Transplantation

Question 1

HLA are found on which chromosome?

Answer 1

Chromosome 6

Question 2

HLA B27 is associated with which diseases?

Answer 2

Ankylosing, Inflammatory bowel diseases, psorisis, Relters syndrome

Question 3

What % chance does a sibling have to be a perfect match for transplantation?

Answer 3

25%, because you get 2 sets of HLA genes, 1 from father and 1 from mother

Question 4

What are the most important HLA genes for solid organ transplants?

Answer 4

HLA-A HLA-B HLA-DR

Question 5

What is GVHD?

Answer 5

Graft vs. host disease, donated mature CD8 T-cells react to recipient and seen in bone marrow transplants

Question 6

What clinical features do you see in GVHD

Answer 6

Rash, Diarrhea, High bilirubin and Liver function test (LFT)

Question 7

What time do you see a hyperacute rejection

Answer 7

min to hours

Question 8

What time do you see acute rejections?

Answer 8

Weeks to months

Question 9

What time do you see chronic rejections?

Answer 9

Years

Question 10

What type of immune cells are seen in hyperacute rejections

Answer 10

preformed antibodies, neutrophils due to complement

Question 11

What do you see if someone is having a hyperacute reaction?

Answer 11

Blood vessel spasm, intravascular coagulation, ischemia

Question 12

How do you prevent a hyperacute reaction?

Answer 12

Cross screening

Question 13

What type of immune cells do you see in an acute reaction?

Answer 13

Primary activation of lymphocytes especially CD8 and antibody mediated

Question 14

What type of allorecognition do you see in acute rejection?

Answer 14

Direct

Question 15

What type of immune cells do you see in accelerated rejections?

Answer 15

Memory cell activation

Question 16

What clinical features do you see in acute rejection

Answer 16

Rapid decline in urine output, increase in serum creatinine and edema/tenderness of graft

Question 17

What type of allorecognition do you see in chronic rejection

Answer 17

Indirect

Question 18

What clinical features do you see in chronic rejection?

Answer 18

Thickening of glomerular basement, interstitial fibrosis leading to a loss of function.

Question 19

What type of immune cells do you see in a chronic rejection

Answer 19

HMI, CMI, cytokines, immune complexes, fibrosis. Think T cells over anything especially CD4 early.

Question 20

How is GVHD good?

Answer 20

Can kill remaining cancer cells because the donor immune cells will recognize them as foreign. NK cells get involved too.

Question 21

What is direct allorecognition? And what rejection is it seen in

Answer 21

Recognition by recipient T cells of MHC on donor APC (the peptide on the MHC is irrelevant) ex: Acute rejection

Question 22

What is indirect allorecognition? And what rejection is it seen in?

Answer 22

Recognition by recipient T cells of processed donor HLA molecule on recieptent APC Ex: Chronic

Question 23

What type of solid organ is most likely to get GVHD (remember it is usually seen in bone marrow transplants)

Answer 23

The liver

Question 24

Hyperacute rejection is what type of hyper sensitivity reaction

Answer 24

They are preformed antibodies so: Class II