Develop a 1- to 2-page case study analysis in which you: Cells Case Study Analysis Cells Case Study Analysis Explain why you think the patient presented the symptoms described. Identify the genes that may be associated with the development of the disease. Explain the process of immunosuppression and the effect it has on body systems.
Cells Case Study Analysis
The case presented is of a 34-year-old male presenting for a kidney transplant. The patient had an uneventful postoperative course and was discharged on anti-rejection drugs tacrolimus, cyclosporine, and azathioprine. The patient, however, presented six months later, manifesting decreased urine output, weight gain, fatigue, and temperatures of 101˚F, and was diagnosed with acute kidney transplant rejection.
The Reasons for the Patient’s Symptoms
The patient manifestations were a result of allograft rejection. Transplant rejection occurs when the host’s immune system attacks the grafted organ. Fever is usually one of the signs of organ rejection. Oetting et al. (2018) report that immune responses that precede graft rejection often result from the induction of pyrogenic cytokines as a part of the innate mechanisms to eliminate the graft. This may explain the occurrence of fever in the case presented. The fever may also result from immunologic responses secondary to graft ischemia. Decreased urinary output in this patient’s case may be a consequence of kidney failure or rejection. Kidney failure after transplantation may be caused by decreased or insufficient blood flow to the grafted kidney (Shimizu et al., 2018). The consequent ischemia may further lower kidney functionalities, resulting in decreased urinary output. Kidney rejection occurs when the host mounts immune responses against the graft. The subsequent destruction of the kidney may result in kidney rejection. Consequently, this manifests as decreased urinary output with consequent weight gain. The patient in the case presented may have developed kidney rejection. The manifestations of weight gain, fever, and decreased urinary output are all indicative of kidney rejection.
Genes Associated with Acute Rejection
Several genetic variations have been implicated in acute rejection risks. Hu et al. (2020) report that single nucleotide polymorphisms of the genes ATP-binding cassette, subfamily B, member 1 (ABCB1), Angiotensin l-converting enzyme (ACE), Allograft inflammatory factor-1(AIF), Angiotensin type 1 receptor (AT1R), Cytotoxic T-lymphocyte-associated protein 4 (CTLA4), and others have been shown to increase the likelihood of kidney rejection. Gene deletions have also been shown to increase the propensity of developing acute rejection after a kidney transplant. Individuals with a deletion on or near the gene LIMS1 have up to an 80% chance of developing acute kidney rejection. Innate immunity genetics have also been implicated in graft rejection. Single nucleotide polymorphisms on the genes TNF, CRP, IL1B, TGFB, IL10, IL6, and IL6R can result in either an increase or a decrease in the production of pro-inflammatory or inflammatory mediators (Hu et al., 2020). Increases in pro-inflammatory and inflammatory mediators compound graft rejection.
The Process of Immunosuppression
Immunosuppression defines reductions in the immune system’s capacity to respond to foreign agents effectively. Immunosuppression prevents allograft rejection by inhibiting immune cell activation, cytokine production, immune cell differentiation, and proliferation. Therapeutic immunosuppression is achieved with a combination of immunosuppressants; tacrolimus, azathioprine, and cyclosporine listed in the case study are examples of commonly used immunosuppressants. The first step in immunosuppression is the induction phase. Induction immunosuppression is often done at the time of transplantation and is targeted at preventing early acute rejections (Claeys & Vermeire, 2019). Antilymphocytes are biological agents, and interleukin 2 receptor antagonists can be used in this regard. The second step is the maintenance phase. Maintenance medication can also be initiated at the time of transplantation. The most commonly used immunosuppressants are calcineurin inhibitors, corticosteroids, mammalian target rapamycin (mTOR), antiproliferatives, and others (Nelson et al., 2022). These medications are valuable in long-term treatment or organ transplants and help in preventing acute rejection.
Conclusion
The case represented is a demonstration of the cellular effects of organ transplantation. Rejection accustomed to immune responses sometimes occurs. Essentially, immunosuppressant medications help prevent acute rejection. Nonetheless, rejection may sometimes occur even with the use of immunosuppressants, as seen in the case.
References
Claeys, E., & Vermeire, K. (2019). Immunosuppressive drugs in organ transplantation to prevent allograft rejection: Mode of action and side effects. Journal of Immunological Scien