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Exam 3 > 03/15f Immunopathology II > Flashcards

03/15f Immunopathology II Flashcards

1
Q

What tissues can you transplant?

A

Vascularized solid organs - kidney, liver, heart, lung, pancreas, small bowel
Cornea
Skin
Bone marrow
Blood and blood products
Cell suspensions - pancreatic islet cells, fetal adrenal cells

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2
Q

What is an isograft?

A

Transplant between genetically identical donor and recipient

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3
Q

What is a xenograft?

A

Transplant between donor and recipient of different species

Can be concordant (preformed antibodies are absent) or discordant (preformed antibodies are present)

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4
Q

What is an orthotopic graft?

A

A graft implant at the same site as the organ it replaces - done for heart, lung, liver, and small bowel

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5
Q

What is a heterotopic graft?

A

A graft implanted at a site distinct from the organ it replaces - done for kidney, pancreas

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6
Q

What are the three categories of allograft donors?

A

Living related
Living unrelated
Cadaveric/deceased donors

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7
Q

What are the four modes of allograft rejection?

A

Hyperacute
Accelerated
Acute
Chronic

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8
Q

What is the timecourse and mechanism of hyperacute rejection

A

Timecourse - minutes to hours
Mechanism - binding of preformed antibodies to graft antigens (usually HLA or ABO), followed by complement fixation, attraction of neutrophils, and tissue damage

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9
Q

What is the histology of hyperacute rejection? How is it treated?

A

Site of attack - vascular endothelium, especially in kidney and heart transplant patients
Histology - hemorrhage, edema, vascular necrosis, acute inflammation
No satisfactory therapy

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10
Q

Why would a recipient have prior sensitization to an allograft?

A

Blood transfusion
Pregnancy
Previous allografts
Natural immunity - ABO blood groups

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11
Q

How is hyperacute rejection avoided?

A

Through cross-matching - testing of recipient serum for antibodies that are reactive with donor lymphocytes
Cross-match is done through flow cytometry or testing complement-mediated cytotoxicity

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12
Q

What is the timecourse and mechanism of accelerated graft rejection?

A

Onset - days to weeks after graft (starts within days)

Mechanism - may involve antibodies produced after graft, or small quantities of preformed antibodies

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13
Q

What is the histology of accelerated rejection? How is it treated?

A

Site of attack - vascular endothelium
Histology - hemorrhage, edema, vascular necrosis, acute inflammation
Therapy - plasmaphoresis, IVIG, Rituximab (anti-CD20)

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14
Q

What is the timecourse and mechanisms of acute graft rejection?

A

Onset - weeks to months after graft (starts within days)
Mechanism - recognition of graft antigens by allospecific T cells, followed by cytotoxicity (CD8 T cells) and release of inflammatory cytokines (CD4 T cells)

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15
Q

What are the sites of attack of acute rejection, according to organ?

A

Kidneys - tubules, interstitium
Liver - venous endothelium, bile ducts
Heart - myocytes
Lung - arterioles

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16
Q

What is the histology and treatment of acute rejection?

A

Histology - infiltration of lymphocytes and macrophages, tissue damage, hemorrhage and necrosis in severe cases
Treatment - pulse IV steroids, anti-T cell antibodies

17
Q

How is acute rejection prevented?

A

Donor-recipient matching through HLA typing
Pre-transplant conditioning - immunosuppressive agents
Post-transplant therapy - immunosuppression, prednisone

18
Q

What is the timecourse and mechanism of chronic allograft rejection?

A

Onset - months to years after graft

Mechanism - unknown, but probably a mixture of cell-mediated and antibody-mediated rejection

19
Q

What are the sites of attack of chronic rejection, according to organ?

A

Kidney - vasculature, tubules, interstitium
Liver - bile ducts (“vanishing bile ducts”), chronic arteriopathy
Heart - vasculature
Lungs - bronchioles (bronchiolitis obliterans)

20
Q

What is the histology and treatment of chronic rejection?

A

Histology - fibrosis, atrophy, vascular thickening

No satisfactory treatment available, besides re-transplant

21
Q

What are some other problems involved in solid organ grafts, besides rejection? List six

A

Recurrence of the original disease
Occurrence of a new primary disease
Infection of the graft, or multi-systemic infection
Immunosuppressant drug toxicity
Failure of anastomoses
Malignancies due to immunosuppression - lymphoproliferative disorders, skin cancers

22
Q

Why do we do bone marrow transplants?

A

To treat heritable or acquired hematopoietic disorders, such as SCIDS or aplastic anemia
To perform marrow reconstitution follow cancer therapy for leukemias and some solid tumors

23
Q

What are some complications of bone marrow transplantation?

A

Failure to engraft
Graft-versus-host disease
Infection
Recurrence of primary tumor

Exam 3 (10 decks)

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