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Year 2 MIS > Transplant Immunology > Flashcards

Transplant Immunology Flashcards

1
Q

What is an alloanitgen?

1 - antigen present in some but not others that does not cause an immune response
2 - antigen that all people posses but can cause autoimmunity
3 - antigen that not everyone has and can cause an immune response
4 - antigen that everyone has and does not cause an immune response

A

3 - antigen that not everyone has and can cause an immune response

  • eg: people with blood type A and B have A and B antigens, respectively
  • if blood type A got blood type B then their body would produce an immune response against the B antigens on the B blood type
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2
Q

There are a number of ways by which transplant tissue can be acquired. The type of tissue will determine the name and all names end with graft, but with a different suffix. One type is where a genetically identical individual (homozygos twins) (iso/syngeneic) donates tissue for transplant. Which of the following matches with this description of where the tissue comes from?

1 - Isograft/iso/syngeneic
2 - Allograft/allogeneic
3 - Autograft/autologous
4 - Xenograft/xenogeneic

A

1 - Isograft/iso/syngeneic

- synergist and iso = same, as in same genetics

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3
Q

There are a number of ways by which transplant tissue can be acquired. The type of tissue will determine the name and all names end with graft, but with a different suffix. One type is where a genetically disparate member of the same species donates tissue for transplant. Which of the following matches with this description of where the tissue comes from?

1 - Isograft/iso/syngeneic
2 - Allograft/allogeneic
3 - Autograft/autologous
4 - Xenograft/xenogeneic

A

2 - Allograft/allogeneic

- similar DNA but donor and recipient are likely to have antigens that the other doesn’t (alloanitgen)

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4
Q

There are a number of ways by which transplant tissue can be acquired. The type of tissue will determine the name and all names end with graft, but with a different suffix. One type is tissue is taken from another site on the same individual (e.g. after a burn). Which of the following matches with this description of where the tissue comes from?

1 - Isograft/iso/syngeneic
2 - Allograft/allogeneic
3 - Autograft/autologous
4 - Xenograft/xenogeneic

A

3 - Autograft/autologous

- autologous = same person is auto, and analogue means a copy of what is needed

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5
Q

There are a number of ways by which transplant tissue can be acquired. The type of tissue will determine the name and all names end with graft, but with a different suffix. One type is tissue is taken from a different species (pig/monkey to human). Which of the following matches with this description of where the tissue comes from?

1 - Isograft/iso/syngeneic
2 - Allograft/allogeneic
3 - Autograft/autologous
4 - Xenograft/xenogeneic

A

4 - Xenograft/xenogeneic

  • xeno = from another species
  • geneic = different genetics
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6
Q

There are a number of ways by which transplant tissue can be acquired. The type of tissue will determine the name and all names end with graft, but with a different suffix. There are 4 types:

1 - Isograft/iso/syngeneic
2 - Allograft/allogeneic
3 - Autograft/autologous
4 - Xenograft/xenogeneic

Which of the above 4 types is the most common?

A

2 - Allograft/allogeneic

- tissue from non-genetically identical individual, but same species

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7
Q

When we talk about organ transplant, we talk about warm ischaemic time. What does this mean?

A
  • time period that begins at removal of the organ
  • then treated with hypothermic preservation solution
  • then transplanted into the recipient and blood perfusion recommences
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8
Q

When we talk about organ transplant, we talk about cold ischaemic time. What does this mean?

A
  • time between stopping of blood flow and reconnecting blood flow in recipient
  • treatment with hypothermic preservation until blood flow starts again
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9
Q

Human leukocytes antigen (HLA) matching is crucial in transplants and is often the major reason for transplant rejection. Which of the following HLA parts is most important in the first 6 months of a transplant?

1 - HLA-DR
2 - HLA-DQ
3 - HLA-DP
4 - HLA-A

A

1 - HLA-DR

- gene encoding for a specific type of MHC-II complex

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10
Q

Human leukocytes antigen (HLA) matching is crucial in transplants and is often the major reason for transplant rejection. Which of the following HLA parts is most important in the first 2 years of a transplant?

1 - HLA-DR
2 - HLA-DQ
3 - HLA-DP
4 - HLA-A

A

4 - HLA-A

  • gene encoding for a specific type of MHC-I complex
  • the body begins producing antibodies against the graft
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11
Q

What are the 3 main cells involved in an organ transplant rejection?

1 - B, T cells and neutrophils
2 - B, T cells and antigen presenting cells
3 - B, T cells and basophils
4 - B, T cells and eosinophils

A

2 - B, T cells and antigen presenting cells

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12
Q

Are T helper cells able to bind both MHC-I and MHC-II complexes?

A
  • no just MHC-II complexes

- they can then stimulate an immune response

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13
Q

Are cytotoxic T cells able to bind both MHC-I and MHC-II complexes?

A
  • no just MHC-1

- they check self antigens

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14
Q

Which cells are MHC-I and II classes presented to?

1 - T cells
2 - B cells
3 - macrophages
4 - dendritic cells

A

1 - T cells

  • MHC-I = CD8
  • MHC-II = CD4
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15
Q

Alloantigens, are antigens that not every person has and can elicit an immune response in others. For example, blood group A and B have A and B antigens respectively. Receiving B blood if you have blood type A would cause an immune response against the B antigens. Recognition of alloantigens by the immune system can be subdivided into direct and indirect recognition. What is direct recognition?

1 - MHC-I and MHC-II presented by APC in donor cells recognised directly by recipient T cells
2 - MHC-I and MHC-II presented by APC in donor cells recognised directly by recipient APC
3 - MHC-I and MHC-II present on donor cells recognised directly by recipient B cells
4 - MHC-I and MHC-II present on donor cells recognised directly by recipient B and T cells

A

1 - MHC-I and MHC-II presented by APC in donor cells recognised directly by recipient T cells
- T cells do not require activation by APCs

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16
Q

Recognition of alloantigens by T cells can be subdivided into direct and indirect recognition. What is indirect recognition?

1 - MHC-II antigens present on graft tissue bind with CD4 B cells
2 - MHC1 and MHC-II antigen on graft is bound by recipient APC, recipient APC binds with CD4 or CD8 T cells
3 - MHC-I antigens present on graft tissue bind with CD4 T cells
4 - MHC-I antigens present on graft tissue bind with CD4 B cells

A

2 - MHC1 and MHC-II antigen on graft is bound by recipient APC, recipient APC binds with CD4 or CD8 T cells
- CD4 T helper cells can then activate B cells to produce antibodies if required against the antigen

17
Q

Recognition of alloantigens by T cells can be subdivided into direct and indirect recognition. Which recognition is responsible for the acute rejection in the 1st 6 months and which is responsible for chronic rejection around 2 years?

A
  • acute = antibodies already present in host and direct pathway (HLA-DR MHC-II)
  • chronic = indirect (HLA-A MHC-I)
18
Q

Organ donor rejection can be a class II and IV hypersensitivity. Why can it be a type II hypersensitivity?

1 - CD8 cell bind alloantigens, CD8 cell activates B cells, B cell produce antibodies
2 - CD8 cell bind alloantigens, CD4 cell activates B cells, B cell produce antibodies
3 - APC cell binds alloantigens, CD4 cell activates B cells, B cell produce antibodies
4 - APC or CD4 cell bind alloantigens, CD4 cell activates B cells, B cell produce antibodies

A

4 - APC or CD4 cell bind alloantigens, CD4 cell activates B cells, B cell produce antibodies

  • APC can bind antigen and present on MHC-II to CD$ T cell or CD4 T helper cells bind with antigens on donor tissue and are activated
  • CD4 T helper cells activate B cells that produce antibodies against the antigen
  • antigen-immune complexes form and cause tissue specific damage and inflammation
19
Q

Organ donor rejection can be a class II and IV hypersensitivity. Why can it be a type IV hypersensitivity?

1 - CD8 cell bind alloantigens, CD8 initiates an immune response without antibodies
2 - CD8 cell bind alloantigens, CD4 cell activates B cells, B cell produce antibodies
3 - APC cell binds alloantigens, CD4 cell activates B cells, B cell produce antibodies
4 - CD4 cell bind alloantigens, CD4 initiates an immune response without antibodies

A

4 - CD4 cell bind alloantigens, CD4 initiates an immune response without antibodies

  • T helper cell bind with MHC-II alloantigens on graft tissue (this can also be self APC binds with MHC-II alloantigens which then presents MHC-II to CD4 T helper cells)
  • once activated T helper cells elicit a delayed immune response targeting graft tissue
  • T cell mediated response with no need for antibodies
20
Q

What are the 2 first basic co-stimulatory stages of T cell activation?

1 - T cell bind B cell and then CD40-CD40L bind
2 - T cell bind lectin antigen and then CD40-CD40L bind
3 - T cell bind peptide antigen and then CD28-B7 bind
4 - T cell bind peptide antigen and then CD40-CD40L bind

A

3 - T cell bind peptide antigen and then CD28-B7 binds

21
Q

As graft tissue does not present self antigens it cannot be killed by activated T cells. However, cytotoxic T cells can attack MHC-I molecules that are not self antigens, such as alloantigens. What is the most common cause of graft rejections?

1 - B cells secrete cytokines causing tissue damage and inflammation
2 - T cells secrete cytokines causing tissue damage and inflammation
3 - B and T cells secrete cytokines causing tissue damage and inflammation
4 - B cells secrete antibodies causing tissue damage and inflammation

A

2 - T cells secrete cytokines causing tissue damage and inflammation

22
Q

Hyper-acute rejection of an organ generally occurs within minutes to hours. What is the main driving factor for this?

1 - innate immune cells attack the graft
2 - antibodies already present in recipient begin attacking the graft
3 - cytotoxic T cells attack the graft
4 - B cells produce new antibodies that attach the graft

A

2 - antibodies already present in recipient attack the graft

  • create a blood clot, causing ischaemia and graft death
  • just like when we receive the wrong blood transfusion, patient with blood type A receiving blood type B, the anti-B antibodies would attack the B antigens in the wrong blood
  • will also activate the complement pathway and other features of the innate immune system
23
Q

Hyper-acute rejection of an organ generally occurs within minutes to hours. The main driving factor for this is antibodies already present in recipient attack the graft. This can create a blood clot, causing ischaemia and graft death. What are the 3 main reasons why some patients already have antibodies presenting in their blood?

A
  • blood transfusions
  • pregnancy
  • pervious transplants
24
Q

Acute rejection generally occurs in weeks, months and up to a year from the surgery. What happens here?

1 - cytotoxic T cells begin attacking the MHC-II complex on graft tissue
2 - cytotoxic T cells begin attacking the MHC-II complex on graft tissue
3 - T cells begin to recognise and bind with MHC-I and II molecules on graft tissue
4 - B cells begin recognising and bind with MHC-I and II molecules on graft tissue

A

3 - T cells begin to recognise and bind with MHC-I and II molecules on graft tissue
- initiate a type IV hypersensitivity

25
Q

Chronic cellular rejection in organ donation can occur over months to years. What is the main driving force behind this?

1 - cytotoxic T cells begin attacking the MHC-II complex on graft tissue
2 - cytotoxic T cells begin attacking the MHC-II complex on graft tissue
3 - T cells begin to recognise and bind with MHC-I and II molecules on graft tissue
4 - activated B cells begin producing antibodies against the graft tissue

A

4 - activated B cells begin producing antibodies against the graft tissue
- part of indirect pathway and can lead to type II hypersensitivity

26
Q

Patients who have an organ transplant are often on immune suppression medication for the rest of their lives. What is one of the core drugs we need to be aware of that can is an immunosuppressant?

1 - Azathiopurine
2 - Teriparatide
3 - Tacrolimus
4 - Rapamycin

A

1 - Azathioprine

  • inhibits purine (as per the name of the drug) synthesis needed for DNA/RNA, so less leukocytes are produced
  • purines are needed in cells that proliferate and need DNA/RNA like WBC
  • less purines mean less WBCs
  • less WBC means less of an immune response
27
Q

Patients who have an organ transplant are often on immune suppression medication for the rest of their lives. What is a core drug we need to be aware of that is an immunosuppressant?

1 - Rituximab
2 - Cyclosporin
3 - Tacrolimus
4 - Rapamycin

A

2 - Cyclosporin

  • inhibits calcineurin and in doing so cytokine expression and synthesis
  • reducing cytokines specifically IL-2 means no T cell activation so no immune response
28
Q

What is haematopoeticcell transplantation?

A
  • CD34 stem cells are extracted from a healthy donor
  • CD34 stem cells are then infused into the patient
  • stimulates bone marrow proliferation
29
Q

CD34 stem cells are used in Haematopoeticcell transplantation. These cells are then able to proliferate into what?

A
  • lymphoid lineage (B and T cells)

- myeloid lineage (all other WBCs)

30
Q

What is graft to host disease?

1 - graft tissue contains mature B cells that attack the host
2 - graft tissue contains mature T cells that attack the host
3 - graft tissue contains APC that attack the host
4 - graft tissues complement pathway attacks the host

A

2 - graft tissue contains mature T cells that attack the host

31
Q

When preparing a patient for a transplant, there are a number of steps that must be taken. What are the 4 things we must screen the patients for?

A

1 - blood typing (ABO grouping)
2 - HLA typing
3 - screening for blood grouping and pre-formed antibodies
4 - mixed lymphocyte reaction (MLR) for T-helper cell activation

32
Q

When trying to match a healthy donor in the family, out of parent, 1 sibling and 2 sibling, which is likely to have the best genetic match?

A
  • 2 siblings = 44% change of match
  • 1 siblings = 25% change of match
  • mother/father = 25% change of match
33
Q

What are panel reactive antibodies?

A
  • recipients are screened for a host of HLA antibodies

Year 2 MIS (48 decks)

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