66 Questions
Which grade of cardiac allograft rejection is characterized by diffuse infiltrate with multifocal myocyte damage and may present with edema, hemorrhage, and vasculitis?
Grade 3R
What is the gold standard for diagnosing cardiac allograft rejection?
Endomyocardial biopsy
Which cells are predominantly involved in acute cellular rejection?
All of the above
What is the main mechanism of injury in antibody-mediated cardiac rejection?
Activation of classical complement pathway
When does antibody-mediated cardiac rejection typically occur after transplantation?
Within the first month
Which patients are at greater risk for developing antibody-mediated cardiac rejection?
All of the above
What is the treatment for antibody-mediated cardiac rejection?
All of the above
What does asymptomatic antibody-mediated rejection may portend a higher risk of developing?
Chronic rejection
What are the histologic features of antibody-mediated cardiac rejection?
All of the below
What are the clinical manifestations of antibody-mediated cardiac rejection?
Decreased CO and hypotension
Which type of rejection primarily targets the cardiac myocyte?
Acute (cellular) rejection
Which type of rejection is characterized by immune complex formation in small vessels, often in the absence of inflammation?
Antibody-mediated rejection
Which type of rejection primarily targets the endothelial cells of the epicardial coronary arteries?
Chronic rejection (graft vasculopathy)
Which type of rejection is caused by pre-formed antibodies in a presensitized patient?
Hyperacute rejection
When does acute (cellular) rejection typically develop after a transplant?
Within weeks to months
What is the most common form of rejection?
Chronic rejection (graft vasculopathy)
What is the gold standard procedure for assessing cardiac rejection?
Surveillance Endomyocardial biopsy
Where are most biopsies performed through for surveillance endomyocardial biopsy?
Subclavian veins, tissue samples taken from the right ventricle.
When are frequent biopsies typically performed during the patient follow-up?
During the first month
What is the main cause of graft failure after 1 year?
Chronic rejection (graft vasculopathy)
Which grade of cardiac allograft rejection is characterized by diffuse infiltrate with multifocal myocyte damage and may present with edema, hemorrhage, and vasculitis?
Grade 3R
What grade has no histopathologic findings?
Grade 0R
Which grade of cardiac allograft rejection is characterized by interstitial and/or perivascular infiltrate with up to 1 focus of myocyte damage?
Grade 1R
What is the histopathologic finding in Grade 2R of cardiac allograft rejection?
Two or more foci of infiltrate with associated myocyte damage
What is the histopathologic finding in Grade 3R of cardiac allograft rejection?
Diffuse infiltrate with multifocal myocyte damage and may present with edema, hemorrhage, and vasculitis
Which type of rejection primarily targets the endothelial cells by complement-mediated pathways and is classically devoid of significant lymphocytic response?
Antibody-mediated cardiac rejection
What is the main mechanism of injury in antibody-mediated cardiac rejection?
Damage to the endothelium
Which grade of cardiac allograft rejection is characterized by diffuse infiltrate with multifocal myocyte damage and may present with edema, hemorrhage, and vasculitis?
Grade 3R
What is the gold standard for diagnosing cardiac allograft rejection?
Endomyocardial biopsies
What are the clinical manifestations of cardiac allograft vasculopathy?
CHF, ventricular arrhythmias, sudden death
What are the histologic features of cardiac allograft vasculopathy?
Lymphocyte and macrophage infiltration
What is the main cause of graft failure after 1 year?
Chronic rejection
Which type of rejection is caused by a pre sensitized patient with antibodies agent the transplant antigens, typically the endothelium?
Hyperacute rejection
Which type of rejection is characterized by diffuse intimal hyperplastic lesions that compromise vascular flow and cause ischemia that develops months to years after transplantation?
Cardiac allograft vasculopathy
What is the main limitation of long-term success of heart transplantation, with close epidemiologic relation to graft failure and post-transplant lymphoproliferative disease?
Cardiac allograft vasculopathy
What is the most important cause of death after 1 year of heart transplantation?
Cardiac allograft vasculopathy
What is the grade of rejection characterized by diffuse infiltrate with multifocal myocyte damage and may present with edema, hemorrhage, and vasculitis?
Grade 3R
What is the gold standard for diagnosing cardiac allograft rejection?
Endomyocardial biopsy
What is the histopathologic finding in Grade 1R of cardiac allograft rejection?
Mononuclear infiltrate
What is the main mechanism of injury in antibody-mediated cardiac rejection?
Formation of immune complexes in small vessels
When does acute (cellular) rejection typically develop after a heart transplant?
Within days to weeks
Where are most biopsies performed for surveillance endomyocardial biopsy?
Right ventricle
Which cells are part of the innate immunity in host defense against microbes?
NK cells and macrophages
What is the role of cytokines in the activation of vascular smooth muscle cells?
They elicit activation of smooth muscle cells
Which infection is listed as a risk factor for graft failure?
Cytomegalovirus
What are the risk factors for graft vessel injuries in cardiac allograft vasculopathy (CAV)?
Ischemia/reperfusion injury
Which type of rejection is characterized by acute fibrinoid necrosis of vessel walls and occlusion of lumens by precipitated fibrin and cellular debris?
Hyperacute rejection
What is the primary diagnostic tool for cardiac allograft vasculopathy?
Intravascular ultrasound
What is the main mechanism of injury in cardiac allograft vasculopathy?
Indirect allorecognition pathway of cell-mediated response
What is the morphologic result of cardiac allograft vasculopathy?
Accelerated atherosclerosis and concentric intimal thickening
What is the main cause of Coronary Artery Transplant Vasculopathy (CAV)?
Chronic immune response of the recipient to the donor vasculature
What is the primary site of involvement in cardiac allograft vasculopathy?
Arteries (epicardial and smaller branches)
What is the histopathologic finding in Grade 2R of cardiac allograft rejection?
Interstitial and/or perivascular infiltrate with up to 1 focus of myocyte damage
Which of the following is NOT a risk factor for atherosclerosis?
Alloresponse
Which type of vasculopathy is characterized by concentric intimal hyperplasia composed predominantly of smooth muscle cells and their associated extracellular matrix?
Coronary artery transplant vasculopathy (CAV)
Which type of vasculopathy can involve the entire arterial tree within a transplanted organ?
Coronary artery transplant vasculopathy (CAV)
Which type of vasculopathy typically takes several years to become clinically significant?
Atherosclerosis
Which type of vasculopathy becomes clinically significant in 50% of patients within 5 years after transplantation?
Coronary artery transplant vasculopathy (CAV)
Which cells are damaged by activated recipient immune cells in coronary allograft vasculopathy?
Endothelial cells
Which type of rejection is characterized by T-cell infiltrate and moderate myocyte necrosis?
Acute rejection
Which type of vascular lesion is characteristic of atherosclerosis?
Focal and eccentric
Which type of rejection primarily targets the luminal endothelial cells?
Antibody-mediated rejection
Which type of rejection is characterized by coronary artery narrowing and pruning?
Chronic rejection
Which type of rejection is immediate and mediated by preformed antibodies to graft endothelium?
Hyperacute rejection
Which type of rejection is characterized by T-cell infiltrate and moderate myocyte necrosis?
Acute cellular rejection
Which type of rejection typically occurs within days to months after transplantation and has complement deposition?
Humoral rejection
Test your knowledge on cardiac rejection classification and immune responses with this quiz! Explore the different types of rejection, including acute (cellular) rejection and antibody-mediated rejection, and learn about the target tissue and time of onset for each category.
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