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