Deck 9: Transplant Immunology

Question 1

Which of the following is TRUE of both MHC Class I and II receptors?

A)nonfunctional if alpha and beta chains are not properly associated.
B)heterodimers composed of alpha and beta chains.
C)alpha chain similar in structure to an immunoglobulin heavy chain and beta chain similar in structure to an immunoglobulin light chain.
D)necessary to present foreign antigen to lymphocytes.
E)All of the above are true.

Answer 1

All of the above are true.

Question 2

An important component of the immune response that Class III MHC genes code for is

A)immunoglobulins.
B)complement components.
C)lysozyme.
D)interferon.
E)myeloperoxidase.

Answer 2

complement components.

Question 3

In what manner are MHC genes expressed?

A)Activated
B)Silent
C)Dominant
D)Codominant
E)Recessive

Answer 3

Codominant

Question 4

Which set of HLA gene(s)is considered the "classic" set of Class I MHC molecules?

A)HLA A, B, and C
B)classic complement components
C)HLA DP, DQ, and DR
D)beta 2 microglobulin
E)alpha/beta heterodimer

Question 5

In order to transplant allogeneic progenitor (stem)cells, the recipient must

A)have a normal immune system.
B)be completely immunodeficient.
C)be on immunosuppressive therapy.
D)be cytokine stimulated to promote engraftment.

Question 6

All the following are contraindications to harvesting organs from a particular donor except

A)cardiac activity.
B)presence of antibodies to human immunodeficiency virus.
C)presence of metastatic carcinoma.
D)neurologic activity.

Question 7

What antigen(s)are Class I and II MHC molecules capable of presenting to T cells?

A)Antigens endogeneous to the normal host cell
B)Antigens digested from phagocytized material
C)Antigens produced by viruses inside the host cell
D)All of the above

Question 8

When foreign tissue is transplanted, the recipient's T cells react against

A)public epitopes.
B)private epitopes.
C)alloepitopes.
D)All of the above.

Question 9

Why are red blood cell transfusions not rejected in the same way that transplanted tissues are?

A)MHC Class II molecules are unstable on red blood cells once they are removed from the body.
B)Mature red blood cells do not express MHC Class II.
C)Mature red blood cells do not express MHC Class I.
D)Refrigerator storage of red blood cells inactivates both MHC Class II and I.
E)MHC Class I molecules are unstable on red blood cells once they are removed from the body.

Question 10

The proteins of the HLA system are said to belong to the superfamily because most have a constant and variable region.

A)immunoglobulin
B)complement
C)immune receptor
D)autoantigen

Question 11

Panel reactive antibody (PRA)testing in organ transplantation is a system to test

A)organ donors for preexisting HLA- primed T cytotoxic cells.
B)organ recipients for preexisting HLA- primed T cytotoxic cells.
C)organ recipients for preexisting HLA antibodies.
D)organ donors for preexisting HLA antibodies.

Question 12

What is the best current technology for determining HLA types?

A)Flow cytometry detecting mixed lymphocyte cytotoxicity reactions.
B)Flow cytometry using labeled antibodies to cell surface antigens.
C)Molecular determination of which HLA alleles are in the DNA.
D)Molecular determination of which HLA alleles are expressed by the RNA.

Question 13

A donor organ has the following HLA and ABO types: A positive
HLA type-A1, A3, B4, B5, DR 6, DR7
Observe the potential recipient information below. Based on UNOS criteria, which recipient should this organ?

A)Recipient 4-47 years old, never received an organ Current medical condition-poor A positive
HLA type-A1, A3, B4, B10, DR 6, DR7
Panel reactive antibodies-positive; cross- match with donor tissue positive Time on waiting list-15 years
B)Recipient 2-5 years old, never received an organ Current medical condition-stable A positive
HLA type-A2, A3, B4, B5, DR 6, DR9
Panel reactive antibodies-negative Time on waiting list-1 year
C)Recipient 1-65 years old, never received an organ Current medical condition-poor B positive
HLA type-A1, A3, B4, B5, DR 6, DR7
Panel reactive antibodies-negative Time on waiting list-5 years
D)Recipient 3-29 years old, received an organ 2 years ago and has rejected it Current medical condition-poor O positive
HLA type-A2, A3, B1, B5, DR 6, DR7
Panel reactive antibodies-negative Time on waiting list-2 years

Question 14

What role do HLA (MHC)antigens play in the thymus?

A)Selection of T cell clones that bind to foreign antigen
B)Selection of T cell clones capable of binding to HLA (MHC)antigens
C)Elimination of autoreactive T cell clones
D)All of the above

Question 15

Which of the following is true regarding inheritance of MHC genes?

A)Alleles can be homozygous or heterozygous.
B)Inheritance of MHC genes follows Mendelian genetics (Law of Segregation or Law of Independent Assortment).
C)The rate of gene recombination is low, but there are some "hot spots" of increased recombination.
D)All of the above.

Question 16

All of the following cell types express Class I MHC antigens except

A)mature red blood cells.
B)mature lymphocytes.
C)brain cells.
D)platelets.
E)differentiated muscle cells.

Question 17

What is beta- 2- microglobulin?

A)The beta chain of the Class II MHC molecule
B)The alpha chain of the Class I MHC molecule
C)The alpha chain of the Class II MHC molecule
D)The beta chain of the Class I MHC molecule

Question 18

Which of the following cell types is not associated with MHC Class II expression?

A)Lymphocytes
B)Macrophages
C)Dendritic cells
D)Muscle tissue
E)Monocytes

Question 19

Which of the following is(are)used to transplant progenitor cells (pluripotent stem cells)?

A)Growth factor stimulated peripheral blood
B)Umbilical cord blood
C)Bone marrow
D)All of the above

Question 20

The products of the major histocompatibility complex that are responsible for tissue type are called because they were initially identified on white blood cells.

A)leukocyte thymic education antigens
B)Gorer white antigens
C)human leukocyte antigens
D)Landsteiner leukocyte markers

Question 21

Which statement below best summarizes how information regarding a patient's HLA type is used with respect to diseases associated with specific HLA types?

A)Odds ratios can be calculated for certain HLA types and the diseases with which they are associated. This is used as supplemental information in diagnosis and counseling.
B)HLA typing is done to exclude the presence of a disease and is an important part of diagnosis.
C)HLA typing is done to confirm the presence of a disease and is an important part of diagnosis.
D)HLA associations with diseases are so unreliable that they are never used in diagnosis.

Question 22

The greatest immediate risk after allogeneic progenitor (stem)cell transplant is graft versus host disease.

Question 23

Transplants are most successful if the recipient is both and _ compatible with the donor's tissue

Question 24

There is no benefit from graft versus host disease to any patient population.

Question 25

Which of the following patients is a candidate for autologous progenitor (stem)cell transplant?180

A)Breast cancer patient
B)Multiple myeloma patient
C)Acute myelogeneous leukemia patient
D)Patient with severe combined immune deficiency disease (SCID)cause by genetic ADA deficiency
E)Sickle cell anemia patient

Question 26

The number of alleles for genes present in the major histocompatibility complex make this the most set of human genes ever identified.

Question 27

Patients with seronegative inflammatory joint problems could benefit from HLA typing to see if they are _ positive.

A)A1
B)DQ1
C)A56
D)B11
E)B27

Question 28

When T cells do not recognize an antigen presented by a cell in conjunction with MHC Class I or II molecules, this is called _.

Question 29

MHC pseudogenes express alpha and beta MHC receptor chains that are similar to heavy and light immunoglobulin chains.

Question 30

MHC Class I expression in a particular cell type remains constant through that cell's life cycle once it matures.

Question 31

The final decision as to whether a person receives a particular organ for transplant in the United States is made by UNOS (United Network of Organ Sharing).

Question 32

The probability that two siblings from the same parents have identical HLA types is 25%.

Question 33

Organs for transplant in the United States are allocated based on which person on the waiting list is the sickest.

Question 34

People with the HLA haplotype A1, B8, DR3 have an increased nonresponse rate to which vaccine?

A)Polio
B)Hepatitis B virus (HBV)
C)Measles/mumps/rubella (MMR)
D)Influenza virus
E)Diptheria/pertussis/tetanus (DPT)

Question 35

The best donor for progenitor (stem)cell transplantation if the recipient himself.

Question 36

The HLA types DR2 and DQ1 are associated with .

Question 37

The cluster of genes found on the short arm of chromosome 6 that determine "tissue type" is called .

Question 38

To date, the strongest association of an HLA type with a disease is the association of 5- CREG with Hodgkin's disease.

Question 39

One of the reasons that compatible organs for transplantation are so difficult to find is that there is a relatively high rate of recombination in the MHC genes.

Question 40

Certain HLA types have been associated with the progression of .

A)rheumatoid arthritis.
B)systemic lupus erythematosus.
C)herpes varicella zoster (chicken pox).
D)AIDS.

Question 41

Describe the composition of the Class I MHC molecule on a cell's surface.

Question 42

Explain linkage disequilibrium and how it relates to predicting the frequency of particular HLA alleles.

Question 43

Discuss the nomenclature of the HLA alleles.

Question 44

Discuss the optimal circumstances to approach a family about organ donation.

Question 45

Explain why as a general rule a child's HLA type is only 50% identical to his father's and 50% identical to his mother's.