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Immuno Exam 3 > Transplantation Immunology > Flashcards

Transplantation Immunology Flashcards

1
Q

______ are classified on the basis of the genetic relationship between the host and the donor.

A

Grafts

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2
Q

These are grafts exchanged from one part to another part of the same individual.

A

Autografts

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3
Q

These are grafts exchanged between different individuals of identical genetic constitutions (i.e., identical twins).

A

Isografts

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4
Q

These are grafts exchanged between nonidentical members of the same species.

A

Allografts (allogeneic)

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5
Q

These are grafts exchanged between members of different species.

A

Xenografts (xenogeneic)

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6
Q

Xenografts are particularly susceptible to rapid attack by naturally occurring ______ and complement. The insertion of human genes into the genomes of the donor animals (miniature swine) increases the chances of successful survival.

A

Abs

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7
Q

There are hundreds of allelic forms of ______ molecules. Each individual inherits only 10-12 alleles/person.

A

HLA

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8
Q

HLA Ags are co-dominantly expressed. The class-I HLA Ags (______ and ______) are particularly strong barriers to transplantation. The class-II HLA, the three most important for transplantation pairs, are _____, _____, and ______.

A

HLA-A; HLA-A

HLA-DR; HLA-DP; HLA-DQ

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9
Q

The _______ allorecognition pathway is primary response against graft. The T cell receptors on recipient T cells directly recognize the donor MHC molecules.

A

Direct

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10
Q

The _______ allorecognition pathway has recipient T cells recognize donor MHC molecules that have been processed by recipient APCs. The donor MHC molecules are presented as peptides in the context of recipient MHC class II molecules.

A

Indirect

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11
Q

The indirect pathway is important during _______ ______ (when the number of donor professional APCs is low to stimulate a direct immune response).

A

Chronic rejection

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12
Q

This type of graft rejection is caused by the pre-existing Abs binding to the endothelial cells lining the blood within minutes to hours.

A

Hyperacute

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13
Q

In ________ graft rejection, the recipient has pre-existing Abs that are reactive with the donor tissue. This may be caused by:

– ABO blood group incompatibility

– The recipient has been sensitized to the donor MHC by previous transplants, multiple blood transfusions, or pregnancy.

– Abs bind to endothelial cells which activates the classical pathway of complement activation

– Complement activation can lead to death of the endothelium.

A

Hyperacute

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14
Q

This type of graft rejection occurs in days to weeks and is initiated by alloreactive T cells. Donor DCs (also called passenger leukocytes) play an important role in triggering this type of rejection.

A

Acute

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15
Q

In acute graft rejection, after transplantation, donor ______ migrate to the lymph nodes draining the organ and stimulate a primary recipient response.

A

DCs

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16
Q

In acute graft rejection, once activated the T cells migrate to the organ and it leads to tissue damage. Both _____ and _____ T cells can cause graft rejection, and the indirect response can also contribute to acute rejection.

A

CD4+

CD8+

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17
Q

This type of graft rejection occurs in months to years following transplantation. It occurs due to the occlusion of blood vessels and subsequent ischemia of the organ.

A

Chronic

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18
Q

In chronic graft rejection, ________ infiltrate and smooth muscle cell proliferation is often seen.

A

Macrophages

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19
Q

In chronic graft rejection, the main pathogenic mechanism is the (DIRECT/INDIRECT) pathway. Abs can also be involved in chronic rejection (the deposition of complement in graft tissues).

A

Indirect

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20
Q

Non-immunologic factors in a chronic rejection may be:

– Ischemia-reperfusion damage

– Recurrence of the disease that caused failure of own kidney

– The effects of _________ drugs (i.e., cyclosporine A)

A

Nephrotoxic

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21
Q

T/F. Chronic rejection responds well to immunosuppressive therapy.

A

False. Chronic rejection does not respond to immunosuppressive therapy.

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22
Q

The key concepts that determine transplant outcome include:

1) The condition of the _______
2) Donor-host antigenic disparity
3) Strength of host anti-donor response
4) _________ regimen

A

Allograft

Immunosuppressive

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23
Q

Mechanical trauma and _______-_______ can cause injury to the graft tissues.

A

Ischemia-reperfusion

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24
Q

When transplanted, damaged graft tissues release ________ which trigger several biochemical cascades leading to immediate tissue damage. These early pro inflammatory responses, if uncontrolled, can result in allograft _______.

A

Mediators

Rejection

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25
Q

Damaged graft tissues release mediators that trigger several biochemical cascades leading to tissue damage, which includes:

– Clotting cascade generates ______ and ________.

A

Fibrin; Fibrinopeptides

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26
Q

Fibrinopeptides increase local vascular permeability and serve as ________ for neutrophils and macrophages.

A

Chemoattractant

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27
Q

Damaged graft tissues release mediators that trigger several biochemical cascades leading to tissue damage, which includes:

– The kinin cascade produces ________ that causes vasodilation, smooth muscle contraction, and increased vascular permeability.

A

Bradykinin

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28
Q

In the donor-recipient work-up, ______ blood group compatibility is first established. Very strong cell surface Ags are found on many other tissues.

A

ABO

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29
Q

In the donor-recipient work-up, tissue typing to identify ______ is then performed.

A

HLAs

30
Q

In the donor-recipient work-up, cross-matching is used to test the recipient serum for preformed _____ against donor’s HLAs.

A

Abs

31
Q

In the donor-recipient work-up, the mixed lymphocyte reaction may be used to determine if the donor cells stimulate _________ of the recipient’s lymphocytes.

A

Proliferation

32
Q

This is the major blood group system.

A

ABO

33
Q

ABO is a barrier to transplantation of solid ______.

A

Organ

34
Q

Abs to A and B are in individuals w/o these antigens on their _______.

A

RBCs

35
Q

ABO matching is not important for…

A

Corneal transplantation
Heart valve transplantation
Bone and tendon grafts

36
Q

ABO incompatibility is not a contraindication to _____ ______ transplantation.

A

Stem cell

37
Q

Blood group Ags are also expressed on other ______ (renal, endothelium).

A

Tissues

38
Q

***Study the ABO tables (Slide 23-26)

A

Study for 5 minutes

39
Q

The success of transplantation is dependent on matching of the _______ Ags. These Ags are encoded by the major histocompatibility complex, _______ and _______.

A 
MHC 
MHC class I
MHC class II
40
Q

In humans, the MHC is termed the _______ complex.

A

HLA (Human leukocyte antigen)

41
Q

HLA compatibility between donor and recipient is required due to the extreme _________ of HLA.

A

Polymorphism

42
Q

The identification of HLA Ags until recently has been complement-dependent _______.

A

Serology

43
Q

The convenient sources of lymphocytes for HLA typing are the ______ and ______ ______ (from cadaver).

A

Spleen

Lymph node

44
Q

HLA antisera are mostly obtained from multiparous women or from planned immunization of volunteers. The antisera contain ______ to HLA Ags.

A

Abs

45
Q

Abs bind to HLA Ag on the surface of ________.

A

Lymphocytes

46
Q

The Ag-Ab complex formed activates the classical complement cascade and this will result in lymphocyte ______.

A

Lysis

47
Q

Cross-matching is used to test the recipient serum for preformed Abs against donor’s HLAs. This is needed to prevent hyperactive Ab-dependent ________ of graft.

A

Rejection

48
Q

The presence of preformed Abs reactive with various allogeneic HLA Ags can cause hyperactive graft rejection. Recipients are screened for the presence of such Abs by using a __________ test with complement-activated cell damage.

A

Microcytotoxicity

49
Q

Recipient’s ______ is mixed with cells of a donor – if there is no cell damage, then a potential donor is identified.

A

Serum

50
Q

In the microcytotoxicity test for preformed Abs, if there are no Abs in the recipient then the donor cells are not _______.

A

Stained

51
Q

Class II ______ typing – mixed lymphocyte reaction (MLR) may be used to determine if the donor cells stimulate proliferation of the recipient’s lymphocytes.

A

HLA

52
Q

In class II HLA typing, leukocytes from two unrelated individuals are _______. Lymphocytes from the donor are irradiated to stop their proliferation and called ________ cells.

A

Mixed

Stimulator

53
Q

Stimulator cells are used for presentation of _________ Ags.

A

Class II MHC

54
Q

Lymphocytes from the recipient are intact and called _______ cells. These cells will be activated by mismatched class II MHC and proliferate. Proliferation (the response) is measured by incorporation of _______ ______.

A

Responder

Tritiated thymidine

55
Q

If class II MHC Ags are the same, proliferation (WILL/WILL NOT) occur.

A

Will not

56
Q

When a kidney is transplanted the recipient’s T cells attack the transplant, this is called…

A

Host-versus-graft disease

57
Q

When bone marrow is transplanted the T cells in the transplant attack the recipient’s tissues, this is called…

A

Graft-versus-host disease

58
Q

In a host-versus-graft response, the host immune system attacks the donor tissue. It is an _______ immune response against a graft. The immune response against a graft is much more vigorous and strong than the response seen against a pathogen.

A

Adaptive

59
Q

A more vigorous and strong immune response against grafts than pathogens is due to a higher frequency of _______ that recognize the graft as foreign.

A

T cells

60
Q

Unimmunized individual has less than 1/100,000 T cells which respond upon exposure to a virus. About 1/100-1/1,000 T cells respond to allogeneic ______.

A

APCs

61
Q

The immune memory of previous encounters with donor Ags is important:

– From animal experiments - if a second graft is performed from the same donor, it is rejected more (SLOWLY/RAPIDLY).

A

Rapidly

62
Q

Up to 2 percent of the host T cells are capable of recognizing and responding to single foreign ______.

A

MHC

63
Q

Non-immune injury of the graft (Danger Signals) activates endothelial cells, and T cells enter the allograft. Ag-specific T cells interact with ______ and become stimulated (activated). The inflammatory cytokine/chemokine field is created and causes further activation of _____, endothelium and leukocyte traffic.

A

APC

APC

64
Q

Effector mechanisms of graft rejection:

    • ________ rejection Th2 (IL-4, IL-5 and IL-10)
    • ________ rejection Th1 (IL-2, IFN-y)
A

Humoral

Cellular

65
Q

Graft-versus-host disease often occurs when transplants are small bowel, lung, or liver, which naturally contain a number of _______.

A

T cells

66
Q

GVHD is caused by the reaction of grafted mature _______ in the tissue transplant with allo-Ags of the host. Reaction is directed against miHAs of the recipient (HLA Ags are usually matched).

A

T cells

67
Q

GVHD occurs in the immunocompromised recipients because their immune system is unable to reject the _______ cells in the graft.

A

Allogeneic

68
Q

For solid grafts, GVHD may be classified as:

– _______ GVHD - epithelial cell death in the skin, liver, and GI (clinically – rash, jaundice, diarrhea, and GI hemorrhage).

– _______ GVHD - fibrosis and atrophy of affected organ (clinically – may lead to complete dysfunction of the affected organ, or two of the same)
(May produce obliteration of small airways)

A

Acute

Chronic

69
Q

After the initiation phase, donor APCs can activate donor ______ T cells by cross-presenting exogenously acquired Ags (through the uptake of apoptotic recipient or shed proteins) on MHC class I molecules.

A

CD8+

70
Q

T/F. In this case, donor APCs could reprime donor CD8+ T cells previously activated by recipient APCs against the same antigens expressed by recipient APCs. Alternatively or in addition, donor APCs could activate naive donor CD8+ T cells against new, non-hematopoietic Ags (epitope spreading).

A

True

Immuno Exam 3 (6 decks)

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