This week at the Division of Transplant Surgery they told me that if I collaborate on the creation of a database they will put me as a co-author of a study. This would be my fist published paper so I was happy to say yes. The database will contain information about the outcome of the transplants that the patients have undergone. Patients are always closely followed up for many years after a transplant surgery, and all the data that is gathered should be put into a database so that it can be easily accessed, especially given the fact that each doctor has his own way of writing reports. It is quite shocking that it is still done this way and that it is not better organized.
Another highlight of the week was to take part in an anatomy lecture in the nephrology lab. I realized that my knowledge about anatomy is very limited, and I wished that our course in Ithaca that is supposed to prepare us for the Summer Immersion had included at least some content about human anatomy.
I also learned other interesting things such as that the immune rejection of an organ is entirely mediated by the innate immune response, and there are several types of T-cells, each with a specific job, for example cytotoxic T-cells attack viral infections while suppressor T-cells perform immunosurveillance which protects us against cancer and helper T-cells activate other T and B-cells. Most of the immune function is mediated by the MHC or Major Histocompatibility Complex, but there are 6 types of these, of which only three are important for transplant patients, the A, B and DR types. Interestingly, Natural Killer Cells will look for the MHC in the cells that they encounter and if they don´t find it they will kill the cell. Surprisingly, the MHC is in fact a collection of 160 genes, half of which are of unknown function! A certain degree of matching between MHCs of donor and recipient of an organ is essential for the well being of the recipient and the outcome of the transplant. Doctors have to pay attention as to what type of mismatch their patients have and act accordingly.
The worst case scenario, which will lead to a lawsuit against the surgeon, is if there is a phenomenon called Hyperacute Rejection in which the recipient has preformed antibodies against the blood of the donor, in other words, if there is an ABO mismatch. In other types of rejection, kidney malfunction appears months or years after the transplant, but the ABO mismatch will result in the transplant turning black even within the first day!