Transplant Flashcards
Acute phase proteins made by liver (9)
- fibrinogen
- haptoglobin
- CRP
- C3
- ceruloplasmin
- alpha-antitrypsin
- alpha-antichymotrypsin
- alpha-acid glycoprotein
- amyloid A
Lab findings with hepatocellular injury
Increased AST/ALT
Lab findings with liver obstruction (5)
Increased ALP, GGT, Bili (D), 5-nucletidase, leucine amino peptidase
Lab findings of decreased liver function (5)
Decreased albumin, transferrin, coag factors (=Increased INR)
Hypoglycemia
Altered glucose metabolism
What are MHC antigens?
Surface antigens, aka HLA (human leukocyte antigens)
Reason for organ rejection as molecules involved in antigen presentation to Tcells
What are class I MHC?
HLA-A,B,C
ALL CELLS have these on surface
same internal contents of cell and bring to surface for presentation
Recognized by CD8 = cell death
Expression increased by cytokines and interferons
What are Class II MHC?
Expression of HLA DR, DQ, DP, DM
Only on antigen presenting cells - present to CD4 cells
Leads to B-cell antibody development and presenting cell damage
Leads to macrophage activation
What is indirect antigen recognition?
Conventional antigen presentation. Antigens taken up and then presented in MHC to t-cells
What is direct antigen recognition?
In solid organ transplant, antigen presenting cells present themselves = rejection
Role of antibodies? (4)
Target for phagocytosis
Activate complement
Neutralize toxins
Block attachments of pathogens to cells or tissue
5 classes of immunoglobulins
Ig A,D,E,G,M
What is the structure of immunoglobulins?
4 peptide chains
heavy x 2
light x 2
What does IgD do?
On surface of B cells, function unknown
What does IgA do?
low levels blood, most abundant at mucosal surfaces (i.e. gut)
What does IgM do?
Surface of B cells. Secreted as pentamer (5 molecules).
Activates complement
First antibody produced at time of infection
What does IgE do?
Low amount in blood. Bound to mast cells and basophils.
Responsible for type I hypersensitivity.
Increased in parasitic infections
What does IgG do?
Most abundant AB
Production depends on cytokines
Leaves bloodstream and enters tissues
ACTIVELY TRANSPORTED ACROSS PLACENTA (the only one)
Activates complement
neutralizes toxins
Contraindications to transplant donation (4)
Sepsis - start abx before taking
Viral infection (HTLV1, HIV, HBV, HCV, EBV, CMV, HSV)
Cancer
No consent
What are contraindications to receiving transplant? (7)
HIV (actually not an absolute indication if lvls are controlled)
Malignancy
Irreversible brain damage
Irreversible infxn
Irrreversible multiple organ faiilure
Irreversible significant cardiopulmonary dz
Inability to comply with medical therapy
Contraindications specific to liver transplant? (8)
Inability to have procedure
Recent intracranial hemorrhage
Irreversible neurologic impairment
Active substance abuse
Intractable hypotension
Evidence of systemic infection
Extrahepatic malignancy
Inability to comply with followup/meds
Contraindications specific to renal transplant (3)
Recurrent renal dz (FSGS, hemolytic uremia syndrome, MPGN)
Liver transplant contraindications
psychosocial
What does blood transfusion effect refer to in context of organ rejection?
Improved graft survival believed to be secondary to suppression of rejection mechanisms in patients who receive blood before their transplant
What is hyper acute rejection?
Minutes to hours
can happen across ABO groups
preformed IgG antibodies
TYPE AND SCREEN
What is acute rejection?
1-3 weeks but most common 3-6 months
T cells
2 types - vascular and cellular
Treat with methylprednisolone –> taper
