ABTC CCTN flashcards
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- Tacrolimus mechanism
- Calcineurin inhibitor that blocks T-cell activation and IL-2 production; requires therapeutic drug monitoring due to narrow therapeutic index and CYP3A4 interactions.
- Mycophenolate teratogenicity
- Antimetabolite that is teratogenic; pregnancy must be excluded before starting and two forms of contraception are required during therapy.
- Live vaccine contraindication
- Live attenuated vaccines are contraindicated after transplant because immunosuppression risks disseminated infection; inactivated vaccines are safe but may be less effective.
- Acute cellular rejection treatment
- High-dose IV corticosteroids are first-line; antibody therapy may be used for steroid-resistant or severe episodes, with increased infection monitoring afterward.
- CYP3A4 drug interactions
- Azole antifungals and macrolides increase calcineurin inhibitor levels, while rifampin and some anticonvulsants decrease them; monitor levels and adjust doses.
- mTOR inhibitor effects
- Sirolimus and everolimus impair wound healing and can cause proteinuria, hyperlipidemia, and pneumonitis; often avoided immediately post-transplant.
- Induction therapy purpose
- Given at transplant to reduce early rejection; lymphocyte-depleting agents increase infection risk, while basiliximab is an IL-2 receptor antagonist with a favorable safety profile.
- Therapeutic drug monitoring
- Measurement of whole-blood trough levels for narrow-therapeutic-index drugs; timing of the last dose affects interpretation and dosing decisions.
- ABO compatibility
- Required for most solid organ transplants; incompatible ABO matching risks hyperacute rejection and is generally avoided except in specialized protocols.
- Panel-reactive antibody
- Quantifies the breadth of preformed anti-HLA antibodies; higher PRA indicates greater sensitization and complicates organ matching.
- Positive crossmatch
- Indicates preformed donor-specific antibodies and generally contraindicates kidney transplant due to risk of hyperacute rejection.
- MELD-Na score
- Liver allocation score using bilirubin, INR, creatinine, and sodium; higher scores reflect greater 90-day mortality risk and priority.
- Psychosocial evaluation
- Assesses adherence history, social support, mental health, and substance use because these predict post-transplant outcomes and guide candidacy.
- Pretransplant vaccination
- Inactivated vaccines should be completed before immunosuppression when feasible; live vaccines must be given before transplant or avoided afterward.
- Living donor evaluation
- Confirms voluntary consent free of coercion, ABO compatibility, adequate donor organ function, and absence of transmissible disease.
- HLA matching relevance
- Most critical for kidney transplant; less relevant for liver and heart allocation, where ABO compatibility and urgency dominate.
- Hyperacute rejection
- Occurs within minutes to hours from preformed antibodies; requires immediate graft removal and is largely prevented by crossmatch testing.
- BK virus nephropathy
- Causes rising creatinine with BK viremia; management is reduction of immunosuppression, not increased therapy, because more immunosuppression worsens outcomes.
- PTLD association
- Post-transplant lymphoproliferative disorder is associated with Epstein-Barr virus and intensified immunosuppression; treatment includes reducing immunosuppression.
- CMV disease diagnosis
- CMV DNA PCR (viral load) is used for diagnosis and monitoring; treatment is IV ganciclovir, with dose adjustment for renal function.
- Infection timeline
- Early infections are surgical and nosocomial; 1-6 months bring opportunistic infections (CMV, Pneumocystis, fungal); late infections are community-acquired.
- Pneumocystis prophylaxis
- Trimethoprim-sulfamethoxazole is typically given for at least 6-12 months post-transplant and longer with ongoing intensified immunosuppression.
- Chronic allograft dysfunction
- Manifests as interstitial fibrosis and tubular atrophy in kidney, cardiac allograft vasculopathy in heart, and bronchiolitis obliterans in lung.
- GVHD targets
- Graft-versus-host disease after hematopoietic stem cell transplant classically affects skin, gastrointestinal tract, and liver.
- Dead donor rule
- Vital organs may only be recovered after death is declared by neurologic or circulatory criteria; organ recovery must not cause death.
- OPTN/UNOS role
- The OPTN operates under federal contract to set listing, allocation, and data reporting policies; UNOS is the current contractor.
- Informed consent elements
- Must disclose risks, benefits, alternatives, and the voluntary nature of donation free of coercion, in a language the patient understands.
- Living donor independence
- Donor evaluation is performed by a team independent of the recipient's care to avoid conflicts of interest and coercion.
- Allocation ethical principles
- Utility weighs expected survival benefit, justice weighs fair access, and urgency weighs medical need; OPTN policy sets specific rules.
- Teach-back method
- Patient education technique where the patient explains information in their own words to confirm comprehension and identify gaps.
- Mandatory UNOS reporting
- Waitlist updates, transplant events, and post-transplant follow-up must be reported at defined intervals per OPTN policy.
- Financial incentive prohibition
- The National Organ Transplant Act prohibits financial incentives for organ donation; altruistic non-directed donation is permitted with screening for coercion.