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Transplantation

Transplant immunology . As early as first half of last centaury principle of graft failure thought to be graft rejection is donor specificRejection possesses memoryFirst sit rejection is cell mediated Second sit rejection is largely antibodies mediated . Types of rejection. Hyper acute : prefor

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Transplantation

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    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

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