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Immunology > Transplant > Flashcards

Transplant Flashcards

1
Q

Twin to twin transplant

A

Isograft

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2
Q

Non-identical human to human transplant

A

Allograft

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3
Q

Self to self transplant

A

Autograft

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4
Q

Inter-species transplant

A

Xenograft

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5
Q

Most common organ transplant

A

Kidney

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6
Q

Principle of HLA

A 
Class I (A, B, C) on all cells, class II (DR, DQ, DP) on APCs
Each HLA has many variations (e.g. HLA-DQ4)
HLA matching is important for transplant - mismatch = rejection
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7
Q

T-cell or antibody mediated rejection

A

Rejection due to HLA mismatch

hyperacute if pre-sensitised or acute

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8
Q

Antibody mediated rejection only

A

Rejection due to ABO mismatch

hyperacute

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9
Q

Antibodies against HLA vs. antibodies against ABO

A

ABO antibodies naturally occurring (e.g. if you are group A you automatically have anti-B)
HLA not naturally occurring (require exposure)

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10
Q

Two types of immune rejection

A

T-cell mediated

Antibody mediated

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11
Q

5 ways to prevent rejection

A
  1. Matching (PCR)
  2. Screen for antibodies in recipient (via CDC, FACS, Luminex)
  3. Cross match recipient + donor blood
  4. Immunosuppression of recipient
  5. Re-check recipient for antibodies post-transplant
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12
Q

3 forms of immunosuppression

A
  1. Pre-transplant induction
  2. Immunosuppressants post-transplant
  3. Acute rejection treatment
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13
Q

3 induction agents

A

Target T cells

Anti-CD52 (alemtuzumab) or anti-CD25(IL2R) (basiliximab) or OKT3/ATG

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14
Q

3 post-transplant immunosuppressants

A

CNI + MMF/Aza +/- steroids

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15
Q

Treat acute rejection (T cells)

A

Steroids + OKT3/ATG

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16
Q

Treat acute rejection (antibody)

A

IVIG + plasma exchange + anti-CD2 + anti-CD20

17
Q

Recipient APC presents to recipient T cells

A

Indirect recognition
CHRONIC REJECTION
(More natural immune response)

18
Q

Donor APC presents to recipient T cells

A

Direct recognition

ACUTE REJECTION

19
Q

HLA most important to match

A

DR > B > A

20
Q

Preformed Ab activates complement
Minutes-hours after transplant
Thrombosis + necrosis
Rejection type + treatment?

A

Hyperacute

Should have crossmatched

21
Q 
Cd4+ binds APC
Weeks-months after transplant
Cellular infiltrate
Treat by T cell immunosuppression
Rejection type?
A

Acute (cell mediated)

22
Q

Type IV hypersensitivity

A

Requires 2 exposures
1st exposure = APC to CD4+ cells to produce memory CD4+ (Th1) against antigen
2nd exposure = APC to memory CD4+ releases IFN-gamma, IL2 and IL3 - activates macrophages to produce TNF-alpha

23
Q

Produced by Th2 cells to dampen Th1 cells

A

IL10

24
Q 
B cell activation + antibody production
Antibodies bind endothelium
Vasculitis
Weeks-months after transplant
Treat by Ab removal + B cell suppression
Rejection type?
A

Acute (antibody mediated)

25
Q 
Months-years after transplant
Smooth muscle growth + blockage of graft vessels -> ischaemia + fibrosis
Bronchiolitis obliterans
Treat by minimising organ damage
Rejection type?
A

Chronic

26
Q 
Feature of HSC transplant
Recipient BM eliminated + replaced by donor BM
Donor cells recipient tissues
Skin rash, D+V, bloody stool, jaundice
Treat with corticosteroids
Rejection type?
A

GVHD

27
Q

5 types of rejection

A 
Hyperacute
Acute (cellular)
Acute (antibody)
Chronic
GVHD
28
Q

GVHD prophylaxis

A

Methotrexate / Cyclosporine

29
Q

Poor prognostic factor for transplant

A

Hypertension

30
Q

2 post-transplant complications

A

Infection (conventional / opportunistic)

Malignancy (Kaposi’s HHV8, skin cancer)

31
Q

T cell activated by:
HLA-DR
HLA-A

A

CD4+

CD8+

32
Q

HLA expressed on:
All cells
APCs

A 
Class I (A, B, C)
Class II (DR, DQ, DP)
Coded by MHC on chromosome 6
33
Q

T-cell mediated rejection

A
  1. Recognition - CD4+ cells recognise mismatched HLA, presented on APCs. This may be direct (donor APCs) or indirect (recipient APCs)
  2. Activation - of CD4+ cells when they bind APCs
  3. Effector - CD4+ cells activate CD8+, B cells, macrophages etc. to mount an immune response that destroys the transplant

Occurs in acute cell-mediated rejection

34
Q

Antibody mediated rejection

A

Hyperacute rejection - pre-formed Abs floating in blood attack foreign ABO on RBCs or foreign HLA on graft endothelium, resulting in rejection

Acute antibody-mediated - B cells bind foreign HLA - independently activated to form plasma and memory cells - produce antibodies against foreign HLA on graft endothelium resulting in rejection

35
Q

2 types of acute rejection

A

T cell-mediated

Antibody-mediated

36
Q

Antibodies against HLA attack…

A

Graft endothelium

37
Q

anti-ABO vs. anti-HLA antibodies

A

anti-ABO - naturally occurring; attack RBCs

anti-HLA - not naturally occurring - require previous exposure (prev. transplant, pregnancy, transfusion)

38
Q

5 types of transplant rejection

A 
Hyperacute
Acute cell-mediated
Acute antibody-mediated
Chronic
GVHD
39
Q

3 risk factors for chronic rejection

A

Hypertension > Most important
Multiple acute rejection
Hyperlipidaemia

Immunology (9 decks)

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