Finals-Overview In Organ Transplantation

Question 1

Developed surgical technique of the vascular anastomosis

Answer 1

Alexis Carrel

Question 2

he was the first to report a series of human-to-human kidney transplants in the 1940s

Answer 2

Yu Yu Voronoy

Question 3

He learned that immune system plays a crucial role in the failure of skin grafts; birth of transplant immunobiology

Answer 3

Sir Peter B. Medawar

Question 4

He performed the first human transplant with long-term success in kidney transplant between identical twins and no immunosuppression
was required

Answer 4

Joseph Murray

Question 5

the first liver transplant was performed by

Answer 5

Thomas Starzl

Question 6

the first lung transplant was performed by

Answer 6

James Hardy

Question 7

first pancreas transplant was performed by

Answer 7

William Kelly and Richard Lillehei

Question 8

first successful heart transplant was performed by

Answer 8

Christiaan Barnard

Question 9

is the process of transferring an organ, tissue, or cell from one place to another

Answer 9

Transplantation

Question 10

surgical procedure wherein a
failing organ is being replaced by a functioning organ

Answer 10

Organ Transplantation

Question 11

Organ transplant in the same anatomic location in the recipient as it was in the donor

Answer 11

Orthotopically

Question 12

Organ transplant in another anatomic location

Answer 12

Heterotopically

Question 13

Tranplatation from one part of the body to another part in the same person (skin, vessels, bone, cartilage,
nerve).

no immunosuppression is required

Answer 13

Autotransplant

Question 14

from one person to another of the same species; except identical twins;immunosuppression is
required to avoid rejection of the donated organ

Answer 14

Allotransplant

Question 15

Transplant from one organism to another of a different species;

animal-to-human transplant

Answer 15

Xenotransplant

Question 16

Antigen encoding genes are located on chromosome

Answer 16

6

Question 17

Class of antigens that are expressed by all nucleated cells

Answer 17

Class I
##FOOTNOTE
HLA-A, HLA-B, HLA-C

Question 18

Class of antigens that are expressed by antigen- presenting cells (APCs) such as B lymphocytes, dendritic cells, macrophages, and other phagocytic cells.

Answer 18

Class II

HLA-DR, HLA-DP, HLA-DQ

Question 19

HLA can trigger rejection via two mechanisms. This mechanism is the most common mechanism in which the damage is caused by activated T-lymphocytes

Answer 19

Cellular rejection

Question 20

This mechanim of rejection by the HLA is mediated by circulating antibodies against the donor’s HLA molecules

Answer 20

Humoral rejection

Question 21

The process of one’s body discrminating the immune system of each persons between self and nonself cells and tissues

Answer 21

Allorecognition

Tcells play a crucial roll

Question 22

True or False

Indirect recognition occurs when the recipient’s T cells are activated by direct interaction with the donor’s HLA molecules.

Answer 22

False

this is direct recognition

Question 23

True or False

Indirect recognition occurs when the recipient’s T cells are activated by interaction with APCs that have processed and presented the foreign antigen.

Answer 23

TRUE

Question 24

Rejection is divided into three main types. These are

Answer 24

Hyperacute, acute and chronic

Question 25

a very rapid type of rejection, results in irreversible damage and graft loss within minutes to hours after organ reperfusion

Answer 25

Hyperacute ## FOOTNOTE It is triggered by preformed antibodies against the donor’s HLA or ABO blood group antigens. These antibodies activate a series of events that result in diffuse intra- vascular coagulation, causing ischemic necrosis of the graft.

Question 26

the most common type of rejection, usually occurs within a few days or weeks posttransplant

Answer 26

Acute Rejection ## FOOTNOTE it is further divided into cellular (T-cell–mediated) rejection, humoral (antibody-mediated) rejection, or a combination of both. The diagnosis is based on the results of biopsies of the transplanted organ, special immu- nologic stains, and laboratory tests

Question 27

This type of rejection occurs slowly and usually is progressive. It can manifest within the first year posttransplant but most often takes place gradually over several years

Answer 27

Chronic rejection ## FOOTNOTE As advances in immunosuppression have diminished the incidence of acute rejection, this form of rejection is becoming more common.

Question 28

Immunosuppresion is delivered in two phases namely

Answer 28

Induction and maintenance

Question 29

Immunosuppression phase starting immediately posttransplant, when the risk of rejection is highest

Answer 29

Induction

Question 30

Immunosuppression phase usually starting within days posttransplant and usually continuing for the life of the graft and the recipient

Answer 30

Maintenance

Question 31

During which time period is the degree of immunosuppression highest post-transplant, requiring prophylaxis against opportunistic pathogens?

Answer 31

First 3 to 6 months ## FOOTNOTE during this time, prophylaxis against a number of different bacterial, viral, or even antifungal opportunistic pathogens is administered.

Question 32

Immunosuppressive phase which includes the use of depleting or nondepleting antibodies within the first month posttransplant

Answer 32

Induction ## FOOTNOTE induction with antibody regimens may prevent acute rejection, potentially leading to improved graft survival and the use of less maintenance immunosuppression.

Question 33

A depleting antibody that is a purified gamma globulin obtained by immunizing rabbits with human thymocytes.

Answer 33

Thymoglobulin (Rabbit antithymocyte globulin)

Question 34

The only available anti-CD25 monoclonal nondepleting antibody; not designed to be used to treat acute rejection. Its selectivity in blocking IL-2–mediated responses makes it a powerful induction agent without the added risks of infections, malignancies, or other major side effects.

Answer 34

Basiliximab ## FOOTNOTE it is followed by the use of calcineurin inhibitors, corticosteroids, and MMF as maintenance immunosuppression.

Question 35

An anti-CD52 monoclonal antibody initally used to treat chronic lymphocytic leukemia; its use has grown in the field of transplantation, given its profound lymphocyte-depleting effects.

Answer 35

Alemtuzumab ## FOONOTE causes cell death by complement-mediated cytolysis, antibody-mediated cytotoxicity, and apoptosis. One dose alone (30 mg) depletes 99% of lymphocytes.

Question 36

MOA: Binds to cyclophilin Inhibits calcineurin and IL-2 synthesis Clinical Use: Improved bioavailability of microemulsion form

Answer 36

Cyclosporine ## FOOTNOTE Nephrotoxicity Tremor Hypertension Hirsutism

Question 37

MOA: Binds to FKBP Inhibits calcineurin and IL-2 synthesis Clinical Use: Improved patient and graft survival in (liver) primary immunosuppression and rescue therapy Used as mainstay of maintenance protocol

Answer 37

Tacrolimus (FK506)

Question 38

MOA: Antimetabolite Inhibits enzyme necessary for de novo purine synthesis CLINICAL USE: Effective for primary immunosuppression in combination with tacrolimus

Answer 38

Mycophenolate mofetil ## FOOTNOTE ADVERSE EFFECTS Leukopenia GI Toxicity

Question 39

MOA: Inhibits lymphocyte effects driven by IL-2 receptor CLINICAL USE: May allow early withdrawal of steroids and decreased calcineurin doses

Answer 39

Siroliums ## FOOTNOTE ADVERSE EFFECTS Thrombocytopenia Increased serum cholesterol/LDL Poor wound healing

Question 40

MOA: Multiple actions Anti-inflammatory Inhibits lymphokine production CLINICAL USE: Used in induction, maintenance, and treatment of acute rejection

Answer 40

Corticosteroids ## FOOTNOTE Cushingoid state Glucose intolerance Osteoporosis

Question 41

MOA: Antimetabolite Interferes with DNA and RNA synthesis CLINICAL USE: Used in maintenance protocols or if intolerance to mycophenolate mofetil

Answer 41

Azathioprine ## FOOTNOTE ADVERSE EFFECTS Thrombocytopenia Neutropenia Liver dysfunction

Question 42

MOA: T-cell blocker CLINICAL USE New drug for maintenance immunosuppression in renal transplants only

Answer 42

Belatecept ## FOOTNOTE Increased risk of bacterial infections

Question 43

A chimeric anti-CD20 (anti-B cell) monoclonal antibody; currently FDA approved for treating several types of lymphoma; include the treatment of antibody- mediated rejection and use in desensitization protocols; usually used in conjunction with plasmapheresis, steroids, and intravenous immunoglobulin (IVIG).

Answer 43

Rituximab

Question 44

A proteasome inhibitor for treating multiple myeloma. It can directly target plasma cells shown to cause apoptosis of normal plasma cells, thereby decreasing alloantibody production in sensitized patients

Answer 44

Bortezomib

Question 45

humanized monoclonal antibody, for treating paroxysmal nocturnal hemoglobinuria, hemolytic uremic syndrome, and generalized myasthenia gravis It blocks the activation of the terminal complement cascade increased risk of infections: Neisseria meningitidis therefore meningococcal vaccine should be given at least 2 weeks before the administration

Answer 45

Eculizumab

Question 46

Infection occuring within 1 month posttransplant can be due to a wide spectrum of pathogens

Answer 46

Early infection

Question 47

2nd most common cause of graft loss in pancreas recipient after vascular thrombosis

Answer 47

Intra abdominal abscess

Question 48

Signs and symptoms of intra-abdominal infections

Answer 48

Oeritonitis: fever, hypotension, ileus and abdominal pain

Question 49

Intra abdominal infections are usually polymicrobial, these bacteria includes

Answer 49

E.coli, Enterococcus, Klebsiella and Pseudomonas spp.

Question 50

For medical infections, what should be the treatment

Answer 50

Empiric antibiotics and anti fungal meds

Question 51

infections that are primarily due to chronic immunosuppression, specifically the depression of cell-mediated immunity that renders recipients susceptible to viruses, fungi, and parasites.

Answer 51

Late infections ## FOOTNOTE usually occur 3 to 6 months posttransplant or during treatment for rejection

Question 52

the most common etiologic agents of viral infections posttransplantation

Answer 52

Herpesvirus group ## FOOTNOTE Herpes simplex virus Cytomegalovirus Epstein Barr virus

Question 53

Most prominent etiologic agent for viral infection

Answer 53

EBV

Question 54

found in chicken, pidgeon, and bat droppings in the Ohio River and Mississippi River valleys. Dissemination is commonplace; up to a quarter of patients have central nervous system (CNS) involvement. Treatment consists of prolonged (3 to 13 months) administration of oral itraconazole.

Answer 54

Histoplasma capsulatum

Question 55

grows in moist soil in the Midwest and Southeast regions of the United States. Diagnosis is confirmed by biopsy; the preferred treatment is IV amphotericin B.

Answer 55

Blastomysis dermatitidis

Question 56

cause invasive coccidioidomycosis after inhalation of aerosolized infectious particles. It is endemic in the Southwest, Northern Mexico, and various parts of Central and South America. This infection can be resilient and difficult to treat. The first line of treatment is high-dose amphotericin B.

Answer 56

Coccidiodes immitis

Question 57

infections exhibiting a 20% mortality rate. Prophylaxis with fluconazole has been shown to reduce invasive fungal infections in liver recipients

Answer 57

Candida or Aspergillus

Question 58

species that are rare but can cause serious fungal infections

Answer 58

Aspergillus, Cryptococcus, Mucor and Rhizopus

Question 59

is ubiquitous and can cause pulmonary disease in immunocompromised patients. TMP-SMX is an effective prophylaxis

Answer 59

Pneumocystis jiroveci

Question 60

Enumerate types of malignancies

Answer 60

Kaposi’s sarcoma nonmelanoma skin cancer non-Hodgkin’s lymphoma and cancer of the liver, anus, vulva, and lip