Week 2- DMS 241 Transplants

list some indication for a liver transplant exam:

hx of liver transplant

post-op eval

HA stenosis

elevated LFTs

jaundice

PHTN

fluid collection

liver transplant donor HA anastomosed to...

recipient HA

liver carrel patch

Another method of arterial anastomoses in liver transplant is when the donor CA and a small part of the AO are attached to the recipient HA

HA is usually anastomosed __________ to ___________

end to end

liver transplant donor IVC are anastomosed to...

recipient IVC

The IVC can be anastomosed _________ to ____________ OR ___________ to ______________

end to end

end to side (piggyback)

liver transplant donor PV is anastomosed to...

recipient PV

PV is usually anastomosed __________ to ___________

end to end

if there is chronic PV thrombosis/occlusion a _____________________ is used

jump graft

the jump graft bypasses any obstruction in the MPV

true

normal range of HA RI is

0.55 to 0.7 RI

list some causes of elevated HA RI:

cirrhosis

hepatic venous congestion

transplant rejection

list some causes of decreased HA RI:

transplant stenosis

atherosclerosis

arcuate ligament syndrome

PHTN

post trauma

iatrogenic

elevated HA RI may also be caused by __________________ or ___________________

postprandial state or advanced pt age

normal hepatic venous waveforms are _______________________ or _______________________

triphasic or tetraphasic

A wave

represent atrial contraction seen above the baseline

S wave

represents ventricular systole seen below the baseline at the first point of the W

the ___ wave is usually the highest peak velocity in hepatic venous waveforms

S

V wave

represents atrial filling and is a transitional phase between S and D may be above or below baseline

D wave

represents ventricular diastole seen below the baseline as the second point on the W

list some causes for pulsatile hepatic venous waveform:

tricuspid regurg

right sided CHF

list some causes of decreased hepatic venous phasicity:

cirrhosis

HV thrombosis (Budd-chiari syndrome)

hepatic veno-occlusive disease

hepatic venous outflow obstruction

normal PI of MPV is...

more than 0.5

list some causes for pulsatile PV flow:

tricuspid regurg

right sided CHF

cirrhosis

list some findings of PHTN:

low PV velocity (less than 16cm/s)

hepatofugal PV

portosystemic shunts

dilated portal vein

post-op eval of liver transplant should include:

liver parenchyma

perihepatic space

biliary system

vasculature

if liver parenchyma is coarse or heterogenous there may be concern for:

recurrent cirrhosis

infection

ischemia

necrosis

steatosis

neoplasm

if there are any focal lesions seen in the liver there may be concern for:

neoplasm

infarct

abscess

ductal abnormality

if there is increased RI within the liver there may be concern for:

extrinsic compression

advanced parenchymal disease

venous outflow obstruction

reperfusion injury

if there is decreased RI within the liver there may be concern for:

HA stenosis

atherosclerosis

median arcuate ligament compression

the HA is crucial for blood supply to the __________________________

bile ducts

caval anstomotic stenosis or kinking may cause ____________________ and ____________________

outflow obstruction and transplant dysfunction

you will look for tardus parvus within the ______________________ arteries

intraparenchymal

Pseudoaneurysm shows the _______________________ sign

yin yang

fluid collection from a liver transplant may be caused by:

seroma

hematoma

biloma

abscess

lymphocele

another complication of liver transplants is __________________

hepatic fibrosis

renal transplant exam includes eval of:

renal size and echogenicity

collecting system

ureter condition

fluid collection

color/spectral of renal and illiac vessels

cadaveric renal transplant

MRA harvested with portion of AO and attached to recipient EIA

live donor renal transplant

direct end-to-side renal arterial graft to EIA or end-to-end with IIA

urinary drainage of renal transplant:

donor ureter into recipient bladder

pediatric recipients of adult kidneys may be anastomosed to ______________

distal AO or IVC

in en bloc transplant donor IVC and AO are attached to recipient:

EIV and EIA

normal RI of intrarenal arteries

0.6-0.7

echogenic kidney may cause concern for

CKD

take RI of ___________________ arteries

interparenchymal

take PSV of _____________________ artery

main renal

at the area of stenosis velocity is ___________________

highest

criteria for severe renal stenosis

SAT- more than 0.7 sec

SAI- less than 300cm/sec^2

PSV- more than 200cm/sec

RA/IA ratio- 2

RI- less than 0.5

normal range of PSV for MRA

150-300cm/sec

transplant kidney is usually placed in the _________

RLQ

acceleration time

measured from beginning of systole to peak systole

list some complications of renal trasnplants:

parenchymal abnormalities

acute tubular necrosis

hyperacute

rejection

drug nephrotoxicity

infection

list some indication for a renal transplant exam later in years:

increased creatinine

hydronephrosis

high BP

ATN

post transplant renal function impairment

ATN is most common in ______________________ donors

cadaveric

ATN should resolve in _____ weeks

2

what causes ATN

donor kidney ischemia during transplant and reperfusion injury

sonographic findings of ATN

renal enlargement

altered echogenicity

reduced diastolic flow in interlobar vessels

diagnosis of ATN must be be confirmed by

biopsy

treatment of ATN

immunosuppressive drugs

what is the most common kind of rejection

acute

clinical findings of acute renal rejection

asymptomatic

flu-like symptoms

pyrexia

graft tenderness

acute rejection must be confirmed by

biopsy

sonographic findings of acute rejection:

kidney enlargement

altered echogenicity

high PI and RI

RA with reversed diastolic flow

chronic rejection begins ___ months after transplantation

3

factors of chronic rejection

acute rejection

subclinical rejection

ATN

drug toxicity

donor age

chronic rejection must be confirmed by _________________

biopsy

sonographic appearance of chronic rejection:

hyperechoic

cortical thinning

reduced number of intrarenal vessels

mild hydro

______________ is the most common vascular complication of renal transplants

RAS

direct assessment of RAS

PSV of MRA to determine if there is high velocity

indirect assessment of RAS

RI of segmental branches to determine if there is tardus parvus

emphysematous pyelonephritis

the formation of air within the kidney parenchyma secondary to bacterial infiltration

list some other complications of renal transplants:

infarction

renal vein thrombosis

AV fistula

pseudoaneurysm

urinoma

obstruction

stones

hematoma

lymphoceles

perinephric abscess

AV fistula creates arterialization of a vein

true

indication for pancreas transplant

diabetic patient with insulin dependency

indications for sono exam of pancreas transplant:

post-op eval

arterial/venous thrombosis

complications

guidance for biopsy

SPK

simultaneous pancreas and kidney

PAK

pancreas after kidney

PTA

pancreas transplant alone

Y-graft is made up of the donor...

CIA, EIA, IIA

in pancreas transplant donor IIA is connected to:

recipient splenic artery

in pancreas transplant donor EIA is connected to:

recipient SMA

in pancreas transplant the donor CIA/Y-graft is connected to:

recipient CIA

in pancreas transplant the donor PV is connected to:

recipient EIV

in pancreas transplant the donor duodenum is connected to:

recipient bladder or small intestine

2D eval of pancreas transplant includes:

asses head, neck, body, and tail

measure panc duct

fluid collection

the most common complication of pancreas transplant is _________________

venous thrombosis

list some othe complications of pancreas transplants:

arterial thrombosis

edema

AV fistula

pancreatitis

rejection

sonographic appearance of pancreatitis:

may look normal

enlarged

edematous

pseudocyst

take the RI of the ___________________________ arteries in pancreas transplant

head, body, and tail

take PSV of the _____________________________ arteries in pancreas transplant

iliac arteries

Y graft

SMA

splenic artery

iliac vein

portal vein