Immunology and Rejection

Question 1

What is auto-transplanation?

Answer 1

Transplantation of self tissue, such as using own blood before surgery.

Question 2

What is iso-transplantation?

Answer 2

Transplanation of tissue or organs between genetically identical individuals.

This does not activate the immune response.

Question 3

What is allotransplantation?

Answer 3

Transplantation between genetically different people.

This will trigger the immune response.

Question 4

What is xenotransplantation?

Answer 4

Transplantation between different species.

Question 5

A humoral response involves the production of __ by plasma cells (__-cells)?
1. immunoglobulins, B
2. immunoglobulins, T
3. cytokines, B
4. cytokines, T

Answer 5

1

Question 6

A cellular response involves communication between what?
1. Lymphocytes
2. Immunoglobulins
3. Cytokines
4. Antibodies

Answer 6

1

Question 7

T-cells are involved in…
1. Cellular-mediated immunity
2. The humoral immune response
3. The migration of immature lymphocytes through the thymus
4. The migration of immature lymphocytes through the bone marrow
5. Differentiation to memory cells, cytotoxix cells, helper cells, and suppresor cells.
6. Differentiation to memory cells (IgM, IgG, IgA, IgE).
5. 2, 4, and 6 only
6. 1, 2, and 5 only
7. 1, 3, and 5 only
8. 2, 4, and 5 only
9. All of the above

Answer 7

7

Question 8

B-cells are involved in…
1. Cellular-mediated immunity
2. The humoral immune response
3. The migration of immature lymphocytes through the thymus
4. The migration of immature lymphocytes through the bone marrow
5. Differentiation to memory cells, cytotoxix cells, helper cells, and suppresor cells.
6. Differentiation to memory cells (IgM, IgG, IgA, IgE).
5. 2, 4, and 6 only
6. 1, 2, and 5 only
7. 1, 3, and 5 only
8. 2, 4, and 5 only
9. All of the above

Answer 8

5

Question 9

Cytokines act as hormonal __?

Answer 9

Messengers

Question 10

Are cytokines are involved in the humoral immune response or in cell-mediated immunity?

Answer 10

Cell-mediated immunity

Question 11

What is the major source of cytokines?

Answer 11

T lymphotcytes

Question 12

The cytokine’s cell surfaces contains __ that allows for recognition of foreign pathogens.
1. Antigen-specific receptors
2. Antibodies
3. Rh factor
4. Hormones

Answer 12

1

Question 13

What is the name of the system that drives rejection in allotransplantation?
What is the name of that system in humans?

Answer 13

Major Histocompatibility System (MHC)
Human Leukocyte Antigen System (HLA)

Question 14

What are HLA antigens?
What do they do?

Answer 14

Proteins (or markers) on the surface of our cells.
They act as genetic identification.

Question 15

True or False: HLA typing changes routinely and must be monitored yearly.

Answer 15

False

HLA typing never changes

Question 16

HLA typing…
1. Is how we define ourselves immunologically
2. Is based on our genetic inheritence
3. Is altered through blood transfusions
4. Never Changes
5. 1, 2, and 3 only
6. 2, 3, and 4 only
7. 1, 2, and 4 only
8. All of the above

Answer 16

7

Question 17

What is the chance that 2 offspring will be HLA identical?
1. 10%
2. 25%
3. 50%
4. 100%

Answer 17

2

Question 18

What are the chances of finding an HLA identical match for the general population?
1. 1: 10,000
2. 1: 25,000
3. 1: 50,000
4. 1: 100,000

Answer 18

3

Question 19

HLA Antibody testing is done…
1. Never
2. After transplant
3. Before Transplant
4. After a desensitizing process
5. 2, 3, and 4 only

Answer 19

5

Question 20

When are the 3 times HLA crossmatch will occur?

Answer 20

1. Prospective
2. Restrospective
3. Virtual

Question 21

Which statement is true?

HLA antibodies are classified as Class I and Class II and exist on:
1. Class 1: on all cells, Class 2: on all cells
2. Class 1: on all cells, Class 2: on B cells
3. Class 1: on B cells, Class 2: on all cells
4. Class 1: on B cells, Class 2: on B cells

Answer 21

2

Question 22

What are 5 examples of sensitizing events?

Answer 22

1. Blood products
2. Pregnancy
3. Transplant (any organ)
4. Mechanical circulatory support
5. Tissue graft

Question 23

cPRA is defined as the __ of potential donors a specific patients will have a __ crossmatch.
1. %, Positive
2. %, Negative
3. Number, Positive
4. Number, Negative

Answer 23

1

The higher the cPRA, the harder it is to find a good match.

Question 24

Which type of typing is a more specific way of identifying HLA receptors?
1. Serotyping
2. Phenotyping

Answer 24

2

Question 25

In transplant, we pay attention to 6 loci within the HLA classes. Be familiar with what they are.

Answer 25

MHC Class 1 *HLA-A * HLA-B * HLA-C MHC Class 2 * HLA-DP * HLA-DQ * HLA-DR

Question 26

For purposes of the CCTC test, which of the following statements is true regarding crossmatches? 1. Regardless of your center's protocol for transplant, all crossmatches must be positive. 2. Regardless of your center's protocol for transplant, all crossmatches must be negative. 3. Transplant centers may determine to transplant a patient that is crossmatch negative or positive.

Answer 26

2

Question 27

Is antibody screening is done on the donor or recipient?

Answer 27

Recipient

Question 28

At what frequency is antibody testing done when there is no evidence of sensitization?

Answer 28

Every 6 months

Question 29

At what frequency is antibody testing done with patients with antibodies >10%?

Answer 29

Monthly

Question 30

At what frequency is antibody testing done with patients with LVAD patients?

Answer 30

Weekly or with a heart offer

Question 31

At what frequency is antibody testing done for blood transfusions?

Answer 31

1-2 weeks after the event

Question 32

What is the recommended frequency for antibody screening for pediatric, retransplant patients, or for pregnant women?

Answer 32

Every 3 months

Question 33

A prospective crossmatch will determine what?

Answer 33

If a recipient has HLA antibodies to a donor

Question 34

A prospective crossmatch combines what? 1. Recipient cells with donor serum 2. Recipient cells with donor cells 3. Recipient serum with donor serum 4. Recipient serum with donor cells

Answer 34

4

Question 35

In a virtual crossmatch, the recipient's \_\_ is matched against the donor's \_\_? 1. Antibody profile, Antigens 2. Antibody profile, Antibody profile 3. Antigens, Antibody profile 4. Antigens, Antigens

Answer 35

1

Question 36

Why must you be confident you can manage a positive retrospective crossmatch?

Answer 36

It is done at the time of transplant and will result when the organ is already in.

Question 37

In a Complement-dependent cytotoxicity crossmatch (CDC), recipient serum potentially containing \_\_ is added to donor \_\_ along with complement. 1. T or B lymphocytes, T or B lymphocytes 2. Donor-specific antibodies (DSA), Donor-specific antibodies (DSA) 3. T or B lymphocytes, donor-specific antibodies (DSA) 4. Donor-specific antibodies (DSA), T or B lymphocytes

Answer 37

4

Question 38

In a Complement-dependent cytotoxicity crossmatch (CDC), if DSA is \_\_ then no lysis occurs and the result is \_\_. 1. Present, Positive 2. Present, Negative 3. Not Present, Positive 4. Not Present, Negative

Answer 38

4

Question 39

In a flow cytometry crossmatch, recipient \_\_ is added to donor \_\_ and incubates them with antibodies against human \_\_. 1. Serum, Lymphocytes, IgG 2. Serum, Lymphocytes, IgM 3. Lymphocytes, Serum, IgG 4. Lymphocytes, Serum, IgM 5. Serum, Serum, IgG 6. Lymphocytes, Lymphotcytes, IgM

Answer 39

1

Question 40

The following is an example of a how many antigen mismatch? **Donor:** HLA-A2, - HLA-B5, B8 HLA-DR3, DR7 **Recipient:** HLA-A2, A3 HLA-B5, B8 HLA-DR3, DR7

Answer 40

0 (Zero antigen mismatch) ## Footnote This example is a zero antigen mismatch because the recipient has everything the donor has. It has an extra A3, but it still has everything the donor has. So the key to finding a mismatch it to determine what the donor has that the recipient doesn't have.

Question 41

The following is an example of a how many antigen mismatch? **Donor:** HLA-A2, A3 HLA-B5, B8 HLA-DR3, DR7 **Recipient:** HLA-A2, - HLA-B5, B8 HLA-DR3, DR7

Answer 41

1 (One antigen mismatch) ## Footnote This example has a one antigen mismatch because the recipient has an A3 that the donor doesn't have. So the key to finding a mismatch it to determine what the donor has that the recipient doesn't have. For testing purposes, this would NOT be acceptable.

Question 42

Are Rh antigens present on lymphocytes? Are they taken into account for organ transplantation? 1. Yes, Yes 2. Yes, No 3. No, No 4. No, Yes

Answer 42

3 ## Footnote Rh antigens are not present on lymphoctyes and are not taken into account for organ transplants.

Question 43

A blood type O recipient will be compatible with a donor blood type...

Answer 43

O

Question 44

A blood type A recipient will be compatible with a donor blood type...

Answer 44

O, A

Question 45

A blood type B recipient will be compatible with a donor blood type...

Answer 45

O, B

Question 46

A blood type AB recipient will be compatible with a donor blood type...

Answer 46

O, A, B, AB

Question 47

A blood type O donor will be compatible with a recipient blood type...

Answer 47

O, A, B, AB

Question 48

A blood type A donor will be compatible with a recipient blood type...

Answer 48

A, AB

Question 49

A blood type B donor will be compatible with a recipient blood type...

Answer 49

B, AB

Question 50

A blood type AB donor will be compatible with a recipient blood type...

Answer 50

AB

Question 51

What are the 4 types of liver rejection?

Answer 51

1. Hyperacute (Anti-body mediated) 2. Antibody-mediated rejection (AMR) or humoral 3. Acute (Cellular) 4. Chronic

Question 52

Hyperacute rejection happens in <1% of transplants. How was that able to be reduced so low?

Answer 52

By performing crossmatches

Question 53

Hyperacute rejections happens how fast?

Answer 53

In minutes to days

Question 54

What can cause hyperacute rejection? | 3 items

Answer 54

* Blood group mismatch * Circulating antibodies * Vascular thrombosis

Question 55

What are 3 signs of hyperacute rejection as caused by circulating antibodies?

Answer 55

1. Complement activation 2. Endothelial damage/inflammation 3. Platelet aggregation

Question 56

What is the treatment for hyperacute rejection? | 2 items

Answer 56

Support (such as ECMO) Possible relist for transplant

Question 57

Antibody Mediated Rejection is caused by \_\_ cell antibodies and characterized by \_\_ inflammation and damage. 1. T, vascular 2. B, vascular 3. T, interstitial 4. B, interstitial

Answer 57

2

Question 58

Antibody Mediated Rejection is diagnosed by biopsy and reveals what 2 main results? | 1. Type of deposits seen 2. A specific test that is done

Answer 58

1. IgM and IgG deposits 2. C3d, C4d, and CD68 stains

Question 59

What are the main AMR treatments when the patient is asymptomatic? | 3 items

Answer 59

1. Steroids 2. Change in Maintenance Immunosuppression 3. Monitor DSAs/pathological findings

Question 60

What are the main AMR treatments when the patient is mildly symptomatic? | 4 items

Answer 60

1. High dose steroids 2. Thymoglobulin (rabbit ATG) 3. IV immune globulin 4. Change in Maintenance Immunosuppression

Question 61

What are the main AMR treatments when the patient is hemodynamically compromised? | 5 items

Answer 61

1. High dose steroids 2. Plasmapheresis/apheresis 3. IV immune globulin 4. Rituximab, etc. 5. Change in Maintenance Immunosuppression

Question 62

The most common type of rejection is \_\_ and happens in about \_\_ of cases. 1. AMR, 10% 2. AMR, 50% 3. Acute Cellular, 50% 4. Acute Cellular, 10%

Answer 62

4

Question 63

When does acute cellular rejection take place?

Answer 63

Weeks to months after transplant

Question 64

What is the main cause for cellular rejection? 1. Antibody response 2. Cytokine-induced vascular leak 3. An allergic reaction to immunosuppression medications 4. Hemorrhage

Answer 64

2

Question 65

What 4 main things could you see on a biopsy indicating cellular rejection?

Answer 65

1. Endothelialitus 2. Parenchymal cell damage 3. Insterstitial inflammation 4. Edema and mild hemmorhage

Question 66

What is the treatment for cellular rejection? | 2 items

Answer 66

1. High dose steroids 2. Optimization of drugs

Question 67

When does chronic rejection take place?

Answer 67

Months to years after transplant

Question 68

What are the signs of liver rejection? | 6 items

Answer 68

* Elevated liver enzymes * Tenderness over liver * Yellow eyes or skin * Dark urine * Ascites * Fever

Question 69

What are the signs of kidney rejection? | 6 items

Answer 69

* Elevated BUN, creatinine * Decreased UOP * Weight gain * Pain at kidney site * Leg swelling * Fever

Question 70

What are the signs of heart rejection? | 6 items

Answer 70

* Irregular heart beat (could be fast or slow) * Low BP * SOB * Weight gain * Fatigue * Fever

Question 71

What are the signs of lung rejection? | 5 items

Answer 71

* SOB * Fatigue * Productive cough * Change in color of sputum * Fever

Question 72

Will you see high or low blood glucose levels with pancreas rejection?

Answer 72

High

Question 73

What are the signs of intestine rejection? | 6 items

Answer 73

* Increase in stool output * Fatigue * Abdominal pain/distention * Dusky stoma * Weight loss * Fever

Question 74

A cellular response leads to intracellular destruction of foreign what? 1. T-cells 2. B-cells 3. Cytokines 4. Antibodies

Answer 74

1