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Renal system > Transplantation and immunology > Flashcards

Transplantation and immunology Flashcards

1
Q

donor

A

the individual or specimen donating tissue is the donor

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2
Q

the individual receiving the tissue is the

A

recipient

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3
Q

the tissue can be described as a transplant but is often called a

A

graft

tissue may or may no be an organ

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4
Q

what word describes the immune response to the graft, this is separate to graft failure which may occur for other reasons

A

rejection

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5
Q

autograft

A

donor is the recipient

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6
Q

isograft

A

donor is genetically identical to recipient

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7
Q

allograft

A

donor is same species as recipient

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8
Q

xenograft

A

donor is of diffenent species

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9
Q

what is a orthotopic graft

A

donor tissue mobilised into natural anatomical location

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10
Q

heterotopic graft

A

donor tissue mobilised into unnatural anatomical location e.g. skin, bone, kidney

grafts can be living or cadaveric depending on the state of the donor

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11
Q

England scotland and Wales have an opt-out system for organ donation what do northern ireland do

A

opt-in

Conditions that typically cause ineligibility for tissue donation 
Active cancer 
HIV, hepatitis 
Ebola virus 
CJD

DCD- circulatory deceased individuals
DBD - brain dead ones
Living donors

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12
Q

most common living donor organ

A

kidney

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13
Q

domino transplants

A

e.g. cystic fibrosis - heart and lungs from deceased donor to CF patient , heart from CF patties to another recipient

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14
Q

what is transplantation immunology

A

Transplantation immunology - sequence of events that occurs after an allograft or xenograft is removed from donor and then transplanted into a recipient.
A major limitation to the success of transplantation is the immune response of the recipient to the donor tissue

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15
Q

what graft do not provoke an immune reaction

A

isografts and autografts

the there do

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16
Q

do decullarised transplants carry antigens

A

no - bioprosthetic valve

vascular transplants are spared

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17
Q

what things mediate the immune reaction

A

human leukocyte antigens HLA incompatibility
ABO incompatibility
minro histocompatibility complexes

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18
Q

on erythrocytes surface what are the antigens called

A

agglutinogens

blood groups seperated by presecene of these nations

19
Q

what are the two glycolipid antigens

A

A and B

each person has 2 ABO
individuals who lack A or B antigen will have the corresponding antibodies in the serum
anit- A and anti-B antibodies

20
Q

if some is O blood willl they have no antigens therefore anti-A and aNti-B antibodies will be present

A

yes

21
Q

what blood group is universal recipient

A

AB

22
Q

what blood group is universal donor

A

O

23
Q

HLA know as MHC antigen how many classes

A

2
MHC -I
MHC II- antigen presenting cells

24
Q

HLA know as MHC antigen how many classes

A

2
MHC -I - 3 subtypes
MHC II- antigen presenting cells

matched HLA makes more of a difference

25
Q

3 patterns of rejection

A

hyper acute rejection - minutes to hours
acute rejection - weeks to months
chronic rejection - years

26
Q

what is a hyperacute rejection

A

this tends to be mediated by pre-formed antibodies (e.g. ABO incompatibility)

27
Q

where can you find ABO antibodies

A

line vascular endothelium in addition to RBCs
binding of antibodies mediates immune response
the graft becomes inflamed and organ failure occurs
the graft must be removed immediately to avoid overwhelming the systemic inflammation

28
Q

acute rejection

A

humoral or cell mediated ( antibody or T cell mediated)
antibodies are not pre-formed they need to be produced

normall due to HLA incompatibiltity
T cells recognise these cells with the HLA and start an immune response

29
Q

direct recognition

A

recognition of an intact MHC molecules displayed by donor APC in graft
T cell recognises the structure of intact allogeneic MHC molecule
involves both CD8 and CD4

30
Q

indirect recognition

A

donor MHC is processed and presented by recipient APC by cals II MHC molecules
donor MHC molecule is handled like any other rforign antigen
involves only CD4 and T cells -

31
Q

once immune process started the rest of acute rejection

A

cytotoxic T cell kill targets
natural killer trigger apoptosis
t helper cell recruit macohoahse and CD8 TC and type 2 recruit B cells
mononuclear infilatrate occur leading to necrosis of arterial walls
signs may include graft failure and tenderness
can be reversed - if you catch it early enough

32
Q

chronic rejection

A

due to long term low grade cell mediated immunity
this may also be related to MHC
endovascular inflammation ( mediated by T cells, alloantibodies, macrophages, cytokines)
smooth muscle hyperplasia - vascular congestion
fibrosis
also know as allograft vasculopathy
new graft will then be required

33
Q

how do we reduce rejection

A 
donor/recipient matching 
Cross matching 
ABO matching ( must) 
HLA matching ( A,B,C, HLA-D)

immunosuppressive therapy

34
Q

What is cross matching

A

test preformed to test for pre-formed antibodies - recipient previously expose to HLAs may be antibodies already present that would increase the chances of rejection
this is tested by cross-matching which involves mixing some of the donors blood cells with the recipients serum. If the cords matching test is negative the transplant is likely to be successful

e.g. lymphocyte sign tests - ANit-HLA antibodies attatahc to HLAs on lymphocyte then complement and trepan blue dye are added - cell damaged bu complement and takes up the dye

35
Q

when is tissue typing done

A

before graft takes place and between donor and recipient tissue typed for HLA

HLA myst b matched as closely as poss , but HLA subtype and type of transplant influence importance e.g. HLA DR very important for renal transplant
A 6 antigen match is not always necessary as can use immunosuppressive drugs

36
Q

3 types of immunosuppressants used

A

anti-proliferative
glucocorticoid
calcineurin inhibit

37
Q

what are anti-proliferative

A

anti-metabolites - methotrexate but the pro drug azathioprine - purine synthesis and impairs DNA replication in cell reducing cell turnover and prolifferatun

38
Q

glucocorticoids

A

anti-inflammatory and immunosuppressant
inhibit phophliase As - reduce eicosanoid synthesis, reduce cytosine secretion , reduced adhesion molecules and induces endonuclease that mediate apoptosis within white cells - paradoxically neutrophils frequently raised

39
Q

calcineurin inhibitors

A

calcium dependent enzyme
intracellular signallign with T cells - inhibits the enzyme imparts production of Il-2 chichis important for enhancement of cell mediated immunity so no T cell stores e.g. Th2 formation from naive
most important is Tacrolimus

40
Q

immunosuppression is the balance between

A

rejection and infections/tumours

41
Q

what is the major issue of tissue or organ transplant is immune rejection

A

true

42
Q

rejection can be 3 processes what are they

A

hyper acute
acute
chronic - depress of this will always occur in grafts

43
Q

what is th usual regime for treatment of rejection

A

triple therapy - steroids, calcineurin inhibitors and antimetabolites

44
Q

when someone is genetically identical , cellularised and vascular grafts are sued - ABO and HLA matching is performed to reduce what

A

immune response

Renal system (21 decks)

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