General Transplant Principles and Supportive Care

define allograft rejection

immune response causing inflammation and direct destruction of transplanted organ

define hyperacute rejection

occurs instantly and results in graft failure

list components of the innate immune system

dendritic cells, macrophages, NK cells, neutrophils

List the components of the adaptive immune system

b cells and T cells like t helper (CD4) and T cytotoxic (CD8)

______ cells cause antibody mediated rejection

B

define acute cellular rejection

T cell mediated rejection that can occur at any time post transplant

Define antibody medulated rejection

b cell mediated rejection that can occur at any time post transplant

define chronic rejection

combo of B and T cell injuries that can occur months-years post transplant. Acute rejection is a risk for chronic rejection

rank organs in their risk of rejection. what causes risk to inc? (use <)

liver < kidneys, pancreas < heart < small bowel, lung. Risk increase with more lymphoid tissue

_____ age has lower chance of rejection

older

______ (race) have inc risk of rejection. what is a reason?

african americans because they are rapid metabolizers of tacrolimus

list agents that could be used for induction

basiliximab, ATG, alemtuzumab, and corticosteroids

explain the MOA of basiliximab

binds to alpha subunit of IL2 (CD25) on t lymphocyte

explain the MOA of basiliximab

no

Use of basiliximab

induction only

list polyclonal antibodies used for induction

rATG and eATG

ATG causes lymphocyte depletion for up to _____

3 months

list uses of ATG

induction and/or rejection treatment

ATG is infused over ______ ideally via _____

4-12 hours via central line

which induction therapies should be premedicated and with what?

ATGs and alemtuzumab with APAP, diphenhydramine, and steroids 30-60 mins before administration

List ADRs of ATGs

cytokine release syndrome, leukopenia/thrombocytopenia (dose limiting), serum sickness, and increased risk of infection and malignancies