Immune Response and Transplant

T-cells mature in the

thymus

B-cells mature in the

bone marrow

neutropenic precautions goal

protect immunocompromised patients

if infection is possible, physically assess

lymph nodes

If spleen is not present in body,

it makes the body more susceptible to infection

Functions of the immune system

• can recognize any foreign body

• helps clean up damage within the body

• monitors for abnormal cells

innate immunity

• Born with it

• responds quick

• unable to respond to a new exposure

acquired immunity

• learned immunity

• adapted

• develops after exposure

ACTIVE immunity

your body makes the antibodies; the body does the work and develops memory

PASSIVE immunity

• you receive antibodies

• antibodies were made elsewhere and given to you

• short-lived

central lymphoid organs

• thymus gland

• bone marrow

peripheral lymphoid organs

• lymph nodes

• spleen

• tonsils

• associated lymphoid tissues

The lymph nodes are…

where immune response happens and filters foreign materials the body comes in contact with and will circulate lymphocytes in the body

the spleen is the…

primary filtration site for foreign cells

What cell (t or b) is apart of the adaptive immune system

t-cells

helper t-cells

• organize the immune response

• releases cytokines to initiate the immune response

cytotoxic t-cells

• help recognize cells as foreign and attempts to directly attack them!!!

Regulatory T-cells

help control the immune system to ensure it doesn’t become excessive

memory t-cells

remember specific antigens

an antigen is

a target on a cell

an antibody is

specifically fit to a target antigen

memory b-cells remember

antigens

b-cell activation when coming in contact with an antigen

• An antigen triggers a B cell to activate, turn into a plasma cell that makes antibodies, and create memory cells for future protection

• Antigen: A foreign substance, like a virus or bacteria, enters the body.

• B-cell: A white blood cell finds and matches the antigen using its surface receptors.

• Plasma Cell: The activated B cell turns into a factory cell that pumps out large amounts of antibodies.

• Antibody: Specialized proteins attach to the antigen to neutralize or mark it for destruction.

• Memory: Some activated B cells become long-lived memory cells that stay in the body to recognize the same antigen quickly if it returns

plasma cells

• The activated B cell turns into a factory cell that pumps out large amounts of antibodies.

• 
  

IgG immunoglobulins

• long-term protection

• most abundant in blood

• can cross placenta

• needed for long-term immunity

IgM

• first responder

• the first antibody made during a new infection; highly effective at activating the early immune response

IgA immunoglobulins

• secretion

• helps protect mucous membranes, respiratory secretions, saliva, tears- where pathogens may enter the body

• also found in breastmilk

IgE immunoglobulins

• allergies

• for allergic reactions, hypersensitivity reactions, and some pathogens

IgD immunoglobulins

• b-cell receptors

• only on b-cell lymphocytes- for b-cell activations

Hypersensitivity reactions: Type 1

• immediate reaction

• due to allergies

• IgE-mediated

• an allergen cross-links IgE on mast cells and basophils→ release of histamine and other mediators

• anaphylaxis

Hypersensitivity reactions: type 2

• antibody-mediated (cytotoxic)

• IgG or IgM antibodies bind to antigens on cell surfaces→ complement activation, opsonization, or cell destruction

Hypersensitivity reactions: type 3

• immune complex- mediated

• Immune complexes (antigen and antibody) form in circulation → deposit in tissues → complement activation and inflammation

• allergies and inflammation

Hypersensitivity reactions: type 4

• delayed

• t-cell mediated

• sensitive t cells recognize antigen → release cytokines → recruit and activte macrophages→ tissue damage

• causes tissue damage

anaphylaxis reactions manifestations

• skin: pruritus (itching), angioedema (facial edema), urticaria (hives)

• respiratory: hoarseness, coughing, wheezing, dyspnea

• cardio: hypotension, dysrhythmias, tachycardia

• neuro: headache, dizziness, feeling of impending doom

• GI: cramping, abdominal pain, nausea, vomiting, diarrhea

recombinant position purpose

used to increase blood pressure; for hypotension

nursing interventions for anaphylaxis

• airway

• administer epinephrine

• provide high flow O2 (8-10L/min) via face mask

• IV access

  • IV meds: diphenhydramine (to stop reaction), corticosteroids (open airway and help with reaction; usually Solu-Medrol), nebulizer albuterol (bronchodilator

• Recumbent position with legs elevated- gets blood flow back to heart

• monitor vital signs, airway, respiratory effort, LOC, heart rhythm, and urinre output

  • monitor for stridor= airway is compromised

Organ transplants are needed when

an organ is failing

hospital stay post organ transplant

really fucking long

needs of every transplant patient…

immunosuppressants and continuous labs

how to get on organ transplant list

• extensive process

• dr referral to transport team

  • labs- to determine overall health, blood type, cross-match

  • counselling (mental health)

  • committee decides an applicant’s status

goal of organ transplant

• increase quality of life

• increase survival

• replace failed organ

prior to transplant, to ensure compatibility, this must occur

tissue typing (HLA typing, ABO blood typing, crossmatch)

HLA typing

• “human leukocyte antigen”

• IV tags

• antigens on surface of cell

cross match

• checks blood type

• +: antigens don’t match completely

  • high risk of rejection

biggest worry of transplants

organ rejection

goal of organ matching

• ensure there is no rejection

• increased compatibility decreases the likely to reject

goal of immunosuppression with transplants

• help body not reject transplanted organ

• protect organ

if the transplanted organ is rejected,

IMS is suppressed

if there was too much immune response with a transplanted organ, it causes

rejection

if there was not enough of an immune response with a transplanted organ, it causes

an increased risk of infection (will cause infection)

possible medication issues with transplant patients

mediation toxicity

autograft

comes from the pts own body

isograft

someone with an identical twin: one twin gives graft to other twin

allograft

transplant from donor (human)

xenograft

transplant from different species

why organ rejection happens…

Immune response!!!

1. the body recognizes it as foreign

2. body activated the immune system and attacks the foreign tissue

3. ORGAN DAMAGE!!!!!

The t cells attack the transplanted organ, and the b cells make antibodies to attack the organ therefore damaging the new transplanted organ

three types of rejection

• hyperacute

• acute

• chronic

rejection type: hyperacute

• immediate response (mins to hours)

• can cause thrombosis and rapid

• non-reversible

rejection type: acute

• days to months

• IMS recognized it as foreign

• impairs organ function

• treatment: increased dose of immunosuppressants and corticosteroids

rejection type: Chronic

• slow and progressive

• occurs years after

• causes fibrosis and impairs blood flow to body

• causes vascular changes to organ, no blood/oxygen is getting there= organ failure

• eventually organ fails completely

Immunosuppressant med WE NEED TO KNOW and associated info

• Tacrolimus— decreases t-cell activation

  • required med level through labs

  • most common rejection med

  • no grapefruit juice

  • same time every day

  • NEVER MISS A DOSE

  • monitor kidney function, bp, electrolytes, and drug levels

  • high infection risk: practice good hand hygiene, avoid sick people, and stay up to date on vaccines (no live vaccines)

  • use sun protection

purpose of immunosupressive medications

reduce the immune response so the body does not recognize the transplanted organ “foreign” and attack

What to monitor for transplant patients

• graft function

  • urine output

  • serum creatinine, BUN

  • weight, edema

  • BP

• Labratory

  • drug levels

  • CBC

  • electrolytes

  • liver and kidney function

  • glucose, lipids

• signs of complications

  • fever, chills

  • cough, SOB

  • pain, redness, drainage

  • nausea, vomiting

  • headache, tremors, confusion

Organ rejection signs

• decreased organ rejection

• increased creatinine and BUN

• fluid overload/ edema

• increased bp

  • pain or tenderness over graft site

signs of infection to report

• fever or chills

• respiratory symptoms

• urinary symptoms

• wound changes

• GI symptoms

What transplant patients must report ASAP

• fever of greater or equal to 100.4F

• decreased urine output

• sudden weight gain

• swelling

• SOB

• pain, redness, or drainage from incision site

• n/v/d

patient education for Prevention of infection in transplant pts

• hand hygiene!!

• wear a mask in public or crowded areas

• limit exposure to sick people

• avoid large crowds

• follow food safety guidelines

• no fresh fuit or veg

• no fresh flowers

• keep vaccines up to date (no live vaccines)

• avoid gardening, soil, and cleaning litter boxes