Transplant

Question 1

Etiology:

Preformed recipient antibodies against graft antigens

Answer 1

Hyperacute (Minutes to hours)

Question 2

Gross mottling & cyanosis

Arterial fibrinoid necrosis & capillary thrombotic occlusion

Answer 2

Hyperacute (Minutes to hours)

Question 3

Vascular wall thickening & luminal narrowing
Interstitial fibrosis & parenchymal atrophy
(Vascular fibrosis)

Answer 3

Chronic (>6 months)

Question 4

Etiology:
Chronic low-grade immune response refractory to immunosuppression
Mixed cell-mediated andhumoral

Answer 4

Chronic (>6 months)

Question 5

Cellular: lymphocytic interstitial infiltrate & endotheliitis
Humoral: C4d deposition, neutrophilic infiltrate, necrotizing vasculitis

Answer 5

Acute (<6 months)

Question 6

Etiology:
Exposure to donor antigens induces activation of naive immune cells
Predominantly cell-mediated (HOST T cell sensitization of GRAFT MHC)

Answer 6

Acute (<6 months)

Question 7

graft-versus-host disease (GVHD), a condition that usually occurs after allogeneic bone marrow transplantation. However, GVHD can also occur following transplantation of ______ or ______

Answer 7

organs rich in lymphocytes (liver)

transfusion of non-irradiated blood

*T lymphocytes found in the donor organ become sensitized against the MHC antigens of the recipient

Question 8

_____ is an immunosuppression drug that inhibits inosine 5’-monophosphate dehydrogenase in the de novo _____ pathway.

Answer 8

Mycophenolate

purine synthesis

It provides relatively specific suppression of lymphocyte proliferation, they lack an established purine salvage pathway that is present in other hematopoietic cell lines.

Question 9

Mycophenolate is an immunosuppression drug that inhibits ____ in the de novo purine synthesis pathway.

Answer 9

inosine 5’-monophosphate dehydrogenase

Question 10

____ is an essential protein in the activation of interleukin-2, which promotes the growth and differentiation of T cells. Immunosuppressants such as cyclosporine and tacrolimus work by inhibiting its activation.

Answer 10

Calcineurin

Question 11

Calcineurin is an essential protein in the activation of interleukin-2, which promotes the growth and differentiation of T cells. Immunosuppressants such as ___ & ___ work by inhibiting calcineurin activation.

Answer 11

cyclosporine and tacrolimus

Question 12

_____ binds to the immunophilin FK binding protein (FKBP) in the cytoplasm, forming a complex that binds and inhibits mTORthis blocks IL-2 signal transduction and prevents cell cycle progression and lymphocyte proliferation

Answer 12

Sirolimus

Question 13

a medication that inhibits lymphocyte proliferation by directly blocking interleukin-2 signal transduction

Answer 13

Sirolimus

Question 14

Sirolimus causes the inhibition on ____ thus inhibiting IL-2

Answer 14

mTOR (mammalian target of rapamycin).

Question 15

Preformed host antibodies to donor ABO or HLA

Neutrophilic infiltration with fibrinoid necrosis and thrombosis

Answer 15

Hyperactue lung rejection (min–hrs)

Question 16

Cell-mediated response to mismatched donor HLA

Perivascular (small lung vessels) & submucosal (bronchiole) lymphocytic infiltrates

Answer 16

Acute lung rejection (<6 months)

Question 17

Chronic, low-grade, mixed cell-mediated and antibody response to HLA antigens

Submucosal inflammation → granulation, scarring & bronchiolitis obliterans

Answer 17

Chronic lung Rejection (months–years)