Transplant 1 Word Scramble
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Question | Answer |
Describe the interaction btw cells with MHC and T-cell receptors | Interact with T cells and stimulate them to either coordinate immune response (CD4 T cell) or directly attack microbes/ infected cell/ tumor cell (CD8 T cell) |
MHC Class I: | on surface of all nucleated cells (interact with CD8) |
MHC Class II: | on surface of APCs (interact with CD4) |
Direct Pathway | T-cells and their receptors identify foreign MHC molecules on donor cells. This stimulates CD8 T Cells to attack an organ and cause rejection |
Indirect Pathway | CD4 T cells recognize foreign proteins after presentation by APC’s (APC’s pick up peptides shed from transplanted organs) |
Key component on T cell: | TCR = Cell surface protein |
Cytokine responsible for the majority of immune cell activation | IL-2 |
Differences in survival between the various solid organs | Kidney: 85%; Kidney/Pancreas: 85%; Liver: 74%; Heart: 72%; Lung: 47%; Intestine: 47% |
Panel Reactive Antibodies (PRA): | Recipient’s blood is tested for Abs that react vs panel of foreign cells; higher % indicates presence of more Abs, greater chance for rejection |
Tolerance: | state of immune acceptance without immunosuppression; the overall goal of TP (rarely achieved) |
Hyperacute rejection | immediate destruction (as soon as blood flows through vessels) of a transplanted organ |
Acute Rejection | Rejection of transplanted organ that most often occurs between 5-90 days after receiving a TP (caused by T-cells). |
Chronic Rejection | graft vasculopathy |
Induction Immunosuppression | Antilymphocyte Abs used to prevent rejection until maintenance suppression is therapeutic |
Induction Immunosuppression: given when: | Given before or at time of TP |
Mainstay of LT immunosuppression tx: | steroid tx (prednisone) |
OKT3 MOA | Directed against CD3 antigen on T cells, TCR is removed from lymphocyte surface membrane, lymph cannot fn |
Zenapax & Simulect MOA | Antibodies directed against IL-2 receptor |
Inhibit DNA synthesis in quickly dividing cells | antimetabolites |
Cyclosporine / Tacrolimus MOA | Binds to calcineurin / impairs intracellular cascades which results in the decreased expression of IL-2 and the IL-2 receptor |
Sirolimus MOA | prevents T cells from entering the cell cycle |
Renal TP: 3 things to be sewn in: | renal a., renal v., ureter |
Used to assess renal TP post-op | US |
Renal TP complications | ATN; lymphoceles; renal a/v thrombosis; urine leak |
Why prefer the left kidney? | left renal vein is longer |
TP: CI include: | lack of psychosocial support |
Liver TP: candidate only if demonstrate: | low risk for EtOH relapse |
Liver TP: 5-yr survival: | 85% |
Liver TP: complications | Primary non-function of graft; vanishing bile duct syndrome; Biliary Leak; Thrombosis of hepatic artery |
Primary indication for panc TP | T1DM (not T2DM) |
Genl indication for TP | end stage dz of the organ being transplanted |
Heart TP: survival (1 & 5 yrs) | 1 year survival is 80%, 5 year survival is 70% |
Heart TP complications: | right heart dysfunction, brady arrhythmias |
Heart TP: Tachycardia is associated with: | acute rejection |
Lung TP: indicated for lung dz w/ life expectancy of: | < 2 years |
Lung TP survival (1 & 5 yr) | 1 yr survival is 70%, 5 yr survival is 50% |
Lung TP complications | infxn (pneumonia); chronic rejection |
Created by:
Abarnard
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