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Surgery 2

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