18. Transplant Immunology

Question 1

What are the 3 types of transplant?

Answer 1

Tissue
Haematopoietic stem cell
Solid organ

Question 2

Which type of transplant is immunologically easy?

Answer 2

Tissue transplant

Doesn’t require immunosuppression

Question 3

What are the requirements for a something to be considered a tissue transplant?

Answer 3

Must be non-vascularised and non-haematopoietic

Question 4

What are the most common tissue transplants?

Answer 4

Bone
Heart valves
Blood vessels
Cornea

Question 5

Where can haematopoietic stem cells be taken from?

Answer 5

Bone marrow
Blood
Umbilical cord

Question 6

What type of transplant is associated with graft vs host disease?

Answer 6

HSC

Donor T cells attack host

Question 7

What are the indications for a solid organ transplant?

Answer 7

Irreversible organ failure
Disease with a low risk of recurrence
Recipient has no infection of malignancy
Fit for major surgery
Psychologically suitable

Question 8

What is the importance of HLA matching?

Answer 8

Better outcomes

Less sensitisation makes it easier for a young person when they need a second transplant

Question 9

What is the probability of having the same HLA as a sibling?

Answer 9

25%

Question 10

When does hyper acute rejection occur?

Answer 10

<24 hours

Question 11

What does acute cellular rejection occur?

Answer 11

<6 months

Question 12

When does acute antibody mediated rejection occur?

Answer 12

<6 weeks

Question 13

When does chronic rejection occur?

Answer 13

Years

Question 14

What is the mechanism of hyper acute and acute antibody mediated rejection?

Answer 14

Antibody and complement

Acute inflammation and thrombosis

Question 15

What is the cause of cellular rejection?

Answer 15

T cell cytotoxic damage

Question 16

What are preformed antibodies?

Answer 16

Most commonly blood group antibodies and anti-HLAs

Causes hyper acute rejection

Question 17

How can the body be sensitised to make preformed antibodies?

Answer 17

Blood transfusion
Pregnancy
Previous allograft

Question 18

What transplant is preformed antibodies not a contraindication for?

Answer 18

Liver

Question 19

What are the indications for HSCT?

Answer 19

Malignancy
Genetic diseases
Severe autoimmune diseases

Question 20

What is the process of preparing for a HSCT?

Answer 20

Deplete mature stem cells to prevent graft vs host

Condition recipient: radio and chemo, ablate bone marrow, isolation until WBCs recover

Question 21

What are the complications associated with HSCT?

Answer 21

Non-engraftment
Infection
GvHD
Malignancy recurrence
Toxicity of conditioning

Question 22

What are the acute symptoms of GvHD?

Answer 22

Rash
GI inflammation
Abnormal LFTs
Damage to bone marrow

Question 23

What are the chronic symptoms of GvHD?

Answer 23

Skin thickening and scarring
Sicca syndrome
Pneumonitis
Develop immunodeficiency

Question 24

What is sicca syndrome?

Answer 24

Damage to lacrimal and salivary glands

Question 25

What drug is given short term post renal transplant?

Answer 25

Anti-CD25: T cell depleting antibody

Question 26

What drugs are given long term post renal transplant?

Answer 26

Tacrolimus
Mycophenylate
Steroids

Question 27

What is the function of mycophenylate?

Answer 27

Anti-proliferative