Transplant Immunology

Question 1

Hyperacute rejection

Answer 1

Minutes to hours

Question 2

Acute rejection

Answer 2

1 week-6months

Question 3

Chronic rejection

Answer 3

months to years

Question 4

Endarteritis

Answer 4

Type II rejection

Question 5

Acute rejection

Answer 5

Cellular

Antibody mediated

Question 6

Antibody mediated rejection (acute)

Answer 6

Antibodies against any non-self molecules (ABO antigens, MHC antigens)
Primary target- endothelium of arteries and capillaries

Question 7

AMR histological features

Answer 7

Neutrophils in peritubular capillaries
Thrombosis
Severe arteritis/fibrinoid necrosis of vessels
Haemorrhage
Infarction
C4d deposition

Question 8

Donor specific antibody

Answer 8

C4d Deposition correlation

Question 9

C4d

Answer 9

Can stain peritubular capillaries

Question 10

Criteria acute AMR

Answer 10

Evidence acute renal injury on histology
Evidence of antibody activity- C4d staining in peritubular capillaries
Circulating anti-donor specific antibodies

Question 11

Hyperacute rejection

Answer 11

Antibody mediated
Go attack transplant
EC activation + damage
Preformed antibodies
1 hour- neutrophils in peritubular capillaries + glomeruli
12-24hrs- intravascular coagulation + cortical necrosis

Question 12

Why a graft fails

Answer 12

Damaged before transplant
Surgical complications
Recurrence of original disease
Rejection

Question 13

Preventing Rejection

Answer 13

ABO compatibility
O- universal donor
AB- universal recipient
Screen for pre-formed antibodies 
--> direct cross-match
--> add serum to donor cells (look for activation), or beads with bound HLA (look + see if recipient serum had antibody that bound)

Question 14

Ischaemia

Answer 14

Upregulates adhesion molecules
Increases adhesion of leucocytes during re-perfusion
Increases non-specific damage
Increases acute rejection

–> ischaemia-reperfusion injury