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Path Immunology > Transplantation > Flashcards

Transplantation Flashcards

1
Q

What are the 3 stages of transplant rejection?

A

1) Recognition
2) Activation
3) Effector function

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2
Q

What is recognised following a transplantation?

A

HLA - A, B, DR = these are the most important
Minor HLA - other polymathic self peptides
ABO Blood Antigens

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3
Q

What are the two types of recognition that occur in transplantation?

A

1) Direct

2) Indirect

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4
Q

What is Direct Transplant Recognition?

A

Donor APC presenting antigen and/or MHC to recipient T-cells. Acute rejection mainly involves direct presentation

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5
Q

What is Indirect Transplant Recognition?

A

Recipient APC presenting donor antigen to recipient T-cells - i.e. the immune system working normally, as it would for an infection. Chronic rejection mainly involves indirect presentation

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6
Q

Hyperacute Transplant Rejection - Time frame?

A

Mins-Hrs

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7
Q

Hyperacute Transplant Rejection - Mechanism?

A

Preformed Ab which activates Complement

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8
Q

Hyperacute Transplant Rejection - Pathology?

A

Thrombosis and Necrosis

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9
Q

Hyperacute Transplant Rejection - Treatment?

A

Prevention - Crossmatching

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10
Q

Acute Cellular Transplant Rejection - Time frame?

A

Weeks-Months

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11
Q

Acute Cellular Transplant Rejection - Mechanism?

A

CD4 activating a Type IV reaction

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12
Q

Acute Cellular Transplant Rejection - Pathology?

A

Cellular Infiltrate

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13
Q

Acute Cellular Transplant Rejection - Treatment?

A

T-cell Immunosuppression

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14
Q

Acute Antibody Mediated Transplant Rejection - Time frame?

A

Weeks - Months

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15
Q

Acute Antibody Mediated Transplant Rejection - Mechanism?

A

B-cell activation - antibody attacks vessels

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16
Q

Acute Antibody Mediated Transplant Rejection - Pathology?

A

Vasculitis, C4d

17
Q

Acute Antibody Mediated Transplant Rejection - Treatment?

A

Ab removal and B-cell Immunosuppression

18
Q

Chronic Transplant Rejection - Time frame?

A

Months - Years

19
Q

Chronic Transplant Rejection - Mechanism?

A

Immune and non-immune mechanism

20
Q

Chronic Transplant Rejection - Pathology?

A

Fibrosis

21
Q

Chronic Transplant Rejection - Treatment?

A

Minimise Organ Damage

22
Q

Graft v Host Disease - Time frame?

A

Days - weeks

23
Q

Graft v Host Disease - Mechanism?

A

Donor cells attack Host

24
Q

Graft v Host Disease - Pathology?

A

Skin (rash), Gut (D+V, bloody stool) and liver (jaundice) involvement

25
Q

Graft v Host Disease - Treatment?

A

Prevention/ Immunosuppression - corticosteroids

26
Q

Immune Recognition

A

T cells recognise antigen with MHCs, B cells can recognise just antigen
APCs present antigen to T cells (dendritic cells, Macrophages, B cells)

27
Q

Tissue Matching for Transplant

A

Important to reduce Antigen differences and therefore recognition and rejection

1) determine donor and recipient blood group and HLA type - PCR. Maximise similarity
2) Check recipients pre-formed Ab against ABO and HLA - via CDC (complement Dependent Cytotoxicity), FACS (flow cytometry) and Luminex (like solid phase FACS- can pick up abs to individual HLAs)
3) Cross Match- via CDC and FACS. test if serum from recipient is able to bind/kill donor lymphocytes - positive crossmatch is contraindicated for transplantation
4) after transplant check again for new antibodies vs the graft

28
Q

Pre-transplant induction agents?

A

Suppress T cell responses e.g. anti CD52 Alemtuzumab or anti-CD25 Basiliximab

29
Q

What can you use to treat repeat episodes of acute rejection?

A

Cellular - Steroids, IVIG

Ab-mediated - IVIG, plasma exchange, anti-c5

30
Q

3 Other post transplantation complications?

A

1) Infections
2) Malignancy
- Viral associated (x100) Kaposi’s (HHV8) and Lymphoproliferative Diseases (EBV)
- Skin Cancer (x20)
- other - lung, colon (x2-3)
3) Atherosclerosis - Hypertension and hyperlipidaemia (x20)

Path Immunology (8 decks)

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