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Graft vs host disease: is mediated by T cells.


Hyperacute rejection:

  • Due to pre-formed antibodies
  • (Avoid by not transplanting when cross-match is positive)


Acute rejection:

  • Due to foreign MHC antigens of graft cells.
  • Bx shows lymphocytic infiltrate
  • Tx w/OKT3


Chronic rejection: gradual loss of blood supply. No treatment


Immunosuppression: is largely cellular and not humoral system, therefore viral risk > bacterial


See increase CA: (skin, leukemia, lymphoma, cervical)


CMV is #1 virus post-transplant


EBV: Virus responsible for post-transplant lymphoma


Azathioprine:

  • 6MP derivative
  • Purine analog that acts as an antimetabolite
  • Decreases DNA synthesis


Mycophenolate (cellcept):

  • Blocks purine synthesis to decrease T and B cell proliferation.


Cyclosporine:

  • Inhibits mRNA encoding IL-2
  • Rotamase inhibitor
  • Nephrotoxic


FK506:

  • More potent than Cyclosporine
  • Blocks IL-2 expression/production from T cells.


Prendisone: Blocks IL-1 from macrophages


OKT3:

  • Monoclonal antibody, used to treat rejection


Biliary stricture post liver transplant?

  • Check hepatic artery flow, may be due to ischemia


#1 cause of oliguria s/p renal transplant is ATN


Cardiac transplant: 84% 1-year survival


Liver transplant: 70% 1-year graft survival

Pages in category "Transplant"

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