Transplantation Transfer of tissues from individual to

1
Transplantation

• Transfer of tissues from individual to individual
  
• Orthotopic or heterotopic
• Autotransplant same or identical
• Allogenic between non identical member of same
  species
• Xenogenic between member of differen species

2
Transplant immunology

• As early as first half of last centaury principle
  of graft failure thought to be
• graft rejection is donor specific
• Rejection possesses memory
• First sit rejection is cell mediated
• Second sit rejection is largely antibodies
  mediated

3
Types of rejection

• Hyper acute preformed circulating cytotoxic
  antibodies
• Acute 5-14 days ,cell mediated
• Chronic ischemic graft damage , micro vascular
  endothelial damage

4
Why do rejection occurs?

• What led to recognition of donor tissue as
  foreign?
• The response to transplanted tissue is
  genetically determined
• Transferred tissue carries antigens
• Immune response well be evoked
• HLA ( Human Leukocyte associated antigens) are
  the major determinant of histo-compatibility MHC
• MHC Complex are specialized cell surface molecules

5
MHC Complex

• Are carried On short arm of chromosome 6
• Classified in Class 1 , class 2 and class 3
• Class1 of HLA-A,HLA-B and HLA-C
• Class 2 of HLA-DR groups
• Class 3 are many factors including complement and
  INF

6
Tissue typing

• Can determined the chance of success
• Class 1 can be defined by
• Monoclonal antibodies
• Flow cytometry
• Polymerized chain reaction(PCR)
• Class 1 are expressed on all nucleated cells
• Class 2 used to identified by Mixed leucocytes
  reaction
• Class 2 are expressed on B-Lymphocyte, Monocyte
  ,Macrophages,Breast epithelia and respiratory
  epithelia

7
T- lymphocyte

• Lymphocyte with thymus maturation
• Carries specific cell receptors and marker
• They can recognized foreign antigen presented by
  APC(antigen presenting cell)
• Once presented with an antigen they will produce
  IL,and other factors ,proliferate (cloning)

8
Reduction of immune response

• The best is by induction of tolerance
• Radiation
• Chemo reduction

9
Condition with suppressed immunity

• Uremia
• Profound Jaundice
• Advanced Malig
• AIDs
• Controlled reduction

10
Immune modulation

• 6-mercatopurine
• Steroids
• Azathioprine
• Anti Lymphocyte globulin
• Cyclsporin A
• Rapamycin(RAPA)
• New Drugs

11
Cyclsporin A

• Revolution
• Decrease Antibody production
• Decrease lymphocytic function with selective
  inhibition of Y cells

12
Side effect of steroids

• Vascular necrosis of bone
• Diabetes
• Obesity
• Cushing's Synd
• Pancreatitis
• Cataract
• Skin necrosis
• psychosis

13
Side effect of AZ

• Bone marrow suppression
• Polycythemia
• Hepatic toxicity

14
Side effect of cyclosporine A

• Nephrotoxic
• Hepatic toxic
• Tremor
• Skin problem
• Gingival hypertrophy
• Hemolytic anemia
• Hypertension
• Malignant changes

15
New drugs

• Purina biosynthesis
• Mizoribine (Bredinine)
• Mycophenolate mofetil(MMF)

16
New drugs

• Anti Pyrimidine Brequinar sodium (BQR)
• FK506 (Tacrolimus) is amacrolide antibiotics it
  specifically reduce IL2 production

17
Ethical issues

• Death definition
• The Person right to dispose his organ and tissues
  (SALE????)
• Patients are individuals which are unique doctors
  should do all possible for their interest
• Dont do harm
• costs