Transplant Rejection

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  • Created by: Emma Gill
  • Created on: 12-05-13 15:11

Transplant Rejection


This is often via direct antigen presentation of donor HLA via donor APC to recipient CD4+ T-cells also via CD8+ cells recognising foreign HLA

  • APC secrete IL-12 to cause Th1 proliferation IL-2 to ^ NK cells, IL-3 to ^ HSC, INF-y to inhibit Th1 production, ^ MHC and activate NK cells
  • APC secrete IL-10 to cause Th2 proliferation, these produce IL-3 to ^ HSC, IL-4 ^ IgE, IgE antibodiy switching in B-cells, ^ T-cell growth, ^ mast cells, IL-5 to ^ Eosinophils and activate B-cells
  • CD8+ secretes INF-y to ^ MHC, activate NK, Inhibit Th2, TNF-a causes macrophages to induce apoptosis by increasing NO synthesis, perforin causes cell lysis


This occurs longer term and is via in-direct antigen presentation of donor shed HLA via recpient APC to CD4+ T-cells.

Normally a thickening of interlobular arteries (lipid laden macrophages, odema). 

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Transplant Rejection

Saftey Precautions


  • Blood type (Checking donor and recipient)
  • HLA compatibility (ELISA, cross-match in serum+complement, flow cytometry)


  • Rituzimab, Plasmaphoresis, High dose IgG (remove antibodies in sensitized patients)
  • Cyclosporine inhibits calcineurin and therefore T-cell activation is suppressed
  • Azathiorpine prevents proliferation of T-cells
  • Rapamycin inhibits cell cycle
  • Mabs prevents activation of T-cells via IL-2 receptor

Risks: Tissue Ischemia, more chance of perfusion injury when blood supply and oxygen restored. Also cutting may induce inflammatory response (neutrophils - proinflammatory cytokines)

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