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Transplantation > Transplantation: Immunology > Flashcards

Transplantation: Immunology Flashcards

1
Q

What is HLA matching has the greatest influence on short term and long-term graft survival?

A

Short-term: B and DR

Long-term: A

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2
Q

What does a high PRA level mean?

A

Corresponds with an elevated anti-HLA Ab load

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3
Q

When is the highest risk of CMV infection?

A

3-6 months after transplant, without prophylaxis. In those who have received prophylaxis, the risk is highest in the 3-6 months after prophylaxis has been discontinued.

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4
Q

Which patient is at the highest risk for CMV viraemia?

A

D+ / R- (40-58% incidence)

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5
Q

What is the typical schedule for screening with BKV?

A
  • monthly in the first 6 months

- every 3 months until the 2nd post transplant year

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6
Q

What are the most common fungal infections among transplant recipients?

A
  • candida (49%), yeast
  • Cryptococcus (15%), yeast
  • Aspergillus (14%), mold
  • Endemic mycoses (10%), yeast or cold
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7
Q

What is an important cause of fungal infection in Arizona?

A
  • Coccidodomycosis

- Incidence 3.8-6.9%

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8
Q

Do the mTORi have any effect on CMV?

A
  • Both sirolimus and everolimus have anti-CMV activity
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9
Q

What are the direct and indirect effects of CMV infection?

A

Direct effects:

  • CMV syndrome
  • GI disease
  • Pneumonitis (rare)
  • Retinitis (very rare)

Indirect effects:

  • Increase susceptibility to other infections
  • Possible increased risk for rejection
  • Increased risk of death and cardiovascular mortality longterm.
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10
Q

When do cryptococcus infections tend to occur after transplant?

A
  • late

- 83-85 months

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11
Q

What is the spectrum of disease with cryptococcus?

A
  • Fungaemia
  • Meningitis
  • Pulmonary infection
  • Soft tissue or bone infection (rare)
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12
Q

What agents are used to treat cryptococcosis?

A
  • Amphotericin
  • Fluconazole
  • 5-flucytosine in CNS disease
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13
Q

What is the likelihood of 2, 1, and no haplotype match among siblings?

A
  • 2 haplotype match 25%
  • 1 haplotype match 50%
  • 0 haplotype match 25%
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14
Q

What cell type express HLA class I?

A
  • all nucleated cells

- present peptides (smaller proteins)

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15
Q

What cell type express HLA class II?

A
  • professional antigen presenting cells
  • B-cells
  • macrophages
  • dendritic cells
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16
Q

Why do HLA identical siblings still require some immunosuppression after transplant?

A
  • Minor histocompatibility antigens; these are small endogenous peptides that occupy the antigen-binding site of the donor MHC molecules.
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17
Q

What allorecognition pathways have been implicated in chronic ABMR?

A
  • Indirect pathway

- Semi-indirect pathway

18
Q

What is the basic procedure in CDC crossmatch?

A
  • Recipient’s serum is added to potential donor lymphocytes
  • Complement is added
  • If recipient anti-donor antibodies are present, the added complement will result in cell lysis
  • Cells that are treated in this way are then examined using a fluorescent dye, which by colimetry tells if cells have lysed or not.
  • Semiquantitative
19
Q

What is the anti globulin-enhanced CDC crossmatch?

A
  • The procedure is identical to the standard CDC crossmatch
  • EXCEPT Anti-human Ig potentiating reagent is added before complement
  • Can detect antibodies that are present in small amounts or non-complement binding antibodies.
20
Q

What is the benefit of flow crossmatch over the standard procedure?

A
  • It is more sensitive
21
Q

What is the PRA, in basic terms?

A
  • The percentage of potential donors cells that were ‘killed’ by the patients serum
  • The higher the PRA, the more likely that the crossmatch will be positive, I.e. 80% PRA means 20% chance of negative CM
22
Q

What are the most common causes of death in transplant recipients?

A
  • Cardiovascular disease
  • Infection
  • Malignancy
23
Q

How many weeks should be allowed elapse between the administration of a live vaccine and kidney transplantation?

A
  • 4-6 weeks
24
Q

Live vaccines are contraindicated in transplant recipients. True/False

A

True

Examples include:

  • MMR
  • Varicella live
  • Nasal influenza
  • Zoster-live (Zosta-vax)
25
Q

What are the common infections within one month of transplantation?

A
  • UTI
  • RTI
  • Surgical wound infection
  • Vasc access infection
  • Candida
26
Q

When are transplant patients at the greatest risk for unconventional or opportunistic infections?

A
  • 1 - 6 months
27
Q

What infections should you consider in patients who have had multiple rejection episodes or those who have required intensification of immunosuppression?

A
  • The unconventional or opportunistic infections that can occur in months 1-6
I.e.
CMV
HSV
VZV
BKV
28
Q

What changes are associated with CMV viraemia on FBC?

A
  • Leucopenia

- Thrombocytopenia

29
Q

For how long should PJP prophylaxis be continued post transplant?

A
  • 1 year
30
Q

In what type of transplant recipient might you consider fluconazole prophylaxis?

A
  • SPK
  • Patients from endemic areas
  • History of Valley fever
31
Q

The pp65 antigenaemia is more sensitive than CMV DNA testing. True/False

A
  • False
32
Q

When might you consider adding CMV Ig or IVIg to treatment of CMV viraemia?

A
  • Life-threatening disease
  • CMV pneumonitis

But there’s no evidence for it

33
Q

What treatments are given to resistant strains of CMV?

A
  • Cidofovir
  • Foscarnet

Test UL97 or UL54

34
Q

What is the seroprevalence rate of BKV?

A

> 60 - 90%

35
Q

What are the clinical manifestation of BKV?

A
  • Viruria
  • Ureteral stenoses
  • TIN
  • BKVAN
36
Q

What is the median time to BKVAN?

A

9 months

37
Q

How would you treat a transplant patient who has been exposed to VZV?

A
  • VZ Ig within 96 hrs of exposure

- >96 hrs: give 7 day course of acyclovir starting 7-10 days after the exposure.

38
Q

Inferferon based therapies are safe to use in kidney transplant recipients True/False

A

False

They are associated with an increased risk of infection.

39
Q

When is the highest incidence of adenovirus infection?

A
  • within the first 3 months of transplant

- occurs in 4-5% of recipients

40
Q

What is the treatment of adenovirus infection in patients with transplant?

A
  • reduce dose of immunosuppression

- cidofovir?

41
Q

How does adenovirus infection present?

A
  • haemorrhagic cystitis

- AKI

42
Q

Does enteric coated formulation reduce the risk of diarrhoea with MMF?

A

No

Transplantation (3 decks)

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