B4- Allograft Injury Flashcards
What is clad
Chronic lung allograft dysfunction
What 2 types of injury to lung wre there after transplant
Alloimmune (eg response to hla) and non alloimmune injuries eg aspiration/infection
Why are transpalnt patients susceptible to infection
Immunosupressnts
What is decreased in clad shpwing airway obstruction
Fev1
What % of transpalnt pateints have clad sfter 3 years
50%
Ehat is a major type of clad
Bronchiolitis obliterans syndrome BOS
What is it
Airway obstruction ,epithelial damage and inflammation of the bronchioles
What are the 2 major allogrsft injuries causing clads
Aspirstion/reflux and infections
What do these cause
Epithelial damage, airway remodelling and obstruction
What is BAL measuring allgraft rejection
Bronchioalveolar lavage is where bronchoscope passed then washint using saline
What other things are used
Immunohistochemistrt and brush cultures
What to visualise
Viral titre, cutokines, infection
Why are allograft patients vulnerbale to ger and aspiration
Vagal damage during transplantation causes gastroparesis and changed emptying of stomach
Which muscles usually stop teflux
Oesophagwl sphincters
What measures teflux
Impedance messurements
What is measured when a pladtic catheter is inderted to measure reflux
Electrical resistance increase as fluid moves ip and also ph
What surgery refuces BOS via tigthening sphincter muscles reducing reflux
Fundoplication
Aspiration is usually hidden. What increases in alount in transplant patients which shoes aspiration
Pepsin increwses from gwetric juice
Which infection is seen with cf
Pseudomonas aeruginosa
Can this also lead to bos
Yes due to chronic infection lrading to inflammation and dmsage to walls etc
What is the rgidence for it coming from aspiration
75% pf pa was identical in gastric juice and sputum
Which artyicle links aspirstion to cf
Al momani et al 2016
What was lowered in diversity in cf gj ans sputum in presence of p. Aeruginosa
Faecaelibacterium, lactobacillus and roseburia
Would all refuce inflammation
What fungi was also present in all cf gj and sputum samples
Candida and aspergillus
What phase does pa come ftom yo form biofilm
Planktonic phase
How do they communicwte in biofilms and conform virulence
Quorum signalling
Which article links Pa to inflammstion and potentiallt bos/clad
Malhotra 2019
What does ros damage/ oxudative stress
Lung tissue
Which amp would usually refuce pa infection
LL 37
Why can pa thrive in inflammation compsred to commensas
Can use nitrate as aea to grow
Why does pa when it attracts neutorphils still resistant
Can trap NETs in biofilm and also exotoxins kills/lyses neutrophils
Which chemokine increases in clad / after transplantation
Il 8
What article discusses bos in detail including the emt shift
2009 robertson et al
What % does fev decrease for it to be considered a clad (robertson)
20%
Why is there alck of coughing and mucociliary clearnace ib allograft causing furhter infection
Denervation
What in reflux juices can induce neutrophils and il8,
Bile salts
Why can bile dalts also cause pulmonary collapsing
Reduce surfactant
Which mmps released after aspiration/infectikn cause emt transition- fibro proliferation seen in bos
Mmp2 and 9
Other than il8 what is also present after aspiration/infection
Il17 caudint inflammation
