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Immunology - Organ Transplantation + Rejections (Organ *Transplant…
Immunology - Organ Transplantation + Rejections
Organ *Transplant Rejection
Hyperacute Rejection
Acute Rejection
Chronic Rejection
*Kidney transplant rejection
HYPER ACUTE = minutes to hours
ACUTE = less than 6 months
CHRONIC = months to years
--> chronic kidney transplant rejection starts with hypertension
--> comes from OBLITERATIVE and FIBROUS thicking of the kidney parenchyma
Hyperacute Transplant Rejection
minutes to hours post transplant
"white graft rejection" in the lungs
Clinical Cases
Clinical Case
Clinical Case
Notes
:
note that
Acute Transplant Rejection
.>= 6 months post transplant
Acute rejection of heart transplant example
Notes
:
note that difference between sub acute acute and chronic are the timelines
--> subactue = minutes to hours
acute = 1 -4 weeks
chronic = greater than 6 months usually
note that in subacute you get hemorrage and necrosis
--> due to already preformed antibodies
in acute and chronic you get more cell mediated infiltration by lymphocytes
Clinical Case
Chronic Transplant Rejection
.>= 6 months post trasnplant
within 5 years of LUNG transplants 50% will have chronic rejection
Chronic lung trasnplant rejection example
Clinical Case
Notes
:
note in the case above a key finding in the presentation are the end expiratory SQUEAKS or POPS
--> this indicates chronic lung transplant rejection
chronic rejection in the lungs also shows infiltration of the small airway SUBMUCOSA
--> this presents as airway obstruction
--> on PFTs there is thus an obstructive pattern of lowered FEV1/FVC ratio
hyperacute comes from antibodies etc. to ABO and HLA
--> "white graft rejection" in the lungs
--> fibrinoid necrosis and hemorrage
acute is more cell- mediated and occurs in the small blood vessels
--> this makes sense as this is where the t cells and macrophages etc. would first exit the blood stream and into the lung tissues
key in lung rejection is find the time of rejection into the 3 different types, then that determines the location
*Organ Specific transplants
*Lung Traansplants
*Lung transplant rejection
HYPER ACUTE = minutes to hours
ACUTE = less than 6 months
CHRONIC = months to years
*Graft vs Host Transplant rejection
note that this normally happens with bone marrow transplants
but can also happen with other organs that may be rich in lymphocytes
--> liver for example
this is from T cells that get activated and then start killing the host cells
most common effected organs
--> skin
--> liver
--> GI tract
Clinical Cases
Clinical Case
Clinical Case
Notes
:
note that
*DIRTY USMLE
*Types of organ transplants
autograph
--> Auto = means self = self-graft = same person
isograft
--> iso = means equal
--> thus equal genes or DNA or from a genetically identical twin
Organ *Transplant Rejection
Hyperacute Rejection
Acute Rejection
Chronic Rejection
WEAK TEETH
4 rotting vasculits Wisdom TEETH only
--> holes in them and blood vessels
MONTHS later
get FIBROSIS FILLINGS in all 24 TEETH
--> NO meds will help
