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6 Cards in this Set
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A 62-year old man who had a motorcycle accident has been in a coma for several weeks. He is on a respirator, has had pneumonia on and off, has been on vasopressors, and shows no sign of neurologic improvement. The family inquires about brain death and possible organ donation.
How should this patient be managed? |
At one time we were very fussy about who was accepted as an organ donor. Now, with 65,000 patients on transplant waiting lists and many dying every day for lack of organs, we take almost anybody. The rule now is that all potential donors are referred to the local organ harvesting organization.
Donors with specific infections (eg, hepatitis) can be used for recipients with the same infection. Even donors with metastatic cancer are eligible for eye donation.
A positive HIV status remains the only absolute contraindication to a patient serving as an organ donor. |
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Ten days after liver transplant, levels of gamma-glutamyltransferase (GGT), alkaline phosphatase, and bilirubin begin to go up. There is no U/S evidence of biliary obstruction or Doppler evidence of vascular thrombosis.
What is this? How should this patient be managed? |
Acute rejection - It occurs after the first 5 days, and usually within the first few months - Signs of organ dysfunction suggest it, but BIOPSY will confirm it - First line of therapy is steroid boluses; if unsuccessful, antilymphocyte agents (OKT3) are used |
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On the third week after a closely matched renal transplant, there are early clinical and lab signs of decreased renal function.
What is this? How should this patient be managed? |
Acute rejection - It occurs after the first 5 days, and usually within the first few months - Signs of organ dysfunction suggest it, but BIOPSY will confirm it - First line of therapy is steroid boluses; if unsuccessful, antilymphocyte agents (OKT3) are used |
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Two weeks after a lung transplant, the patient develops fever, dyspnea, hypoxemia, decreased FEV1, and interstitial infiltrate on CXR.
What is this? How should this patient be managed?
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Acute rejection - It occurs after the first 5 days, and usually within the first few months - Signs of organ dysfunction suggest it, but BIOPSY will confirm it - First line of therapy is steroid boluses; if unsuccessful, antilymphocyte agents (OKT3) are used |
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How and when should a patient with a heart transplant be monitored for acute rejection? |
There are no clinically early signs of acute rejection; thus biopsies are done routinely at set intervals
Once diagnosed, first line of therapy is steroid boluses; if unsuccessful, antilymphocyte agents (OKT3) are used |
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Several years after a successful (renal / hepatic / cardiac / pulmonary) transplant, there is gradual, insidious loss of function.
What is this? How should this patient be managed? |
Chronic Rejection - Poorly understood, and irreversible - We have no treatment for it, but correct answer is to do BIOPSY - Late acute rejection episodes could be the problem and we can treat those |
