Transplantation : part 1

Question 1

What is the difference between life-saving and life-enhancing transplantation?

Answer 1

Life-saving – other life-supportive methods are not fully developed or other life-supportive methods have reached the end of their possibleuse Life-enhancing – other life-supportive methods are less good e.g. Kidneys and dialysis – the organ is not vital but it improves the quality of life

Question 2

Whata re the two main types of donor. What are the two types of deceased donor?

Answer 2

Two main types : Living and deceased.Donor after brain death – brain dead but heart-beating Donor after cardiac death –non-heart beating donors(look at 19-21,if you have time)

Question 3

What must be excluded before harvesting organs from a deceased donor?

Answer 3

Viral infection Malignancy Drug abuse, overdose or poison

Question 4

What are the main obstacles to donation?

Answer 4

Contraindication for use of that organ .Family not approached for consent .Family declined consent.

Question 5

On which chromosome is the HLA gene encoded?

Answer 5

Chromosome 6

Question 6

What are the two classes of HLA and which HLA subtypes are in each class?

Answer 6

HLA Class I – A, B and C = present on all cells HLA Class II – DP, DQ, DR = present on specialised immune cells

Question 7

How is rejection diagnosed?

Answer 7

Histological examination of graft biopsy

Question 8

How can rejection be prevented?

Answer 8

Maximise HLA compatibility, Life-long immunosuppressive therapy

Question 9

List some treatments for Antibody-mediated rejection.

Answer 9

Anti-CD20 antibodies ,Bortezomib (proteasome inhibitor) ,Anti-complement antibodies, Plasma exchange, IVIg ,Splenectomy

Please interpret image.

Question 11

What is normally used for baseline immunosuppression following transplantation?

Answer 11

Signal transduction blockade: usually a calcineurin inhibitor (tacrolimus or cyclosporin) ,Antiproliferative agent (e.g. azathioprine), Corticosteroids

Question 12

On general wen are organs transplanted

Answer 12

•Organs are transplanted when they are failing or have failed, or for reconstruction

Question 13

What is the Standard immunosuppressive regime preimplantation

Answer 13

•Pre-transplantation - Induction agent (T-cell depletion or cytokine blockade)

Question 14

What is a composite tranplsant

Answer 14

One with different types of tissue(e.g. a face transplant)