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


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

Mycophenolate (cellcept):

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


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


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

Prendisone: Blocks IL-1 from macrophages


  • 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

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