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Questions and Answers
Which virus is associated with lymphoma?
Which virus is associated with lymphoma?
- Human immunodeficiency virus
- Human herpesvirus 8
- Epstein–Barr virus (correct)
- Human papillomavirus
What is a major concern regarding organ transplantation?
What is a major concern regarding organ transplantation?
- High cost of organ transplant procedures
- Ineffective anti-rejection medications
- Shortage of organ donors (correct)
- Low survival rates of transplanted organs
Which of the following is a consequence of immunosuppression?
Which of the following is a consequence of immunosuppression?
- Reduced incidence of all types of cancer
- Increase in viral infections only
- Slight increase in common cancers not linked to viruses (correct)
- Enhanced anti-cancer surveillance
What is the main purpose of immune checkpoint inhibitors?
What is the main purpose of immune checkpoint inhibitors?
Why is non-altruistic organ donation illegal in most countries?
Why is non-altruistic organ donation illegal in most countries?
Which immune checkpoint is targeted by the drug pembrolizumab?
Which immune checkpoint is targeted by the drug pembrolizumab?
What can lead to the evasion of immune responses by cancer cells?
What can lead to the evasion of immune responses by cancer cells?
What type of cancers have shown benefit from immune checkpoint inhibitors?
What type of cancers have shown benefit from immune checkpoint inhibitors?
What is chronic allograft failure primarily associated with?
What is chronic allograft failure primarily associated with?
What does HLA typing help with in the context of transplantation?
What does HLA typing help with in the context of transplantation?
What does a positive cross-match indicate?
What does a positive cross-match indicate?
What is the role of C4d staining in post-transplant biopsy?
What is the role of C4d staining in post-transplant biopsy?
What is a major long-term complication of immunosuppressive treatment?
What is a major long-term complication of immunosuppressive treatment?
Which medication is specifically used for cytomegalovirus prophylaxis?
Which medication is specifically used for cytomegalovirus prophylaxis?
Which of the following types of vaccines is appropriate for transplant recipients?
Which of the following types of vaccines is appropriate for transplant recipients?
What factor does NOT contribute to chronic allograft failure?
What factor does NOT contribute to chronic allograft failure?
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Study Notes
Chronic Allograft Failure
- Chronic rejection leads to graft loss, characterized by vascular smooth muscle proliferation, interstitial fibrosis, and scarring.
- Pathogenesis remains poorly understood; factors include immunological damage, hypertension, hyperlipidaemia, and chronic drug toxicity.
Pre-Transplantation Testing
- HLA Typing: Identifies individual HLA polymorphisms for donor-recipient matching.
- Recipients screened for anti-HLA antibodies; presence can exclude from transplantation.
- Donor-Recipient Cross-Matching: Functional assay that tests recipient serum against donor lymphocytes; a positive result indicates a contraindication for transplantation due to hyperacute rejection risk.
Post-Transplant Biopsy: C4d Staining
- C4d is a complement protein fragment; its deposition in graft capillaries indicates classical complement pathway activation.
- Useful for early diagnosis of vascular rejection.
Complications of Transplant Immunosuppression
- Long-term immunosuppression requires a combination of two or more drugs to minimize adverse effects.
- Major complications are infection and malignancy; prophylactic medications like ganciclovir and trimethoprim-sulfamethoxazole reduce some infection risks.
- Immunization is critical; killed vaccines are appropriate, while live vaccines are avoided due to immune suppression.
- T-cell suppression increases malignancy risks, particularly for virus-associated tumors linked to Epstein-Barr virus, human herpesvirus 8, and human papillomavirus.
Organ Donation
- Shortage of organ donors is a significant challenge; cadaveric donors often come from healthy individuals who suffered brainstem death.
- Living donation is common in renal transplants, typically from altruistic relatives, but carries risk for donors and is tightly regulated.
- Non-altruistic organ donation, including sale, is illegal in most countries.
Tumour Immunology
- The immune system plays a critical role in monitoring and eliminating damaged or mutated cells.
- Cancer immunogenicity and specificity affect the immune system's effectiveness in targeting cancer cells.
- Tumor antigens may be poorly expressed or mutate, evading immune responses.
- Cancer cells can exploit inhibitory pathways meant to maintain self-tolerance, aiding evasion of immune destruction.
- Immune checkpoint inhibitors (e.g., targeting CTLA-4, PD1, PD-L1) enhance anti-tumor immunity; examples include ipilimumab, nivolumab, and pembrolizumab.
- These therapies have shown efficacy in several cancers but may cause serious inflammatory side effects.
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