organ transplantation

Question 1

life saving vs life enhancing transplants

Answer 1

liver, heart and bowel vs kidney and pancreas

Question 2

define allografts

Answer 2

transplants between different individuals of same species

Question 3

define autografts

Answer 3

transplants from within same individual (eg stem cells)

Question 4

types of donor

Answer 4

mostly deceased, but also living

Question 5

types of deceased donors

Answer 5

DBD (after brainstem death) or DCD (after circulatory death)

Question 6

transplant selection vs allocation

Answer 6

selection is whether someone is eligible to be on the waiting list, allocation is who on the waiting list gets the organ

Question 7

what allocation is dependent on

Answer 7

waiting time, how genetically close they are, and age difference between donor and recipient

Question 8

how to increase transplantation activity

Answer 8

more deceased donation eg more elderly/DCD donor, more living donation, and more stem cell research for future (autografts)

Question 9

problem with DCD donors

Answer 9

unlike DBD donors, organs less useful

Question 10

problem with organ transplantation and solution

Answer 10

antibodies against blood group antigens- to solve, the antibodies are removed by plasma exchange

Question 11

DIAGRAM other problem and how this occurs

Answer 11

HLA differences- recipient APC takes off MHC molecules from DONOR cells, and presents these to T cells

Question 12

most polymorphic HLA types and what this means

Answer 12

HLA-A, HLA-B, HLA-DR, meaning most likely to cause immune reaction

Question 13

DIAGRAM how to calculate mismatches

Answer 13

in first column, only one mismatch

Question 14

diagnosis and treatment of immune rejection

Answer 14

histological biopsy ie look for lots of inflammatory cells- treatment involves immunosurpression

Question 15

types of rejection

Answer 15

either T cell mediated/antibody-mediated, or acute/chronic rejection

Question 16

T cell mediated

Answer 16

APC removes MHC from donor cells (see before)- T cells then go to organ

Question 17

DIAGRAM how T cells attack kidney and how to tell they are T cells

Answer 17

can see T cells infiltrate interstitial space, they rupture the BM, and they affect the actual tubules (tubulitis)- they all have CD3

Question 18

types of antibody-mediated rejection

Answer 18

either against HLA or AB antigens- either pre-transplant (SENSITISED PEOPLE already have antibodies) or post

Question 19

how antibody-mediated rejection occurs

Answer 19

antibody binds on surface of ENDOTHELIAL cells and recruits complement OR macrophages= endothelial death death

Question 20

antibody rejection vs T cell rejection

Answer 20

intravascular (eg glomerulonephritis) vs interstitium+tubule

Question 21

post transplant monitoring for rejection

Answer 21

look at if organ deteriorating eg look at kidney function

Question 22

post transplant prevention and treatment

Answer 22

prevent HLA differences, and give immunosuppressive drugs

Question 23

main immunosuppressive drugs against T cells

Answer 23

azothrioprine, steroids and calcineurin inhibitor

Question 24

main immunosuppressive drugs against B ells

Answer 24

retuxinab (anti-CD20), and proteosome inhibitors

Question 25

problem with immunosupression

Answer 25

increases risk of infection (often viral) and cancer (skin, EBV cancer and kaposis sarcoma)