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Transplant 1
Surgery 2
| 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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