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Immunology > Transplantation 2 > Flashcards

Transplantation 2 Flashcards

1
Q

what transplant was successfully performed last january

A

the first ever porcine to human heart
transplant - obtained from a genetically engineered pig

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2
Q

3 disadvantages of xenografting with primates even though they’re concordant

A

endangered
ethical concerns
retrovirus

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3
Q

2 disadvantages of xenografting with monkeys even though they’re concordant

A

small size
retrovirus

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4
Q

2 disadvantages of xenografting with cow/horse/sheep

A

dis concordant
large size

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5
Q

2 reasons why xenografting with dog would be bad

A

dis concordant
ethical concerns

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6
Q

2 advantages of xenografting with pig, although requires genetic engineering

A

partly concordant
size- compatible

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7
Q

what must be performed in xenografting to avoid rejection

A

genetic modification

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8
Q

2 key genetic modifications to date

A

knock out porcine carbohydrate genes (GAL)

induce expression of human complement and coagulation regulatory molecules

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8
Q

2 key genetic modifications to date

A

knock out porcine carbohydrate genes (GAL)

induce expression of human complement and coagulation regulatory molecules

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9
Q

what is Donation after Circulatory Death

A

the retrieval of organs
from patients whose death is diagnosed and confirmed using cardiorespiratory criteria

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10
Q

2 types of Donation after Circulatory Death (DCD)

A

Controlled
Uncontrolled

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11
Q

when does controlled DCD take place

A

after death caused by planned withdrawal of life-sustaining treatments

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12
Q

what is uncontrolled DCD

A

organ retrieval after a unexpected cardiac arrest, from which the patient cannot or should not be
resuscitated.

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13
Q

how many organs are donated after circulatory death

A

40%

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14
Q

islet cell transplant process

A
  1. donor pancreas
  2. Ricordi chamber - key islet isolation device
  3. separated islets
  4. islets introduced into the liver of recipient
  5. transplanted islets secreting insulin in liver
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15
Q

what do islet cells produce in the pancreas

A

insulin

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16
Q

4 advantages of islet transplants

A

Can remove the need for insulin
injection

Prevents hypos

Improves overnight control

Transplant surgery is easy, quick and minimally invasive

Potential for xenotransplantation

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17
Q

3 limitations of islet transplantation

A

Only 2% of the donor pancreas is islet material

Repeated transplants often necessary

Shortage of donors

Immunosuppression
required – side effects

18
Q

3 sites for islet transplantation for diabetes treatment

A

the anterior chamber of the eye
spleen
bone marrow
kidney capsule
subcutaneous space

19
Q

what cells are involved in the future of islet transplantation

A

induced pluripotent stem cells

20
Q

what is Bone marrow transplantation

A

the transfer of bone marrow cells from
one human to another

21
Q

what can bone marrow transplantation be used to treat

A

leukaemia
immunodeficiency or anaemias

22
Q

how many BMTs are over 350,000 centres in europe performing a year

A

more than 20,000

23
Q

whats a serious complication of BMTs

A

graft-versus-host disease

24
Q

how can HSC reconstitute damaged bone marrow

A

if they are harvested from cultures derived from bone marrow cells and are re-infused

25
Q

whats the chance of match for stem cells for transplant from matched sibling

A

25%

26
Q

whats the chance of match for stem cells for transplant from matched unrelated donor

A

50%

27
Q

what has restricted availability but better outcomes than matched unrelated donor and less graft-versus-host disease

A

stem cells from umbilical cord blood

28
Q

whats autologous HSCT

A

transplanted stem cells
previously taken from the patient (bone marrow/peripheral blood stem cells)

29
Q

why is autologous HSCT less complicated

A

as it is MHC compatible

30
Q

what does autologous HSCT allow for pre-transplantation, which will irreversibly damage bone marrow

A

high dose chemo and radiotherapy

31
Q

7 steps of autologous HSCT

A
  1. Mobilise stem cells using growth factor and chemotherapy
  2. stem cells collected from peripheral blood
  3. stem cells frozen until required
  4. conditioning chemotherapy to suppress IS
  5. stem cells thawed and re-infused
  6. support with blood products and antibiotics (2 weeks)
  7. Further follow-up as outpatient for 2-3 months with regular blood tests and medication
32
Q

how does collection differ with cord blood vs bone marrow

A

cord blood- collection is non-invasive, painless and poses no risk to the donor

Bone marrow - collection is invasive and painful, and must be performed in hospital surgery

33
Q

why is GVHD reduced to 10% with cord blood

A

due to absence of antibodies in stem cells

34
Q

why does it require grater HLA match to perform a transplant with bone marrow compared to cord blood

A

due to maturity of stem cells

35
Q

is cord blood or bone marrow less expensive

A

cord blood

36
Q

how much out of all unrelated bone marrow transplants does serious GVHD occur in

A

60%

37
Q

when does GVHD occur

A

when immune cells from the donor (largely T-cells), attach the
recipient’s tissues

38
Q

When does graft vs leukaemia effect occur (often simultaneously with GVHD)

A

when immune
cells from the donor
(largely Tcells), eliminate residual
leukaemia cells in the
recipient

39
Q

what must be measured post-transplant for indicate outcome

A

level of engraftment

40
Q

for malignancies, how much donor engraftment is required to prevent relapse

A

100%

41
Q

what may be enough to correct anaemias and enzyme deficiencies

A

mixed chimerism

42
Q

how is chimerism most often measured for analysis

A

STR analysis (short tandem repeat)

Immunology (13 decks)

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