Amyloidosis and Graft Rejection MCQs

Irradiation with a dose of 2,500 cGy at the center of the irradiation field, with a minimum dose of 1,500 cGy at any point in the field inhibits proliferation of donor lymphocytes but has no significant adverse effect on red cell, platelet or granulocyte function. It should be noted that though the other options are also effective in reducing the leukocytes but they do not completely deplete the lymphocytes and so can cause GVHD. Reference: Wintrobes, 13th ed, Pg: 704-705.

Different stains for amyloid are: Congo Red shows apple-green birefringence under polarized light Methyl or cresyl violet Thioflavin T with examination using fluorescence microscopy Reference: Hamodat M. Amyloidosis. Pathology Outlines.com

Patients on long-term hemodialysis for renal failure can develop amyloid deposits derived from β2-microglobulin. This protein is present in high concentrations in the serum of individuals with renal disease and in the past it was retained in the circulation because it could not be filtered through dialysis membranes. With new dialysis filters, the incidence of this complication has decreased substantially. The classical features of this form of amyloidosis are the triad of scapulohumeral periarthritis, carpal tunnel syndrome and flexor tenosynovitis of the hand. Renal involvement gives rise to proteinuria that may be severe enough to cause the nephrotic syndrome. Progressive obliteration of glomeruli in advanced cases ultimately leads to renal failure and uremia. Renal failure is a common cause of death. Reference: Robbins Basic Pathology, 10 th ed, Pg: 185-186.

Donor for kidney transplantation: Donors can be deceased or volunteer living donors. Living donors are usually family members who have at least partial compatibility for HLA antigens. At least 50% HLA match (3/6) is a must requirement for kidney transplant Living volunteer donors should be normal on physical examination Should have the same major ABO blood group, because crossing major blood group barriers prejudices survival of the allograft. Should have two normally functioning kidneys Donor should be free of malignant neoplastic disease, hepatitis and HIV. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, Chapter - 6, pg 234

Transplant patients are among those most vulnerable to CMV infection, especially in the critical few months after the transplant. Between 20% and 60% of people with a solid organ transplant develops a symptomatic CMV infection. These symptoms are similar to the flu - fever, body aches, sore throat and may be difficult to control. The disease caused by post-transplant CMV (PT-CMV) occurs due to: Transmission from the transplanted organ, Due to reactivation of latent infection, or After a primary infection in seronegative transplant patients. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition Chapter 20, pg 896

Important terminologies for Donors in transplant im-munology: Matched Donor: HLA allelic identity at HLA A, B, C and DRB1 loci which is referred as 8/8match. (These 4 HLA antigens have 2 alleles each that makes it 8). Related Donor: Siblings from same parents who is HLA matched for HLA A, B, DRB1 minimum at the antigen level. So obviously, the answer here is matched related donor. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, Chapter - 6, pg 234