Transplantation

Question 1

Most commonly transplanted organ?

Answer 1

Kidney

Question 2

Living donor organs

Answer 2

Bone marrow
Kidney
Liver

Question 3

Reasons for transplant rejection rejection

Answer 3

HLA mismatch (DR>B>A)
ABO mismatch

Question 4

Two types of rejection

Answer 4

T-cell mediated
Antibody mediated

Question 5

Compare the types of rejection

Answer 5

Question 6

What is the maximum possible HLA mismatches

Answer 6

6

Question 7

What investigations are done pre-transplant?

Answer 7

Tissue typing - HLA and blood group
Cross reactivity - cytotoxicity, FACS and solid phase

Question 8

What investigations are done post-transplant?

Answer 8

Repeat cross reactivity
weekly → monthly checks on rejection

Question 9

Immune suppression regime for transplant

Answer 9

Induction - T cell depletion (anti-cd52 alemtuzumab or anti-CD25 basiliximab)
Maintenance - steroid + calcineurin inhibitor + antiproliferative
Acute:
* cellular - steroids (3x methylpred + oral taper), OK3/ATG
* Ab-mediated - IVIG, plasma exchange, anti-C5, anti-CD20

Question 10

GvHD prophylaxis

Answer 10

Methotrexate/cyclosporin
irradiate blood products

Question 11

GvHD treatment

Answer 11

Corticosteroids

Question 12

Post-transplantation immunosuppression complications

Answer 12

Infection - conventional and opportunisitic
Malignancy - viral associated (x100), skin (x20)
Atherosclerosis