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22 Cards in this Set
- Front
- Back
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• Remains most important barrier to long- term success
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Allograft Rejection
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• Due to pre‐formed alloantibodies directed against either blood
group or HLA (MHC) antigen |
Hyperacute Rejection
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• Prevented by HLA crossmatch
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Hyperacute Rejection
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Antibody‐mediated Rejection
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minimized via
– IV immunoglobulin – Plasmapheresis – Rituximab (anti‐CD20 monoclonal Ab) – Splenectomy |
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Acute rejection shows what in the interstitium?
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• Intersititial mononuclear infiltrate
– Lymphs and monocytes/macrophages – Can see similar infiltrate in absence of rejection as well as a tubulitis, intimal arteritis |
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intimal arteritis is associated with what?
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acute rejection
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Banff Classification of Acute Rejection
IA:? |
Significant interstitial infiltration (>25% of parenchyma affected) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells)
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IIA Acute rejection
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IIA Significant interstitial infiltration and mild to moderate intimal arteritis
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Significant interstitial infiltration and mild to moderate intimal arteritis is what stage rejection
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IIA Significant interstitial infiltration and mild to moderate intimal arteritis
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Transmural" arteritis or fibrinoid change and necrosis of medial smooth
muscle cells is what stage of rejecion? |
III
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describe IIB rejection
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IIB Severe intimal arteritis comprising > 25% of the lumenal area
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Acute Rejection Tx
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• Intensify immunosuppression
• Directed against T cells • Anti‐lymphocyte agents – Monoclonal – Polyclonal • Corticosteroids – Anti‐inflammatory – Cytotoxic |
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describe direct allorecognition
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when recipient T-lymphs recognize foreign HLA
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indirect allorecognition describe that
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• Recipient T lymphs recognize processed proteins
from the donor organ expressed by recipients APCs (indirect allorecognition) |
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• Recipient T lymphs recognize processed proteins
from the donor organ expressed by recipients APCs (indirect allorecognition) |
indirect allorecognition
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• Recipient T lymphs recognize foreign HLA within the
transplant |
(direct allorecognition
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Thought to perhaps be repair response to early
post‐transplant injury, especially acute rejection |
Chronic Allograft Nephropathy
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Chronic Allograft Nephropathy
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Thought to perhaps be repair response to early post‐transplant injury, especially acute rejection
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• Subtle on‐going immune attack
• Drug toxicity • Hypertension |
Chronic Allograft Nephropathy
Thought to perhaps be repair response to early post‐transplant injury, especially acute rejection |
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Chronic Allograft Nephropathy
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control hypertension, protein
restriction, change immunosuppression, other drugs |
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Calcineurin‐inhibitor Toxicity
• Produces intense |
vasoconstriction in preglomerular
arterioles at high doses |
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Calcineurin‐inhibitor Toxicity
• Produces intense vasoconstriction in preglomerular arterioles at high doses leading to |
• Leads to acute drop in GFR
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