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PCH CCTC Study > Immunology and Rejection > Flashcards

Immunology and Rejection Flashcards

1
Q

What is auto-transplanation?

A

Transplantation of self tissue, such as using own blood before surgery.

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2
Q

What is iso-transplantation?

A

Transplanation of tissue or organs between genetically identical individuals.

This does not activate the immune response.

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3
Q

What is allotransplantation?

A

Transplantation between genetically different people.

This will trigger the immune response.

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4
Q

What is xenotransplantation?

A

Transplantation between different species.

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5
Q

A humoral response involves the production of __ by plasma cells (__-cells)?
1. immunoglobulins, B
2. immunoglobulins, T
3. cytokines, B
4. cytokines, T

A

1

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6
Q

A cellular response involves communication between what?
1. Lymphocytes
2. Immunoglobulins
3. Cytokines
4. Antibodies

A

1

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7
Q

T-cells are involved in…
1. Cellular-mediated immunity
2. The humoral immune response
3. The migration of immature lymphocytes through the thymus
4. The migration of immature lymphocytes through the bone marrow
5. Differentiation to memory cells, cytotoxix cells, helper cells, and suppresor cells.
6. Differentiation to memory cells (IgM, IgG, IgA, IgE).
5. 2, 4, and 6 only
6. 1, 2, and 5 only
7. 1, 3, and 5 only
8. 2, 4, and 5 only
9. All of the above

A

7

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8
Q

B-cells are involved in…
1. Cellular-mediated immunity
2. The humoral immune response
3. The migration of immature lymphocytes through the thymus
4. The migration of immature lymphocytes through the bone marrow
5. Differentiation to memory cells, cytotoxix cells, helper cells, and suppresor cells.
6. Differentiation to memory cells (IgM, IgG, IgA, IgE).
5. 2, 4, and 6 only
6. 1, 2, and 5 only
7. 1, 3, and 5 only
8. 2, 4, and 5 only
9. All of the above

A

5

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9
Q

Cytokines act as hormonal __?

A

Messengers

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10
Q

Are cytokines are involved in the humoral immune response or in cell-mediated immunity?

A

Cell-mediated immunity

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11
Q

What is the major source of cytokines?

A

T lymphotcytes

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12
Q

The cytokine’s cell surfaces contains __ that allows for recognition of foreign pathogens.
1. Antigen-specific receptors
2. Antibodies
3. Rh factor
4. Hormones

A

1

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13
Q

What is the name of the system that drives rejection in allotransplantation?
What is the name of that system in humans?

A

Major Histocompatibility System (MHC)
Human Leukocyte Antigen System (HLA)

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14
Q

What are HLA antigens?
What do they do?

A

Proteins (or markers) on the surface of our cells.
They act as genetic identification.

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15
Q

True or False: HLA typing changes routinely and must be monitored yearly.

A

False

HLA typing never changes

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16
Q

HLA typing…
1. Is how we define ourselves immunologically
2. Is based on our genetic inheritence
3. Is altered through blood transfusions
4. Never Changes
5. 1, 2, and 3 only
6. 2, 3, and 4 only
7. 1, 2, and 4 only
8. All of the above

A

7

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17
Q

What is the chance that 2 offspring will be HLA identical?
1. 10%
2. 25%
3. 50%
4. 100%

A

2

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18
Q

What are the chances of finding an HLA identical match for the general population?
1. 1: 10,000
2. 1: 25,000
3. 1: 50,000
4. 1: 100,000

A

3

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19
Q

HLA Antibody testing is done…
1. Never
2. After transplant
3. Before Transplant
4. After a desensitizing process
5. 2, 3, and 4 only

A

5

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20
Q

When are the 3 times HLA crossmatch will occur?

A
  1. Prospective
  2. Restrospective
  3. Virtual
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21
Q

Which statement is true?

HLA antibodies are classified as Class I and Class II and exist on:
1. Class 1: on all cells, Class 2: on all cells
2. Class 1: on all cells, Class 2: on B cells
3. Class 1: on B cells, Class 2: on all cells
4. Class 1: on B cells, Class 2: on B cells

A

2

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22
Q

What are 5 examples of sensitizing events?

A
  1. Blood products
  2. Pregnancy
  3. Transplant (any organ)
  4. Mechanical circulatory support
  5. Tissue graft
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23
Q

cPRA is defined as the __ of potential donors a specific patients will have a __ crossmatch.
1. %, Positive
2. %, Negative
3. Number, Positive
4. Number, Negative

A

1

The higher the cPRA, the harder it is to find a good match.

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24
Q

Which type of typing is a more specific way of identifying HLA receptors?
1. Serotyping
2. Phenotyping

A

2

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25
Q

In transplant, we pay attention to 6 loci within the HLA classes. Be familiar with what they are.

A

MHC Class 1
*HLA-A
* HLA-B
* HLA-C
MHC Class 2
* HLA-DP
* HLA-DQ
* HLA-DR

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26
Q

For purposes of the CCTC test, which of the following statements is true regarding crossmatches?
1. Regardless of your center’s protocol for transplant, all crossmatches must be positive.
2. Regardless of your center’s protocol for transplant, all crossmatches must be negative.
3. Transplant centers may determine to transplant a patient that is crossmatch negative or positive.

A

2

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27
Q

Is antibody screening is done on the donor or recipient?

A

Recipient

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28
Q

At what frequency is antibody testing done when there is no evidence of sensitization?

A

Every 6 months

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29
Q

At what frequency is antibody testing done with patients with antibodies >10%?

A

Monthly

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30
Q

At what frequency is antibody testing done with patients with LVAD patients?

A

Weekly or with a heart offer

31
Q

At what frequency is antibody testing done for blood transfusions?

A

1-2 weeks after the event

32
Q

What is the recommended frequency for antibody screening for pediatric, retransplant patients, or for pregnant women?

A

Every 3 months

33
Q

A prospective crossmatch will determine what?

A

If a recipient has HLA antibodies to a donor

34
Q

A prospective crossmatch combines what?
1. Recipient cells with donor serum
2. Recipient cells with donor cells
3. Recipient serum with donor serum
4. Recipient serum with donor cells

35
Q

In a virtual crossmatch, the recipient’s __ is matched against the donor’s __?
1. Antibody profile, Antigens
2. Antibody profile, Antibody profile
3. Antigens, Antibody profile
4. Antigens, Antigens

36
Q

Why must you be confident you can manage a positive retrospective crossmatch?

A

It is done at the time of transplant and will result when the organ is already in.

37
Q

In a Complement-dependent cytotoxicity crossmatch (CDC), recipient serum potentially containing __ is added to donor __ along with complement.
1. T or B lymphocytes, T or B lymphocytes
2. Donor-specific antibodies (DSA), Donor-specific antibodies (DSA)
3. T or B lymphocytes, donor-specific antibodies (DSA)
4. Donor-specific antibodies (DSA), T or B lymphocytes

38
Q

In a Complement-dependent cytotoxicity crossmatch (CDC), if DSA is __ then no lysis occurs and the result is __.
1. Present, Positive
2. Present, Negative
3. Not Present, Positive
4. Not Present, Negative

39
Q

In a flow cytometry crossmatch, recipient __ is added to donor __ and incubates them with antibodies against human __.
1. Serum, Lymphocytes, IgG
2. Serum, Lymphocytes, IgM
3. Lymphocytes, Serum, IgG
4. Lymphocytes, Serum, IgM
5. Serum, Serum, IgG
6. Lymphocytes, Lymphotcytes, IgM

40
Q

The following is an example of a how many antigen mismatch?

Donor:
HLA-A2, -
HLA-B5, B8
HLA-DR3, DR7

Recipient:
HLA-A2, A3
HLA-B5, B8
HLA-DR3, DR7

A

0 (Zero antigen mismatch)

This example is a zero antigen mismatch because the recipient has everything the donor has. It has an extra A3, but it still has everything the donor has.
So the key to finding a mismatch it to determine what the donor has that the recipient doesn’t have.

41
Q

The following is an example of a how many antigen mismatch?

Donor:
HLA-A2, A3
HLA-B5, B8
HLA-DR3, DR7

Recipient:
HLA-A2, -
HLA-B5, B8
HLA-DR3, DR7

A

1 (One antigen mismatch)

This example has a one antigen mismatch because the recipient has an A3 that the donor doesn’t have.
So the key to finding a mismatch it to determine what the donor has that the recipient doesn’t have.
For testing purposes, this would NOT be acceptable.

42
Q

Are Rh antigens present on lymphocytes?
Are they taken into account for organ transplantation?
1. Yes, Yes
2. Yes, No
3. No, No
4. No, Yes

A

3

Rh antigens are not present on lymphoctyes and are not taken into account for organ transplants.

43
Q

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

44
Q

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

45
Q

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

46
Q

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

A

O, A, B, AB

47
Q

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

A

O, A, B, AB

48
Q

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

49
Q

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

50
Q

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

51
Q

What are the 4 types of liver rejection?

A
  1. Hyperacute (Anti-body mediated)
  2. Antibody-mediated rejection (AMR) or humoral
  3. Acute (Cellular)
  4. Chronic
52
Q

Hyperacute rejection happens in <1% of transplants. How was that able to be reduced so low?

A

By performing crossmatches

53
Q

Hyperacute rejections happens how fast?

A

In minutes to days

54
Q

What can cause hyperacute rejection?

3 items

A
  • Blood group mismatch
  • Circulating antibodies
  • Vascular thrombosis
55
Q

What are 3 signs of hyperacute rejection as caused by circulating antibodies?

A
  1. Complement activation
  2. Endothelial damage/inflammation
  3. Platelet aggregation
56
Q

What is the treatment for hyperacute rejection?

2 items

A

Support (such as ECMO)
Possible relist for transplant

57
Q

Antibody Mediated Rejection is caused by __ cell antibodies and characterized by __ inflammation and damage.
1. T, vascular
2. B, vascular
3. T, interstitial
4. B, interstitial

58
Q

Antibody Mediated Rejection is diagnosed by biopsy and reveals what 2 main results?

1. Type of deposits seen
2. A specific test that is done

A
  1. IgM and IgG deposits
  2. C3d, C4d, and CD68 stains
59
Q

What are the main AMR treatments when the patient is asymptomatic?

3 items

A
  1. Steroids
  2. Change in Maintenance Immunosuppression
  3. Monitor DSAs/pathological findings
60
Q

What are the main AMR treatments when the patient is mildly symptomatic?

4 items

A
  1. High dose steroids
  2. Thymoglobulin (rabbit ATG)
  3. IV immune globulin
  4. Change in Maintenance Immunosuppression
61
Q

What are the main AMR treatments when the patient is hemodynamically compromised?

5 items

A
  1. High dose steroids
  2. Plasmapheresis/apheresis
  3. IV immune globulin
  4. Rituximab, etc.
  5. Change in Maintenance Immunosuppression
62
Q

The most common type of rejection is __ and happens in about __ of cases.
1. AMR, 10%
2. AMR, 50%
3. Acute Cellular, 50%
4. Acute Cellular, 10%

63
Q

When does acute cellular rejection take place?

A

Weeks to months after transplant

64
Q

What is the main cause for cellular rejection?
1. Antibody response
2. Cytokine-induced vascular leak
3. An allergic reaction to immunosuppression medications
4. Hemorrhage

65
Q

What 4 main things could you see on a biopsy indicating cellular rejection?

A
  1. Endothelialitus
  2. Parenchymal cell damage
  3. Insterstitial inflammation
  4. Edema and mild hemmorhage
66
Q

What is the treatment for cellular rejection?

2 items

A
  1. High dose steroids
  2. Optimization of drugs
67
Q

When does chronic rejection take place?

A

Months to years after transplant

68
Q

What are the signs of liver rejection?

6 items

A
  • Elevated liver enzymes
  • Tenderness over liver
  • Yellow eyes or skin
  • Dark urine
  • Ascites
  • Fever
69
Q

What are the signs of kidney rejection?

6 items

A
  • Elevated BUN, creatinine
  • Decreased UOP
  • Weight gain
  • Pain at kidney site
  • Leg swelling
  • Fever
70
Q

What are the signs of heart rejection?

6 items

A
  • Irregular heart beat (could be fast or slow)
  • Low BP
  • SOB
  • Weight gain
  • Fatigue
  • Fever
71
Q

What are the signs of lung rejection?

5 items

A
  • SOB
  • Fatigue
  • Productive cough
  • Change in color of sputum
  • Fever
72
Q

Will you see high or low blood glucose levels with pancreas rejection?

73
Q

What are the signs of intestine rejection?

6 items

A
  • Increase in stool output
  • Fatigue
  • Abdominal pain/distention
  • Dusky stoma
  • Weight loss
  • Fever
74
Q

A cellular response leads to intracellular destruction of foreign what?
1. T-cells
2. B-cells
3. Cytokines
4. Antibodies

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