Term
|
Definition
HTNsive nephrosclerosis;
DM II;
re-transplantation/graft loss;
Polycystic kidneys;
DM I |
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Term
| Absolute C/Is for Renal Transplant |
|
Definition
active untreated infection;
active substance abuse;
uncontrolled psychiatric illness;
recent or active malignancy;
chronic diseases with life expectancy <1 yr; |
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Term
| Relative C/Is for Renal Transplant |
|
Definition
etiology of renal dx;
sensitization to donor;
non-compliance/non-adherence to meds;
active glomerulonephritis;
advanced forms of extra-renal dx; |
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Term
| Pre-Transplant Lab Studies |
|
Definition
CBC, electrolytes, LFTs, coagulation studies;
Viral serology: CMV, EBV, VZV, HIV, Hep B & C, PPD, urinalysis, CXR;
Immunologic Profile: blood typing (A,B,O), panel reactive antibody (PRA), HLA typing;
Cardiac: EKG, stress test, ECHO;
Pscyhosocial Evaluation (VERY IMPORTANT!!!) |
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Term
| Surgical Complications of Renal Transplant |
|
Definition
Surgical site wound infections;
Bleeding;
Acute thrombosis;
Urine leak: diminished output, elevated SCr, suprapubic discomfort, UltraSound or CT used to look for fluid collection;
Rejection: hyperacute;
Delayed Graft Function (DGF): cadaver > live donor, resolves within 2-6 days; |
|
|
Term
| Factors influencing Incidence of Delayed Graft Function (DGF) |
|
Definition
cold ischemic time;
age of donor;
medical condition of organ donor; |
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Term
| Induction therapy for Renal Transplant Immunosuppression |
|
Definition
1) Anti-thymocyte globulin (Polyclonal Ab)
- Thymoglobulin [rabbit] - most often used;
2) Monoclonal Abs
- alemtuzumab (Campath-1H)
- basiliximab (Simulect) |
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|
Term
| Maintenance Therapy for Renal Tranplat Immunuosuppression |
|
Definition
Must be individualized for pt;
1) Calcineurin Inhibitor - **Most used
- tacrolimus (Prograf) - preferred
2) Anti-Proliferative
- mycophenolate preferred
3) Corticosteroids: growing trend toward steroid free regimens, withdrawn 3-5 days post-transplant |
|
|
Term
| Most Common Maintence Treatment for Renal Transplant Immunosuppression |
|
Definition
| tacrolimus (Prograf) + mycophenolate (CellCept) |
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|
Term
| Most Common Cause of Liver Transplant |
|
Definition
|
|
Term
| Common Causes of Liver Transplant |
|
Definition
Chronic hepatitis: B, C, viral, auto-immune;
Cholestatic dx;
Fulminant hepatic necrosis;
Metabolic dx: Wilson's, glycogen storage, alpha-1-antitrypsin deficiency;
ALCOHOLIC CIRRHOSIS |
|
|
Term
| Absolute C/I for Liver Transplant |
|
Definition
ACTIVE EtOH or substance abuse;
Uncontrolled psychiatric disorder;
Chronic diseases w/ life expectancy <1 yr;
Extrahepatic malignancy;
Uncontrolled infection; |
|
|
Term
| Transplant Center-Specific C/Is |
|
Definition
HIV;
Obesity;
Adherence or compliance issues to meds; |
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|
Term
| Model for End-Stage Liver Disease (MELD) |
|
Definition
numerical scale used to assess 90 day mortality in pts w/ end-stage liver dx;
Score range: 6 - 40;
Higher numbers indicate high mortality rates;
Utilizes 3 lab values: Bilirubin, INR, SCR; |
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|
Term
| Postoperative Care for Liver Function |
|
Definition
Monitor for primary non-function (PNF):
- normalization of coagulation system
- appropriate glucose metabolism
- adequate bile production
- hemodynamic stability |
|
|
Term
| Induction Therapy for Liver Tranpslant Immunosuppression |
|
Definition
| Monoclonal Ab: basiliximab (Simulect) |
|
|
Term
| Maintenance Therapy for Liver Transplant Immunosuppression |
|
Definition
Calcineurin Inhibitor: tacrolimus (Prograf) - PREFERRED;
Corticosteroids: methylprednisolone;
Anti-Metabolites: generally NOT USED, use mycophenolate if used |
|
|
Term
| Common Infections in Early (1 month) Post-Transplantation Period |
|
Definition
Nosocomial or surgery related(most common):
- Drug-resistant: MRSA, VRE, Candida
- C. diff
Donor-Derived (NOT common:
- HSV
- HIV
Recipient Associated:
- Aspergillus
- Pseudomonas |
|
|
Term
| Common Infections in Intermediate (2-6 months) Post-Transplantation Period |
|
Definition
Opportunistic:
- PCP
- Listeria monocytogenes
- Nocardia
- T. cruzi;
Viral:
- Hep C
- HSV
- CMV
- BK virus |
|
|
Term
| Common Infections in Late (>6 months) Post-Transplantation Period |
|
Definition
Community-Acquired:
- UTIs
- Pneumonia
Opportunistic Infections
Viral:
- West Nile virus
- JC virus
- HSV encephalitis |
|
|
Term
| Pneumocystis Pneumonia (PCP) |
|
Definition
Most prevalent in intermediate post-transplantation period;
Clinical Presentation:
- dyspnea
- non-productive cough
- fever
- presence of bilateral diffuse interstitial infiltrates on CXR |
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|
Term
|
Definition
TMP/SMX (DRUG OF CHOICE) x 3-6 months;
Dapsone for Sulfa allergic pts (must evaluate G6PD);
Atovaquone 1500 mg PO daily - suspension must be given w/ HIGH FAT meal |
|
|
Term
|
Definition
SMX/TMP 15-20 mg/kg/day in divided doses;
IF SULFA ALLERGIC: Pentamidine 4 mg/kg daily |
|
|
Term
|
Definition
most relevant polyomavirus taht causes NEPHRITIS in renal transplant patients;;
Clinical Presentation:
- renal dysfunction: acute rise in SCr or slow progressive rise seen 10-13 months after transplant;
Diagnosis: renal biopsy (GOLD STANDARD), Viremia (>7000 copies/mL); |
|
|
Term
| First Line Tx of BK Virus Nephritis |
|
Definition
First Line:
- hold antiproliferative (MMF or azathioprine)
- reduce anti-proliferative by 50%
- reduce Calcineurin Inhibitor dose to lowest acceptable trough level; |
|
|
Term
| Second Line Tx for BK Virus Nephritis |
|
Definition
No consensus therapy;
1) Antiviral: Cidofovir - nephrotoxic at doses >5 mg/kg;
2) Immunosuppressant: Leflunomide - used in combo w/ decrease of maintenance immunosuppressive regimens - Target >40 mcg/mL;
3) Antibiotic: Fluoroquinolones - used 1st as 2nd line therapy |
|
|
Term
| Screening for BK Virus Nephritis |
|
Definition
Urine Cytology: look for decoy cells q3 months during 1st 2 yrs & annually for following 3 yrs;
PCK BKV;
Renal biopsy |
|
|
Term
|
Definition
| polyomavirus that causes encephalopathy in HIV/AIDS pts w/ |
|
|
Term
|
Definition
major cause of morbidity among solid organ transplant pts;
most common cuase of infection in solid organ transplant pts during 1st month following transplantation; |
|
|
Term
| Risk Factors for CMV Infection |
|
Definition
Immunologic status;
Primary infection: most severe form, R-/D+;
Reactivation: R+/D- or R+/D+;
Medicatoins: polyclonal Abs;
Lung > liver > kidney |
|
|
Term
|
Definition
pp65 Antigenemia: detects infected cells;
CMV PCR: produces actual viral load, highest in tissue invasive disease;
No standardized values established; |
|
|
Term
| Universal Prophylaxis for CMV |
|
Definition
All at-risk pts receive:
- valgancyclovir 900 mg PO daily x 6 months (R+/D+)
OR
- ganciclovir 1000 mg PO TID (much less bioavailability) |
|
|
Term
| Pre-Emptive Prophylaxis Therapy for CMV |
|
Definition
Pts monitored routinely (weekly using PCR);
Pts given anti-viral therapy when evidence of replication exists;
Benefits: late-onset dx eliminated, less risk of drug toxicity;
Risks: higher lab costs, more difficult to coordinate |
|
|
Term
|
Definition
Ganciclovir IV: mainstay of therapy, CANNOT use oral formulation;
Duration: clinical resolution of Sx, virologic clearance, minimum of 2 wks;
OR
Valganciclovir (noninferior to ganciclovir) 900 mg PO BID; |
|
|
Term
| Risk Factors for Ganciclovir Resistant CMV |
|
Definition
prolonged low dose oral prophylaxis;
R-/D+ serostatus;
Increased intensity of immunosuppression;
Lung transplant; |
|
|
Term
| Tx of Ganciclovir Resistant CMV |
|
Definition
Pts w/ 2 wks adequate tx who do NOT respond to ganciclovir:
- Severe: switch to or add foscarnet
- Non-severe: increase ganciclovir dosing up to 10 mg/kg BID OR 50% dose of ganciclovir & 50% dose of foscarnet |
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