TRANSPLANT REJECTION

Question 1

When does hyper acute rejection occur?

Answer 1

Within minutes to hours

Question 2

What causes hyper acute rejection?

Answer 2

Pre-existing antibodies against ABO or HLA antigens leads to widespread thrombosis of graft vessels = ischaemia and necrosis of transplanted organ

Question 3

What type of hypersensitivity reaction is hyper acute rejection?

Answer 3

Type 2

Question 4

Whats the management for hyper acute rejection?

Answer 4

No treatment is possible and the graft must be removed

Question 5

When does acute graft failure occur?

Answer 5

Within 6 months

Question 6

What causes acute graft failure?

Answer 6

Mismatched HLA or inadequate immunosuppression
It’s caused by cytotoxic T cells

Question 7

How is acute graft failure managed?

Answer 7

Steroids and immunosuppressants

Question 8

What can multiple episodes of acute graft failure cause?

Answer 8

Chronic graft failure

Question 9

When does chronic graft failure occur?

Answer 9

Usually after 6 months

Question 10

What causes chronic graft failure?

Answer 10

Antibody and cell-mediated mechanisms cause fibrosis
Or recurrence of original disease

Question 11

What is induction therapy?

Answer 11

immunosuppressive therapy administered at the time of kidney transplantation to reduce the risk of allograft rejection

Question 12

What is used as induction therapy in the UK?

Answer 12

Basiliximab
Rabbit anti-human thymocyte immunoglobulin

Question 13

What is used as maintenance therapy?

Answer 13

Tacrolimus
Belatacept
Mycophenolate
Sirolimus
Everolimus

Question 14

Whats the moa of Ciclosporin?

Answer 14

Inhibits calcineurin (a phosphotase involved in T cell activation)

Question 15

Whats the moa of tacrolimus?

Answer 15

Inhibits calcineurin

Question 16

Whats the moa of mycophenolate?

Answer 16

Blocks purine synthesis and so inhibits proliferation of B and T cells

Question 17

Whats the moa of sirolimus?

Answer 17

Blocks T cell proliferation by blocking IL-2 receptor

Question 18

What should patients on long term immunosuppression for organ transplantation be monitored for?

Answer 18

CVD
Renal failure
Malignancy

Question 19

Why are patients on long term immunosuppression for organ transplantation at risk for CVD?

Answer 19

Tacrolimus Ciclosporin can cause hypertension, hyperglycaemia and tacrolimus can also cause hyperlipidaemia

Question 20

Why are patients on long term immunosuppression for organ transplantation at risk for renal failure?

Answer 20

Tacrolimus and Ciclosporin have nephrotoxic effects

Question 21

What malignancy are patients at risk for when on long term immunosuppression for organ transplantation?

Answer 21

Squamous cell and basal cell carcinomas

25% of patients who live for 20 years after a transplant develop some type of cancer