Transplantation Immunology

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Incidence is high (30%) for the first 90 days

Slide 17

Acute Rejection

T-cell, macrophage and Ab mediated,

myocyte and endothelial damage,

Inflammation

Slide 18

Chronic Rejection

Occurs in most solid organ transplants

Heart

Kidney

Lung

Liver

Characterized by fibrosis and vascular abnormalities with loss of graft function over a prolonged period.

Slide 19

Chronic Rejection

Macrophage – T cell mediated

Concentric medial hyperplasia

Chronic DTH reaction

Slide 20

Tissue and Organ Transplantation

Today it is possible to transplant many different organs and tissues including.

Most common transplantation is blood transfusion.

Bone Marrow transplantation

Organs : Heart, kidneys, pancrease, lungs, liver and intestines.

Tissues : include bones, corneas, skin, heart values, veins, cartilage and other connective tissues.

Slide 21

Most Common Transplantation -Blood Transfusion-

Transfuse

Not transfused

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Bone Marrow Transplantation

Used for Leukemia, Anemia and immunodeficiency, especially severe combined immunodeficiency (SCID).

About 109 cells per kilogram of host body weight, is injected intravenously into the recipients.

Recipient of a bone marrow transplant is immunologically suppressed before grafting.

Eg. Leukemia patients are often treated with cyclo-phosphamide and total body irradiation to kill all cancerous cells.

Because the donor bone marrow contains immunocompetent cells, the graft may reject the host, causing graft versus host disease (GVHD).

Slide 23

Graft vs. Host Disease

Caused by the reaction of grafted mature T-cells in the marrow inoculum with alloantigens of the host

Acute GVHD

Characterized by epithelial cell death in the skin, GI tract, and liver

Chronic GVHD

Characterized by atrophy and fibrosis of one or more of these same target organs as well as the lungs

Slide 24

Heart Transplantation :

First heart transplant in South Africa by Dr. Christian Barnard in 1964.

One year survival rate is >80%.

HLA matching is desirable but not often possible, because of the limited supply of heart and the urgency of the procedure.