transplantation Flashcards
complications: explain the risks and complications associated with transplantation and transplant immunosuppression
2 methods for prevention of rejection
maximise HLA compatibility, life-long immunosuppressive drugs
treatment for rejection
more immunosuppressive drugs
what do immunosuppressive drugs target in rejection
T and B cell activation and proliferation, and B cell antibody production
what do immunosuppressive drugs target to overcome T cell mediated rejection
interaction between APC and T-cell (target T cell receptor and HLA presentation, co-stimulation, cytokine stimulation), attack cell cycle, deplete T cell directily (apoptosis)
what do immunosuppressive drugs target to overcome B cell/antibody mediated rejection
anti-CD20 drugs, proteosome inhibitors with anti-T cell actions and cause plasma cell apoptosis (e.g. bortezomib), anti-C5 (i.v. immunoglobulin plasma exchange)
3 stages of standard immunosuppresive regime
pre-transplantation with induction agent -> from time of implantation with base-line immunosuppression -> if needed treatment of episodes of acute rejection
what is a pre-transplantation induction agent required for in standard immunosuppresive regime
T cell depletion or cytokine blockade
examples of base-line immunosuppression from time of implantation in standard immunosuppresive regime
signal transduction blockade (usually CNI inhibitor), antiproliferative agent (e.g. MMF), corticosteroids
examples of T cell mediated treatment of episodes of acute rejection in standard immunosuppresive regime
steroids, anti-T cell agents
examples of antibody-mediated treatment of episodes of acute rejection in standard immunosuppresive regime
i.v. antibodies, plasma exchange, anti-CD20, anti-complement
what must be balanced in immunosuppression
rejection vs infection, tumour and drug toxicity
post-transplantation, what infection types are there increased risks of (hence give prophylactic treatment)
conventional infections (bacterial, viral, fungal) or opportunistic infections (cytomegalovirus, BK virus)
2 examples of post-transplantation malignancy
skin cancer, post transplant lymphoproliferative disorder (Epstein Barr virus driven in immunosuppressed)
