BCTXP flashcards
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- Hyperacute rejection
- Antibody-mediated rejection occurring within minutes to hours after transplantation, caused by preformed recipient antibodies against donor antigens; prevented by crossmatching.
- Panel-reactive antibody (PRA)
- Percentage of the donor pool to which a recipient has antibodies; higher PRA indicates greater sensitization and reduced compatible donor options.
- Crossmatch
- Test of recipient serum against donor lymphocytes to detect preformed antibodies; complement-dependent cytotoxicity and flow cytometry are common methods.
- MELD score
- Model for End-Stage Liver Disease; used to prioritize liver transplant candidates based on bilirubin, INR, and creatinine; higher scores indicate greater urgency.
- Contraindication to transplant
- Active malignancy, uncontrolled infection, or severe irreversible organ failure not amenable to transplant are absolute contraindications; active substance use may be relative.
- Psychosocial evaluation
- Assessment of adherence, social support, mental health, and substance use before listing; identifies risk factors for poor post-transplant outcomes.
- Donation after circulatory death
- Organ procurement after withdrawal of life support and declaration of circulatory death; associated with higher risk of delayed graft function compared to brain death donation.
- Cold ischemia time
- Time from organ procurement to reperfusion; prolonged cold ischemia increases risk of delayed graft function and primary nonfunction.
- University of Wisconsin solution
- Static cold storage preservation solution containing lactobionate, raffinose, glutathione, and adenosine; reduces metabolic demand and protects organs.
- Machine perfusion
- Technique of continuously perfusing organs with preservation solution at hypothermic or normothermic temperatures; may improve viability assessment and outcomes for marginal grafts.
- Kidney transplant anastomosis
- Surgical connection of donor renal artery and vein to recipient external iliac vessels; ureter is implanted into bladder with anti-reflux technique.
- Liver transplant biliary reconstruction
- Duct-to-duct anastomosis is preferred; Roux-en-Y hepaticojejunostomy is used when duct-to-duct is not feasible, such as in primary sclerosing cholangitis.
- Delayed graft function
- Need for dialysis within the first week after kidney transplant; associated with prolonged cold ischemia, donor age, and DCD donation.
- Calcineurin inhibitors
- Tacrolimus and cyclosporine inhibit calcineurin, blocking T-cell activation; tacrolimus is preferred in most protocols due to lower rejection rates.
- Mycophenolate mofetil
- Antimetabolite that inhibits purine synthesis and lymphocyte proliferation; common side effects include gastrointestinal intolerance and teratogenicity.
- Antibody-mediated rejection
- Rejection mediated by donor-specific antibodies; treated with plasmapheresis, intravenous immunoglobulin, and rituximab; bortezomib may be used in refractory cases.
- Induction therapy
- Immunosuppressive treatment at the time of transplant (e.g., basiliximab, antithymocyte globulin) to reduce early acute rejection risk.
- CMV prophylaxis
- Valganciclovir given for 3-6 months after transplant, especially for D+/R- patients, to prevent cytomegalovirus infection and disease.
- Pneumocystis pneumonia prophylaxis
- Trimethoprim-sulfamethoxazole for 6-12 months after transplant; alternatives include dapsone or atovaquone for sulfa-allergic patients.
- BK virus nephropathy
- Viral infection of the kidney graft causing nephropathy; screened by plasma BK viral load; first-line treatment is reduction of immunosuppression.
- Post-transplant lymphoproliferative disorder
- EBV-associated lymphoproliferative disorder occurring after transplant; management includes reduction of immunosuppression and rituximab.
- Graft survival rates
- Kidney transplant survival exceeds 90% at 1 year and ~70% at 5 years; liver transplant ~85% at 1 year and ~70% at 5 years.
- Post-transplant malignancy
- Skin cancers, especially squamous cell carcinoma, are most common; immunosuppression increases risk; regular skin examinations are recommended.
- Non-adherence
- Failure to follow immunosuppression regimen; a major risk factor for late acute rejection and graft loss; requires monitoring and intervention.
- Post-transplant diabetes mellitus
- Diabetes occurring after transplant, often due to corticosteroids and calcineurin inhibitors; screened with fasting glucose or oral glucose tolerance test.
- OPTN
- Organ Procurement and Transplantation Network; operated under federal contract by UNOS; oversees organ allocation and transplantation policy in the United States.
- National Organ Transplant Act
- 1984 U.S. law that prohibited the sale of human organs and established the Organ Procurement and Transplantation Network.
- Uniform Anatomical Gift Act
- Model legislation governing organ donation; first-person consent laws allow donation based on deceased's registration without family consent.
- Kidney allocation system
- Uses estimated post-transplant survival (EPTS) and kidney donor profile index (KDPI) to allocate kidneys; also considers waiting time and geographic proximity.
- Informed consent
- Process of discussing risks, benefits, alternatives, and need for lifelong immunosuppression with transplant candidates; essential ethical and legal requirement.
- Living donor advocate
- Independent team that ensures living donors are voluntary, altruistic, and fully informed; protects donor interests throughout evaluation and donation.
- HLA matching
- Matching of HLA-A, -B, and -DR antigens between donor and recipient; zero mismatch is associated with superior graft survival.