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Transcript
TRANSPLANTATION & tissue rejection Organ transplantation: Is the moving of an organ from one body to another for the purpose of replacing the recipient's damaged or failing organ with a working one from the donor site. Organ donors can be living or deceased Organs that can be transplanted: the heart, kidneys, liver, lungs, pancreas, eyes and intestine. Tissues that can be transplanted: bones, tendons, cornea, heart valves, veins, and skin Types of transplants 1.Autograft • Transplant of tissue to the same person. e.g. skin, vein, stem cells 2.Allograft: • Transplant of an organ or tissue between two genetically nonidentical members of the same species • Most human tissue and organ transplants are allografts 3.Isograft: (Syngeneic) • A subset of allografts from a donor to a genetically identical recipient (e.g. identical twin). • Isografts don't trigger an immune response. 4.Xenograft: • A transplant of organs or tissue from one species to another • e.g. porcine heart valve transplants Immunologic Basis of Allograft Rejection Grafts rejection Is a kind of specific immune response to the organ which causes failure of the transplant – Specificity – Immune memory Transplantation antigens: I. Major histocompatibility antigens (MHC molecules) II. Minor histocompatibility antigens III. Other alloantigens I. Major histocompatibility antigens (MHC molecules) • Main antigens of grafts rejection • Cause fast and strong rejection • Difference of HLA types is the main cause of human grafts rejection II. Minor histocompatibility antigens • Also cause grafts rejection, but slow and weak III. Other alloantigens • • ABO blood group antigens Some tissue specific antigens: – Skin, kidney, heart, pancreas ,liver – VEC (vascular endothelial cell) antigens Mechanism of allograft rejection 1. Cell-mediated Immunity 2. Humoral Immunity 3. Role of NK cells Cell-mediated Immunity • T cell-mediated cellular immune response against alloantigens on grafts • T cells of the recipient recognize the allogeneic MHC molecules i.e. uptake and presentation of allogeneic donor MHC molecules by recipient APCs • activated CD4+T cells MΦ activation and recruitment • Activated CD8+T cells Kill the graft cells Humoral immunity • Important role in hyperacute rejection - Complements activation - ADCC - Opsonization Role of NK cells • mediators secreted by activated Th cells can promote NK activation Classification of Allograft Rejection 1. Host versus graft reaction (HVGR) Conventional organ transplantation 2. Graft versus host reaction (GVHR) Bone marrow transplantation Host versus graft reaction (HVGR) 1. Hyperacute rejection 2. Acute rejection 3. Chronic rejection Hyperacute rejection Occurs within minutes to hours after host blood vessels are anastomosed to graft vessels Pathology: • Thrombotic occlusion of the graft vasculature • Ischemia, denaturation, necrosis Mechanisms: • • • • • Antibody against ABO blood type antigen Antibody against VEC antigen Antibody against HLA antigen Complement activationEndothelial cell damage Platelets activation Thrombosis, vascular occlusion, ischemic damage Acute rejection Occurs within days to 2 weeks after transplantation, 8090% of cases occur within 1 month Pathology • Acute humoral rejection: Acute vasculitis manifested mainly by endothelial cell damage • Acute cellular rejection: Parenchymal cell necrosis along with infiltration of lymphocytes and MΦ Mechanisms • Vasculitis: IgG antibodies against alloantigens on endothelial cell • Parenchymal cell damage o Delayed hypersensitivity mediated by CD4+Th1 o Killing of graft cells by CD8+Tc Chronic rejection Develops months or years after acute rejection reactions have subsided Pathology • Fibrosis and vascular abnormalities with loss of graft function Mechanisms • • • • Not clear Extension and results of cell necrosis in acute rejection Chronic inflammation mediated by CD4+T cell/MΦ Organ degeneration induced by non immune factors Graft versus host reaction (GVHR) • Graft versus host reaction (GVHR) – Allogeneic bone marrow transplantation. – Rejection to host alloantigens. – Mediated by immune competent cells in bone marrow. • Graft versus host disease (GVHD) – A disease caused by GVHR, which can damage the host. – Acute GVHD – Chronic GVHD • Conditions - Enough immune competent cells in grafts. - Immunocompromised host. - Histocompatability differences between host and graft. 1. Acute GVHD • Endothelial cell death in the skin, liver, and gastrointestinal tract • Rash, jaundice, diarrhea, gastrointestinal hemorrhage • Mediated by mature T cells in the grafts 2. Chronic GVHD • Fibrosis and atrophy of one or more of the organs • Eventually complete dysfunction of the affected organ Both acute and chronic GVHD are commonly treated with intense immunosuppresion Prevention and Therapy of Allograft Rejection 1. Tissue Typing • ABO and Rh blood typing • HLA typing (HLA-A and HLA-BHLA-DR) • Screening of the recipient for anti-HLA antibodies (also called antibody screening) • Lymphocyte cross matching (also called compatibility testing) 2. Immunosuppressive Therapy • Corticosteroids: block the synthesis and secretion of cytokines • Azathioprine, Cyclophosphamide: block the proliferation of lymphocytes.