Transplant immunology
Components to check
[edit | edit source]- Major Histocompatibility Complex (MHC)
- Type I: all cells (HLA-A, B, C)
- Type II: antigen-presenting cells (HLA-DP, DQ, DR)
- The greater the degree of match, the better the outcome
- HLA-DR, HLA-B and HLA-A are the most important
- Direct cross-match
- Performed immediately before transplant
- Lysis of donor lymphocytes/complement suggests hyperacute rejection will occur
- Flow cytometry cross-match
- Binding of non-complement fixing Ab in recipient serum to donor lymphocytes indicates increased risk acute rejection
- Panel reactive Ab
- Can be tested for each potential recipient to generic Abx
- Patients previously sensitised will have higher levels, and will likely then have positive cross-match to more donors
- Mixed lymphocyte reaction
- Used for living donation
Innate immunity - responds to generic molecular motifs associated with pathogenic organisms
[edit | edit source]- Macrophages, neutrophils, NK cells
- Does not contribute to organ rejection per se but does respond to the general inflammation - ischaemia, reperfusion injury, procurement-associated trauma
- Therefore, we need to augment the nonspecific immune suppression at time of transplant
- 'induction immunosuppression'