Week 2: Transplantation

Question 1

Most important matching that must occur in solid organ transplantation

Answer 1

MHC class matching (aka Human Leukocyte Antigen in humans)

Question 2

What are the 3 types of solid organ rejection

Answer 2

1. Hyperacute (within minutes)
2. Acute (days to weeks)
3. Chronic (months to years)

Question 3

Describe Billingham’s criteria (in bone marrow replacement)

Answer 3

1. Graft has immunocompetent cells
2. Recipient has Ag not found in donor graft
3. Pt cannot reject donor graft (cos immunosuppressed) so graft attacks them

Question 4

Pathophysiology of hyperacute rejection

Answer 4

Pre-existing humoral (B cell) immunity ie pre-formed Ab

eg previous blood transfusion/ pregnancy

Question 5

Pathophysiology of acute rejection

Answer 5

Eventually happens to some extent in all transplants

Due to formation of cell immunity (by macrophages and T lymphocytes)

Thus need to give pt immunosuppressants.

Recurrent episodes of acute rejection will lead to chronic rejection

Question 6

Pathophysiology of chronic rejection

Answer 6

Fibrosis of transplant blood vessels

Occurs after recurrent episodes of acute rejection

Question 7

Clinical features of acute GvHD disease

Answer 7

1. Liver damage
2. Skin damage (rash)
3. Mucosal damage (Pain and scarring)
4. GI tract inflammation (abdo pain, diarrhoea)

Question 8

Pros and cons of performing a T cell-depleted BM transplant

Answer 8

PRO
1. No mature lymphocytes to mount a GvHD response

CON
1. Will also get diminished graft vs tumour effect (which can be useful cos BM transplant usually used in leukaemia)

2. Will make pt more immunodeficient