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9 Cards in this Set

  • Front
  • Back

What are HLA molecules and where are the individual subclasses found?

Polymorphic surface antigens.



Class I - A, B, Cw - present on most cells



Class II - DR, DP, DQ - present on B cells and activated/injured other cells

Name 3 sensitising events for HLA antibodies?

Pregnancy


Blood transfusion


Previous transplants

How is crossmatch tested?


• White cells from donor added to serum
of recipients
• Complement added
• Cell membrane destroyed if antibody
binds to antigen

What are options for non-compatible transplants?

Desensitisation: ABOi
– Plasma exchange/immunoabsorption
– IVIg

What induction drugs are used for immunosuppression?

IL-2 inhibitors: Basiliximab i.e. Simulect - stops T cells replication and activation of B cell


Antithymocyte globin - large reduction circulation T cells via cell lysis

What maintenance drugs are used for immunosuppression?

Steroids: suppressed cell-mediated immunity inhibiting cytokines and TNF


Azathioprine: prevents clonal proliferation T and B lymphocytes via blocking purine synthesis, or give MMF - competitive inhibitor IMPDH - inhibit guanosine synthesis - inhibit T and B cell


Cyclosporin/Tacrolimus - calcineurin inhibitors - reduced function of T cells


Rapamycin - mTOR inhibitor: interferes with signal transduction and lymphocyte clonal proliferation.

What are some surgical complications of renal transplantation?

– Bleeding
– Arterial/venous thrombosis
– Urinary leak
– Incisional hernia
– Collections

What are some medical complications of renal transplantation?


– Infections: viral (CMV,BK), bacterial (urine,chest), fungal (candida), protozoan
(pneumocystis)
– Cardiovascular disease, HTN, PE, DVT
– NODAT (new onset of diabetes drugs induced)
– osteoporosis
– Gastritis and gastric ulcer
– Hypertricosis, gum hyperplasia
– De novo cancer (skin, PTLD)

What are transplant specific complications of renal transplantation?

– Rejection (cellular, anti-body mediated)
– Primary non function