Graft vs host disease: is mediated by T cells.
- Due to pre-formed antibodies
- (Avoid by not transplanting when cross-match is positive)
- 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
- Blocks purine synthesis to decrease T and B cell proliferation.
- Inhibits mRNA encoding IL-2
- Rotamase inhibitor
- 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