Keeping It Renal
You are a kidney transplant surgeon working at AT Still Memorial Hospital. Minutes after attaching the donor’s renal artery to the recipient’s external iliac artery, you notice the donor kidney beginning to turn white. This is an example of a:
A. Type I HSR
B. Type II HSR
C. Type III HSR
D. Type IV HSR
B. Type II HSR
You are treating a patient who developed an acute transplant reaction following liver transplantation. The most appropriate course of action would involve:
A. Immediate removal of the transplant
B. Immunosuppressant use
C. Unilateral prone pressure (catwalk variation)
D. Irradiation of transplant area
B. Immunosuppressant use
You are a pediatric oncologist talking to a 7-year-old child who was diagnosed w/ GVHD after undergoing an allogeneic bone marrow transplant. He asks you about the underlying cause of his disease. You tell him:
A. Your immune cells are attacking the transplanted bone marrow
B. Your immune cells are attacking parasites introduced by the bone marrow
C. Immune cells from the transplanted bone marrow are attacking your cells
D. Immune cells from the transplanted bone marrow are undergoing apoptosis
C. Immune cells from the transplanted bone marrow are attacking your cells
Graft-versus-host disease is classified as what kind of HSR?
A. Type I HSR
B. Type II HSR
C. Type III HSR
D. Type IV HSR
D. Type IV HSR
4 months after receiving a kidney transplant, you begin to experience fever as well as pain at the site of the transplant. Work-up reveals vasculitis of the donated kidney vessels and lymphocyte infiltration. This is an example of a:
A. Type I HSR
B. Type II HSR
C. Type III HSR
D. Type IV HSR
E. Type IV and Type II
E. Type IV and Type II
A 47-year-old male presents for a follow-up after undergoing a liver transplant 2 months prior. He states he has been reading about graft-versus-host disease online and wants to know more about it. Which of the following statements are true?
A. You cannot develop GVHD following liver transplantation; it only occurs in patients who undergo bone marrow transplantation
B. GVHD is a type II HSR
C. GVHD involves host antibodies attacking the graft
D. GVHD can potentially be useful in patients with leukemia who undergo bone marrow transplantation
D. GVHD can potentially be useful in patients with leukemia who undergo bone marrow transplantation
Which of the following types of transplants would have the least chance of being rejected?
A. Autologous
B. Allogeneic
C. Isograft
D. Xenograft
E. Syngeneic
A. Autologous
A 14-year-old girl develops lower abdominal pain two hours after undergoing allogeneic kidney transplantation for polycystic kidney disease. Physical examination reveals tenderness to palpation in the area the donor kidney was placed. An ultrasound of the donor kidney reveals diffuse tissue edema. Serum creatinine begins to increase and dialysis is initiated. Which of the following is the most likely cause of this patient's symptoms?
A. Immune complex deposition in donor tissue
B. Irreversible intimal fibrosis and obstruction of vessels
C. T-lymphocyte activation by donor HLA peptides
D. Proliferation of donor T lymphocytes
E. Preformed antibodies against class I HLA molecules
E. Preformed antibodies against class I HLA molecules
You are a debt collector with a passion for science who works for A.T. Still Memorial Hospital. A patient who underwent a liver transplant 3 years prior has not paid his medical bills, so you have been assigned to remove his liver. Upon examination of the donor liver, you notice arteriosclerosis and interstitial fibrosis–as well as CD4+, CD8+, and immunoglobulins–in the liver. This patient’s transplant rejection is which type of HSR(s)?
A. Type I HSR
B. Type II HSR
C. Type III HSR
D. Type IV HSR
E. Type III and II
F. Type IV and II
F. Type IV and II
Two weeks after undergoing allogeneic stem cell transplant for multiple myeloma, a 55-year-old man develops a severely pruritic rash, abdominal cramps, and profuse diarrhea. He appears lethargic. Physical examination reveals yellow sclerae, a generalized maculopapular rash on his face, trunk, and lower extremities, and desquamation of both soles. Laboratory studies reveal a serum alanine aminotransferase of 115 U/L (reference range: 10–40 U/L), a serum aspartate aminotransferase of 97 U/L (reference range: 12–38 U/L), and a serum total bilirubin of 2.7 mg/dL (reference range: 0.1–1.0 mg/dL). The most likely underlying cause of this patient's condition is:
A. Donor T cells in the graft
B. Newly formed anti-HLA antibodies
C. Preformed cytotoxic anti-HLA antibodies
D. Activated recipient T cells
E. Proliferating transplanted B cells
A. Donor T cells in the graft
An investigator studying immune-mediated pulmonary damage performs an autopsy on a bilateral lung transplant recipient who died of hypercapnic respiratory failure. The patient underwent lung transplantation for idiopathic pulmonary fibrosis. Microscopic examination of the lung reveals diffuse eosinophilic scarring of the terminal and respiratory bronchioles and near-complete luminal obliteration by polypoidal plugs of granulation tissue. Examination of the skin reveals no abnormalities. The most likely diagnosis is
A. Acute GVHD
B. Recurrence of primary disease
C. Acute graft rejection
D. Chronic graft rejection
E. Transfusion-related acute lung injury
F. Hyperacute graft rejection
D. Chronic graft rejection