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TRANSPLANTATION IMMUNOLOGY

Professor B. Hanchard

OBJECTIVE

TO UN!ERSTAN! THE BASIC IMMUNOLOGY RELATE! TO THE

TRANSPLANTATION O" HUMAN TISSUES

Ter#$no%o&'

o A%%o&ene$c ho#o&raf( )a%%o&raf(*  – graft between genetically non-

identical individuals within the same species

o A+(o&raf( – graft from an individual to himself/herself 

o S'n&ene$c ho#o&raf(  – graft between genetically identical individuals

(identical twins)

o ,eno&raf( – graft between different species

The majority of transplants are allografts. Among those that have been

transplanted are

o !eart

o !eart and lung

o "idney

o #iver 

o $ornea

o %ace

o &ancreas

o 'one marrow

The major factor involved in the transplantation of organs is rejection. ifferent

organs vary in their capacity to generate an immune response when transplanted.'one marrow and sin elicit the greatest response while liver elicits the least

response.

*

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+ejection of transplants involves the recognition of foreign donor antigens by the

recipient and the mounting of an immune response.

The major donor antigens are those of the !#A system present on all nucleatedcells and blood group antigens present on the surface of red cells. The rejection

immune response is largely cell mediated but humoral mechanisms also

contribute.

+enal transplantation for the treatment of end-stage idney disease has been in

 practice for decades and the rejection phenomena associated with this transplant

have been well documented.

*. H'-erac+(e rejection (within minutes of the transplant) due to an immune

reaction to preformed circulating antibodies.

,. Ac+(e rejection ( – ,* days) due to cell mediated immunity to antigens inthe donor idney

. Chron$c rejection (> 3 months) due to a combination of cell mediated

immunity and humoral immunity resulting from disturbances in graft/hosttolerance.

The rejection phenomenon can be controlled by immunosuppressive drugs

(steroids cyclosporine a0athioprone) but these have side effects particularly thedevelopment of (post transplantation) renal cancers in the donor idney.

+es($ons

*. !yperacute rejection of renal transplants is due to1

/(a) !umoral immunity

  (b) $ell-mediated immunity

(c) 2nfection in the donor idney

  (d) 2schaemia of the donor idney

,. A graft from between genetically identical individuals is1

  (a) 2sograft

  (b) Autograft

  /(c) 3yngeneic homograft

,

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  (d) 4enograft