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Haematology > Immunology - Transplantation > Flashcards

Immunology - Transplantation Flashcards

1
Q

What is rejection?

A

Damage done by the immune system to a transplanted organ

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2
Q

What is an autologous transplant?

A

Tissue returning to the same individual after a period outside the body, usually in a frozen state

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3
Q

What is a syngeneic transplant?

A

transplant between identical twins; there is usually no problem with graft rejection
Also called isograft

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4
Q

What is allogeneic transplant?

A

Takes place between genetically nonidentical members of the same species; there is always a risk of rejection

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5
Q

What is xenogeneic transplantation?

A

Takes place between different species and carries the highest risk of rejection

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6
Q

What is an autograft?

A

From one part of the body to another

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7
Q

What criteria must be met before transplantation?

A

There must be good evidence that the damage is irreversible
That alternative treatments are not applicable
The disease must not recur

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8
Q

How can risk of rejection be minimised?

A

The donor and recipient must be ABO compatible
The recipient must not have anti-donor human leukocyte antigen (HLA) antibodies
The donor should be selected with as close as possible HLA match to the recipient
The patient must take immunosuppressive treatment

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9
Q

What is hyperacute rejection?

A 
Preformed antibodies binding to either ABO blood group or HLA class I antigens on the graft
Antibody binding triggers a type II hypersensitivity reaction, and the graft is destroyed by vascular thrombosis
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10
Q

How soon after transplantation does hyperacute rejection occur?

A

Within hours

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11
Q

How can hyperacute rejection be prevented?

A

through careful ABO and HLA cross-matching

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12
Q

What is acute rejection?

A 
Type IV (cell-mediated) delayed hypersensitivity reaction
Donor dendritic cells stimulate an allogeneic response in a local lymph node and T cells proliferate and migrate into the donor kidney
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13
Q

How soon after transplantation does acute rejection occur?

A

Days to weeks

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14
Q

What is the main cause of acute rejection?

A

HLA incompatability

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15
Q

How soon after transplantation does chronic rejection occur?

A

Months or years

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16
Q

Which type of stem cell is used to restore myeloid and lymphoid cells?

A

Haematopoietic stem cells

17
Q

How is an autologous SCT carried out?

A

Marrow is removed, frozen, and reinfused after potent chemotherapy has been given
Autologous transplants carry minimal immunological risk

18
Q

What are additional risks with allogeneic SCT due to?

A

GVHD

19
Q

When is allogenic SCT carried out?

A

Haematological malignancy
Cases when myeloid cell production is reduced or notably abnormal, such as in aplastic anaemia
Primary immunodeficiencies such as severe combined immunodeficiency (SCID)

20
Q

Sources of stem cells

A

Bone marrow
Peripheral blood
Cord blood

21
Q

When does GVHD occur?

A

When donor T cells respond to allogeneic recipient antigens

Mismatches in major or minor histocompatibility antigens

22
Q

Which SCT patients are given immunosuppression?

A

All of them, even if donor and recipient are HLA identical

23
Q

Immunosuppressive drugs

A

Corticosteroids
T-cell signalling blockade
IL-2 blockade
Antiproliferatives

24
Q

What do corticosteroids act on?

A

Low doses - antigen presenting cells

Higher dose - direct effect on T cells

25
Q

T-cell signalling blockade drugs

A

Cyclosporin and tacrolimus

26
Q

IL-2 blockade drugs

A

Monoclonal antibodies

Rapamycin

27
Q

How do antiproliferatives work?

A

Inhibit DNA production

Prevent lymphocyte proliferation, but they are not specific for T cells and can cause myelotoxicity

28
Q

Side effects of cyclosporin

A 
Infections
Increased risk of certain cancers
Nephrotoxicity
Diabetes
Hypertension
29
Q

Side effects of Rapamycin

A 
Raised lipid and cholesterol levels
Hypertension
Anaemia
Diarrhoea
Rash
Acne
Thrombocytopenia
Decrease in platelets and haemoglobin
30
Q

Which cells are responsible for the effects of chronic rejection?

A

T cells

Haematology (18 decks)

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