Renal transplant Flashcards
(24 cards)
What are the 4 different types of transplant grafts
Xenograft
Isograft
Autograft
Allograft
What type of transplant graft has the highest risk of rejection
Xenografts
Between different species
What types of transplant grafts cause no rejection
Autograft –> one part of the body to another
Isograft –> between genetically identical people
What are the antigens responsible for rejection called
Human leukocyte antigens (HLA)
What T cells are MHC-I and MHC-II associated with
1 = CD8+
2= = CD4+
Summarise the 3 signals to t cell rejection
1) APC + HLA + MHC activates T cells and causes downstream signalling
2) Co-stimulatory receptor ligands –> CD28, CD40 amplify signals and cause t cell activation. Initiate downstream signalling
3) Growth factor activation –> IL-2, activated cell cycle and causes proliferation
What are the 3 downstream signalling pathways associated with t cell rejection
1) IP3 +Ca2+ –> NFAT –> nucleus transcription
2) MAPK –> AP-1 –> transcription
3) IKK – NFkB –> transcription
Transcription of pro-inflammatory cytokines and IL-2
What is the most common way to reduce chances of rejection
Immunosuppression
What are the 4 drugs used in immunosuppression INDUCTION
Corticosteroids
Basiliximab
ATG
Alemtuzumab
What are the 5 drugs used in immunosuppression MAINTENANCE
ciclosporin
azathioprine
corticosteroids
balatacept
sirolimus
What is the target and action of basilixumab
Targets IL-2 receptor
Decreased cell cycle activation and proliferation
not T cell depleting
What is the target and action of alemtuzumab
Targets CD52 call surface antigen
T cell lysis and depletion
What can alemtuzamab cause on the first dose
Neutropoenia
anemia
What is the target and action of ATG
Blocks T cell membrane proteins
T cell lysis and cel depletion
What can cause cytokine release syndrome and what are the symptoms
Cell lysis
fever
rash
hypotension
What is the target and action of corticosteroids
Reduced NfKB transcription factor
Reduction in pro-inflammatory cytokines and T cells
What are the side effects of corticosteroids
Adrenal suppression
HTN
diabetes
GI disturbances
What is the MOA of ciclosporin and tacrolimus
Inhibits calcineurin phosphatase
suppresses t cell acitvation and inhibits IL-2 production
What must you ensure happens in ciclosporin
Must stay on same brand the whole time
What is an ADR with azathiporine
Allopurinol
Reduce dose to 1/4 amount
What is the MOA of azathioprine
Inhibits nucleotide production which stops DNA synthesis
Inhibits T and B cell proliferation
Why would you give someone 6 month prophylaxis of co-trimoxazole following a transplant
PCP
What should you give for fungal infection prophylaxis
Nystatin solution
How many doses should be given with basiliximub
1st dose = immediately after surgery
2nd dose = 4 days later
