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Renal Transplant Rejection

Kidney Transplant Rejection


Presentation

  • E-Selectin was present, at low intensity, in some pretransplant biopsies and also some post-transplant biopsies which were reported histologically as normal.[ncbi.nlm.nih.gov]
  • Individuals and organizations with common interests are urged to consolidate or coordinate their presentations, and request time for a joint presentation. All requests to make oral presentations must be received no later than April 6, 2017.[fda.gov]
Ascitic Fluid
  • The ascitic fluid contained 4,000 leukocytes per microliter. No source of infection was detected, so the diagnosis of SBP was made. The patient was treated with ciprofloxacin intravenously and received low-dose steroid pulse therapy.[ncbi.nlm.nih.gov]
Hunting
  • The team is also on the hunt for insights into rejection-related complications such as BK viremia or infections with other viruses following transplant-related immunosuppression.[genomeweb.com]
Rhinitis
Hypertension
  • Manikkam Suthanthiran, the Stanton Griffis Distinguished Professor of Medicine at Weill Cornell Medical College in New York and chief of transplantation medicine, nephrology and hypertension at NewYork-Presbyterian/Weill Cornell Medical Center.[news.weill.cornell.edu]
  • The most common adverse reactions and laboratory abnormalities (incidence 5% higher than comparator) are urinary tract infection, abdominal pain, hypertension, nausea, shortness of breath, fever, headache, anxiety, chills, increased potassium levels in[thymoglobulin.com]
  • Hypertension, diabetes, and cancer (except possibly CNS tumors) in prospective living donors usually preclude kidney donation.[merckmanuals.com]
  • Patient survival is 91% (10/11): 1 patient relocated out of state and was reported to have died from complications of hypertensive encephalopathy.[ncbi.nlm.nih.gov]
  • Approximately 50% of all renal transplant patients have hypertension.[emedicine.medscape.com]
Neglect
  • Given that Banff-classification consider only diffuse expression as diagnostic criteria, the data from several studies, indicating that focal C4d expression was associated with worsening of graft survival, cannot be neglected, although decrease of survival[omicsonline.org]
Anuria
  • Manifestations of Kidney Transplant Rejection by Category Rejection Category Manifestations Hyperacute Fever, anuria Accelerated Fever, oliguria, graft swelling and tenderness Acute Fever, increased serum creatinine, hypertension, weight gain, graft swelling[merckmanuals.com]

Workup

  • Diagnostic Procedures A complete cardiac workup, including angiography, is not necessary in every patient.[emedicine.medscape.com]
  • A systematic approach can then be utilized to ensure that the vast majority of the possible complications are detected; particularly those that may require further diagnostic workup or surgical/radiologic intervention.[appliedradiology.com]
  • DSA testing should be performed during the workup of graft dysfunction when AMR is concerned. Routine screening for the development of de novo DSA may permit early detection of AMR in high risk patients [15].[file.scirp.org]
Staphylococcus Aureus
  • The ascites culture grew Staphylococcus aureus that was highly sensitive to ciprofloxacin. The patient recovered rapidly. We could avoid laparotomy, which is associated with high mortality in patients suffering from SBP. No relapses of SBP occurred.[ncbi.nlm.nih.gov]
  • Posttransplantation month 1 is dominated by infections directly related to the surgical procedure, including urinary tract infection ( Escherichia coli ), line infection ( Staphylococcus aureus and viridans streptococci), wound infection ( S aureus and[emedicine.medscape.com]
Complement Fixing Antibody
  • Solid phase assays • ELISA – detect complement and non complement fixing antibodies • Pei et all 1998-microbeads coated with purified HLA antigens,detected by flow cytometry • Luminex assay-HLA attached to bead-most applied • Extremely sensitive,no accepted[slideshare.net]
Colitis
  • The team at TSRI is already planning on investigating other diseases with a substantial immune component, such as ulcerative colitis and asthma.[medicalnewstoday.com]
  • The scientists also plan to investigate the genetic expression profiles of patients with diseases such as asthma and ulcerative colitis, in which the immune system is also active.[scripps.edu]

Treatment

  • CONCLUSIONS: Treatment of acute renal transplant rejection with Thymoglobulin is a cost saving strategy when compared with treatment with Atgam.[ncbi.nlm.nih.gov]

Prognosis

  • We propose that the presence of arterio-venous shunting suggests renal transplant rejection and may indicate a poor prognosis for reversal of this rejection.[ncbi.nlm.nih.gov]
  • Our data also favor the independent influence of C4d expression on PTC on the late ATR prognosis.[omicsonline.org]
  • This combination of UCHL-1/PASH greatly improves the accuracy of diagnosing of acute cellular tubulointerstitial rejection and helps determine the therapeutic course and prognosis. back to top References: Brown ED, Chen MY, Wolfman NT, Ott DJ, Watson[sigmaaldrich.com]
  • […] rejection – pain, fever, high BP, needs a biopsy to confirm Late new renal disease chronic rejection – HTN, proteinuria, slow rise in creat, no real treatment infection – common and opportunistic side effects of immunosuppressants skin cancers and lymphoma PROGNOSIS[lifeinthefastlane.com]
  • C4d negative AMR • In chronic AMR • as common, if not more than the C4d-positive AMR and has similar poor prognosis in terms of graft survival • Loupy et al. [38,39] showed that C4d or capillaritis in 3-month protocol biopsies were risk factors for later[slideshare.net]

Etiology

  • Ongoing controversies regarding etiology, diagnosis, treatment Many aspects of etiology, diagnosis, and treatment are controversial.[clinicaladvisor.com]
  • The most common causes of renal disease leading to kidney transplantation are the following: Understanding the etiology of renal disease is important because the primary renal pathology may influence the outcome with respect to the propensity for recurrence[emedicine.medscape.com]
  • Renal vein thrombosis is more common than renal artery thrombosis and typically occurs between the third and eighth days post transplant (Figure 8). 18 Possible etiologies include poor surgical technique, compression of the renal vein by a fluid collection[appliedradiology.com]
  • Interstitial fibrosis and tubular atrophy, no evidence of any specific etiology (may include nonspecific vascular and glomerular sclerosis, but severity graded by tubulointerstitial features) I.[rrtjournal.biomedcentral.com]

Epidemiology

  • 1 Schieppati A, Remuzzi G: Chronic renal diseases as a public health problem: epidemiology, social, and economic implications. Kidney international. Supplement . 2005:S7–S10. PubMed CrossRef 2 Gorer PA: The antigenic basis of tumour transplantation.[f1000.com]
Sex distribution
Age distribution

Pathophysiology

  • Chronic rejection is the single most important cause of graft failure in the first posttransplant decade, but its pathophysiology remains poorly understood.[ncbi.nlm.nih.gov]
  • In conclusion, we suggest that in the setting of early acute and severe ABMR, the prompt and upfront administration of eculizumab has the potential to rapidly reverse the ongoing pathophysiological process of ABMR.[pediatrics.aappublications.org]
  • Pathophysiology The pathogenesis of antibody mediated rejection occurring within the first few days of transplantation is believed to be due to preformed antibodies reactive against donor antigens.[tpis.upmc.com]

Prevention

  • There was little or no benefit of muromonab-CD3 over ATG or ALG in reversing rejection, preventing subsequent rejection, or preventing graft loss or death.[cochrane.org]
  • Abstract 15-deoxyspergualin (DSG) is a novel immunosuppressant which has been shown to be effective in preventing and treating rejection in animal allo- and xenotransplant models.[ncbi.nlm.nih.gov]

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