kidney, pancreas, liver transplant
post liver transplantation, we need to evaluate what 4 things
-MPV and intrahepatic branches -main hepatic artery and intrahepatic branches -IVC and all intrahepatic veins -anastomotic sites
3 most common renal allograft complications
-acute tubular necrosis (from DD) -chronic rejection -drug toxicity
3 ultrasound findings that may indicate chronic rejection
-decrease kidney length -thing & echogenic cortex - increases RI
3 nonspecific findings for renal vein thrombosis
-enlarged renal allograft -MRV dilation with hypoechoic/anechoic thrombus -absence of venous flow
describe the systemic venous enteric drainage lcoation orientation arterial supply
-location: RLQ -orientation: pancreas tail is usually caudal -arterial supply: donar SMA & splenic a to recipient CIA
describe the systemic venous-bladder drainage location orientation arterial supply
-location: RLQ (right lower quandrant) -orientation: pancreatic head is caudal -arterial supply: Y-shaped donar arterial graft to recipient/s CIA
3 types of liver transplants
-orthotopic liver transplantation of the whole cadaver liver (most common) -living donar segmental transplant -reduced size or split deceased donar allografts (pediatric)
pancreas transplant abnormalities includes (6)
-rejection -graft thrombosis -pancreatitis (common) -AVF -fluid collections -miscellaneous
acute rejection is seen in ___________ % of all renal transplants
20-40%
normal MRA velo in renal transplant
200-250 cm/s
hyperacute rejection occurs ___________ post op
<24 hrs
abnromal RI in renal transplant
>0.8
most common cause of graft dysfunction?
Acute tubular necrosis (ATN)
describe hepatic artery anastomoses in liver transplant
DD celiac axis via carrel patch or fishmouth technique
absence of flow in the extra/intrahepatic arteries indicates
HA thrombosis
if a HA waveform goes from showing normal diastolic flow to absent diastolic flow, with dampened systolic peak, you should suspect
HA thrombosis
in most renal allografts, the ________ is directly anastomosed end-side with the ________
MRA EIA
PSV, RI, accel time in a normal HA
PSV: <200 cm/sec RI: 0.5-0.8 accel time: <0.08 sec
PSV and ratio for renal artery stenosis
PSV: >250 cm/s >/= 2:1 ratio
most common complication post renal transplant
RAS (renal artery stenosis)
___________ rejection is seen days to months after transplant
acute
hepatic artery thrombosis presents as severe
acute liver failure
whats the benefit of the carrel patch?
allows you to take more tissue from the aorta to make the anastomotic area bigger
method to diagnose acute rejection
biopsy
a ____________ rejection is a progressive decline in renal function that can be seen >3 months post op
chronic
why must we document collaterals pre liver transplantation
collaterals need to be ligated
a carrel patch is used with a ___________ donar
deceased
two most common reason for renal transplant?
diabetes severe polycystic disease
describe IVC anastomoses in liver transplant
donar HVs and IVC connected to recipient IVC
describe portal vein anastomosis in a liver transplant
end to end deceased donar and recipient MPVs
describe billiary anastomoses in a liver transplant
end to end donar CBD w/ recipient commmon hepatic duct
what 2 body system is the pancreas a part of?
endocrine digestive
insulin decreases _______ levels
glucose
glucagon increases
glucose levels
vascular complications are the second most common cause of
graft loss
what is the 2nd leading cause of loss in pancreas transplants?
graft thrombosis
2nd most common complication post liver transplant
hepatic artery stenosis
most common complication post liver transplant
hepatic artery thrombosis
most common cause of ATN
ischemic insult to renal transplant from being in ice
which kidney is preferred for harvesting? (L/R) and why?
left kidney b/c it has a longer renal vein
it is very important to measure the RI, PSV, and accel time in intrahepatic arteries post ____________ transplantation
liver
in a liver transplant, portal vein flow is _____________ with continuous hepatopetal direction
monophasic
biggest limiting factor in organ transplant
organ shortage
________________ fluid collections are very common post op renal allograft
perinephric fluid
function of pancreas
produces hormones to regulate glucose and aid in digestion
why is it common to place a stent in the ureter in renal allograft procedures?
reduce stricture
what is the number 1 leading cause of loss in pancreas transplants?
rejection
allograft tenderness with a hypoechoic and enlarged kidney in gray scale is an indication of
renal artery thrombosis
most common area to place a transplanted kidney?
right iliac fossa
what is hydronephrosis?
swelling of kidney due to buildup of urine common in transplants early hydronephrosis is considered normal
__________ drainage directs venous outflow and insulin drainage into the EIV via donor's portal vein
systemic venous bladder drainage
exocrine drainage via anastomomosis of donor duoddenal segment to recipient urinary bladder describes
systemic venous bladder drainage
__________________ drainage delivers insulin into the portal vein and maintains enteric drainage of pancreatic exocrine secretions
systemic venous enteric
in _______________ drainage, the donar portal vein is anastomosed to side of recipient SMV for venous drainage
systemic venous enteric drainage
2 surgical techniques for pancreatic transplant
systemic-venous bladder drainage (old) portal venous enteric drainage
in a liver transplant, the hepatic veins and IVC should show _____________ waveform patterns
triphasic
pancreatic transplant is usually done in cases of major complications from
type 1 diabetes
describe the doppler waveforms in the veins and arteries after a pancreatic transplant
veins: monophasic venous flow arteries: low-resistant flow
how is acute rejection treated?
with steroids or increased immunosuppresion