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Transplant 1

Surgery 2

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