Learning Objectives

• Understand the different types of grafts and terminology used in transplantation immunology
• Explain the mechanisms of graft rejection (humoral and cell-mediated)
• Appreciate the roles of central and peripheral immunological tolerance in graft acceptance/ rejection
• Describe the steps taken before transplantation to optimise graft survival and minimise rejections including the basic principles of laboratory based investigations for matching recipients and donors
• Describe the key indications for haematopoietic cell transplantation and explain the basic mechanisms of graft versus host disease (GVHD)
• Describe the role and use of immunosuppressive drugs in transplants

Introduction

• what is the most common organ transplant?
• Transplantation Terminology

Histocompatibility Antigens

• what are histocompatibility antigens?
• what are the most clinically significant histocompatibility antigens?
• in MHC-identical grafts, why can rejection still occur?
• what is the difference between major and minor antigen graft rejection?

Pre-Transplant Compatibility Testing

• how many alleles are aimed to be matched (in HLA matching)?
• what types of pre-transplant compatibility testing are performed?
• what is a panel reactive antibody (PRA) level used to determine?