Transplantation and amyloidosis Flashcards
Heterologous transplant
Transplant between different species
Allogenic Transplant
tissue transplant between two individuals of the same species
Autologous transplant
patient transplants something to themselves
Factors that determine if host accepts the graft
HLA matching- the more matches the better Recipient immunosuppression
Complications of organ transplant
Graft rejection Recipient immunosuppresion allowing for opportunisitic infections and neoplasms GVHD- Bone marrow transplants
Rejection mechanisms- T cell mediated
CD4 mediated delayed Hypersensitivity rxn CD8 mediated cytotoxicity
Rejection mechanisms- B cell
Preformed Ig against graft Acquire or make Ig against graft
Hyperacute Rejection- mediated by
Preformed Ig- probably from previous blood transfusions, normally test to ensure this doesn’t occur
Hyperacture Rejection - when
Quickly in the OR
Acute rejction- mediated by
Combined cellular and humoral rejection
Acute rejection- when
Days after transplant or much later if occurs after patient stops their immunosuppressive meds
Acute rejection- can transplant be salvaged
maybe if the pt goes back on their immunosupressive meds
Chronic rejection is associated with
Progressive deterioration vascular damage and fibrosis from host attacking the graft
Chronic rejection- can the transplant be salvaged
NO
GVHD
immunocompetent cells are transplanted into an immunocompromised host
GVHD- types of transplants
Bone marrow
GVHD commonly affects what areas
skin, liver, and intestine
Amyloidosis- what is amyloid
pathologic proteinatinaceous substance
Amyloidosis appearance
amorphous, pink, hyaline
Amyloidosis- intra or extracellular
extracellular- presses on cells causing pressure atrophy
Amyloidosis- structure
uniform appearance due to beta pleated sheet structure
What is localized amyloidosis?
limited to single organ
What is generalized amyloidosis?
systemic- can be split into primary and secondary
Primary amyloidosis is associated with
immune system- plasma cell dyscardia
Secondary amyloidosis is the result of
complication of underlying chronic inflammation
What is AL amyloid
Immunoglobulin light chains
what is AA amyloid
Associated amyloid non immunoglobulin synthesized by the liver
what is AB amyloid
beta amyloid found in CNS ALZ lesions
AL amyloid is often produced by, and is associated with what disease
malignant plasma cell clone Multiple Myeloma
how many different types of light chain are in AL vs normal
normally both lambda and kappa type light chains are found AL only consists of one or the other
Where is AA synthesized
Liver, but isnt cleared properly
stimulation of what cells leads to AA
macrophages
what diseases are associated with AA
rheumatoid arthritis TB chronic osteomyelitis
How would bone marrow of AL patients look
probably hypercellular due to multiple myeloma
when AL is stained what color is it in normal light
Pink
AL stain under polarized light
apple green fluoresence under polarized light
what organs are often effected by amyloidosis
Kidney Liver heart- stiff and lack elasticity GI tract- poor motility, diarrhea due to lack of absorption
Acute cellular rejection- what features do you notice
Acute cellular rejection of a renal allograft. A, An intense mononuclear cell infiltrate occupies the space between the tubules.
B, T cells (stained brown by the immunoperoxidase technique) are abundant in the interstitium and infiltrating a tubule.
Small nuclei are lymphocytes and lumen of tubules can become fibrotic
Ig mediated acute rejection
Antibody-mediated damage to the blood vessel in a renal allograft.
The blood vessel is markedly thickened, and the lumen is obstructed by proliferating fibroblasts and foamy macrophages.
Chronic Rejection
A, Changes in the kidney in chronic rejection: graft rteriosclerosis, tubular atrophy, and interstial fibrosis
B, Graft arteriosclerosis. The vascular lumen is replaced by an accumulation of smooth muscle cells and connective tissue in the vessel intima.
GVHD rash
Rash commonly associated with GVHD- seen on skin and mucous membranes
GVHD histo
Epidermis
Blue dots are donor T cells attacking host epithelial cells
Amyloidosis of kidney
Amyloidosis of the kidney. The glomerular architecture is almost totally obliterated by the massive accumulation of amyloid.
Pink material in the BM of glomerular caps.
Congo red under routine light is pink
Amyloidosis in liver
A section of the liver stained with Congo red reveals pink-red deposits of amyloid in the walls of blood vessels and along sinusoids
Normally starts near BV wall but it can go anywhere
Cardiac Amyloidosis
Cardiac amyloidosis. The atrophic myocardial fibers are separated by structureless, pink-staining amyloid (arrows).
- Shrunken myocytes. Wavy material in heart
Normal colon epithelium vs colon epithelium with amyloidosis
Thickened BM that seperates epithelium from the lamina propria.
This can impair absorption leading to diarrhea
What is this
what stain is this
Congo red stain of colon mucosa under polarized light thus appearing apple green
