The single most important factor in determining whether to perform a transplant between a specific donor and recipient is:
ABO blood typing and HLA typing (HLA-A, -B, and - DR) are required before a kidney transplant. The method of screening for preformed antibodies against HLAs (because of prior transplants, blood transfusions, or pregnancies) is evolving. The panel-reactive antibody (PRA) assay is a screening test that examines the ability of serum from a kidney transplant candidate to lyse lymphocytes from a panel of HLA-typed donors. A numeric value, expressed as a percentage, indicates the likelihood of a positive cross-match with a donor. A higher PRA level identifies patients at high risk for a positive cross-match and therefore serves as a surrogate marker to measure the difficulty of finding a suitable donor and the risk of graft rejection.
The most common diagnosis leading to a heart transplant is:
The most common diagnosis leading to a heart transplant is ischemic dilated cardiomyopathy, which stems from coronary artery disease, followed by idiopathic dilated myopathy and congenital heart disease. About 3000 patients are added to the waiting list each year.
All of the following are side effects of cyclosporine administration for prevention of organ rejection EXCEPT:
The metabolism of cyclosporine is via the cytochrome P450 system, resulting in many significant drug interactions (see Table 1 1-1). Calcineurin inhibitors are nephrotoxic and constrict the afferent arteriole in a dose-dependent, reversible manner (Table below). They can also cause hyperkalemia and hypomagnesemia. Several neurologic complications, including headaches, tremor, and seizures, also have been reported. Cyclosporine has several undesirable cosmetic effects, including hirsutism and gingival hyperplasia. It is associated with a higher incidence of hypertension and hyperlipidemia than is tacrolimus.
Drug interactions and side effects associated with calcineurin inhibitors:
All of the following are true of extracorporeal membrane oxygenation (ECMO) EXCEPT:
A new development to minimize ischemic injury to organs procured after cardiac death has been the application of declaration of cardiac death (DCD) differs in two key ways:
The initial experience with organs procured using ECMO has been encouraging.
The most significant side effect of sirolimus is:
One of the most significant side effects of sirolimus is hypertriglyceridemia, a condition that may be resistant to statins and fibrates. Impaired wound healing (immediately post-transplant in particular), thrombocytopenia, leukopenia, and anemia also are associated with sirolimus, and these problems are exacrbated when it is used in combination with MMF.
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