Acute Rejection

Acute Rejection

 

  • T cell mediated (Cellular Rejection)
    • Infiltration of the graft by lymphocytes and inflammatory cells
    • Treatment: high dose steroids (methyl pred) is first line (~ 5 days +)
      • Thymoglobulin (polyclonal Ig anti-T cell)
      • Use depends on severity of rejection
      • Indicated if Cr fails to improve after steroids
      • T cell subsets are measured before and during treatment until depleted
      • Tacro target levels are reset to ~8 if treated for acute T cell mediated rejection

 

 

  • Antibody Mediated Rejection (ABMR)
    • Acute tissue injury with circulating donor-specific antibodies (DSAs); requires evidence of antibody-mediated damage
      • Ig’s deposit and activate complement: key is C4d staining in the graft will be strongly positive
    • Treatment:
      • IV methyl prednisone (3-5 days)
      • Plasmapheresis
      • + IVIG
        • Followed often by Rituxan before d/c