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Organ Transplantation, Immunology and Rejection

Organ Transplantation, Immunology and Rejection

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Published by: 2012 on Mar 18, 2009
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08/31/2010

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Organ Transplantation, Immunology and Rejection
OS 214: Excretory System
Dr. Dennis Serrano
Exam #2
March 17, 2009 | Tuesday
Page 1 of 2Cielo
Co
Collantes
Concepcion
 
OUTLINEI.Intoduction to Organ TransplantationII.Intoduction to Transplant
PART 1.
Six organs maybe transplanted:
Kidney 
Heart 
Pancreas
Lung 
Liver 
Small intestine
Development of Organ Transplantation
Replacement of tissue with artificial parts.
Dates back several hundred years ago
o
Chinese drawing: heart being taken or replaced
o
Cosmos and Damien (Patron Saints of Transplantation) with angels in the background:replacing a leg
o
1950s: First successful transplant (kidney) onidentical twins.
Sir then showed a picture of a healthy kidney with theureter vein and artery resting on the iliac area. Sabi niya, hindi tinatanggal yung lumang kidneys pag nagtratransplant, dinadagdagan yung kidney,nilalagay ung bago sa iliac area. Thus, 3 na yung kidney nung pasyente :p
Tapos picture naman ng kidney na nireject, nagging kulay violet na at ayon sa 2011, thrombosed na daw.
Organs are harvested en bloc from cadaver donors.
Rules of Tissue Transfer 
Blood Type
Donor Blood TypeRecipient Blood TypeSafetyO*non-OsafeRh-Rh+safeRh+Rh-safeAnon-AdangerousBnon-BdangerousAB**non-ABdangerous
*Universal Donor; **Universal Recipient 
Human Leukocyte Antigen (HLA)
Gene found in chromosome 6 that is important intransplantation.
There are 6 loci, but for organ transplantation, onlyHLA-A, HLA-B, and HLA-DR matter. (we have 2 of each, therefore, 6 ang minamatch)
Blood type must match first before proceeding to HLAmatching.
The number of matches/mismatches predict theprobability of transplant success.
o
Best: 0 mismatch (6 match)
o
Worst: 6 mismatch (0 match)
However, pwede pa rin magtransplant kahit na 6 mismatch, mas-iiimmunosuppress lang.
HLA-DR is most predictive of rejection (
kung nagmatch ang isang HLA-DR sa isang donor, kahit meron pang donor na nagmatch ung HLA-A at HLA-B, un pa ring may match ng HLA-DR ang pipiliin).Cross-matching 
A test for identification of antibody in the serum of potential recipients which reacts directly with thelymphocytes or other cells of a potential donor 
A positive crossmatch is an absolute contraindicationto transplantation
Other Considerations
Patient’s immune status (no transplants for AIDSpatients)
Co-morbidities
What Leads to Rejection
Recognition of foreign antigen (donor organ)
Activation and proliferation of antigen specificlymphocyte
Damage to donor organ by antibodies.
What to do to prevent rejection
1960s: whole body irradiation (not done today)
o
Prevents acute rejection, but not delayed.Patients body eventually recovers andmanufactures antibodies.
Drugs – immunosuppressants; anti-thymus globulins
o
Human T lymphocytes in thymus injected into thehorse / rabbit
o
Antibodies against human T lymphocytes aredeveloped
o
Antibodies are injected to the recipient, where Tlymphocytes of the recipient will be killed
Organ Donation
In some countries, brain dead = organ donor.
Here in the Philippines, there are donor cards. (
Back of driver’s license
, etc)
Brain Death Criteria
Deep Coma
No breathing
No movement (except DTRs)
No brainstem reflexes
o
No papillary light reflex
o
No blinking
o
No eye movement
o
No grimacing
o
No gagging or coughing
Body temp > 32.2
0
C
A condition that can cause brain death must beestablished
No depressant drugs in blood/ urine
*
Bedside diagnosis; transplant surgeon cannot proclaim braindeath.
Criteria of Organ Donation
OrganAgeLimitCompatibility*ABOHLACrossmatchMaximaltissueischemiaCornea65---72 hrs.Kidney65-70+++72 hrs.Pancreas15-50+++24 hrs.

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