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Types of Grafts

Homograft = self
Heterograft = same species
Xenograft = different species

Transplant considerations

1. HLA matching:
   • Histocompatibility antigens defined by tissue typing - A, B, C, DP, DQ, DR (chromosome 6)
   • HLA Match essential: renal, pancreas
   • HLA Match non-essential: cardiac, hepatic
   • ABO blood group essential: renal, pancreatic, cardiac, hepatic (ie, all of them)
2. Donor considerations
   • Established brainstem death
   • No sepsis
   • No maligancy (except primary brain)
   • No HIV, HBV
   • Not high risk : IVDU

Graft rejection

1. Hyperacute rejection
   • recipient serum antibodies vs donor antigens (very bad news) - thrombosis, graft infarction within hours
   • treat by removal of graft
2. Acute rejection
   • cell-mediated CD4 immunocytes (T-helper) within 3 months
   • Treated with steroids / immunosuppression
3. Chronic rejection
   • Humoral / cell-mediated immune responses occurs months - years
   • Not treatable or reversible