Immunology

of Renal Transplant

Ahmad Jaber ALMUJALHEM-K.U.B. R III-Academic Day 30th Jan 2014

Outline

Immunology in Urology

Selection & Preparation of kidney transplant:

Recipient

Donor

RENAL ALLOGRAFT REJECTION

Classification of Rejection

Immunology in Urology

Immunocompromised patient

Auto Immune diseases

Wound healing and Immune system

Neoplasm and Immune system

Infection and Immune system

Infertility and Immune system

Vaccine

Immunotherapy

Immunosuppressant

Facts!

Facts!

SELECTION AND PREPARATION OFKIDNEY TRANSPLANT RECIPIENTS Preliminary Screening Next…

Recipient

Next…

Donor

Next…

RENAL ALLOGRAFT REJECTION

Next…

Histocompatibility ABO blood group Major histocompatibility complex (MHC): Class I antigens:

HLA-A, HLA-B & HLA-C T lymphocytes

Class II antigens: HLA-DR,HLA-DQ, HLA-DP

B lymphocytes, activated T lymphocytes, monocytes, macrophages,dendritic cells &some endothelial cells

Classification of Rejection Hyperacute rejection:

Immediately after renal revascularization Irreversible process Mediated by preformed circulating cytotoxic antibodies

Accelerated rejection: Mediated by humoral and cellular components Within days to weeks Does not respond to antirejection therapy.

Acute rejection (any time after transplantation) Chronic rejection:

Gradual decline in renal function Interstitial fibrosis Vascular changes Minimal mononuclear cell infiltration

http://www.intechopen.com/books/current-issues-and-future-direction-in-kidney-transplantation/current-and-future-directions-in-antibody-mediated-rejection-post-kidney-transplantation

Nature Reviews Nephrology 8, 670-678 (November 2012) | doi:10.1038/nrneph.2012.212

http://www.intechopen.com/books/current-issues-and-future-direction-in-kidney-transplantation/tolerance-in-renal-transplantation

symptoms of acute kidney transplant rejection “the flu” accompanied by pain Enlarged kidney graft Hypertension Decreased urinary output Fluid retention Increased serum creatinine levels

Dx Needle biopsy of the kidney graft is the

standard to confirm the diagnosis of acute rejection.

Typical histologic findings of acute renal allograft rejection: Mononuclear cellular infiltration Tubulitis Vasculitis

Immunosuppression

http://ukhealthcare.uky.edu/trans/cardiovascular-disease/

http://www.sgh.com.sg/about-us/newsroom/News-Articles-Reports/Pages/Betterdrugsprolongkidneytransplantpatients'lives(SingaporeHealthIssue,May-June2013,Pg5).aspx

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