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Surgery Transplants
Transplantation Surgery
| Question | Answer |
|---|---|
| Drug that revolutionized transplantation | Cyclosporine |
| What percentage of donor candidates/families are approached regarding willingness to be a transplant donor? | 84% approached, 44% yes |
| Antigen | a molecule that can interact with the immune system |
| Antibody | peptides produced by B lymphocytes that attach to foreign material and aid in removing it from the body |
| Antigen presenting complex (APC) | - is a cell that displays foreign antigen complexed with MHC on its surface. T-cells may recognize this complex using their T-cell receptor (TCR) |
| Major Histocompatibility complex (MHC) | genes expressed on the surface of cells which display fragments of molecules from invading microbes to a T cell that has the ability to kill or coordinate the killing of the microbe |
| Human Leukocyte Antigens (HLA) | are encoded by the MHC genes (another name for MHC) |
| Cytokines | Circulation peptides that influence behavior of the immune system (IL-2, IL-6, TNF-alpha) |
| T-cell receptor | a protein complex of T lymphocytes that can identify MHC molecules |
| CD4 lymphocytes | Interact with APC MHC II molecules via the TCR to release cytokines (primarily IL-2) |
| CD8 T lymphocytes | Interact with MHC class I molecules (that contain foreign peptides) and can directly kill the foreign cell |
| Allogeneic | "of the same species" |
| Crossmatch | a test for determining tissue compatibility between a transplant donor and a recipient prior to transplantation using recipient's serum and donor lymphoctyes (or other donor cells) |
| Panel Reactive Antibodies (PRA) | Preexisting antibodies that will react against HLA antigens in the serum of a potential allograft recipient |
| Tolerance | A state of immune acceptance without immunosuppression. Immune system is actually regulating itself. |
| MHC I binds with | CD8 T cell |
| MHC II binds with | CD4 T cells |
| MHC Class I antigens are found on | nearly all cells. Class II antigens found primarily on APC's |
| How many pathways are there of allogeneic recognition? | 2. Direct and Indirect |
| Direct Pathway | T-cells and their receptors identify allogeneic major histocompatibility complex (MCH) molecules. This generates CD8 T Cells which cause attack an organ and cause rejection |
| Indirect Pathway | CD4 T cells recognize donor MHC peptides after presentation by APC’s (APC’s pick up peptides shed from transplanted organs) |
| Main foreign substances | blood type antigens, HLA |
| Intracellular pathways that create immune response | Just teh T cell receptor interacting alone doesn't affect the immune system enough to get a huge immune response. Have to have costimulation |
| Three types of rejection | Hyperacute (immediate, due to preformed antibodies, within a few minutes transplanted organ gets black), Acute (most often occurs 5-90 days after transplant mediated by Tcells), Chronic (Chronic allograft vasculopathy) |
| Immunosuppression | Different drugs are used for immunosupression (OR, maintenance therapy, acute rejection meds) |
| ____is treated with steroids/antilymphocyte preparations for a period of several days | Acute Rejection |
| ATGAM | polyclonal antibody used primarily for steroid-resistant acute rejections. Not preferred, serum sickness/anaphylaxis can occur |
| OKT3 success with reversal of acute rejection | 94% |
| Real important cytokine | IL2 |
| Good cytokines for stopping rejection | IL4, IL10 |
| Corticosteroids MOA | Inhibit macrophage migration and APC function; Inhibits gene expression of IL 1,2,3,6, TNF alpha and IFN gamma |
| Which immunosuppressant suppress bone marrow as an AE? | Azathioprine (Imuran) |
| Which immunosuppressant is used in maintenance therapy? | Cellcept |
| BIG AE's Tacrolimus | Nephrotoxicity and Diabetes; moreso than cyclosporine. However, it is more effective than cyclosporine at preventing acute rejection |
| Cellcept and prograft | common combo for maintenance therapy |
| Complications of immunosuppression | Infections, cancer (squamous cell skin cancer most common) |
| Organ protection | Hyothermia, preservation solution, continuous perfusion devices |
| Warm ischemic time | Kidneys (3 days), Livers (2 days), Pancreas (24 hours), Hearts (6 hours) |
| Lung organ ischemic time | <8 hours; require a specific perfusion/preservation solution |
| Donor Contraindications of renal transplant | HIV, hx of malignancy, active infections, hx of HTN |
| Where is the kidney transplant put? | Right ileac fossa |
| Transplant vs dialysis | Transplants have better outcome and cost less; patients are more independent with transplants |
| Indications for kidney transplants | ESRD from: DM, glomerulonephritis, polycystic kidney dz, hypertensive nephrosclerosis, SLE, interstitial nephritsi |
| Acute rejection tx | OKT3 and steroids |
| Transplantation of the pancreas requires | y segment of iliac vessel |
| Pancreas Transplantation indications | Type I Diabetes (usually done simultaneously with kidney transplant) |
| Small bowel transplantation indications | short gut syndrome dependent on TPN as a result of (IBD, Necrotizing enterocolitis, malrotation, trauma) |
| Complications of heart transplants | Complications: right heart dysfunction, brady arrhythmias. Tachycardia is seen in acute rejection |
| 5 year surivival of heart transplant | 70% |
| ___ accounts for the majority of early morbidity/mortality of lung transplants | infectious complications (pneumonia) |
Created by:
ltm12