Solid Organ Transplantation: Evaluation and Pretransplant Care

Vocabulary flashcards covering solid organ transplant evaluation, organ allocation metrics, intestinal and multivisceral failure, pretransplant care, and waitlist surveillance protocols.

Kidney Donor Profile Index (KDPI)

A classification score for kidneys from deceased donors derived from the Kidney Donor Risk Index, which takes into account donor age, ethnicity, creatinine (mg/dL), history of hypertension, history of diabetes, cause of death, height, weight, donor type (DCD or non-DCD), and HCV status.

Kidney Paired Donation (KPD)

A transplant option for candidates who have a living donor who is willing and medically suitable to donate a kidney but medically incompatible with the intended recipient.

Nondirected Donors

Individuals, also known as altruistic or Good Samaritan donors, who participate in the Kidney Paired Donation program by offering to donate a kidney to a person they do not know.

Simultaneous Kidney/Pancreas (K/P) Transplantation

A transplant procedure indicated for patients with labile type 1 or type 2 diabetes mellitus to halt or prevent secondary complications of diabetes who also have end-stage renal disease (ESRD).

Diabetic Gastroparesis

A clinical condition diagnosed by symptomatology or a gastric-emptying study that is not an absolute contraindication to transplantation, but must be evaluated for effective peri- and postoperative management.

Structural Intestinal Failure

A category of intestinal failure resulting from massive surgical resection or anatomical loss, caused in adults by radiation damage, Crohn's disease, ischemia, familial adenomatous polyposis, or trauma, and in children by necrotizing enterocolitis, gastroschisis, malformation/volvulus, atresia and stenosis, or trauma.

Functional Intestinal Failure

A category of intestinal failure characterized by disease processes that impair gut motility or absorption, caused by pseudo-obstruction in adults, and by Hirschsprung disease, microvillus inclusion disease, or pseudo-obstruction in pediatric patients.

Intestinal Failure Transplant Options

Three surgical options determined by the underlying disease process and coexisting organ failure: isolated intestinal transplant, liver/small bowel transplant, and multivisceral transplant.

Parenteral Nutritional Therapy Failure Indications

Life-threatening complications of intestinal failure warranting intestinal transplantation, which include loss of vascular access preventing fluid and nutritional maintenance, frequent episodes of severe sepsis or dehydration, and presence of or impending liver failure.

Nutritional Assessment Diagnostics

Specific objective testing used during the intestinal and multivisceral transplant evaluation comprising calorie counts, fecal fat measurement, bone density measurement, and serial anthropometries.

Adult Pretransplant Vaccination Protocol

Immunization regimen requiring adult candidates to be vaccinated against hepatitis A, hepatitis B, S. pneumoniae, tetanus, varicella, herpes zoster, annual influenza, and meningitis if enrolled in colleges or universities.

Cardiopulmonary Exercise Test (CPET) Parameters

Serial evaluation tests for heart transplant candidates measuring peak oxygen consumption ($\text{MVO}_2$) and the minute ventilation/carbon dioxide production relationship ($\text{VE/VCO}_2$ slope).

Lung Allocation Score (LAS) Re-evaluation

A scoring system requiring updated clinical information every 6 months to determine appropriate organ allocation, including forced vital capacity, six-minute walk distance, and serum creatinine.

UNOS Re-evaluation for Hepatocellular Carcinoma (HCC)

A mandatory monitoring protocol requiring liver transplant candidates with known HCC to undergo imaging studies and alpha-fetoprotein (AFP) testing every 3 months to continue receiving MELD exception points.

Cirrhotic Waitlist Surveillance Protocol

Periodic surveillance for cirrhotic liver candidates requiring abdominal imaging via ultrasound, CT scan, or MRI every 6 months, along with an annual dobutamine stress echocardiogram.