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transplantation Flashcards

1
Q

autograft

A

graft between different sites on the same individual - autologous transplantation

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2
Q

isograft

A

graft between the same inbred strain of animals or monozygotic twins - syngeneic transplantation

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3
Q

allograft

A

between non-identical animal/humans of the same species - allogeneic transplantation

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4
Q

MHC is called what in humans

A

HLA

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5
Q

MHC is on what chromosome

A

6th chromosome

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6
Q

MHC I receptors are present on what cells

A

presented on most nucleated cells in the body - therefore RBC do not have

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7
Q

MHC II receptors are present on what cells

A

APC macrophages, dendritic cells, and B cells

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8
Q

MHC II involved extracellular antigens/endogenous antigens

A

extracellular antigens

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9
Q

MHC I involved extracellular antigens/endogenous antigens

A

endogenous antigens

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10
Q

MHC I uses TAP/HLA-DM to form the receptor antigen molecule

A

TAP

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11
Q

MHC II uses TAP/HLA-DM to form the receptor antigen molecule

A

HLA-DM

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12
Q

allogeneic hematopoietic stem cell transplant (SCT)

A
  • healthy donors receive G-CSF - patient receives chemotherapy and radiotherapy - transplantation of donor cells
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13
Q

G-CSF

A

cause homeopathic stem cells to leave the bone marrow and enter the peripheral blood

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14
Q

purpose of chemotherapy and radiotherapy

A

called conditioning 1. kills turmor 2. kills recipients ability to make their own blood 3. immunosuppression to the patient so they do not reject graft

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15
Q

graft versus leukemia (GVL) effect

A
  • effect of t -cell depleted allografts - efficacy of donor lymphocyte infusions - outcomes from synergistic transplants
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16
Q

effect of t -cell depleted allografts

A
  • bad - people with grafts that receive t-cell depletion had 50% more relapse than those without
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17
Q

efficacy of donor lymphocyte infusions

A
  • give donor lymphocytes to have patient go back into remission
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18
Q

outcomes from synergistic transplants

A
  • have more relapses - almost the same as the outcome if you did a graft with depleted t-cells
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19
Q

infusion of donor lymphocytes after leukemia had relapsed can cure/hurt leukemia patients who have undergone SCT

A

cure

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20
Q

removing/adding T cells from a stem cell graft increases relapse risk 3 fold

A

removing

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21
Q

using a genetically identical (synergeic) donor increases/decreases relapse risk 3 fold

A

increases

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22
Q

using a genetically identical (synergeic) donor increases/decreases relapse risk 3 fold

A

increases

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23
Q

Impact of HLA matching on overall survival

A

8/8 - best survival rate 7/8 - increased survival 6/8 - less survival too little matching = targeted everywhere

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24
Q

the odds of any sibling being an HLA match

A

1/4

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25
Q

parents and children of patients are almost always

A

half-matches

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26
Q

ethnicity does/does not influence HLA

A

does

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27
Q

the most common HLA type

A

HLA-A*02:01

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28
Q

HLA-A*02:01

A

western europeans

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29
Q

HLA-A*24:02

30
Q

HLA-B*53:01

31
Q

WHO HAS A HIGHER CHANCE OF FINDING A HLA MATCH AFRICAN AMERICANS OR CAUCASIANS?

A

CAUCASIANS

32
Q

current goal is ____ HLA match

33
Q

if a 12/12 match cannot be found

A

umbilical cord blood transplant

34
Q

umbilical cord blood transplant has more/less tolerant T cells

A

more making

35
Q

HLA mis-match transplant would/would not require some degree of T cell depletion

36
Q

you do/do not have to match ABPO blood type in SCT

37
Q

solid organ transplant needs/does not need to match ABO blood type

38
Q

SCT can be performed across ABO incompatibilities because _______ will be provided by the donors stem cells

A

hematopoiesis

39
Q

can/cannot deplete donor stem cell product to remove anti-A or anti-B antibodies if recipient is A+ or B+

40
Q

can/cannot remove red blood cells from the donor stem cell product id patients plasma is expected to react with donor red cells

41
Q

graft versus host disease (GVHD)

A
  • donor derived, t-cell mediated reactivity against recipient tissues - primary cause of non-relapse mortality
42
Q

acute graft versus host disease (GVHD) occurs _____ months after SCT

43
Q

chronic graft versus host disease (GVHD) occurs _____ months after SCT

44
Q

acute GVHD primarily affects

A

skin, colon, liver

45
Q

chronic GVHD primarily affects

A

skin eyes GI tract liver

46
Q

treatment of graft versus host disease (GVHD) with

A
  1. prevention:
    - inhibitors of T-cell activation
  • calcineurin inhibitors: tacrolimus
  • mTOR inhibitors: sirolimus
  • inhibitors of T-cell proliferation
  • methotrexate
  • T-cell depleting antiboides
  • immunosuppressive drugs: steroids
47
Q

acute GVHD ratings how to measure

A

Stages 0-4 Grade A-D liver bilirubin and gut/stool

48
Q

HLA mismatching increases/decreased risk of GVHD

49
Q

GCHD with an HLA matched graft

A

can have minor histocompatibility

this occurs with genetically disimilar people, could bind at a higher affinity

50
Q

stem cell donnor selection

A
  1. male becuase female has no antibodies to the Y
  2. HLA match
  3. ABO type - would like to match but does not have to
  4. stem cell source- peripheral blood stem cells engraft faser than bone marrow dervied stem cells
  5. cytomegalovirus status- negative
  6. related source- sibling perfered
51
Q

solid organ transplant

A
  • long-term tolerance
  • chronic immunosuppression is essential
  • HLA disparities are almost univeral in solid organ transplant except related sibiling renal transplant
  • both humoal and cellular mediated rejection mechanisms exist
52
Q

solid organ graft rejection is mediated by

A

peptide /HLA disparities

53
Q

would you rather transplant a live/deceased organ

54
Q

alloimmunization against foreign HLA

A

blood reansfusions and pregnancies can expose an indivdual to foreign HLA , which can induce an antibody response

55
Q

monitoring anti-HLA antibodies is important becasue

A

as patients develop more anti-HLA antibodies the number of potential organs decreases

56
Q

hyperacute graft rejection

A
  • occurs within hours (antibodies must be preformed)
  • anti-A and anti-B blood gorup
  • anti-HLA
57
Q

direct allorecogntion

A
  • APC derived from donor graft likely mismatched HLA binds to T cell
  • fades out in time becuase the APC donor will die out
  • acute rejection 7-21 days
58
Q

indirect allogrecogntion

A
  • APC dervied from the recipeint uptakes and processes donor proteins which present to T cells
  • chronic recipient verus graft effect
  • chronic rejection > 21 days
59
Q

organ allocation

A
  • far fewer available organs than donors
  • decided with in hours
  • assignemtn based on ranking factors:
  • hyperacute rejection (ABO incompatibilty and alloimmunization to HLA)
  • illness of patient
  • sizing
  • distance of organ from patient
60
Q

rejection prevention for organ transplant

A
  1. anti-inflammatories- corticosteroids
  2. inhibitors of DNA replication- asathioprine, mycophenolate
  3. inhibitors of T cell activation- cyclosporine, tacrolimus, sirlimus
  4. lymphocyte depeleting antibodies- rituximab
61
Q

the goal of SCT is recipiant/donor dervied T cell activation

62
Q

HLA mismatches are associated with increased/decreased GVHD risk

63
Q

even with HLA matching GVHD can occur through

64
Q

hyperacute rejection must be avioded mainly by

A

anti-A. anti-B or anti-HLA antibodies

65
Q

hyperacute organ rejection is primarily a humoral/cell mediated process

66
Q

alloreactivty and graft rejection is primarily a cell-mediated/humoral response

A

CELL-MEDIATED

67
Q
  1. Which of the following donors would be best for a renal transplant?
    1. The kidney donor is the identical twin of the kidney recipient
    2. The kidney donor is an HLA-matched sibling to the kidney recipient
    3. The kidney donor is a living HLA-matched unrelated donor to the kidney recipient.
    4. The kidney is cadaveric but HLA-matched and unrelated to the recipient.
A

The kidney donor is the identical twin of the kidney recipient

68
Q
  1. Which of the following donors would be best for a stem cell transplant to treat high risk leukemia?
    1. The stem cell donor is the identical twin of the stem cell recipient
    2. The stem cell donor is an HLA-matched sibling to the stem cell recipient
    3. The stem cell donor is an HLA-matched but unrelated to the stem cell recipient
    4. The stem cell donor is a haplo-identical (HLA half-matched) sibling to the stem cell recipient.
A

The stem cell donor is an HLA-matched sibling to the stem cell recipient

69
Q
  1. For solid organ transplantation…
    1. Donor grafts and the recipient must be HLA matched
    2. Donor grafts and the recipient must be ABO matched
    3. Donor grafts and the recipient must be ABO compatible
    4. Donor grafts must come from a living donor
A

Donor grafts and the recipient must be ABO compatible

70
Q
  1. Post-transplant immunosuppression increases the risk of all of the following except?
    1. Viral reactivation
    2. Opportunistic infection
    3. New cancers
    4. GVHD

Final Immunology (5 decks)

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