GVHD & transplantation

GVHD & transplantation

1. Transplantation & GVHD SDL-10

2. Learning Objectives What is organ transplantation Define GVHD, and its types; a cute GVHD and chronic GVHD Describe infectious and other complications of GVHD and Transplantation

3. Transplantation Transplantation of tissues and whole organs has become common place . Transplantation is useful for treating a variety of disease conditions not amenable to other therapies . Common transplants are; Bone marrow, kidney, liver and heart and skin grafting

4. Types of Transplantation Autogenous grafts: these are tissues taken from one part of the body and placed in another part in the same person. Examples includes; Autogenous vein coronary bypass grafting, Skin grafting, Bone marrow and Hair Allogeneic grafts : Allografts are tissues and organs taken from one person and grafted into another person (within the human species ) Xenografts: Tissues can be transplanted from other species, but there are major problems with immunologic incompatibility Fetal tissue grafts: Fetal tissues being immunologically immature, offer the potential for providing a graft without the need to worry about immunologic rejection

5. Complications of transplantations Individuals having organ transplantation are at risk of developing; - Graft Versus Host Disease(GVHD ); - Infections - Malignancies

6. Post Transplant Graft Versus Host Disease Graft attacks the host : as marrow itself contains immunocompent cells (lymphocytes) therefore it is possible that these cells in the marrow that engrafts in the host can attack native host cells Tissues mainly affected by GVHD are skin, bowel, and liver The accompanying clinical findings are skin rash, diarrhea, and jaundice GVHD can occur in the weeks to months following transplantation

7. Post Transplant Infections T he immunosuppressive therapy in patients with allografts weakens the immune system, particularly the cell-mediated immunity thus increasing the risk for infections, particularly opportunistic infections Any infections agent can cause infection in transplant recipients: bacterial , viral, fungal, parasitic

8. Post Transplant Infections

9. Post Transplant Malignancies Patients of organ transplants have an increasing risk for each year following transplantation of the allograft for development of malignancies The risk may be 100 times that for persons without an allograft These malignancies can include: Lymphoproliferative disorders ( leukemias , non-Hodgkin's lymphomas, and Hodgkin's disease ) Kaposi's sarcoma Carcinomas (particularly cutaneous carcinomas)

10. Examples of Post transplant infectious agents continued… Gomori methenamine silver (GMS) stain highlights the Pneumocystis carinii organisms

11. L arge cell with intra-nuclear inclusion and perinuclear halo is indicative of cytomegalovirus (CMV) infection in this section of liver at high magnification

12. B udding cells and pseudohyphae seen here in lung with PAS stain are indicative of Candida infection

13. P seudocyst filled with bradyzoites in myocardium seen here results from infection with Toxoplasma gondii .

14. C hronic abscess of right middle lobe of lung from nocardial infection Nocardia organisms can be acid fast after Z-N stain

15. Bacterial infections leads to lung consolidation in bronchopneumonia Neutrophilic exudates are present in alveoli as a result of bacterial infection of the lung with bronchopneumonia

16. Assignment Why organ transplanted individuals are at increased risk of developing in fections and certain malignancies? Enlist the common oppturnistic infections seen in persons having organ transplantation. Enlist the tissues mainly affected in GVHD Mention the malignancies which can develop in patients with organ transplantation Name some common oppturnistic infectious agents.

17. References Robbins Basic P athology 10 th edition by Kumar, Abbas, Aster www.webpath.com