Presentation
This unique presentation of bilateral graft edema following microsporidial keratoconjunctivitis in postgraft patients requires a high index of suspicion as it can be easily be mistaken for and mismanaged as acute graft rejection. [ncbi.nlm.nih.gov]
In the so-called indirect pathway of allorecognition, recipient T lymphocytes recognize antigens of the graft donor after they are presented by the recipient’s own antigen-presenting cells. [humpath.com]
The physiological function of the MHC molecules is to present antigenic peptides to T cells, since the T lymphocytes only recognize antigen when presented in a complex with an MHC molecule. [emedicine.medscape.com]
Entire Body System
- Inflammation
Inflammation predisposes the graft to rejection “Graft rejection is the immune system’s response to chronic inflammation. Chronic inflammation always has an immune component." [healio.com]
Withdrawal of alendronate resulted in rapid resolution of intraocular inflammation and corneal edema. We recommend vigilance in corneal transplant patients on simultaneous bisphosphonate therapy. [ncbi.nlm.nih.gov]
- Falling
If falling donor chimerism suggesting immunologic rejection, consider additional immunosuppression. Determine if graft rejection and consider DLI. [clinicaladvisor.com]
[…] epithelial cell injury, then inflammatory lesions and recruitment of fibroblasts and myofibroblasts, which proliferate and secrete proteins forming scar tissue. [18] Generally thought unpredictable, BOS progression varies widely: lung function may suddenly fall [en.wikipedia.org]
- Sepsis
Septisistä infektioista 40–60 % on lähtöisin virtsateistä, ja jopa 7 %:a VTI:sta komplisoi sepsis «Abbott KC, Oliver JD 3rd, Hypolite I ym. Hospitali...»8, «Renoult E, Aouragh F, Mayeux D ym. Factors influen...»9. [kaypahoito.fi]
Results are generally poor ( Table 18, “Patient and graft survival after transplantation” ) due to graft rejection, sepsis and multi-organ failure. [surgwiki.com]
- Fatigue
Symptoms of Organ Rejection The most common symptoms or signs of rejection are: Flu-like symptoms Cough/chest pain Fatigue Fever Shortness of breath Decreased peak flow Decreased incentive spirometry Decreased oxygen saturation If you develop any of these [columbiasurgery.org]
Gastrointestinal
- Nausea
In patients with PNH, the most frequently reported adverse events observed with Soliris treatment in clinical studies were headache, nasopharyngitis (runny nose), back pain and nausea. [news.alexionpharma.com]
Flu-like symptoms such as chills, aches, nausea, cough, shortness of breath may also present. Rarely, patients report pain or swelling in the abdominal region, possibly accompanied by a fever. [news-medical.net]
Symptoms may include: The organ's function may start to decrease General discomfort, uneasiness, or ill feeling Pain or swelling in the area of the organ (rare) Fever (rare) Flu-like symptoms, including chills, body aches, nausea, cough, and shortness [medlineplus.gov]
Snapshot A 60-year-old-man presents with nausea and vomiting to his primary care physician. Medical history is significant for a liver transplantation approximately 2 weeks prior to presentation. [medbullets.com]
Liver, Gall & Pancreas
- Jaundice
Yet, jaundice progressed. He died of liver failure on day 176. Postmortem examination revealed neither GVHD nor VOD. [ncbi.nlm.nih.gov]
Transplants, because the donated tissue has a large amount of immune cells.The immune cells from the graft spread through the body and cause systemic symptoms that are not isolated to the transplanted organ.Symptoms commonly include diarrhea, rash and jaundice [stomponstep1.com]
[…] intestinal failure, no artificial means of support exists for patients with liver failure, and so patients either die before a liver transplant becomes available or come to transplantation with advanced liver disease and its complications, including jaundice [surgwiki.com]
Cardiovascular
- Thrombosis
Two of the 12 patients suffered fatal hepatic vessel thrombosis during the study. [ncbi.nlm.nih.gov]
Vascular - transplant renal artery and vein thrombosis, anastomotic bleeding, peri-transplant haematoma, transplant renal artery stenosis. Lymphatic - lymphocele. [surgwiki.com]
This is an example of Type II Hypersensitivity and results in thrombosis and occlusion of the graft vessel. The transplanted organ must be removed immediately. [stomponstep1.com]
Complement fixation occurs, resulting in thrombosis of vessels in the graft, and ischemic death of the graft. [humpath.com]
Eyes
- Visual Impairment
Author information 1 Institute of Experimental Ophthalmology, School of Medicine, University of Münster, Münster, Germany. [email protected] Abstract Corneal diseases cause severe visual impairment that necessitates corneal transplantation and frequently [ncbi.nlm.nih.gov]
Workup
HLA Type
- HLA-A2
The HLA-A2 restricted T cell epitope HCV core 35-44 stabilizes HLA-E expression and inhibits cytolysis mediated by natural killer cells. Am J Pathol (2005) 166(2):443–53. PubMed Abstract | Google Scholar 21. [journal.frontiersin.org]
Treatment
CONCLUSIONS: Prednisolone remains the treatment of choice for management and treatment of graft rejection; however, since the introduction of difluprednate, its use has declined slightly since the introduction of difluprednate. [ncbi.nlm.nih.gov]
Prognosis
In our patient, the prophylactic use of LAT from HLA-matched donors and AMT before PK, may result in a better prognosis of corneal graft survival. [ncbi.nlm.nih.gov]
Prognosis Graft rejection/failure is often a life-threatening complication. [clinicaladvisor.com]
When the organ donor is not the recipient themselves or a genetically identical twin, the immune response to the new organ becomes extremely important to prognosis. [stomponstep1.com]
AR-CGI rendering serum PARP1 as a biomarker for early prognosis. [omicsonline.org]
Etiology
An infectious etiology was suspected and in vivo confocal microscopy ordered, which revealed hyperreflective dots, highly suggestive of microsporidial spores. The patient was prescribed topical fluconazole 0.3% in both eyes. [ncbi.nlm.nih.gov]
Epidemiology
Interdisciplinaire de Génoprotéomique Appliquée-Research (GIGA-R), University of Liège, Liège, Belgium. 15 Institute of Interdisciplinary Research in Molecular and Human biology (IRIBHM), Université Libre de Bruxelles, Brussels, Belgium. 16 Centre of Epidemiology [ncbi.nlm.nih.gov]
Epidemiology Graft failure/rejection occurs in The risk of rejection increases in patients sensitized presumably to HLA antigens by prior blood transfusion or even pregnancy. [clinicaladvisor.com]
Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International [revistas.proeditio.com]
CORTES Study Group Risk factors for graft failure after penetrating keratoplasty: 5-year follow-up from the corneal transplant epidemiological study. Cornea. 2011;Dec;30(12): 1328–35. pmid:21926910 View Article PubMed/NCBI Google Scholar 5. [journals.plos.org]
Pathophysiology
Pathophysiology Graft rejection is a major cause of graft failure and is due to an immune response of residual post immune cells against donor hematopoietic cells. [clinicaladvisor.com]
Acute rejection can be classified according to pathophysiological changes (cellular‐interstitial, vascular, antibody‐endothelial) or underlying immunologic mechanisms (adaptive or innate immune injury) or severity (histologic injury graded by the Banff [els.net]
Panel B shows possible interactions between the major identified marker PARP1 and its multiple interacting partners that can be related to the graft pathophysiology (PARP1, MAPK1 and NFATC1 highlighted). [omicsonline.org]
Prevention
“Both prevention and treatment of graft rejection are correlated with the patient’s risk category,” Dr. Mastropasqua said. “Topical steroids prevent allograft rejection by inhibiting leukocyte migration into the cornea. [healio.com]
Alexion is investigating Soliris for the prevention of acute antibody-mediated rejection (AMR) in kidney transplant recipients, and for the prevention of delayed graft function (DGF) in patients receiving deceased donor kidney transplants. [news.alexionpharma.com]
This treatment prevents acute rejection of the transplants, but at a high cost: Most patients develop opportunistic infections and cancer. [immune-tolerance.fr]
To determine if the use of combined HLA matched limbal stem cells allograft with amniotic membrane transplantation (AMT) is a safe and effective prophylactic surgical procedure to prevent corneal graft after penetrating keratoplasty (PK). [ncbi.nlm.nih.gov]