Transplantation Flashcards
HLA are found on which chromosome?
Chromosome 6
HLA B27 is associated with which diseases?
Ankylosing, Inflammatory bowel diseases, psorisis, Relters syndrome
What % chance does a sibling have to be a perfect match for transplantation?
25%, because you get 2 sets of HLA genes, 1 from father and 1 from mother
What are the most important HLA genes for solid organ transplants?
HLA-A HLA-B HLA-DR
What is GVHD?
Graft vs. host disease, donated mature CD8 T-cells react to recipient and seen in bone marrow transplants
What clinical features do you see in GVHD
Rash, Diarrhea, High bilirubin and Liver function test (LFT)
What time do you see a hyperacute rejection
min to hours
What time do you see acute rejections?
Weeks to months
What time do you see chronic rejections?
Years
What type of immune cells are seen in hyperacute rejections
preformed antibodies, neutrophils due to complement
What do you see if someone is having a hyperacute reaction?
Blood vessel spasm, intravascular coagulation, ischemia
How do you prevent a hyperacute reaction?
Cross screening
What type of immune cells do you see in an acute reaction?
Primary activation of lymphocytes especially CD8 and antibody mediated
What type of allorecognition do you see in acute rejection?
Direct
What type of immune cells do you see in accelerated rejections?
Memory cell activation
What clinical features do you see in acute rejection
Rapid decline in urine output, increase in serum creatinine and edema/tenderness of graft
What type of allorecognition do you see in chronic rejection
Indirect
What clinical features do you see in chronic rejection?
Thickening of glomerular basement, interstitial fibrosis leading to a loss of function.
What type of immune cells do you see in a chronic rejection
HMI, CMI, cytokines, immune complexes, fibrosis. Think T cells over anything especially CD4 early.
How is GVHD good?
Can kill remaining cancer cells because the donor immune cells will recognize them as foreign. NK cells get involved too.
What is direct allorecognition? And what rejection is it seen in
Recognition by recipient T cells of MHC on donor APC (the peptide on the MHC is irrelevant) ex: Acute rejection
What is indirect allorecognition? And what rejection is it seen in?
Recognition by recipient T cells of processed donor HLA molecule on recieptent APC Ex: Chronic
What type of solid organ is most likely to get GVHD (remember it is usually seen in bone marrow transplants)
The liver
Hyperacute rejection is what type of hyper sensitivity reaction
They are preformed antibodies so: Class II
