General Surgery
Transplantation
MBBS surgery notes on transplantation: graft types, matching, rejection, immunosuppression and organ donation, mapped to NMC codes SU13.1 to SU13.4.
MedNext Academy | 3 min read
Transplantation
MBBS surgery notes on transplantation: graft types, matching, rejection, immunosuppression and organ donation, mapped to NMC codes SU13.1 to SU13.4.
This chapter introduces the principles of transplantation surgery. It covers graft types, the immunology of matching and rejection, immunosuppression, donor types and the ethical and legal framework of organ donation.
High-yield: Transplantation
- An autograft moves tissue within the same person, an allograft between individuals of the same species and a xenograft between species.
- Human leucocyte antigen matching and ABO compatibility reduce the risk of rejection in solid organ transplantation.
- Hyperacute rejection occurs within minutes to hours from preformed antibodies and destroys the graft, so it is prevented by cross-matching.
- Acute rejection occurs over days to weeks and is cell mediated, often reversible with increased immunosuppression.
- Chronic rejection develops over months to years with progressive graft fibrosis and vascular changes and responds poorly to treatment.
- Standard immunosuppression combines a calcineurin inhibitor, an antiproliferative agent and corticosteroids.
- Calcineurin inhibitors such as ciclosporin and tacrolimus are nephrotoxic, which complicates kidney transplant care.
- Deceased donors are classed as donation after brain death or donation after circulatory death.
- The kidney is the most commonly transplanted solid organ and can be from a living or deceased donor.
- Living donor transplants generally have better outcomes than deceased donor transplants because of shorter ischaemic time.
- Cold ischaemia time is the period an organ is preserved on ice, and shorter times give better graft survival.
- Long-term immunosuppression raises the risk of opportunistic infection and of skin cancer and lymphoma.
- Brainstem death is diagnosed by strict clinical criteria by two doctors, confirming irreversible loss of brainstem function.
- In India, deceased organ donation is governed by the Transplantation of Human Organs and Tissues Act.
- Graft versus host disease is a concern chiefly in bone marrow transplantation when donor immune cells attack the recipient.
Types of graft rejection
- **Hyperacute:** Minutes to hours; preformed antibodies; graft loss; prevented by cross-matching and ABO matching.
- **Acute:** Days to weeks; mainly cell mediated; often reversible with increased immunosuppression.
- **Chronic:** Months to years; progressive fibrosis and vasculopathy; responds poorly to treatment.
- **Graft versus host:** Donor immune cells attack the recipient, chiefly a risk in bone marrow transplantation.
NMC competencies in this chapter
- **SU13.1:** Principles of transplantation and graft types
- **SU13.2:** Transplant immunology, matching and rejection
- **SU13.3:** Immunosuppression and its complications
- **SU13.4:** Organ donation, brain death and legal framework
Frequently Asked Questions
What are the main types of graft?
An autograft is within the same person, an allograft is between people of the same species, and a xenograft is between different species. Autografts do not provoke rejection.
How do the types of rejection differ?
Hyperacute rejection occurs within hours from preformed antibodies, acute rejection over days to weeks is cell mediated and often reversible, and chronic rejection over months to years causes irreversible fibrosis.
Why are living donor transplants generally better?
Living donation allows planned surgery with a shorter cold ischaemia time and a healthier organ, which improves graft function and long-term survival compared with deceased donation.
What are the risks of long-term immunosuppression?
Increased opportunistic infection, drug toxicity such as the nephrotoxicity of calcineurin inhibitors, and a higher risk of skin cancer and lymphoma over time.
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