Organ Transplantation

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Contents 1 More Specific Terms 2 Laboratory 3 Radiology 4 Complications 5 Management 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• autologous tissue transplantation
• bone marrow transplantation; hematopoietic stem cell transplantation (BMT, HSCT)
• cardiac transplantation (heart transplant)
• intestinal transplantation
• liver transplantation
• lung transplantation
• ovarian tissue transplantation
• pancreatic islet cell transplantation
• renal transplantation
• stem cell transplantation
• xenotransplantation

Laboratory

• Toxoplasma gondii serology IgG (all patients)
• histoplasmosis serology
• Strongyloides serology ( ELISA) & stool ova & parasites
• tuberculin skin testing

Radiology

• chest X-ray as needed (rule out tuberculosis)

Complications

• organ rejection:

• order of increasing tendency for organ rejection: liver > kidney > pancreas
• older organ tranplanted into younger patients results in highest rate of rejection

• infection

• CMV

• most common opportunistic organism in solid organ transplants
• occurs most commonly in CMV-negative transplant recipient & CMV-positive organ donor

• during the 1st month after transplantation:

• most infections result from:

• transmission from the donor organ
• surgical complications
• nosocomial exposures
• similar to other types of surgery

• neutropenia & mucositis are major risk factors for bacterial & Candida infections

• 1-6 months after transplantation

• cytomegalovirus ( CMV)
• Epstein-Barr virus ( EBV)
• varicella zoster
• hepatitis C virus
• Nocardia
• Aspergillus
• Pneumocystis carinii
• Toxoplasma gondii
• polyomavirus BK in renal transplantation patients may cause nephropathy, organ rejection or urethral strictures

• > 6 months after transplantation:

• 75% at risk for same infections as general population
• those transplant patients requiring increased immunosuppression remain at risk of opportunistic infections

• cancer, including skin cancer

• recipients of solid organ transplants are at increased risk of cancer

• kidney transplant, liver transplant, heart transplant, lung transplant
• lymphoma & lung cancer are most common [2]

• cancers may behave aggressively in transplant patients [1]

Management

• prescribe new medications with caution (anti-rejection drug effects are wide)
• immunizations prior to transplantation

• influenza vaccine
• dPT
• hepatitis A vaccine
• hepatitis B vaccine
• Pneumovax
• meningococcal polysaccharide vaccine
• human diploid cell rabies vaccine
• varicella virus vaccine
• BCG

• pharmaceuticals: immunosuppressive agents

• cyclosporine
• sirolimus
• mycophenolate mofetil
• azathioprine

• CMV prophylaxis

• indicated for transplant recipients at risk for CMV
• ganciclovir, valganciclovir or high-dose acyclovir
• can reduce risk of lymphoproliferative disease

• Bactrim for treatment of Pneumocystis pneumonia
• treat Candida in the urine of renal transplantion patients

• suspect kidney infection
• fluconazole is usually effective against Candida sp except Candida glabrata & Candida krusei

• treat Aspergillus early & aggressively
• Strongyloides should be identified prior to transplantation

• Strongyloides hyperinfestation syndrome may occur during immunosuppression
• treat Strongyloides with thiabenzazole or albendazole prior to transplantation

More General Terms

• surgery
• chronic immunologic disease

Additional Terms

• organ donation
• organ transplantation rejection

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
2. Engels EA et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA 2011 Nov 2; 306:1891. PMID: &dopt=Abstract
3. Tullius SG, Milford E. Kidney allocation and the aging immune response. N Engl J Med 2011; 364:1369-1370. PMID: [1]
4. Organ Transplantation: NIH Institute and Center Resources [2]
5. National Guideline Clearinghouse Evidence-based care guideline for cytomegalovirus prophylaxis following solid organ transplants. Cincinnati Children's Hospital Medical Center ngc-guideline: [3]
   - Evidence based clinical practice guideline for management of EBV-associated post-transplant lymphoproliferative disease (PTLD) in solid organ transplant. Cincinnati Children's Hospital Medical Center ngc-guideline: [4]

organ/tissue transplantation