ORGAN AND BMT
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Transcript of ORGAN AND BMT
Complications• Complications associated
with organ transplantation generally consist of :
1. technical problems involving the surgical procedure
2. problems related to immunosuppression
3. special problems specific to the organ transplanted
Immunosuppression• Excessive immunosuppression increases the risk for infection and must
be avoided.• signs :Infectionsdelayed healingHypertensionDiabetes Addison’s disease-type reactions cushingoid features (e.g., edema, ascites, buffalo hump, moonfacies) increased susceptibility to infectionWeaknessfatigue
Rejection• Rejection ---« signs and symptoms of
organ failure.• Organ biopsy is used to confirm the
rejection reaction (Figure 21-9). • evidence of acute rejection -----« increase
dosage of the immunosuppressive agents.• Chronic rejection occurs insidiously and
is progressive.• It cannot be reversed with intensified
therapy.• Chronic rejection ----« organ failure.• Classic evidence of chronic rejection is
found by biopsy.
Drug Side Effects• A major side effect of azathioprine is bone marrow suppression with resulting leukopenia, thrombocytopenia, and anemia. • These changes greater risk for infection and excessive bleeding. • Cyclosporine has replaced azathioprine.• Cyclosporine side effects : severe kidney and liver changes hypertension- bleeding –anemia
potentiate renal injury caused by other agents. gingival hyperplasia hirsutismGynecomastiacancers of the skin and cervix
• Antithymocyte globulin (ATG) and ALG both act as lymphocyte-selective immunosuppressants.• side effects : feverHemolysisLeukopeniaThrombocytopeniatumor developmentincreased risk for infection
Prednisone side effects :hypertensiondiabetes mellitusOsteoporosisimpaired healingmental depressionPsychosesincreased risk for infection adrenal gland suppression.
cancers• Immunosuppressed patients exhibit an increased incidence of certain cancers.• 6% various forms of cancer.• Cancers commonly seen in the general population (carcinomas of lung, breast, prostate, and colon) show no change in occurrence in immunosuppressed patients.• two types of cancer found commonly increased frequency :squamous cell carcinoma of the skincarcinomas of the uterine cervix
• Cancers that are uncommon in the general population but that occur with increased frequency in immunosuppressed patients are
Lymphomaslip carcinomasKaposi sarcomacarcinomas of the kidney carcinomas of the vulva
and perineum
Special Organ Complications• involve: heart bone marrowGVHD is an important and often lethal
complication of allogenic BMT Acute GVHD : first 3 months after
transplantation mucosal, skin, liver,
gastrointestinal tract involvementIntraorally there are nonspecific
mucosal ulcers and palatal mucoceles. (Figures 21-10 to 21-12).
• Chronic GVHD :occurs later (often after day 100) characterized by skin changes similar to those in scleroderma, sicca syndrome, malabsorption, and features of autoimmunity.
Posttransplantation Medical Considerations:
(1) immediate posttransplantation period:
first 3 months afterimmunosuppressive
therapy(2) stable
posttransplantation period (3) chronic rejection
period.
Post transplant Patients
Immediate Post transplantation Period.Stable Post transplantation Period .Risk of Infection.Viral Infections.Excessive Bleeding.Adverse Reaction to Stress.Hypertension.Chronic Rejection Period.
Oral Complications and Manifestations• Oral findings that may indicate
over immunosuppression include :
Mucositisherpes simplex infectionsherpes zosterCMV infectionCandidiasislarge and slow-to- heal
aphthous ulcers and other ulcerations
unusual alveolar bone loss on occasionLymphomaKaposi sarcomasquamous cell carcinoma of
the liphairy leukoplakia.