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MET2 > Transplant Immunology > Flashcards

Transplant Immunology Flashcards

1
Q

Rejection

A

Recipient immune system attacking graft

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2
Q

3 types of rejection

A

Hyperacute
Acute
Chronic

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3
Q

How are types of classification defined

A

Time of occurence

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4
Q

When does hyperacute rejection occur

A

Minutes to hours

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5
Q

When does acute rejection occur

A

1wk - 6 months

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6
Q

When does chronic rejection occur

A

Months to yrs

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7
Q

2 rejection mechanisms

A

Acute cell mediated rejection
Acute antibody mediated rejection

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8
Q

What immune cells are involved in acute cell mediated rejection

A

Helper T lymphocytes
Cytotoxic T lymphocytes
Macrophages

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9
Q

Tubulitis

A

Lymphocytes infiltrate kidney tubules

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10
Q

Endarteritis

A

Lymphocytes infiltrate artery walls

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11
Q

Immune cells involved in antibody mediated rejection

A

Helper T lymphocytes
B lymphocytes

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12
Q

What antigens can antibodies be made against in antibody mediated rejection

A

ABO antigens
MHC antigens
MHC class I related chain A
other non self antigens

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13
Q

What structures are most commonly attacked in antibody mediated rejection

A

Artery endothelium
Capillary endothelium

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14
Q

Histological features of antibody mediated rejection

A

Neutrophils in peritubular capillaries
Thrombosis
Arteritis/fibrinoid necrosis of vessels
Haemorrhage
Infarction
C4d deposition

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15
Q

What does C4d complement bind to in antibody mediated rejection

A

Endothelial cell surfaces and matrix componenets

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16
Q

Criteria for acute antibody mediated rejection

A

Acute renal injury evidence on histology
Antibody activity evidence
Circulating anti donor specific antibodies

17
Q

What immune cells are involved in hyperacute rejection

A

B lymphocytes

18
Q

What causes hyperacute rejection

A

Host already presensitised to antigens on transplant and has antibodies

19
Q

What can pre sensitise a host to a transplant causing hyperacute rejection

A

Previous transplant
Previous transfusion
Previous pregnancy

20
Q

What can cause a graft to fail

A

Damaged before transplantation
Surgical complications
Recurrence of original disease
Rejection

21
Q

Which type of rejection can be caused by pre transplant damage and surgical complications

A

Chronic

22
Q

How can hyperacute rejection be prevented

A

ABO compatibility
Screen for pre formed antibodies

23
Q

How are pre formed antibodies for a transplant screened for

A

Direct cross matching

24
Q

2 techniques for direct cross matching

A

Complement dependent cytotoxicity
Complement flow cytometry

25
Q

What are most preformed antibodies in hyperacute rejection specific for

A

HLA

26
Q

How can acute rejection be prevented

A

HLA matching
Minimise ischaemia - prevent ischaemia reperfusion injury

27
Q

When does warm ischaemia of a transplant occur

A

While artery clamped at normal temp

28
Q

When does cold ischaemia of a transplant occur

A

While transplant on ice waiting to be put in donor

29
Q

Ischaemia reperfusion injury

A

Non specific damage caused by ischaemia upregulating adhesion molecules and increasing adhesion of leucocytes during reperfusion

30
Q

Preventing chronic rejection

A

Choosing best organ
Minimise surgical damage
Minimise acute rejection
Minimise drug toxicity

31
Q

Why does the relationship between the recipient immune system and the graft become less aggressive over time

A

Loss of bone marrow derived cells from donor
Active regulation develops

32
Q

2 types of allorecognition

A

Indirect allorecognition
Direct allorecognition

33
Q

Which type of allorecognition is more aggressive

A

Direct

34
Q

What do immunosuppressants do

A

Prevent activation of helper t lymphocytes

35
Q

How can immunosuppressants act

A

Ablate T cells
Inhibit signal from antibody receptor
Prevent cytokine gene activation
Inhibit IL-2 receptor
Inhibit signal from IL-2 receptor
Inhibit T cell proliferation

MET2 (25 decks)

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