Solid Organ Transplantation Rejection
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Questions and Answers

What is the primary cause of acute allograft rejection?

  • Infiltration of natural killer cells
  • Infiltration of B lymphocytes
  • Infiltration of T cells (correct)
  • Infiltration of macrophages

    • What is the most common type of rejection?

  • Chronic rejection
  • Hyperacute rejection
  • Antibody-mediated rejection
  • Acute cellular rejection (correct)

    • What is antibody-mediated rejection characterized by?

  • Infiltration of B lymphocytes
  • Presence of antibodies against recipient vascular endothelium
  • Presence of antibodies against donor vascular endothelium (correct)
  • Infiltration of T cells

    • What is the primary goal of acute rejection therapy?

    <p>To minimize the intensity of the immune response</p> Signup and view all the answers

    What is plasmapheresis?

    <p>A procedure in which the plasma in the patient's blood is removed and replaced with another fluid</p> Signup and view all the answers

    What is rituximab?

    <p>A monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes</p> Signup and view all the answers

    What is eculizumab primarily used for in renal transplantation?

    <p>To treat atypical hemolytic-uremic syndrome and antibody-mediated rejection</p> Signup and view all the answers

    What should patients receive before receiving eculizumab?

    <p>Vaccination against Neisseria meningitidis</p> Signup and view all the answers

    What is the primary cause of acute allograft rejection?

    <p>Activation of alloreactive T cells and antigen-presenting cells</p> Signup and view all the answers

    What is antibody-mediated rejection (AMR) characterized by?

    <p>The presence of antibodies against donor vascular endothelium</p> Signup and view all the answers

    What is the primary goal of acute rejection therapy?

    <p>To minimize the intensity of the immune response and prevent irreversible injury to the allograft</p> Signup and view all the answers

    What is plasmapheresis?

    <p>A procedure in which the plasma in the patient's blood is removed and replaced with another fluid</p> Signup and view all the answers

    What is the primary use of eculizumab in renal transplantation?

    <p>To treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant</p> Signup and view all the answers

    What prophylactic agents may be added to minimize adverse effects associated with intensive immunosuppression regimens?

    <p>Valganciclovir, nystatin, trimethoprim-sulfamethoxazole, and H2-receptor antagonists or proton-pump inhibitors</p> Signup and view all the answers

    What is the primary goal of acute rejection therapy?

    <p>To minimize the intensity of the immune response</p> Signup and view all the answers

    What is the most common type of rejection?

    <p>Acute cellular rejection (ACR)</p> Signup and view all the answers

    What is chronic rejection?

    <p>A slow and indolent form of ACR</p> Signup and view all the answers

    What is eculizumab?

    <p>A drug used to treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant</p> Signup and view all the answers

    What does eculizumab inhibit to prevent the formation of inflammatory molecules?

    <p>C5</p> Signup and view all the answers

    Hyperacute rejection occurs when preformed donor-specific antibodies are present in the recipient at the time of the transplant.

    <p>True</p> Signup and view all the answers

    Chronic rejection is the most common type of rejection.

    <p>False</p> Signup and view all the answers

    Antibody-mediated rejection is characterized by the presence of antibodies directed against donor vascular endothelium.

    <p>True</p> Signup and view all the answers

    Plasmapheresis is a procedure in which the plasma in the patient's blood is replaced with another fluid, similar to what happens in kidney dialysis.

    <p>True</p> Signup and view all the answers

    Rituximab is a murine monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes.

    <p>False</p> Signup and view all the answers

    Eculizumab is primarily used in renal transplantation to treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant.

    <p>True</p> Signup and view all the answers

    Patients should not receive vaccination against Neisseria meningitidis before receiving eculizumab.

    <p>False</p> Signup and view all the answers

    Prophylactic agents may be added to minimize adverse effects associated with intensive immunosuppression regimens.

    <p>True</p> Signup and view all the answers

    Study Notes

    Solid Organ Transplantation Rejection: Types, Mechanisms, and Treatment

    • Rejection of a transplanted organ is primarily mediated by activation of alloreactive T cells and antigen-presenting cells such as B lymphocytes.

    • Acute allograft rejection is caused primarily by the infiltration of T cells into the allograft, which triggers inflammatory and cytotoxic effects on the graft.

    • There are three types of rejection: hyperacute, acute cellular, and chronic rejection.

    • Hyperacute rejection is evident within minutes of the transplantation procedure when preformed donor-specific antibodies are present in the recipient at the time of the transplant.

    • Acute cellular rejection (ACR) is the most common type and is mediated by alloreactive T-lymphocytes. Biopsy of the allograft is often used to guide therapy.

    • Antibody-mediated rejection (AMR) is characterized by the presence of antibodies directed against donor vascular endothelium. Antibodies activate complement, which creates a membrane attack complex that directly damages the organ.

    • Chronic rejection is a major cause of graft loss and presents as a slow and indolent form of ACR, in which the involvement of the humoral immune system and antibodies against the vascular endothelium appear to play a role.

    • The primary goal of acute rejection therapy is to minimize the intensity of the immune response and prevent irreversible injury to the allograft.

    • Treatment of ACR includes optimizing immunosuppression, increasing the doses of current immunosuppressive drugs, pulse corticosteroids, or short-term treatment with a polyclonal or monoclonal antibody.

    • Treatment of AMR involves removing existing antibodies through plasmapheresis or intravenous immunoglobulin (IVIG) and inhibiting their re-development through rituximab, bortezomib, or eculizumab.

    • Plasmapheresis is a procedure in which the plasma in the patient's blood is removed and replaced with another fluid, similar to what happens in kidney dialysis.

    • Rituximab is a chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes and has been shown to improve graft survival in combination with plasmapheresis and IVIG in patients with AMR.The Use of Eculizumab in Renal Transplantation: Overview, Treatment of AMR, and Re-start Prophylaxis

    • Eculizumab is primarily used in renal transplantation to treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant.

    • Eculizumab inhibits the cleavage of C5, thus preventing the formation of inflammatory molecules C5a and C5b, including membrane attack complex (MAC).

    • Eculizumab appears effective in protecting renal allografts when post-transplant aHUS or AMR occurs, but published cases have relatively short follow-up.

    • Patients should receive vaccination against Neisseria meningitidis before receiving eculizumab.

    • A retrospective observational study showed that eculizumab treatment for early post-transplant AMR increased the median estimated glomerular filtration rate from 21 to 34 mL/min within a week.

    • Only 16.7% of biopsied patients had persistent active AMR within 4-6 months, and no graft losses occurred.

    • Larger trials are needed to evaluate the efficacy of eculizumab in treating AMR.

    • Prophylactic agents, such as valganciclovir, nystatin, trimethoprim-sulfamethoxazole, and H2-receptor antagonists or proton-pump inhibitors, may be added to minimize adverse effects associated with intensive immunosuppression regimens.

    • Valganciclovir is used to prevent cytomegalovirus infection, nystatin for fungal infections, and trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia and urinary tract infections.

    • H2-receptor antagonists or proton-pump inhibitors are used to prevent gastric ulcers caused by immunosuppressive drugs.

    • The use of prophylactic agents should be re-evaluated and restarted as necessary, particularly when immunosuppression is increased or changed.

    • For questions, contact [email protected].

    Solid Organ Transplantation Rejection: Types, Mechanisms, and Treatment

    • Rejection of a transplanted organ is primarily mediated by activation of alloreactive T cells and antigen-presenting cells such as B lymphocytes.

    • Acute allograft rejection is caused primarily by the infiltration of T cells into the allograft, which triggers inflammatory and cytotoxic effects on the graft.

    • There are three types of rejection: hyperacute, acute cellular, and chronic rejection.

    • Hyperacute rejection is evident within minutes of the transplantation procedure when preformed donor-specific antibodies are present in the recipient at the time of the transplant.

    • Acute cellular rejection (ACR) is the most common type and is mediated by alloreactive T-lymphocytes. Biopsy of the allograft is often used to guide therapy.

    • Antibody-mediated rejection (AMR) is characterized by the presence of antibodies directed against donor vascular endothelium. Antibodies activate complement, which creates a membrane attack complex that directly damages the organ.

    • Chronic rejection is a major cause of graft loss and presents as a slow and indolent form of ACR, in which the involvement of the humoral immune system and antibodies against the vascular endothelium appear to play a role.

    • The primary goal of acute rejection therapy is to minimize the intensity of the immune response and prevent irreversible injury to the allograft.

    • Treatment of ACR includes optimizing immunosuppression, increasing the doses of current immunosuppressive drugs, pulse corticosteroids, or short-term treatment with a polyclonal or monoclonal antibody.

    • Treatment of AMR involves removing existing antibodies through plasmapheresis or intravenous immunoglobulin (IVIG) and inhibiting their re-development through rituximab, bortezomib, or eculizumab.

    • Plasmapheresis is a procedure in which the plasma in the patient's blood is removed and replaced with another fluid, similar to what happens in kidney dialysis.

    • Rituximab is a chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes and has been shown to improve graft survival in combination with plasmapheresis and IVIG in patients with AMR.The Use of Eculizumab in Renal Transplantation: Overview, Treatment of AMR, and Re-start Prophylaxis

    • Eculizumab is primarily used in renal transplantation to treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant.

    • Eculizumab inhibits the cleavage of C5, thus preventing the formation of inflammatory molecules C5a and C5b, including membrane attack complex (MAC).

    • Eculizumab appears effective in protecting renal allografts when post-transplant aHUS or AMR occurs, but published cases have relatively short follow-up.

    • Patients should receive vaccination against Neisseria meningitidis before receiving eculizumab.

    • A retrospective observational study showed that eculizumab treatment for early post-transplant AMR increased the median estimated glomerular filtration rate from 21 to 34 mL/min within a week.

    • Only 16.7% of biopsied patients had persistent active AMR within 4-6 months, and no graft losses occurred.

    • Larger trials are needed to evaluate the efficacy of eculizumab in treating AMR.

    • Prophylactic agents, such as valganciclovir, nystatin, trimethoprim-sulfamethoxazole, and H2-receptor antagonists or proton-pump inhibitors, may be added to minimize adverse effects associated with intensive immunosuppression regimens.

    • Valganciclovir is used to prevent cytomegalovirus infection, nystatin for fungal infections, and trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia and urinary tract infections.

    • H2-receptor antagonists or proton-pump inhibitors are used to prevent gastric ulcers caused by immunosuppressive drugs.

    • The use of prophylactic agents should be re-evaluated and restarted as necessary, particularly when immunosuppression is increased or changed.

    • For questions, contact [email protected].

    Solid Organ Transplantation Rejection: Types, Mechanisms, and Treatment

    • Rejection of a transplanted organ is primarily mediated by activation of alloreactive T cells and antigen-presenting cells such as B lymphocytes.

    • Acute allograft rejection is caused primarily by the infiltration of T cells into the allograft, which triggers inflammatory and cytotoxic effects on the graft.

    • There are three types of rejection: hyperacute, acute cellular, and chronic rejection.

    • Hyperacute rejection is evident within minutes of the transplantation procedure when preformed donor-specific antibodies are present in the recipient at the time of the transplant.

    • Acute cellular rejection (ACR) is the most common type and is mediated by alloreactive T-lymphocytes. Biopsy of the allograft is often used to guide therapy.

    • Antibody-mediated rejection (AMR) is characterized by the presence of antibodies directed against donor vascular endothelium. Antibodies activate complement, which creates a membrane attack complex that directly damages the organ.

    • Chronic rejection is a major cause of graft loss and presents as a slow and indolent form of ACR, in which the involvement of the humoral immune system and antibodies against the vascular endothelium appear to play a role.

    • The primary goal of acute rejection therapy is to minimize the intensity of the immune response and prevent irreversible injury to the allograft.

    • Treatment of ACR includes optimizing immunosuppression, increasing the doses of current immunosuppressive drugs, pulse corticosteroids, or short-term treatment with a polyclonal or monoclonal antibody.

    • Treatment of AMR involves removing existing antibodies through plasmapheresis or intravenous immunoglobulin (IVIG) and inhibiting their re-development through rituximab, bortezomib, or eculizumab.

    • Plasmapheresis is a procedure in which the plasma in the patient's blood is removed and replaced with another fluid, similar to what happens in kidney dialysis.

    • Rituximab is a chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes and has been shown to improve graft survival in combination with plasmapheresis and IVIG in patients with AMR.The Use of Eculizumab in Renal Transplantation: Overview, Treatment of AMR, and Re-start Prophylaxis

    • Eculizumab is primarily used in renal transplantation to treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant.

    • Eculizumab inhibits the cleavage of C5, thus preventing the formation of inflammatory molecules C5a and C5b, including membrane attack complex (MAC).

    • Eculizumab appears effective in protecting renal allografts when post-transplant aHUS or AMR occurs, but published cases have relatively short follow-up.

    • Patients should receive vaccination against Neisseria meningitidis before receiving eculizumab.

    • A retrospective observational study showed that eculizumab treatment for early post-transplant AMR increased the median estimated glomerular filtration rate from 21 to 34 mL/min within a week.

    • Only 16.7% of biopsied patients had persistent active AMR within 4-6 months, and no graft losses occurred.

    • Larger trials are needed to evaluate the efficacy of eculizumab in treating AMR.

    • Prophylactic agents, such as valganciclovir, nystatin, trimethoprim-sulfamethoxazole, and H2-receptor antagonists or proton-pump inhibitors, may be added to minimize adverse effects associated with intensive immunosuppression regimens.

    • Valganciclovir is used to prevent cytomegalovirus infection, nystatin for fungal infections, and trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia and urinary tract infections.

    • H2-receptor antagonists or proton-pump inhibitors are used to prevent gastric ulcers caused by immunosuppressive drugs.

    • The use of prophylactic agents should be re-evaluated and restarted as necessary, particularly when immunosuppression is increased or changed.

    • For questions, contact [email protected].

    Solid Organ Transplantation Rejection: Types, Mechanisms, and Treatment

    • Rejection of a transplanted organ is primarily mediated by activation of alloreactive T cells and antigen-presenting cells such as B lymphocytes.

    • Acute allograft rejection is caused primarily by the infiltration of T cells into the allograft, which triggers inflammatory and cytotoxic effects on the graft.

    • There are three types of rejection: hyperacute, acute cellular, and chronic rejection.

    • Hyperacute rejection is evident within minutes of the transplantation procedure when preformed donor-specific antibodies are present in the recipient at the time of the transplant.

    • Acute cellular rejection (ACR) is the most common type and is mediated by alloreactive T-lymphocytes. Biopsy of the allograft is often used to guide therapy.

    • Antibody-mediated rejection (AMR) is characterized by the presence of antibodies directed against donor vascular endothelium. Antibodies activate complement, which creates a membrane attack complex that directly damages the organ.

    • Chronic rejection is a major cause of graft loss and presents as a slow and indolent form of ACR, in which the involvement of the humoral immune system and antibodies against the vascular endothelium appear to play a role.

    • The primary goal of acute rejection therapy is to minimize the intensity of the immune response and prevent irreversible injury to the allograft.

    • Treatment of ACR includes optimizing immunosuppression, increasing the doses of current immunosuppressive drugs, pulse corticosteroids, or short-term treatment with a polyclonal or monoclonal antibody.

    • Treatment of AMR involves removing existing antibodies through plasmapheresis or intravenous immunoglobulin (IVIG) and inhibiting their re-development through rituximab, bortezomib, or eculizumab.

    • Plasmapheresis is a procedure in which the plasma in the patient's blood is removed and replaced with another fluid, similar to what happens in kidney dialysis.

    • Rituximab is a chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes and has been shown to improve graft survival in combination with plasmapheresis and IVIG in patients with AMR.The Use of Eculizumab in Renal Transplantation: Overview, Treatment of AMR, and Re-start Prophylaxis

    • Eculizumab is primarily used in renal transplantation to treat atypical hemolytic-uremic syndrome (aHUS) and antibody-mediated rejection (AMR) post-transplant.

    • Eculizumab inhibits the cleavage of C5, thus preventing the formation of inflammatory molecules C5a and C5b, including membrane attack complex (MAC).

    • Eculizumab appears effective in protecting renal allografts when post-transplant aHUS or AMR occurs, but published cases have relatively short follow-up.

    • Patients should receive vaccination against Neisseria meningitidis before receiving eculizumab.

    • A retrospective observational study showed that eculizumab treatment for early post-transplant AMR increased the median estimated glomerular filtration rate from 21 to 34 mL/min within a week.

    • Only 16.7% of biopsied patients had persistent active AMR within 4-6 months, and no graft losses occurred.

    • Larger trials are needed to evaluate the efficacy of eculizumab in treating AMR.

    • Prophylactic agents, such as valganciclovir, nystatin, trimethoprim-sulfamethoxazole, and H2-receptor antagonists or proton-pump inhibitors, may be added to minimize adverse effects associated with intensive immunosuppression regimens.

    • Valganciclovir is used to prevent cytomegalovirus infection, nystatin for fungal infections, and trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia and urinary tract infections.

    • H2-receptor antagonists or proton-pump inhibitors are used to prevent gastric ulcers caused by immunosuppressive drugs.

    • The use of prophylactic agents should be re-evaluated and restarted as necessary, particularly when immunosuppression is increased or changed.

    • For questions, contact [email protected].

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    SOT6_ACR and AMR_56 (1).pptx

    Description

    Test your knowledge on solid organ transplantation rejection, including types, mechanisms, and treatment options. This quiz covers hyperacute, acute cellular, and chronic rejection, as well as antibody-mediated rejection and the use of eculizumab in renal transplantation. Learn about the primary goals of acute rejection therapy and treatment options for ACR and AMR. Additionally, discover the prophylactic agents used to minimize adverse effects associated with immunosuppression regimens. Test your understanding of this complex topic and see

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