Tumour Immunology and Chronic Allograft Failure
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Questions and Answers

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?

  • 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?

  • 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?

    <p>To enhance anti-tumor immunity</p> Signup and view all the answers

    Why is non-altruistic organ donation illegal in most countries?

    <p>Concerns about coercion and exploitation</p> Signup and view all the answers

    Which immune checkpoint is targeted by the drug pembrolizumab?

    <p>PD-1</p> Signup and view all the answers

    What can lead to the evasion of immune responses by cancer cells?

    <p>Mutations in specific antigens</p> Signup and view all the answers

    What type of cancers have shown benefit from immune checkpoint inhibitors?

    <p>Melanoma and classic Hodgkin’s lymphoma</p> Signup and view all the answers

    What is chronic allograft failure primarily associated with?

    <p>Proliferation of transplant vascular smooth muscle</p> Signup and view all the answers

    What does HLA typing help with in the context of transplantation?

    <p>Matching donors to recipients</p> Signup and view all the answers

    What does a positive cross-match indicate?

    <p>A contraindication to transplantation</p> Signup and view all the answers

    What is the role of C4d staining in post-transplant biopsy?

    <p>To indicate antibody-mediated damage</p> Signup and view all the answers

    What is a major long-term complication of immunosuppressive treatment?

    <p>Malignancy</p> Signup and view all the answers

    Which medication is specifically used for cytomegalovirus prophylaxis?

    <p>Ganciclovir</p> Signup and view all the answers

    Which of the following types of vaccines is appropriate for transplant recipients?

    <p>Killed vaccines</p> Signup and view all the answers

    What factor does NOT contribute to chronic allograft failure?

    <p>High levels of physical activity</p> Signup and view all the answers

    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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    Description

    This quiz explores the complex interplay between tumour immunology and chronic allograft failure, a significant cause of graft loss. It delves into the mechanisms of chronic rejection, associated factors, and the importance of pre-transplantation testing. Test your knowledge on HLA typing and its role in immunological compatibility.

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