Organ Transplantation

-transplant of an organ or tissue from one individual to another of the same species with a different genotype

-transplant between individuals of different species

What is the leading cause of Death With a Functioning Graft (DFWG)?

a) diabetes

b) hypertension

c) cancer

d) CVD

_______ and ________ are two major barrier to successful organ transplantation.

Which HLA matching system is most used?

a) 6 match

b) 10 match

c) 4 match

d) 3 mathc

-is used to treat patients with hematological malignancies, such as non-Hodgkin’s lymphoma and to reconstitute hematopoiesis following high-dose chemotherapy.

What is the ultimate goal of Hematopoietic Stem Cell Transplantation (HSCT)?

What is Myeloablative conditioning?

-cell surface protein found on stem cells that functions as an adhesion molecule to keep stem cells attached to bone marrow

Plerixafor MOA?

Plerixafor is used in combination with ________ to mobilize hematopoietic stem cells for transplantation in patients with ______ &________.

Which cytokine is responsible for activating T-cells?

a) IL-2

b) IL-4

c) IL-10

d) all of the above.

-Occurs within minutes to days of transplantation, is due to preformed IgG antibodies in the recipient that react against antigens in the transplanted organ

-occurs most frequently in the first 6 months after transplantation when immune cells infiltrate the allograft and cause tissue destruction.

-allograft function slowly deteriorates and there is histologic evidence of fibrosis, progressive hypertrophy, and eventual failure of organ transplant.

Which form of rejection is a "B-Cell issue"?

a) hyperacute

b) acute

c) chronic

d) both a & b

Which form of rejection is a mainly mediated by T-cells?

a) hyperacute

b) acute

c) chronic

d) both a & b

Which form of treatment is best to treat Acute rejection?

a) immunosuppressive induction

b) immunosuppressive maintenance

Which form of treatment is best to treat Chronic rejection?

a) immunosuppressive induction

b) immunosuppressive maintenance

-the goal of this therapy type is to greatly reduce the immune system for 2 weeks post-transplant to reduce hyperacute and acute rejection.

-the goal of this therapy is to reduce the immune system's ability to recognize and reject the foreign organ or tissue, while limiting toxicity.

Which therapy is tailored to the individual patient to provide lifelong suppression of the immune system?

a) immunosuppressive induction

b) immunosuppressive maintenance

-the most common underlying long-term cause of allograft loss.

_________ occurs in 50% of renal transplant patients and is responsible for approximately 35% of graft patients.

Explain the T-cell activation cycle.

_______ stimulation of IL-2 results in cell proliferation by a pathway involving ________.

What are our classes of Induction agents (2)?

-purified IgG –based polyclonals obtained by immunization of rabbits with human thymocytes (T-cells).

-most common induction agent used in the United States.

Basiliximab is used in conjunction with _______ and _________.

_________ is not as an effective immunosuppressant but is less toxic than _______.

-IL-2 receptor antagonist

________ is most commonly used in patients at low risk for acute rejection.

a) Basiliximab

b) Thymoglobulin

c) Calcinuerin inhibitors

d) Everolimus

e) Sirolimus

The combined used of CNIs and ______ should be avoided because of risk of nephrotoxicity in early post-transplant period.

a) Basiliximab

b) Thymoglobulin

c) Calcinuerin inhibitors

d) Everolimus

e) Sirolimus

Which immunosuppressants have a narrow Therapeutic Index?

a) Basiliximab

b) Thymoglobulin

c) Calcinuerin inhibitors

d) Everolimus

e) Sirolimus

f) Belatacept

_______ has improved solubility, greater bioavailability, and shorter half life than ________.

Long-term use of Calcinuerin inhibitors (CNI) can cause what? (5)

-suppress the immune system by preventing IL-2 production in T-cells

Tacrolimus is contraindicated with ________ and patients should avoid ________.

Tacrolimus extended-release tablets are safe to be substituted for capsules and granules. T/F?

Mycophenolate mofitil MOA?

Which immunosuppressant is a decoy receptor that interferes with APC CD 80/86 interactions?

a) Basiliximab

b) Thymoglobulin

c) Calcinuerin inhibitors

d) Everolimus

e) Sirolimus

f) Belatacept

Which medication can cause Post-transplant lymphoproliferative disorder in the CNS?

a) Basiliximab

b) Thymoglobulin

c) Calcinuerin inhibitors

d) Everolimus

e) Sirolimus

f) Belatacept

Patients without immunity to _________ can not take Belatacept.

Subsequent warm re-perfusion of grafts causes _______ to be produced which further promote cell damage.

-the need for dialysis within one week after renal transplantation caused by ischemia/re-perfusion injury

What are the prodrugs of Carbon Monoxide that can prevent Ischemia/re-perfusion injuries and graft rejection?