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Host and Defense > EXAM 4 Organ Transplantation and Rejection > Flashcards

EXAM 4 Organ Transplantation and Rejection Flashcards

1
Q

what are the 3 fundamental problems with organ transplantations?

A
  1. transplant must perform its functions
  2. transplant and recipient health must be maintained
  3. recipient immune system must not reject the transplant
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2
Q

what are the two transplant types?

A
  • solid organ
  • blood
    • bone marrow/hematoepoitic stem cell
    • transfusion
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3
Q

transplantations are a solution for ___, but they are not a permanent ___

A
  • organ failure
  • solution
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4
Q

transplant type: donor and recipient are the same individual

A

autologous

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5
Q

transplant type: donor and recipient are genetically identical

A

syngeneic

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6
Q

transplant type: donor and recipient are genetically different but of the same species

A

allogeneic

most common

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7
Q

transplant type: donor and recipient are of different species

A

xenogeneic

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8
Q

___ limits allogeneic transplant survival

A

organ rejection

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9
Q

what are the 3 types of organ rejection?

A
  • hyperacute
  • acute
  • chronic
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10
Q

hyperacute organ rejection is a type ___ hypersensitivity, occurs in ___ to ___ (timing), and involves blood type ___

A
  • II
  • minutes to hours
  • alloantibodies
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11
Q

acute organ rejection is a type ___ hypersensitivity, involves ___ and ___ cells, and involves ___ mismatches

A
  • IV
  • CD4 and CD8 T cells
  • HLA
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12
Q

chronic organ rejection is a type ___ hypersensitivity and involves chronic transplant ___

A
  • III
  • inflammation
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13
Q

most transplants are ___

A

allogeneic

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14
Q

___ and ___ improve transplant organ survival rates

A

donor matching and immunosuppressants

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15
Q

___ between donors and recipients are the biggest predictors of transplant success.

A

histocompatibility

  • blood type
  • major HLA genes
  • minor HLA genes
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16
Q

as donor and recipient histocompatibility mismatches increase, transplant success ___

A

decreases

the number of mismatches increases with time

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17
Q

___ are the most common transplantations

A

blood transfusions

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18
Q

erythrocytes do not express MHC I or II. how is this helpful for histocompatibility?

A

no HLA matching (and therefore, no mismatching)

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19
Q

for blood transfusions, what is matched between donor and recipient?

A
  • blood type
  • rhesus D antigens
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20
Q

are leukocyte transfusions common?

A

no, they are rarely performed

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21
Q

what is removed from blood fractions before blood transfusions?

A

leukocytes

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22
Q

how often can blood be donated?

A
  • whole blood - every 56 days
  • plasma - every 28 days
  • platelets - every 15 days
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23
Q

what are the blood fractions that are commonly transfused?

A
  • erythrocytes
  • plasma - water, protein (albumin and Ig), organic compounds, inorganic salts
  • platelets - clotting factors
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24
Q

___ antigens dictate blood type and transfusion success

A

ABO

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25
Q

gut bacteria express antigens similar to ___ and ___

A

A and B

26
Q

antibodies created against antigens are not expressed on ___

A

erythrocytes

27
Q

what antigens will a type O recipient reject?

A

A, B, and AB

28
Q

which antigen recipient can accept all donations?

A

AB

(can accept O, A, B, or AB)

29
Q

what type of hypersensitivity reaction occurs when blood types do not match?

A

II

30
Q

___ is the universal blood donor

A

O RhD-

31
Q

___ is the universal blood recipient

A

AB RhD+

32
Q

can transplants come from cadavers?

A

yes

33
Q

which transplants can be done from live, healthy donors?

A

kidney and liver (parts of the liver - not the whole thing, obv)

34
Q

in solid organ transplants, the transplant and recipient are in a state of ___

A

inflammation

35
Q

what rejection types are graft rejections?

A

hyperacute, acute, and chronic

36
Q

how does degree of match vary with the cornea, liver, and kidney?

A
  • cornea - no matching or immunosuppression
  • liver - only blood type match
  • kidney - HLA and blood type match
37
Q

how can HLA and blood type matching be determined using mixed lymphocyte reactions?

A
  • mixed lymphocyte reaction - measure T cell proliferation and T cell cytotoxicity to determine if it is a match
38
Q

HLA and blood type matching can be determined in what two ways?

A
  • genetically
  • mixed lymphocyte reaction
39
Q

why do pre-existing blood type antibodies cause hyperacute rejection

A
  • ABO and rhesus incompatibility
  • pre-existing anti-HLA class I antibodies
  • type II hypersensitivity
  • occurs within minutes
  • irreversible organ loss
  • prevented by compatibility assessment
40
Q

direct and indirect ___ leads to graft rejection

A

allorecognition

41
Q

which pathway of allorecognition that leads to graft rejection describes acute rejection?

A
  • direct pathway
    • CD4/CD8 mediated
    • type IV
42
Q

which pathway of allorecognition that leads to graft rejection describes chronic rejection?

A
  • indirect pathway
    • antibody mediated
    • type III
43
Q

direct and indirect allorecognition is carried out by ___ antigens

A

HLA class I and II, and also minor HLA antigens

44
Q

how does direct allorecognition cause acute rejection?

A
  • transplant dendritic cells activate recipient T cells
  • direct MHC interaciton, independent of peptide
  • days to weeks
  • type IV hypersensitivity
45
Q

allogeneic MHC activates ___ cells directly

A

T

  • direct recognition of foreign MHC
  • MHC is structurally different
  • peptide largely irrelevant
  • activated transplant dendritic cells express B7
  • CD8 and Cd4 Th1 response
46
Q

antibodies against transplant MHC I cause ___ rejection. what type of hypersensitivity? what else happens?

A
  • chronic
  • type III hypersensitivity
  • chronic inflammation
  • progressive loss of blood and nutrient supply
  • years
47
Q

bone marrow/hematopoietic stem cells transplantations result in a destruction of the ___

A
  • endogenous blood system
  • replacement with transplanted stem cells
48
Q

what are some reasons for bone marrow/hematopoietic stem cell transplantations?

A
  • blood diseases
  • myeloid and lymphoid cancers
49
Q

bone marrow/hematopoietic stem cell transplantations can be ___ or ___ transplant types

A

autogeneic and allogeneic

50
Q

what are two possible negative outcomes of bone marrow/hematopoietic stem cell transplantations?

A

rejection and graft vs host disease (GVHD)

51
Q

bone marrow/hematopoietic stem cell transplant donor and recipient must share some ___ and ___ haplotypes

A

HLA class I and II

if a donor doesn’t have the same HLA haplotypes, those new blood cells being produced will not respond to infection because the MHC will not interact with the T cells, so there will be no adaptive immune response. There needs to be some degree of similarity between donor and recipient.

52
Q

what is describe as transplant adaptive immune cells that target and kill recipient tissues?

A

graft vs host disease

53
Q

what can happen in GVHD caused by hematopoietic transplants?

A
  • GI, liver, and skin problems are most pronounced
  • can be beneficial in fighting cancers
54
Q

donor T cells cause ___ GVHD

A

acute

55
Q

alloreactive ___ cells can kill recipient leukemia

A
  • NK cells
56
Q

___ suppress NF-kappa B transcriptional activity

A

corticosteroids

57
Q

describe corticosteroids

A
  • immunosuppressants
  • prednisolone is the active compound
  • increase IκBα production to block NF-κB function
  • broad activity
  • non-specific
  • many adverse side-effects
58
Q

what are the signals needed for immunosuppression to target T cell activation?

A
  • signal 1 - activation
  • signal 2 - survival
  • signal 3 - proliferation
59
Q

which two drugs inhibit T cell activation?

A

cyclosporin and tacrolimus

60
Q

___ and ___ prevent T cell survival and proliferation

A

belatacept and anti-CD25

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