Kidney Transplantation

Question 1

Define transplant

Answer 1

Transfer (living tissue or organ) to another part of the body to or another body

Question 2

Define autologous transplant

Answer 2

Donor and recipient are the same individual

Question 3

Define syngenic transplant

Answer 3

Donor and recipient are genetically identical twins

Question 4

Define allogenic transplant

Answer 4

Donor and recipient are not genetically identical twins but are of the same species

Question 5

Define Xenogenic transplant

Answer 5

Donor and recipient are from different species

Question 6

What the difference in survival is the donor is living and not dead?

Answer 6

5 years.

Question 7

What systemic is place in the UK for donations?

Answer 7

NHS Blood and Transplant (NHSBT)

Question 8

Blood type A what antigen and antibody are present and who are compatible donors?

Answer 8

Antigen on RBC: A
Antibody is plasma: anti-B
Compatible donors: A, O

Question 9

Blood type B what antigen and antibody are present and who are compatible donors?

Answer 9

Antigen on RBC: B
Antibody is plasma: anti-A
Compatible donors: B, O

Question 10

Blood type AB what antigen and antibody are present and who are compatible donors?

Answer 10

Antigen on RBC: AB
Antibody is plasma: none.
Compatible donors: A, B, AB, O

Question 11

Blood type O what antigen and antibody are present and who are compatible donors?

Answer 11

Antigen on RBC: O
Antibody is plasma: anti-A, anti-B
Compatible donors: O

Question 12

What’s the risk of donating with blood group incompatibility?

Answer 12

Hyperacute rejection of transplated organ

Question 13

What is the MHC?

Answer 13

Major Histocompatibility complex

- genes present which are associated with acceptance and rejection of transplanted material

Question 14

Where is MHC located?

Answer 14

Chromosome 6

Question 15

What does MHC contain?

Answer 15

Human leukocyte antigen (HLA)

- polymorphic

Question 16

How many classes of HLA are there (relevant)

Answer 16

HLA I

HLA II

Question 17

What does HLA I bind?

Answer 17

peptides derived from IC proteins

- including peptides from viruses

Question 18

What are the HLA I molecules?

Answer 18

HLA-A
HLA-B
HLA-B

Question 19

Where are HLA I molecules expressed?

Answer 19

All cells, including platelets

Question 20

Where are HLA I polymorphs located?

Answer 20

Exons 2 and 3

Question 21

Where are HLA II polymorphs located?

Answer 21

Exon 2

Question 22

What’s the structure of HLA I?

Answer 22

3 alpha units with 1 beta unit

Question 23

Whats the structure of HLA II?

Answer 23

2 alpha units

2 beta units

Question 24

What does HLA II bind?

Answer 24

peptide derived from EC and cell surface peptide

- including those from bacteria

Question 25

What are the HLA II molecules?

Answer 25

HLA-DR HLA-DQ HLA-DP

Question 26

Where are HLA II molecules expressed?

Answer 26

APCs

Question 27

What's the difference between HLA I and HLA II?

Answer 27

- structural differences affecting peptide binding - specialised - immune response

Question 28

Why is there huge diversity within a HLA population?

Answer 28

increases chances of species surviving after exposure to pathogen

Question 29

Give an advantage to HLA polymorphism

Answer 29

Protection against different pathogens

Question 30

Give a disadvantage to HLA polymorphism

Answer 30

Transplantation of tissues and organs between HLA incompatible individuals

Question 31

How can HLA mis-matching be overcome?

Answer 31

Immunosuppression

Question 32

When should you definitely avoid transplantation?

Answer 32

When donor specific antibodies are present in recipient

Question 33

How can patients make antibodies against non-self HLA?

Answer 33

1. Pregnancy 2. Blood transfusions 3. Previous transplant 4. Viral infection

Question 34

What is HLA sensitisation

Answer 34

Status of recipients must be determined prior to transplant

Question 35

Give one contraindication to transplant

Answer 35

presence of donor specific HLA antibodies

Question 36

How are transplants allocated in the UK

Answer 36

1. Paediatric patients (HLA match), highly sensitised - priority based on waiting time 2. Other paediatric patients (HLA match) - priority based on waiting time 3. Adults (HLA match), high sensitised - priority based on waiting time 4. Other adult patients - priority based on waiting time 5. All other eligible patients * 1, 2, and 3 priority given according on a point score based on: waiting time, HLA match, age, age difference, location, HLA homozygosity, and blood group match

Question 37

What is meant by highly sensitised?

Answer 37

A highly sensitised immune system is one that that would attack the transplanted kidney or pancreas Have high donor antibodies (>85% across panel)

Question 38

What test would you perform prior to transplant?

Answer 38

- HLA type patient - HLA type donor - Screen patients for preform HLA allo-antibodies (every 3months) - Cross-match patient and donor

Question 39

What would you do post-transplant?

Answer 39

Monitor for presence of donor-specific antibodies

Question 40

How many transplants do patients usually receive?

Answer 40

>1