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Which is the worst case scenario in a antibody mediated (humoral) transplant rejection?
Hyperacute rejection
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What causes hyperacute transplant rejection?
It is an antibody-mediated rejection due to the presence of preformed antidonor antibodies in the recipient
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Who are most prone to hyperacute transplant rejection?
Multiparous women and individuals exposed to foreign HLA From prior blood transfusions
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What results from antibody mediate hyperacute transplant rejection?
Leads to ischemic necrosis of graft as a result of platelets responding to destroyed endothelial cells after complement binding and neutrophil attack
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How long does it take for hyperacute rejection to take place?
Minutes to hours after the transplant is put in
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What are some physiological changes to a transplanted kidney in hyperacute rejection
Kidney becomes cyanotic, mottled, flaccid. Fibrotic
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What are the types of antibody mediated transplant rejections?
- Hyperacute
- Acute humoral
- Chronic humoral
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How long does it take for onset of an acute transplant rejection?
May occur within days or weeks (with adequate immunosuppression could be months to years)
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True/False: Acute transplant rejection could be cellular or humoral
True. Cellular- mononuclear cell infiltrate with edema and parenchymal injury. Humoral- vasculitis
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How long does it take for onset of chronic transplant rejection?
Presenting late, months to years after transplant
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What is a clinical indication for chronic kidney rejection?
- Progressive rise in serum creatinine level over 4 to 6 months
- Does not respond to immunosuppression
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What is a downside with using immunosuppression therapy to increase graft survival?
- Vulnerability to fungal, viral, bacterial infections and EBC induced lymphoid tumors
- Reactivation of polyoma virus
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What is the drug that inhibit T cell mediated immunity?
Cyclosporin
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What is a type of monoclonal antibodies?
Monoclonal anti-CD4
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What are some complications with allogeneic (from someone else) hematopoietic stem cell transplant?
- Transplant rejection – radiation-resistance T cell and NK cells attack
- Graft-versus-host disease
- Immune deficiencies
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What is the onset for GVHD (graft vs host disease)?
Acute within days to weeks after transplant
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What are the symptoms for GVHD?
Jaundice, bloody diarrhea, generalized rash
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What mediates GVHD?
Donor T cells in marrow attacking recipient by binding to host antigen
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Where are the most common sites of injury for GVHD?
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At how many weeks do the fetus start making surfactant?
26th to 32nd week
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What are the phenotypes in infants with oligohydramnios
- Flattened facies
- Positional abnormalities of hands and feet
- Growth of chest wall compromised – lungs hypoplastic
- Nodules in amnion
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What is Potter’s baby
- Have no kidneys, unable to receive transplant.
- Squished. Death
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What is the risk period of Rubella?
First 8 weeks after conception
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What is the risk period for CMB
- 2nd 8 weeks
- When is the most sensitive embryonic development period?
- From 3 weeks till 8 weeks. Susceptible to teratogen
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What type of drug would lead to congenital malformation in having short and malformed arms?
Thalidomide
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