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2025 CCTC Review Course > 04 Immunology and Rejection > Flashcards

04 Immunology and Rejection Flashcards

1
Q

The immune system recognizes the antigens of the new organ as…

A

non-self

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2
Q

Auto-transplantation is…

A
  • transplantation of self tissue.
  • Not detected as a foreign body, no rejection. Ex. Own blood before surgery
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3
Q

Iso-transplantation is…

A
  • transplantation of tissue or organ between genetically identical individuals.
  • Doesn’t activate immune response.
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4
Q

Allotransplantation is…

A
  • transplantation between genetically different people.
  • This will trigger the immune response. Allograft.
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5
Q

Xenotransplantation is…

A

transplant between two different species.

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6
Q

The immune system protects us through these 3 actions…

A
  • Surveillance
  • Defense
  • Homeostasis
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7
Q

A humoral response involves…

A

the production of antibodies (immunoglobulins) by plasma cells (B-cells)

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8
Q

A cellular response is…

A

communication between cells (lymphocytes). This leads to intracellular destruction of foreign cells (T-cells)

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9
Q

Lymphocytes include…

A
  • T cells
  • B cells
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10
Q

T cells are involved in these 3 processes…

A
  • cell-mediated immunity, therefore responsible for cellular rejection
  • Immature lymphocytes migrate through thymus to mature
  • Differentiate to memory cells, cytotoxic cells, helper cells, suppressor cells
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11
Q

B cells are involved in these 3 processes…

A
  • humoral immune response, therefore responsible for humoral rejection (AMR)
  • Immature lymphocytes migrate through bone marrow to mature
  • Differentiate to memory cells, IgM, IgG, IgA, IgE (plasma cells)
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12
Q

4 Characteristics of the immune system:

A
  • Ability to recognize and eliminate foreign antigens
  • Capacity for immunologic memory
  • Distinct antigen specificities after immunizations
  • Tolerance of self antigens
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13
Q

Cytokines are characterized as these 7 actions…

A
  • hormonal messengers
  • Tells cells to proliferate in response to foreign cells
  • Responsible for most of the biological effects in the immune system
  • Cell-mediated immunity
  • Allergic type responses
  • T lymphocytes are a major source of cytokines
  • Antigen-specific receptors on the cell surface allow recognition of foreign pathogens
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14
Q

The Major Histocompatibility (MHC) System is characterized by these 4 elements…

A
  • the system that drives rejection in allotransplantation
  • In humans it is called human leukocyte antigen system (HLA)
  • HLA antigens are proteins (or markers) on the surface of our cells and act as genetic identification
  • Antigens are determined by two haplotypes and are inherited from biological parents
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15
Q

HLA typing is characterized by these 3 aspects…

A
  • how we define ourself immunologically
  • it is based on our genetic inheritance
  • it never changes
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16
Q

A Haplotype is…

A

a series of HLA “genes” (loci-alleles) by chromosome, one passed from the mother and one from the father.

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17
Q

The chance that two offspring will be HLA identical

A

25%

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18
Q

The chance that two offspring will not share any alleles (HLA non-identical)

A

25%

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19
Q

The chance that two offspring will share one haplotype

A

50%

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20
Q

Outside an individual’s immediate family, the chance of finding an identical HLA match with the general population is

A

1:50,000

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21
Q

HLA typing is done…

A

once. It never changes.

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22
Q

HLA Antibody testing is done how frequently?

A
  • Multiple times:
    • Pre-Transplant
    • Desensitization
    • Post Transplant
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23
Q

HLA Crossmatch is how frequently?

A
  • At time of transplant (crossmatch with donor):
    • Prospective
    • Retrospective
    • Virtual
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24
Q

HLA Antibodies are classified as these 2 classes:

A
  • Class I: on all cells
  • Class II: on B cells
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25
Q

Rejection can occur despite HLA matches due to…

A

Many alles, splits and cregs

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26
Q

Antibodies can be effected by 5 sensitizing events:

A
  • Blood products
  • Pregnancy
  • Transplant (any organ)
  • Mechanical circulatory support
  • Tissue graft
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27
Q

cPRA is defined as

A
  • the percentage of potential donors a specific patient will have a positive crossmatch
  • It is a calculation based on antigen frequency in a given population
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28
Q

The higher the cPRA, the…

A

harder it is to find a good match

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29
Q

In transplant, we pay attention to 6 loci within the HLA classes:

A
  • Major MHC class I
    • HLA-A
    • HLA-B
    • HLA-C
  • Major MHC class II
    • HLA-DP
    • HLA-DQ
    • HLA-DR
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30
Q

Within each of the 6 major loci, there are how many alleles?

A

hundreds of alleles (variations)

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31
Q

Serotyping is a ___________ way of identifying HLA receptors

A

crude

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32
Q

Phenotyping is a ______________ way of identifying HLA receptors

A

more specific

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33
Q

Regardless of your center’s protocols, ALL crossmatches for purposes of the ABTC exam, must be…

A

NEGATIVE

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34
Q

Antibody screening is done in the ________________ (donor or recipient)

35
Q

The frequency of antibody testing when there is no evidence of sensitization is…

A

every 6 months

36
Q

The recommended frequency for antibody screening in patients with antibodies >10% is…

37
Q

The recommended frequency for antibody screening in LVAD recipients is …

A

monthly, may be more frequent

38
Q

The recommended frequency for antibody screening with blood transfusions is…

A

1-2 weeks after the event

39
Q

The recommended frequency for antibody screening after desensitization therapy is…

A

1 -2 weeks

40
Q

The recommended frequency for antibody screening for all others (pediatric, retransplant, pregnant women) is …

A

every 3 months

41
Q

A prospective crossmatch determines if the recipient has…

A
  • Determines if the recipient has HLA antibodies to a particular donor
42
Q

A prospective crossmatch physically does what?

A

Combines recipient serum and donor cells

43
Q

In a prospective crossmatch if the test is positive, this is…

44
Q

In a virtual crossmatch the matching is done by…

A

the recipient’s antibody profile is matched against the donor’s HLA antigens

45
Q

In a retrospective crossmatch, the matching is done at what time?

A
  • Serum is drawn in the OR at the time of transplant. Crossmatch is determined immediately post transplant.
  • Organ is already in when you get the crossmatch results. Have to be confident that you can manage a positive cross-match.
46
Q

In a Complement-dependent cytotoxicity crossmatch (CDC), when Recipient serum potentially containing donor-specific antibodies (DSA) is added to donor T or B lymphocytes, along with complement,
If DSA is not present, what result do we see?

A
  • no lysis occurs and the result is negative.
47
Q

A Flow cytometry crossmatch is more sensitive compared with…

A

CDC cross- matching.

48
Q

When you do a crossmatch, you want the recipient to have every antigen that the donor has.This is called…

A

zero mis-matches

49
Q

T/F If the donor has an antigen that the recipient does not have you can accept the donor.

A

False: this would be a mis-match and you would NOT accept the donor.

50
Q

Rh antigens are not present on lymphocytes and therefore they…

A

are NOT taken into account for organ transplant

51
Q

Regarding ABO compatibility in infants under age 2,

A

ABO incompatible hearts may be accepted.

52
Q

A Direct Coombs Test tests an infant’s Rh. Rh factor __________ considered when accepting an organ offer

53
Q

A blood type O recipient will be compatible with a donor blood type…

54
Q

A blood type A recipient will be compatible with a donor blood type…

55
Q

A blood type B recipient will be compatible with a donor blood type…

56
Q

A blood type AB recipient will be compatible with a donor blood type…

A

O, A, B, AB

57
Q

A blood type O donor will be compatible with a recipient blood type…

A

O, A, B, AB

58
Q

A blood type A donor will be compatible with a recipient blood type…

59
Q

A blood type B donor will be compatible with a recipient blood type…

60
Q

A blood type AB donor will be compatible with a recipient blood type…

61
Q

4 Types of Rejection include…

A
  • Hyperacute (antibody-mediated)
  • Antibody-mediated rejection (AMR) or humoral
  • Acute- cellular
  • Chronic (Obliterative Bronchiolitis, Coronary artery vasculopathy, vanishing bile ducts)
62
Q

Hyperacute Rejection is characterized by these 10 things:

A
  • < 1% incidence (role of cross-match)
  • Minutes to days onset
  • Abrupt organ dysfunction
  • Blood group mismatch
  • Preformed circulating Abs
    • complement activation
    • endothelial damage, inflammation
    • platelet aggregation
  • Vascular thrombosis
  • Support (such as ECMO) and possible relist for transplant
63
Q

Antibody Mediated Rejection is characterized by these 3 things:

A
  • Mediated by B cell antibodies and characterized by vascular inflammation and damage
  • Diagnosed by immunofluorescence stain of biopsy tissue and reveals immunoglobulin deposits (IgM, IgG) C3d, C4d, CD68 stains
  • Antibodies to donor specific antigens
64
Q

AMR Biopsy terminology (histology) includes these 6 terms:

A
  • Intravascular macrophages
  • Capillary destruction
  • Edema
  • Hemorrhage
  • Neutrophilic infiltrates
  • Capillary fragmentation
65
Q

AMR Immunopathology potentially includes the use of these 6 immunofluorescencea:

A
  • C3d
  • C4d
  • HLA
  • Ig
  • Fibrin
  • Cd20
66
Q

6 potential AMR Treatments: When Asymptomatic includes…

A
  • Monitor (pAMR1)
  • no Rx
  • hold steroid taper
  • ∆ maintenance immunosuppression
  • (MMF/FK)
  • monitor DSA/pathology findings
67
Q

5 potential AMR Treatments when Mild Symptoms includes…

A
  • high dose (pulse) steroids
  • thymoglobulin (rabbit ATG)
  • +/- IV immune globulin
  • ∆ maintenance immunosuppression (
  • MMF/FK)
68
Q

7 potential AMR Treatments when hemodynamically compromised includes…

A
  • high dose (pulse) steroids
  • plasmapheresis/apheresis
  • +/- IV immune globulin
  • thymoglobulin (rabbit ATG)
  • “newer” therapies (rituximab, etc.)
  • ∆ maintenance immunosuppression
  • (MMF/FK)
69
Q

The most common form of rejection is…

A

Acute Cellular Rejection (>10%)

70
Q

Acute Cellular Rejection takes place…

A

Weeks to months post-transplant

71
Q

Acute cellular rejection is caused by a…

A

Cytokine-induced vascular leak

72
Q

A biopsy for acute cellular rejection may indicate any of these 4 items:

A
  • Endothelialitus
  • parenchymal cell damage
  • interstitial inflammation
  • Edema and mild hemorrhage
73
Q

In determining acute cellular rejection, PRA screening is not predictive of…

A

NOT predictive of cell injury and graft ischemia

74
Q

Treatment for acute cellular rejection includes…

A

high dose steroids, optimizing drug levels

75
Q

Chronic Rejection takes place…

A

Months to years onset

76
Q

Chronic Rejection is characterized by these 3 things:

A
  • Gradual decline in organ function
  • Chronic healing and scarring Intimal smooth muscle cell proliferation
  • Vascular (or airway or biliary) dense fibrosis (ischemia)
77
Q

Chronic rejection will usually require…

A

Re-transplant

78
Q

6 Signs of Rejection Liver include:

A
  • Elevated liver enzymes
  • Tenderness over liver
  • Yellow color to eyes or skin
  • Dark urine
  • Ascites
  • Fever
79
Q

6 Signs of Rejection Kidney Include:

A
  • Elevated BUN, creatinine
  • Decreased urine output
  • Weight gain
  • Pain at kidney site
  • Leg swelling
  • Fever
80
Q

7 Signs of Rejection Heart include:

A
  • Irregular heartbeat
  • Very fast or very slow heart rate
  • Low BP
  • Shortness of breath
  • Weight gain
  • Tiredness
  • Fever
81
Q

5 Signs of Rejection Lung include:

A
  • Shortness of breath
  • Tiredness
  • Productive cough
  • Change in color of sputum
  • Fever
82
Q

Signs of Rejection Pancreas include:

A

High blood glucose levels

83
Q

6 Signs of Rejection Intestines include:

A
  • Change in stool output
  • Tiredness
  • abdominal pain or distention
  • dusky stoma
  • weight loss
  • Fever

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