kidney transplantation

Question 1

which part of the immune system, adaptive or innate, participates in the rejection process?

Answer 1

both

Question 2

which cells orchestrate the allo-immune response and graft rejection?

Answer 2

T cells - CD8 cytotoxicity and CD4 hypersensitivity

also anibody involvememt

Question 3

what is the best type of organ donor?

Answer 3

living donor

Question 4

what are expanded criteria donors?

Answer 4

older in age, died from shock, background of hypertension

Question 5

what are the other two types of organ donor?

Answer 5

donation after brain death (DBD)

donation after circulatory death (DCD)

Question 6

true or false, younger donor = better survival?

Answer 6

true

Question 7

what should be tested before transplant?

Answer 7

HLA antigens (dont need to match)
anti-HLA antibodies against donor (maybe from pregnancy, transplation, prior transplant)
ABO compatibility

Question 8

how should ABO compatibility be determined?

Answer 8

same ass in blood transfusion

however A2 kidney donors van be transplanted into O or B recipients if anti-A antibody titres are low

Question 9

Which cells are class 1 HLA antigens presented on ?

Answer 9

all nucleated cells

Question 10

which cells are class 2 HLA antigens presented on?

Answer 10

antigen presenting cells and activated endothelial cells

Question 11

if a HLA has 2 letters it is in class _____

Answer 11

2

Question 12

what is a major cause of graft loss?

Answer 12

recipient developing de novo anti hla antibodies

Question 13

what are the three main hla antigens?

Answer 13

A, B, DR

Question 14

which patients are low risk?

Answer 14

non sensitized patient (no previous exposure to the antigens)
receiving minimally HLA mismatched organ
no donor reactive antibodies
older patient

Question 15

which patients are intermediate risk?

Answer 15

sensitized patients with HLA antibodies, not against the donor
husband and wife
child and mother
previous transplanted organ

Question 16

which patients are high risk?

Answer 16

have donor reactive antibody from previous pregnancy or organ transplant
cross match positive
HLA incompatible
younger patient
african american
agressive autoimmune disease

Question 17

at what time is risk of acute rejection highest?

Answer 17

first three months

Question 18

what are the major side effects of immunosupression?

Answer 18

infection, malignancy

Question 19

what antibodies are used as induction immunosupression?

Answer 19

monoclonal:
basiliximab (anti IL2)
alemtuzumab (anti cd52)

polyclonal:
antithymocyte globulin

Question 20

Name a few maintenance immunosupressants

Answer 20

cyclosporin
tacrolimus
corticosteroids
azathioprine
belatacept

Question 21

what are some side effects of tacrolimus?

Answer 21

nephrotoxic effect
hypertension
glucose intolerance
insulin dependent diabetes 
dyslipidaemia

Question 22

what are some common malignancies post transplantation?

Answer 22

skin, thyroid, mouth, tongue, lip, cervix, vulva, vagina, non-hodgekin lymphoma, kidney and ureer, bladder, colorectal, lung

Question 23

which site son the graft are targets for alloantibodies in rejection?

Answer 23

endothelium in peritubular capillaries, glomeruli

Question 24

what are some mechanisms of antibody mediated rejection?

Answer 24

direct antibody injury, complement activation, Fc mediated toxicity

Question 25

what is the main target of acute cellular rejection?

Answer 25

tubulointerstitium