IMUNOLOGI TRANSPLANTASI

Syamsu

Sub bagian Alergi Imunologi Bagian

Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Hasanuddin
Makassar
A. Istilah
Autograft : Jaringan sendiri
Isograft / Syngeneic : Identitas genetik sama
Allograft / allogeneic / homograft : identitas
genetik tidak identik tapi spesies sama
Xenograft / xenogeneic / heterograft : spesies
beda
B. Antigen Transplantasi
Ag golongan darah
Ag Histokompatibilitas major HLA
tissue typing
Ag Histokompatibilitas minor :
- golongan darah non ABO
- sex linked
C. Reaksi Penolakan
1. Primer vs sekunder = II lebih cepat dan lebih
hebat > 1
2. a. Hiperakut - dini : menit jam
- ekselerasi : 1 5 hari
b. Akut = - cepat : 6 10 hari
- lambat : 11 28 hari
3. Reaksi allograft : Transplantasi diterima
sementara vaskularisasi invasi
limfosit dan monosit inflamasi p.
darah rusak nekrosis jaringan
transplantan
4. Graft versus Host ( GvH )
a. Jaringan transplantasi menolak jaringan tubuh
resepien akut : + 40 %
- pembesaran kel. Limfe, limpa, hati
- diare
- rash, eritoderma, bulla
- rambut rontok
-
b. Kronik + 15 %
1. terbatas pada kulit dan hati : prognosis baik
2. luas meliputi kulit, hati, mukosa mulut,
esofagus, kelenjar-kelenjar dll : dapat
berupa skleroderma kulit, kontraktur sendi,
infeksi berulang dan gagal napas.
D. Pencegahan rejeksi
1. Kesesuaian golongan darah ABO
2. Kesesuaian HLA ( tissue typing ) + Ag Lewis
3. Cross matching ( limfosit donor + serum
resipien )
4. Serologis
5. Mixed Leucocyte Reaction
6. Imunosupresi :- kortikosteroid
- azathioprim
- siklosporin
- anti limfosit monoklonal
- tacrolimus
- mycophenolale
7. I radiasi limfosit total
E. Organ yang dapat di transplantasikan
1. Ginjal : pada GGK
2. Jantung dan paru
3. Kornea
4. Kulit
5. Hati : - sirosis
- gagal hati akut
- peny. Metabolik primer
- keganasan
- PBC ; PSC
- Budd Chiari
6. Sumsum tulang : - anemi aplastik
-LLA
-LMA
- Limfoma
- Myeloma
 STEP 4: SEVERE PERSISTENT

GINA 2002 DAILY CONTROLLER:

Inhaled steroid > 1.000 g
+ LABA + (SR-
theophylline/LTRA/oral
LABA + oral steroid)
Avoid or control triggers
STEP 3: MODERATE PERSISTENT
DAILY CONTROLLER: OTHER OPTIONS
Inhaled steroid 200 Inhaled steroid 500-1.000 g + (SR
1.000 g + LABA theophylline/Cromone/LTRA) or
Inhaled steroid > 1.000 g

Avoid or control triggers

STEP 2: MILD PERSISTENT
DAILY CONTROLLER: OTHER OPTIONS
Inhaled steroid 500 g SR-Theophylline
Cromone or
LTRA

Avoid or control triggers

STEP 1: INTERMITTENT

Avoid or control triggers

TREATMENT
GINA: NIH/NHLBI, 2002
 Step 1

STEP 1: INTERMITTENT ASTHMA

DAILY CONTROLLER: OTHER TREATMENT OPTIONS

None required

Avoid or control triggers

GINA, Guidelines 2002

 Step 2
STEP 2: MILD PERSISTENT

DAILY CONTROLLER: OTHER TREATMENT OPTIONS:

Inhaled corticosteroid ( 500 g) SR-theophyllin or
Cromone or
LTRA

Avoid or control triggers

GINA, Guidelines 2002

 Step 3

STEP 3: MODERATE PERSISTENT

DAILY CONTROLLER: OTHER TREATMENT OPTIONS:

Inhaled corticosteroid (200
1000 g) plus LABA
Inhaled corticosteroid (500-1000
g) plus SR-theophyllin, or
Inhaled corticosteroid (500-1000
g) plus oral LABA, or
Inhaled corticosteroid (> 1000
g), or
Inhaled corticosteroid (500-1000
g) plus LTRA

Avoid or control triggers

GINA, Guidelines 2002

 Step 4

STEP 4: SEVERE PERSISTENT

DAILY CONTROLLER: OTHER TREATMENT OPTIONS:

Inhaled corticosteroid (>1000
g) plus LABA plus one of the
following if needed:
SR-theophyllin
LTRA
Oral LABA
Oral corticosteroid

Avoid or control triggers

GINA, Guidelines 2002