transplant immunology

Question 1

3 types of transplantation :

Answer 1

• Haemopoietic Stem Cell (HSC) Transplantation
• Solid Organ Transplantation
• Tissue Transplantation

Question 2

sources of donors:
* — : – autologous / autograft
* Another — : – allogeneic / allograft
* Another — : – Xenogeneic / xenograft

Answer 2

self
human
species

Question 3

tissue transplantation Non-vascularised, non-haemopoietic tissue and are I mmunologically inert , these include:
- —- is not a significant issue
- exposure recipient to — antigens can results in —- impacting future transplantation

Answer 3

tissue which includes:
* Bone grafts
* Heart Valves
* Corneas (occas. need immunosuppression)
* Blood Vessels
rejection
non self HLA antigens
anti HLA antibodies

Question 4

• Allogeneic Bone Marrow
• Autologous Bone Marrow
  are all in —- transplantation
  Stem cells purified from —
• Autologous/Allogeneic stem cell transplantation
• Cord blood stem cells

Answer 4

HSC
blood

Question 5

• Kidney
• Pancreas
• Liver
• Heart
• Lung
• Islet cell transplantation
• Small bowel / multivisceral transplants
• Vascularised composite grafts – face, hand
  are in —- transplantation

Answer 5

solid organ

Question 6

solid organ transplantation indications:
* Irreversible —
* Disease with low risk of —
* Recipient free of —
* Recipient free of —
* Recipient fit for — surgery
* Recipient — suitable

Answer 6

organ failure
reoccurrence
infection
malgincacy
major
psychologically

Question 7

ethical issues includes
* Allocation of —-
* Living — programme
* Xenotransplantation – risk to — – transfer of —

Answer 7

scarce resources
donor
public health
animal pathgens
check slide 13

Question 8

testing pre transplant
1-When recipient listed
* — group x 2
* — type x 2
* —- at listing & — monthly
2-When donor available, donor testing:
* — group
* —-

Run list of potential recipients. Allocation criteria
Crossmatch – final check of compatibility of donor &
recipient

Answer 8

blood
HLA
anti HLA antibodies
3
blood
HLA

Question 9

3 key concepts:
1- — match
* Compare HLA type of donor and recipient
* — match HLA-A, B, Cw, DR, DQ, DP
* 000000 is the — match
2- — compatible
* Recipient has no — against the donor
* Can be well matched or not
3- —- Patient (HSP)
* Patient has antibodies to — percentage of the population
* — to find compatible donor
* Consider — risk transplants to improve access

Answer 9

HLA
6
antibody
no antibodies
Highly Sensitised Patient
high
difficult
high risk

Question 10

HLA matching :
* Relevant to — and —
* Better matching — the immunological barrier
* Better —
* Less – (anti-HLA antibodies)

Answer 10

solid organ n HSCT
decreases
outcomes
sensitisation
check slide 20

Question 11

classification of rejection:
* —- –> <24 hours
* —- — > <6 mths
* —- –> usually < 6 weeks if late ? Non-adherence
* —- —> years

Answer 11

hyper acute
acute cellular
acute antibody mediated
chronic rejection

Question 12

mechanism of tissue damage:
1- Hyperacute (— hours ; should not happen with modern H & I)
Preformed —
Activates —
— inflammation
Endothelium becomes — – thrombosis
2- Acute antibody mediated (first — weeks; late – non-adherence)
Antibody develops – transplant (de novo / rebound)
— activation / inflammation
Change in — function
If untreated may get —
3- Cellular Rejection (first — )
Donor antigen presented to recipient —
T cell — damage
Injures the —
Common (10-20% renals)
4- Chronic Rejection ( — )
Role of antibodies now prominent
Multiple additional factors
— in response to injury
Ultimate cause of — of most grafts

Answer 12

<24
aitbody
complement
acute
prothrombiotic
6 weeks
post
complement
endothelial
thrombosis
first 6 months
T cells
cytotoxic
injures the graft
scarring
loss

Question 13

preformed antibodies to graft:
* Can cause —
* Contraindication
(except for – transplants)
* — antibodies (ABO & other)
* —- antibodies

Answer 13

hyper acute rejection
liver
blood group
anti hla

Question 14

-HLA antibodies sensitisation history :
* —
* —
* Previous —

-Transfusion of a potential transplant recipient should ALWAYS be made at — level
-Also make anti-HLA antibodies after
* — transplantation
* —
* Implanted — eg Left ventricular assist devices

Answer 14

transfusions
pregnancy
allograft
senior
tissue
infection
device

Question 15

true or false in transplant outcomes
Improving over the years
Improvement mostly in early outcomes
Affected by donor & recipient factors

Answer 15

true

Question 16

post reveal transplant - immunosupression:
* — depleting antibody ( aka — )
-Anti-CD-25
-Anti-thymocyte globulin (ATG)
* Tacrolimus – — inhibitor (Inhibit— action)
* Mycophenylate (Inhibit — )
* —

Answer 16

T cell
depletion
calcineurin
cytokine
proliferation
steroids

Question 17

post transplant immunsupression :
All patients significantly immunosuppressed
* Increased risk of:
– —
– —
Need to carefully consider —

Answer 17

infection
malignancy
drug interaction

Question 18

solid organ transplantion summary
* Main problem is —
– Modern testing prevents —
– Can — most cellular rejection, and >80% of antibody mediated rejection

Early outcomes have – significantly
Late attrition of grafts lremains a problem

Answer 18

rejection
hyperacute rejection
reverse
improved

Question 19

in hemopiotic stem cell transplantation
1- what is transplanted ? :-
* Bone marrow
—- (from someone else)
— (patients own)
* Haemopoietic Stem cells
mobilised with—
Autologous
Allogeneic
* — blood

Answer 19

allogenic
autogous
growth factors
cord

Question 20

HSCT indications:
* —- disease
– Leukaemia & lymphoma
– Solid organ tumours, Multiple myeloma
* —- diseases
– Immunodeficiency & Haematological
– Storage disorders
* — disease (rare; few units)
HSCT process:
* Bone marrow/stem cells — and —
* Often depleted of —
* Patients bone marrow ablated
“Conditioning”
* — given
* Patient — until white cells recover
HSCT complication includes :

Answer 20

malignant
genetic
autoimmune
collected n processed
mature T cells
infusion
isolated
complications are:
* Non-engraftment
* Infection
* GvHD (Graft versus Host Disease)
* Recurrence
* Toxicity of conditioning regimen

Question 21

—- Can occur when viable T cells are given to immunodeficienct /
immunosuppressed recipient
also occurs by :
* —- transplantation
* — Tx – lungs & liver (very rarely)
* — n severely immunocompromised

Answer 21

GvHD (Graft versus Host Disease)
bone marrow
solid organ
post transfusion

Question 22

graft vs host disease :
1- acute affects ( which is common ) :
2- chronic causes :
- skin —
- — syndrome
- —
- —

Answer 22

affects skin GIT liver bone marrow and prophylaxis ( (immunosuppression) may
be given ( im not sure if this is for both or only acute )
thickening
sicca
pneumonitis
immunodeficiency

Question 23

transplant immunology summary:
* HSC recipient immune system replaced by—
* Main problem —
* Solid organ – main problem —
* Reduce problems in both situations- — and —
summary :
* Transplant outcomes improving
* Understanding of immunological mechanisms necessary
for rational treatment.
What we would like:
* More targeted immunosuppression
* Organ specific tolerance

Answer 23

donor immune system
graft vs host disease
rejection
matching n immunosuppression