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Questions and Answers
What is the initial mechanism that leads to hyperacute rejection?
What is the initial mechanism that leads to hyperacute rejection?
Which of the following describes acute rejection?
Which of the following describes acute rejection?
What characterizes chronic rejection of a graft?
What characterizes chronic rejection of a graft?
Which statement about the direct rejection pathway is true?
Which statement about the direct rejection pathway is true?
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What is a key factor in the mechanism of acute graft rejection?
What is a key factor in the mechanism of acute graft rejection?
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Which type of rejection occurs within 48 hours after grafting?
Which type of rejection occurs within 48 hours after grafting?
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What is the primary mechanism through which T cells cause damage to the grafted tissue?
What is the primary mechanism through which T cells cause damage to the grafted tissue?
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What condition typically indicates acute rejection in a recipient?
What condition typically indicates acute rejection in a recipient?
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In what type of recipient does hyperacute rejection occur immediately?
In what type of recipient does hyperacute rejection occur immediately?
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Which organ is specifically noted to show signs of acute rejection during evaluation?
Which organ is specifically noted to show signs of acute rejection during evaluation?
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Which of the following is a sign of chronic rejection?
Which of the following is a sign of chronic rejection?
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What common molecule triggers T cell responses during the allograft rejection process?
What common molecule triggers T cell responses during the allograft rejection process?
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Which type of rejection does NOT typically occur rapidly after grafting?
Which type of rejection does NOT typically occur rapidly after grafting?
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What type of graft occurs when tissue is moved to a different part of an animal's own body?
What type of graft occurs when tissue is moved to a different part of an animal's own body?
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Which type of graft is most frequently associated with a strong immune response due to genetic differences?
Which type of graft is most frequently associated with a strong immune response due to genetic differences?
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What is the primary reason xenografts cause the strongest immune reaction?
What is the primary reason xenografts cause the strongest immune reaction?
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What characterizes the rejection mechanism of allografts?
What characterizes the rejection mechanism of allografts?
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Which statement about grafts between genetically identical individuals is true?
Which statement about grafts between genetically identical individuals is true?
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Which of the following statements about genetic factors in graft rejection is correct?
Which of the following statements about genetic factors in graft rejection is correct?
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What type of graft represents a transplant between two genetically identical individuals?
What type of graft represents a transplant between two genetically identical individuals?
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Which strategy is commonly employed to prevent graft rejection?
Which strategy is commonly employed to prevent graft rejection?
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What is the primary goal of immunosuppressive therapy in allograft transplantation?
What is the primary goal of immunosuppressive therapy in allograft transplantation?
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Which type of drug is cyclosporine classified as?
Which type of drug is cyclosporine classified as?
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What is the role of plasmapheresis in allograft rejection prevention?
What is the role of plasmapheresis in allograft rejection prevention?
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Which of the following is an example of an anti-inflammatory drug used in allograft rejection prevention?
Which of the following is an example of an anti-inflammatory drug used in allograft rejection prevention?
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Acute Graft-Versus-Host Disease (GVHD) is primarily caused by which of the following?
Acute Graft-Versus-Host Disease (GVHD) is primarily caused by which of the following?
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In which scenario is GVHD most likely to occur?
In which scenario is GVHD most likely to occur?
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What role does ketoconazole play in the treatment of allograft rejection?
What role does ketoconazole play in the treatment of allograft rejection?
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How soon can allografts in dogs be rejected without treatment?
How soon can allografts in dogs be rejected without treatment?
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What is the primary mediator responsible for hyperacute rejection of a graft?
What is the primary mediator responsible for hyperacute rejection of a graft?
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Which mechanism distinguishes acute rejection from chronic rejection?
Which mechanism distinguishes acute rejection from chronic rejection?
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What triggers the indirect pathway of graft rejection?
What triggers the indirect pathway of graft rejection?
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Which description best matches the process of chronic rejection?
Which description best matches the process of chronic rejection?
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Which type of cells are primarily involved in the mechanism of acute graft rejection?
Which type of cells are primarily involved in the mechanism of acute graft rejection?
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What type of graft is characterized by being transplanted between genetically identical individuals?
What type of graft is characterized by being transplanted between genetically identical individuals?
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Which type of graft typically triggers the strongest immune reaction?
Which type of graft typically triggers the strongest immune reaction?
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Which statement accurately describes the immune response to allografts?
Which statement accurately describes the immune response to allografts?
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What genetic principle explains why offspring do not reject grafts from either parent?
What genetic principle explains why offspring do not reject grafts from either parent?
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What is the primary reason that grafts between genetically non-identical individuals are always rejected?
What is the primary reason that grafts between genetically non-identical individuals are always rejected?
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What mechanism is primarily involved in the destruction of allograft tissue?
What mechanism is primarily involved in the destruction of allograft tissue?
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Which type of graft is an example of tissue transplanted to a different part of an animal’s own body?
Which type of graft is an example of tissue transplanted to a different part of an animal’s own body?
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Which strategy is commonly used to prevent graft rejection?
Which strategy is commonly used to prevent graft rejection?
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What triggers antibody formation in the allograft rejection process?
What triggers antibody formation in the allograft rejection process?
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Which event occurs during the acute rejection process?
Which event occurs during the acute rejection process?
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How does the rejection timeline differ in sensitized individuals compared to unsensitized individuals?
How does the rejection timeline differ in sensitized individuals compared to unsensitized individuals?
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Which symptom is commonly associated with acute rejection of a renal allograft?
Which symptom is commonly associated with acute rejection of a renal allograft?
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What typically signifies the beginning of the chronic rejection process?
What typically signifies the beginning of the chronic rejection process?
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What is the role of chemokines in the acute rejection process?
What is the role of chemokines in the acute rejection process?
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In the context of graft rejection, what are MHC molecules responsible for?
In the context of graft rejection, what are MHC molecules responsible for?
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What is a typical consequence of acute rejection in a renal allograft?
What is a typical consequence of acute rejection in a renal allograft?
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What is the primary aim of immunosuppressive therapy during allograft transplantation?
What is the primary aim of immunosuppressive therapy during allograft transplantation?
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Which class of drugs is specifically used to block T cell costimulatory pathways?
Which class of drugs is specifically used to block T cell costimulatory pathways?
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How does ketoconazole contribute to the treatment of allograft rejection in cats?
How does ketoconazole contribute to the treatment of allograft rejection in cats?
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What is a significant consequence of acute GVHD?
What is a significant consequence of acute GVHD?
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What is the effect of azathioprine and mycophenolate mofetil in preventing allograft rejection?
What is the effect of azathioprine and mycophenolate mofetil in preventing allograft rejection?
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What treatment can enhance allograft survival in dogs?
What treatment can enhance allograft survival in dogs?
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In which situation does GVHD most commonly occur?
In which situation does GVHD most commonly occur?
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Which type of drug is commonly used to prevent allograft rejection in dogs?
Which type of drug is commonly used to prevent allograft rejection in dogs?
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What primarily mediates hyperacute rejection?
What primarily mediates hyperacute rejection?
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Which process is primarily responsible for acute rejection damage to the graft?
Which process is primarily responsible for acute rejection damage to the graft?
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Why does chronic rejection lead to graft failure?
Why does chronic rejection lead to graft failure?
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What type of lymphocyte response is involved in the direct pathway of graft rejection?
What type of lymphocyte response is involved in the direct pathway of graft rejection?
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What characteristic defines acute cellular rejection compared to hyperacute rejection?
What characteristic defines acute cellular rejection compared to hyperacute rejection?
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What is one potential consequence of acute rejection affecting the grafted organ?
What is one potential consequence of acute rejection affecting the grafted organ?
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What characterizes hyperacute rejection in allograft patients?
What characterizes hyperacute rejection in allograft patients?
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Which factor is critical in the development of chronic rejection over time?
Which factor is critical in the development of chronic rejection over time?
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What role do MHC molecules play in the rejection process of allografts?
What role do MHC molecules play in the rejection process of allografts?
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Which clinical manifestation is indicative of acute rejection in a kidney transplant recipient?
Which clinical manifestation is indicative of acute rejection in a kidney transplant recipient?
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What is one of the primary mechanisms causing thrombosis in the acute rejection process?
What is one of the primary mechanisms causing thrombosis in the acute rejection process?
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In sensitized individuals, which response is expected upon receiving an allograft?
In sensitized individuals, which response is expected upon receiving an allograft?
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Which type of immune cells specifically mediate the rejection process of graft tissues?
Which type of immune cells specifically mediate the rejection process of graft tissues?
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Which type of graft is characterized by transplants between genetically different individuals of the same species?
Which type of graft is characterized by transplants between genetically different individuals of the same species?
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What is the primary reason why xenografts elicit a stronger immune response than allografts?
What is the primary reason why xenografts elicit a stronger immune response than allografts?
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Which of the following statements regarding the immune response in graft rejection is true?
Which of the following statements regarding the immune response in graft rejection is true?
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What is the main aim of immunosuppressive therapy in preventing allograft rejection?
What is the main aim of immunosuppressive therapy in preventing allograft rejection?
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Which drug is an example of an inhibitor of T cell signaling pathways?
Which drug is an example of an inhibitor of T cell signaling pathways?
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What typically describes the outcome when grafts are transplanted between genetically identical individuals?
What typically describes the outcome when grafts are transplanted between genetically identical individuals?
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What is the best description of an autograft?
What is the best description of an autograft?
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Which strategy directly targets alloreactive B cells?
Which strategy directly targets alloreactive B cells?
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What type of immunosuppression strategy is azathioprine classified as?
What type of immunosuppression strategy is azathioprine classified as?
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What condition typically allows for the development of Graft-Versus-Host Disease (GVHD)?
What condition typically allows for the development of Graft-Versus-Host Disease (GVHD)?
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In what time frame can allografts in dogs be rejected without treatment?
In what time frame can allografts in dogs be rejected without treatment?
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In the context of graft rejection, what primarily causes the immune system to attack allografts?
In the context of graft rejection, what primarily causes the immune system to attack allografts?
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What role does ketoconazole play in the treatment of allograft rejection in cats?
What role does ketoconazole play in the treatment of allograft rejection in cats?
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Which of the following is a common consequence of acute GVHD?
Which of the following is a common consequence of acute GVHD?
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Study Notes
Organ Graft Rejection
- Organ grafts, like transplants, involve moving tissues or organs from one organism to another.
- The immune system's role in rejection is to identify and destroy non-self ("abnormal") cells. This is a normal immune response.
- Rejection is a reflection of the immune system's function in identifying and destroying foreign cells.
- Organ rejection is a complex process involving various cell types and immune responses from both the recipient and donor.
Types of Organ Grafts
- Autografts: Tissue moved within the same organism. This does not trigger an immune response. Examples include covering a burn with skin, or a segment of vein bypassing a blocked cardiac artery.
- Isografts: Tissue moved between genetically identical individuals. These do not provoke an immune response.
- Allografts: Tissue transplanted between genetically different members of the same species. This is the most frequent type of graft. Differences in MHC and blood group antigens trigger a strong immune response, leading to rejection. Renal allografting is now routine for dogs and cats. Bone marrow allografts are beneficial in some tumors
- Xenografts: Tissue transplanted between animals of different species. This causes the strongest immune reaction, leading to most rapid rejection. Examples include transplanting a baboon heart to a human infant. Xenografts cause faster immune response due to extreme differences.
Genetics of Graft Rejection
- Grafts between genetically identical individuals never get rejected.
- Grafts between genetically non-identical individuals always get rejected.
- Offspring of genetically different individuals will not reject grafts from either parent (though NK cells in the offspring can, often violated by bone marrow transplantation). Grafts from the offspring of two genetically different individuals will be rejected by either parent.
Allograft Rejection
- Allografted organs are major sources of foreign molecules, including blood group antigens and MHC molecules (both class I and class II).
- Rejection mechanisms are similar regardless of the tissue.
- Antibodies and T cells are involved in the rejection process. Acute rejection progresses through various stages.
Acute Rejection Process
- Grafted tissue becomes infiltrated with cytotoxic T cells, leading to progressive endothelial cell damage lining small blood vessels.
- T cell-mediated damage attracts more T cells, triggering cellular destruction, blockage of blood vessels (thrombosis), hemorrhage, and ultimately graft death.
- Repeated grafts from the same donor often trigger rapid rejection involving antibodies and complement. This is due to prior sensitization.
Clinical Renal Allograft Rejection
- Rejection can happen at any time.
- Types of rejection include hyperacute (within 48 hours), accelerated (up to 7 days), acute (after 7 days), and chronic (months after).
- Rejection in unsensitized individuals happens after at least 10 days, but immediately in sensitized individuals (hyperacute). Renal allografting is now routine for dogs and cats. Bone marrow allografts are beneficial in some tumors
Manifestations of Acute Rejection
- Recipient shows a rapidly rising blood creatinine level.
- The kidney becomes enlarged and painful.
- Signs of depression, anorexia, vomiting, proteinuria, and hematuria.
- Ultrasound shows an enlarged, hypoechoic kidney.
Signs of Chronic Rejection
- Gradually rising creatinine and urea levels.
- Proteinuria.
- Macroscopic hematuria.
- A small, hyperechoic kidney.
Pathogenesis of Allograft Rejection
- Allograft rejection targets dominant antigens on graft cells.
- MHC molecules trigger T-cell responses.
- Blood group antigens trigger antibody formation.
Two Stages of the Rejection Process
- Direct pathway: Host lymphocytes directly encounter graft antigens.
- Indirect pathway: Cytotoxic T cells and antibodies from the host enter and destroy graft cells.
Graft Rejection Pathways
- Includes direct and indirect pathways for recognition.
- Direct pathway: Direct recognition of donor MHC molecules on cells of the graft by the recipient's T cells.
- Indirect pathway: Recipient's APCs process and present peptides from donor MHC to T cells.
Mechanism of Graft Destruction (Hyperacute Rejection)
- Thrombotic occlusion of the graft vasculature, rapidly following anastomosis.
- Antibodies in the host's circulation bind to donor endothelial antigens and initiate complement activation.
Acute Rejection
- Injury is caused by multiple factors including inflammation caused by cytokines produced by T cells, CTL-mediated killing of graft cells, and the action of preexisting host antibodies which bind to donor antigens. These factors result in injury to the graft's parenchyma and blood vessels.
Chronic Rejection
- Occlusion of arteries due to intimal smooth muscle cell proliferation and subsequent ischemic damage.
Prevention of Allograft Rejection
- Minimal immunosuppression is the aim. Prevent rejection without making the receiver too susceptible to common infections.
- General strategies involve inhibiting T cell signalling pathways (e.g., cyclosporin, FK506), using antimetabolites (e.g., azathioprine, mycophenolate), and targeting alloantibodies and alloreactive B cells (e.g., plasmapheresis or anti-CD20). Anti-inflammatory drugs (e.g. corticosteroids) are used to prevent rejection. In dogs, azathioprine, leflunomide, prednisolone, and cyclosporine are used; in cats prednisone and cyclosporine. Ketoconazole can complement and prolong cyclosporine half life.
Graft-Versus-Host Disease (GVHD)
- Caused by mature T cells in the grafted bone marrow inoculum reacting against the host's alloantigens.
- Occurs when the host is immunocompromised.
- May follow total-body irradiation or cyclophosphamide treatment.
Acute GVHD
- Epithelial cell death in the skin, liver (biliary epithelium), and gastrointestinal tract, resulting in clinical signs like rash, jaundice, diarrhea, and gastrointestinal hemorrhage.
Chronic GVHD
- Characterized by fibrosis and atrophy of organs.
- No acute cell death; is often a late-stage consequence.
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