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Y2 RNU block > solid organ transplantation > Flashcards

solid organ transplantation Flashcards

1
Q

what is autologous transplant

A

donor and recipient are the same individual (most common)

- e.g. skin graft

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2
Q

what is syngeneic transplant

A

donor and recipient are genetically identical twins

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3
Q

what is allogenic transplant

A

donor and recipient are not genetically identical but are from same species

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4
Q

what is xenogenic transplant

A

donor and recipient are from different species.

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5
Q

what are the types of allogenic donors

A 
Living donors:
haematopoietic stem cells- bone marrow transplant
Kidney- 1 kidney
liver lobe
lung lobe- parents donating to a child
Deceased donors:
Kidney- both kidneys
liver
pancreas
heart (and lung) 
cornea
 and other tissues
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6
Q

What are the compatible donors for blood type A

A

A,O

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7
Q

What is the antigen on RBC and antibody in plasma for people with blood type A

A

Antigen on RBC- A

Antibodies against- B

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8
Q

What are the compatible donors for blood type B

A

B,O

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9
Q

What is the antigen on RBC and antibody in plasma for people with blood type B

A

Antigen on RBC- B

Antibodies against- A

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10
Q

what are the compatible donors for blood type AB

A

O,A,B,AB

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11
Q

What is the antigen on RBC and antibody in plasma for people with blood type AB

A

Antigen on RBC- A,B

Antibodies against- No antibodies against it

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12
Q

what are the compatible donors for blood type O

A

O

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13
Q

What is the antigen on RBC and antibody in plasma for people with blood type O

A

No antigen on RBC

Antibodies against- A, B

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14
Q

what is Hyperacute rejection of transplanted organ

A

occurs immediately after connection of blood vessels.

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15
Q

how can the problem of Hyperacute rejection be overcome

A

immunoadsorption, plasma exchange, immunosuppression (limited to living donors)
taking away antibodies of the recipients- only appropriate when donor is a living donor so can be planned in advance

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16
Q

what chromosomes are the Major histocompatibility complex (MHC) located on and what genes do they contain

A

Located on chromosome 6 and contains our HLA genes

17
Q

what is the structure of HLA class 1 and what exons is the polymorphism located on

A

3 alpha
1 beta chains

Polymorphism located on exons 2 and 3

18
Q

what is the structure of HLA class 2 and what exons is the polymorphism located on

A

2 alpha
2 beta chains

Polymorphism located on exon 2

19
Q

describe the expression of HLA class 1 (types and what it is present on)

A

HLA class 1:
A
B
C

Present on all nucleated cells

20
Q

describe the expression of HLA class 2 (types and what it is present on)

A

HLA class 2:
DQ
DR
DP

present on APCs (macrophages, dendritic cells and B cells)
Present on activated T cells

21
Q

what is alloreactivity and how is it overcome

A

T-cells respond vigorously to non-self HLA molecules .

Major obstacle for transplantation - aim is to match HLA molecules

22
Q

Describe HLA matching in kidneys, liver and cardiothoracic

A

Kidneys: aim to match HLA-A, B, DR
Liver: HLA matching not performed
Cardiothoracic: Not feasible due to logistics

23
Q

Patients can make antibodies against non-self HLA via what routes?

A

Pregnancy- mother sensitised to HLA type of baby that has been inherited from father- so makes harmless antibodies against them

Blood transfusion- sensitised to HLA type of blood donor

Previous transplant

24
Q

Describe hyperacute transplant rejection

A

Patient has pre-formed complement fixing donor reactive antibodies.
Occurs mins/hours after transplant
Extremely rare

25
Q

Describe acute rejection

A

Immune mediated: T-cells (cellular) and B-cells (antibodies)
Treat with modulation of immunosuppression

Risk factor for chronic allograft nephropathy

26
Q

Describe chronic allograft nephropathy

A

Progressive damage to organs

More slowly compromises organ function than acute rejection

27
Q

what do HLA class I molecules bind

A

Binds proteins derived from intracellular proteins, including peptides derived from virus

28
Q

what do HLA class II molecules bind

A

Binds peptides dervied from extracellular proteins and cell surface proteins, including peptides derived from bacteria

29
Q

what are the two tiers of transplant allocation and describe them

A

Tier A- Patients with match-ability score = 10
Patients with 100% calculated reaction frequency
Patients that have accured 7 years of waiting time
Tier B: all other eligible patients (kidney only)

30
Q

what does matchability score mean

A

Matchability score=1 means easy to find HLA matched donor

Matchability score=10 means hard to find HLA matched donor

31
Q

what does 100% calculated reaction frequency mean

A

Prescence of HLA antibodies in patient:
0% = none
100% = antibodies present that react with multiple HLA mismatches

Y2 RNU block (12 decks)

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