Lec6 - Emily's notes.docx

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University of Toronto St. George
Laboratory Medicine and Pathobiology

2/13/2013 8:07:00 AM T regulatory cells clinical transplantation Autograft self isograft genetically identical individual Allograft different members of the same species Shortage of graft donors waiting list patients die Living donors: liver (regenerates fast), kidney Increase the utility –harvest lung from dead donor, damaged in process Increase the utility of available organs Criteria for organ donation Brain death organ function virus infection no malignancy immunosuppression and cancer Resect cancer then transplant? Minor histocompatibility eg male to female, female can recognize Others: blood group antigens, Tissue sp Donor APC is direct Recipient APC Cd4 Acute vascular rejection or acute cellular rejection most often in clinic cells of the graft blood vessel mediated by abs to alloantigens on endothelial cells direct lysis of endothelial necrosis of parenchymal cells t cell mediated cytotoxicity immunosuppress  chronic graft failure antibody and t cell mediated fibrosis irreversible kidney allograft artery blocked near obliteration of the vessel lumen reduce immunogenicity ABO HLA matching suppress the immune response recipients w drugs induce tolerance in recipients corticosteroids side effects hyperlipidemia diabetes rapamycin cyclosporine A side effects nephrotoxicity disadvantages toxicity infection malignancy still can’t prevent chronic rejection Goals: immune competent host no maintenance immunosuppression: costs, side effects prevention of acute rejection moving towards tolerance unresponsiveness to graft but not other antigens complication free aceeptance of graft specifically to donor antigens central and peripheral tolerance wipe out bone marrow then reconstitute with donor cells recipient becomes chimera central
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