Transplantation Flashcards
3 immune responses to transplanted graft.
which is the most important in rejection?
- recognition of foreign antigens
- activation of antigen-specific lymphocytes
- effector phase of graft rejection
key for rejection = recognition
what are the most important genetic markers for immune system recognition of foreign antigen / graft rejection? where are they located?
chromosome 6
HLA: A, B, DR
describe rejection mechanism
signal 1: antigen triggers T cell receptor
signal 2: antigen presenting cell engages CD28 on T cell
signal 3: IL-2 and IL-15 deliver growth signals through PI-3 and mTOR - T cells infiltrate graft
what causes diabetes post-transplant?
immunosuppression from FK506/Tacrolimus
what causes neurotoxicity post-transplant?
FK506/Tacrolimus
what causes hirsutism post-transplant?
cyclosporine
SE of corticosteroids
*not used chronically for post-transplant anymore
weight gain, HTN, hyperlipidemia, osteopenia, cataracts, skin changes, impaired growth, diabetes
mycophenolate mofetil (cellcept)
supposed to be selective against T cells (really shuts down B and T)
alemtuzumab
mAB, wipes out all B and T cells, lasts for 18 months
hierarchy of rejectable solid organs
most = intestines > lung > heart > pancreas > kidney > liver=least
name some graft outcome determinants
living donor better than deceased DR is the most important HLA match Pre-sensitization (if you already have antibodies against donors, kidneys won't last as long) Asian kidneys are best Younger age is best
most common infection after transplant
UTIs - 30% of post transplant infection
transplant pyelo –> 30% decrease in graft longevity
calcineurin inhibitors
includes cyclosporine and tacrolimus
prevent RECOGNITION of foreign antigen by preventing T cells from becoming active
