2: Transplantation Flashcards
What are the different types of transplantation (refering to donor-recipient relation)
- Autografts
- within the same individual
- Isografts
- between genetically identical individuals of the same species
- Allografts
- between different individuals of the same species
- Xenografts
- between individuals of different species
- Prosthetic graft
- plastic, metal
What are the different types of donors that can donate in allograft transplantations?
Allograft= recipiant is different individuum from same species
Donors can be
- Deceased
- DBD (donor after brain stem death)–> neurological criterial for death
- DCD (donor after circulatory death) –> circulatory criteria for death
- Living donor
What are the criteria that need to be met for being an organ donor?
Once death has been confimed
- Excluding of Infections (e.g. HIV, HBV)
- malignany
- drug abuse, overdose or poison
- disease of the transplanted organ
What would happen if an organ with the blood group of A woud be transplanted to someone with blood group B (and anti-A antibodies
Antibodies would bind to endothelial A antigens and cause
- complement activation
- Blood clotting and thrombus formation
- immediate loss of organ due to vascular damage (no perfustion possible)
How are AB0 incompatible transplants performed today?
Remove the antibodies in the recipient (plasma exchange)
- Good outcomes (even if the antibody comes back)
- Kidney, heart, liver
What are the three importatnt Class I and Class II HLA antigens for transplantation?
- Class I (A,B,C)– expressed on all cells
- Class II (DR, DQ, DP) (on Antigen-Presenting cells, but can be upregulated on other cells under stress )
What are the three mainantigens that are involved in performing HLA matching)
Main three (in order of importance) (but others are also important) are
- HLA-DR
- HLA-B
- HLA-A
Explain the concept of (mis)matching of antigens in transplantations
Three molecules are taken into consideration:
- HLA-A, HLA-B, HLA-DR
Every HLA: 2 Alleles (one from each parent)
so: A maximum of 6 Mismatches can be there (2 for each HLA gene)
What is the main problem in transplantations?
What is the overall mechanism behind it?
Rejection
- Exposure to foreign HLA molecules results in an immune reaction to the foreign epitopes
- The immune reaction can cause immune graft damage and failure = rejection
How is organ rejection after transplantation diagnosed?
Mainly: Via histological examination of a graft biopsy
- Clinical signs (e.g. monitor kidney function, liver enzymes etc.)
- Hear only possible with biopsy
What are the two ways you can classify rejections?
- Time-linked classification
- Hyper-acute (directly when organ is implanted)
- Actue (weeks to months)
- Chronic (years-happens in almost all recipients)
- Type of immune reaction
- T-cell mediated
- Antibody mediated
What happens during T-cell mediated rejection?
What are the three phases?
- Phase 1: Antigen-Presenting cells present the foreign HLA molecules (on their own HLA molecules) to T-cells in lymphocytes
- Phase 2: Get activated and cause migration into tissues and
3: Phase 3: Recrtuitement of pro-inflammatory cells that cause tissue damage (with release of cytotoxic things)
Interstitial inflammation
Which inflammatory cells are invove in T-cell mediated rejection?
What is their respective role?
- CD4+ -T-cells
- infiltrate the graft
- CD8+
- cytotoxic: kill cells in graft
- Macrophages
- phagocytosis and proteolysis of cells
When can antibodies that are involved in organ rejection form?
How do you call them?
They can be there pre-transplantation (in “sensitised” patients)
Or after transplantation (de novo)
Explain the process of antibody-mediated organ rejection
Antibodies against HLA and AB antigens
Phase 1: Recogniton of foreign antigens
Phase 2: Prliferation of B cells with Ab production
Phase 3:
- antibodies bind to antigens presnent on endothelial donor cells
- leading to complement and macrophage activation and
Intra-vascular pathology