyperacute (immediate, due to preformed antibodies, within a few minutes transplanted organ gets black), Acute (most often occurs 5-90 days after transplant mediated by Tcells), Chronic (Chronic allograft vasculopathy)
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| Immunosuppression | Different drugs are used for immunosupression (OR, maintenance therapy, acute rejection meds)
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| ____is treated with steroids/antilymphocyte preparations for a period of several days | Acute Rejection
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| ATGAM | polyclonal antibody used primarily for steroid-resistant acute rejections. Not preferred, serum sickness/anaphylaxis can occur
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| OKT3 success with reversal of acute rejection | 94%
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| Real important cytokine | IL2
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| Good cytokines for stopping rejection | IL4, IL10
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| Corticosteroids MOA | Inhibit macrophage migration and APC function; Inhibits gene expression of IL 1,2,3,6, TNF alpha and IFN gamma
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| Which immunosuppressant suppress bone marrow as an AE? | Azathioprine (Imuran)
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| Which immunosuppressant is used in maintenance therapy? | Cellcept
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| BIG AE's Tacrolimus | Nephrotoxicity and Diabetes; moreso than cyclosporine. However, it is more effective than cyclosporine at preventing acute rejection
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| Cellcept and prograft | common combo for maintenance therapy
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| Complications of immunosuppression | Infections, cancer (squamous cell skin cancer most common)
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| Organ protection | Hyothermia, preservation solution, continuous perfusion devices
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| Warm ischemic time | Kidneys (3 days), Livers (2 days), Pancreas (24 hours), Hearts (6 hours)
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| Lung organ ischemic time | <8 hours; require a specific perfusion/preservation solution
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| Donor Contraindications of renal transplant | HIV, hx of malignancy, active infections, hx of HTN
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| Where is the kidney transplant put? | Right ileac fossa
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| Transplant vs dialysis | Transplants have better outcome and cost less; patients are more independent with transplants
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| Indications for kidney transplants | ESRD from: DM, glomerulonephritis, polycystic kidney dz, hypertensive nephrosclerosis, SLE, interstitial nephritsi
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| Acute rejection tx | OKT3 and steroids
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| Transplantation of the pancreas requires | y segment of iliac vessel
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| Pancreas Transplantation indications | Type I Diabetes (usually done simultaneously with kidney transplant)
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| Small bowel transplantation indications | short gut syndrome dependent on TPN as a result of (IBD, Necrotizing enterocolitis, malrotation, trauma)
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| Complications of heart transplants | Complications: right heart dysfunction, brady arrhythmias. Tachycardia is seen in acute rejection
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| 5 year surivival of heart transplant | 70%
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| ___ accounts for the majority of early morbidity/mortality of lung transplants | infectious complications (pneumonia)
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