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[h] Microbiology & Antimicrobials Flashcards

[i] Master this session in just 5 minutes.

[q] Which type of graft rejection?

Onset: Within minutes.

Pathogenesis:
– It is an antibody-mediated reaction that is caused by preformed antibodies (type II hypersensitivity reaction) within the recipient that are directed against donor antigens and activate complement.

– Classically, this form of transplant rejection is diagnosed by the surgeon in the operating room because upon anastomosis of the donor and recipient blood vessels and initial perfusion of the organ, the organ immediately becomes cyanotic and mottled.

– Blood flow through the new organ ceases immediately due to fibrinoid necrosis of the small vessels of the organ in addition to the rapid formation of extensive thrombosis within the transplanted organ.

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[q] Which type of graft rejection?

Occurs one to four weeks following transplant and the histopathology showing a dense infiltrate of mononuclear cells.

Occurs in approximately 2 of every 5 hearts transplanted and in the large majority of cases occurs by the cell-mediated pathway. In rare cases due to anti-donor host antibodies.

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[q] Which type of graft rejection?

Onset: Months to years.

Pathogenesis:
– CD4+ T cells respond to recipient APCs presenting donor peptides, including allogeneic MHC.

– Recipient T cells react and secrete cytokines that induces proliferation of vascular smooth muscle and parenchymal fibrosis and causes an obliterative intimal smooth muscle hypertrophy and fibrosis of cortical arteries (obliterative vascular fibrosis).

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[q] Which type of graft rejection?

Onset: Varies.

Pathogenesis:
– Occurs after allogeneic bone marrow transplantation, transplantation of organs rich in lymphocytes (such as liver), or transfusion of non-irradiated blood.

– Recipient present with  maculopapular rash, jaundice, diarrhea, hepatosplenomegaly.

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[q] ………. binds cyclophilin and acts as Calcineurin inhibitor. Clinical uses include Psoriasis and rheumatoid arthritis. Cause Nephrotoxicity, hypertension, hyperlipidemia, neurotoxicity, gingival hyperplasia, and hirsutism.

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[q] ……… binds FK506 binding protein (FKBP) and acts as Calcineurin inhibitor. Clinical uses include Transplant rejection prophylaxis. Cause nephrotoxicity but no gingival hyperplasia or hirsutism.

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[q] ……. binds FKBP and acts as mTOR inhibitor. Clinical uses include Kidney transplant rejection prophylaxis and Also used in drug-eluting stents. Cause pancytopenia, insulin resistance, and hyperlipidemia as side effects.

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[q] …….. is a monoclonal antibodies that block IL-2R. Clinical uses include Kidney transplant rejection prophylaxis. Cause Edema, hypertension, tremor as side effects.

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[q] …….. is Antimetabolite that inhibits lymphocyte proliferation by blocking nucleotide Synthesis. Cause Pancytopenia as a side effect. Toxicity ↑ by allopurinol.

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[q] ………. reversibly inhibits IMP dehydrogenase, preventing purine synthesis of B and T cells. Clinical uses include Lupus nephritis. Cause Pancytopenia as a side effect.

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[q] ……… inhibit NF-κB and Suppress both B- and T-cell function by ↓ transcription of many cytokines. Can cause iatrogenic Cushing syndrome.

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[q] ………. is IL-2 that is currently used as immunotherapy for metastatic melanoma and renal cell carcinoma.

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