...organ transplant.docx - BPharm(Hons Haematology Immunology BPH 2242 BP1\/18 S4 2020 1 Immunological aspects of transplantation(PBL \u2013 2 x 1.5 hrs The

...organ transplant.docx - BPharm(Hons Haematology...

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BPharm (Hons) Haematology & Immunology BPH 2242 BP1/18 S4 2020 1 Immunological aspects of transplantation (PBL – 2 x 1.5 hrs) The trigger is normally a scenario or clinical vignette involving organ transplantation. The focus of learning is the immunological phenomena associated with organ transplantation; but may also include ethical and other issues. ______________________________________________________________B.Pharm Semester 4 Immunology System – Problem-Based Learning (Organ transplantation) Resource person: Dr. Palanisamy Sivanandy “Vietnam wasn't the only struggle in my life”, Officer Kevin said to his audience in a gathering, celebrating his 14th post-transplant anniversary. He described the start of his scuffle (struggle) with his failing heart fourteen years ago, rather unpleasant. “I began struggling to catch my breath while jogging and I felt tired and weak." Subsequently, “I was diagnosed with cardiomyopathy in my mid-forties.” he added, “At my age and the condition of my heart, a transplant was the only option for survival.” Being a fortunate patient, Kevin waited only 5 months for his compatible donor. Blood type matching and other necessary tests were carried out and soon he started hearing the sound of his second heart, the best gift of life he could ever receive. Since then he has been taking his medications regularly, with no complaints of side effects and no graft rejection or other complications. Kevin ended his speech with these sentences: "I wouldn't have had those years or the time to which I'm looking forward, without my new heart. Thank the family of the donor again, whom their identity has never been revealed to me.” Ethical issues: Indications/ Criteria for heart transplantation are Dilated or ischemic cardiomyopathy Congenital heart disease, intractable angina or malignant cardiac arrhythmias where no conventional therapy exists, or conventional therapy has failed Ejection fraction less than 20% Pulmonary vascular resistance of less than 2 Wood units Age younger than 65 years Ability to comply with medical follow-up care Dilated cardiomyopathy (54%) - This often has an unclear origin Ischemic cardiomyopathy (45%) - This percentage is rising because of the increase in coronary artery disease (CAD) in younger age groups Congenital heart disease and other diseases not amenable to surgical correction (1%) The 2016 International Society for Heart Lung Transplantation, criteria for heart transplantation are based on Heart failure prognosis scores cardiopulmonary exercise testing estimated 1-yr survival of < 80%, as calculated by the Seattle Heart Failure Model (SHFM), or a Heart Failure Survival Score (HFSS) in the high/medium risk range should be considered as reasonable cut points for listing Right heart catheterization (RHC) After left ventricular assist device (LVAD), reevaluation of hemodynamics should be done BMI of ≤35 kg/m 2 (estimated glomerular filtration rate [eGFR] > 30 ml/min/1.73 m 2 )
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  • Winter '19
  • Professor Robert
  • immunosuppression, FOR ORGAN TRANSPLANTATION, Heart Lung Transplantation

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