Author(s): Randall Sung, M.D., 2009License: Unless otherwise noted, this material is made available under the terms of the...
Citation Key                         for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adap...
Transplant Surgery and                 Immunology                   Randall Sung M.D.            Assistant Professor of Tr...
Renal TransplantationTechnical Consideration
Source Undetermined
Source Undetermined
Source Undetermined
Surgical Complications•  Vascular  –  Arterial  –  Venous•  Ureteral leak/stenosis•  Wound  –  Hematoma  –  Lymphocele
Pancreas Transplantation       University of Southern California Department of Surgery
Transplant Immunology The Biology of the Alloresponse
Learning Objectives•  To understand the role of the MHC•  To understand the 3 signals needed for   T-cell activation•  To ...
ThymicSelection            Abbas,Lichtman, Pober: Cellular & Molecular Immunology, 4th Ed
Central Paradigm for Cellular Initiation of          an Immune Response  Bromberg, Magee: Greenfield Surgery, 3rd Ed
Antigen Processing and Presentation         Masur, wikimedia commons                                        Masur, wikimed...
Antigen Presenting Cells•    Dendritic cells•    Macrophages•    B Lymphocytes•    Vascular endothelial cells•    Various ...
Antigen Presentation on APC•  Occurs through the major histocompatibility complex   (MHC)•  The MHC are a group of genes t...
MHC Class I and Class II  Source Undetermined
MHC Class I Molecule (HLA A2)     Source Undetermined
MHC Class I and II•  Class I is presented on all nucleated   cells and recognized by CD8+ T cells•  Class II is presented ...
Human Leukocyte Antigen        (HLA)  HLA s are polymorphic cell-surface molecules (alloantigens) that are encoded by the ...
Source Undetermined
MHC Polymorphism•  MHC molecules are highly polymorphic   to allow extraordinary levels of diversity   in functionally imp...
Three Signals of Tcell Activation •  Antigen presentation and recognition    (provides specificity – essential but not    ...
Source Undetermined
Role of Co-stimulation in T Cell Activation    Abbas,Lichtman, Pober: Cellular & Molecular Immunology, 4th Ed
Source Undetermined
Intracellular signaling pathways in T cell                 activation  Source Undetermined
Allorecognition     Direct vs IndirectSource Undetermined
Additional Source Information                         for more information see: http://open.umich.edu/wiki/CitationPolicyS...
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10.07.08(a): Transplant Surgery and Immunology

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10.07.08(a): Transplant Surgery and Immunology

  1. 1. Author(s): Randall Sung, M.D., 2009License: Unless otherwise noted, this material is made available under the terms of theCreative Commons Attribution – Share Alike 3.0 License:http://creativecommons.org/licenses/by-sa/3.0/We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share,and adapt it. The citation key on the following slide provides information about how you may share and adapt this material.Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, orclarification regarding the use of content.For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use.Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement formedical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you havequestions about your medical condition.Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  2. 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation LicenseMake Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. Transplant Surgery and Immunology Randall Sung M.D. Assistant Professor of Transplant SurgeryFall 2008
  4. 4. Renal TransplantationTechnical Consideration
  5. 5. Source Undetermined
  6. 6. Source Undetermined
  7. 7. Source Undetermined
  8. 8. Surgical Complications•  Vascular –  Arterial –  Venous•  Ureteral leak/stenosis•  Wound –  Hematoma –  Lymphocele
  9. 9. Pancreas Transplantation University of Southern California Department of Surgery
  10. 10. Transplant Immunology The Biology of the Alloresponse
  11. 11. Learning Objectives•  To understand the role of the MHC•  To understand the 3 signals needed for T-cell activation•  To understand the mechanisms of transplant rejection•  To understand how transplant rejection is prevented
  12. 12. ThymicSelection Abbas,Lichtman, Pober: Cellular & Molecular Immunology, 4th Ed
  13. 13. Central Paradigm for Cellular Initiation of an Immune Response Bromberg, Magee: Greenfield Surgery, 3rd Ed
  14. 14. Antigen Processing and Presentation Masur, wikimedia commons Masur, wikimedia commons• MHC I antigen processing • MHC II antigen processing A Protein A Foreign protein B Proteasome B Endosome C MHC class I protein sythesis C Lysosome D Peptides for presentation D Late endosome/Phagolysosome E ER E Rough ER F Plasma membrane F Golgi apparatus1. Ubiquitination G CLIP for antigen exchange2. Protein degradation to peptides by proteasome H Antigen presentation at plasma membrane3. Transporting peptides to the lumen of ER by ABC transporters4. Binding of peptides in a groove of MHC I complex5. Antigen presentation on plasma membrane CC BY-SA-2.5 Masur (Wikipedia) http:// creativecommons.org/licenses/by-sa/2.5/
  15. 15. Antigen Presenting Cells•  Dendritic cells•  Macrophages•  B Lymphocytes•  Vascular endothelial cells•  Various epithelial and parenchymal cells
  16. 16. Antigen Presentation on APC•  Occurs through the major histocompatibility complex (MHC)•  The MHC are a group of genes that are responsible for the recognition of the graft as foreign•  The principal function of MHC is to present foreign antigen fragments that can be recognized by specific antigen receptors on T cells
  17. 17. MHC Class I and Class II Source Undetermined
  18. 18. MHC Class I Molecule (HLA A2) Source Undetermined
  19. 19. MHC Class I and II•  Class I is presented on all nucleated cells and recognized by CD8+ T cells•  Class II is presented on APC and recognized by CD4+ T cells
  20. 20. Human Leukocyte Antigen (HLA) HLA s are polymorphic cell-surface molecules (alloantigens) that are encoded by the MHC genes
  21. 21. Source Undetermined
  22. 22. MHC Polymorphism•  MHC molecules are highly polymorphic to allow extraordinary levels of diversity in functionally important regions (peptide binding site) without losing structural integrity•  The large number of polymorphic MHC molecules expressed by an individual permits binding of an extensive range of structurally different peptides
  23. 23. Three Signals of Tcell Activation •  Antigen presentation and recognition (provides specificity – essential but not sufficient) •  Costimulation – needed for T-cell proliferation •  Autocrine proliferation
  24. 24. Source Undetermined
  25. 25. Role of Co-stimulation in T Cell Activation Abbas,Lichtman, Pober: Cellular & Molecular Immunology, 4th Ed
  26. 26. Source Undetermined
  27. 27. Intracellular signaling pathways in T cell activation Source Undetermined
  28. 28. Allorecognition Direct vs IndirectSource Undetermined
  29. 29. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicySlide 5: Source UndeterminedSlide 6: Source UndeterminedSlide 7: Source UndeterminedSlide 9: University of Southern California Department of Surgery, http://www.uscpancreastransplant.org/pancreastransplants.htmlSlide 12: Abbas,Lichtman, Pober: Cellular & Molecular Immunology, 4th EdSlide 13: Bromberg, Magee: Greenfield Surgery, 3rd EdSlide 14: Masur, Wikimedia Commons, http://commons.wikimedia.org/wiki/File:MHC1_antigen_presentation.svg, CC:BY-SA, http://creativecommons.org/licenses/by-sa/2.5/deed.en; Masur, Wikimedia Commons, http://commons.wikimedia.org/wiki/File:MHC2.svg, CC:BY-SA, http://creativecommons.org/licenses/by-sa/2.5/deed.enSlide 17: Source UndeterminedSlide 18: Source UndeterminedSlide 21: Source UndeterminedSlide 24: Source UndeterminedSlide 25: Abbas,Lichtman, Pober: Cellular & Molecular Immunology, 4th EdSlide 26: Source UndeterminedSlide 27: Source UndeterminedSlide 28: Source Undetermined

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