acute rejection


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a·cute cel·lu·lar re·jec·tion

graft rejection that usually begins within 10 days after a graft has been transplanted into a genetically dissimilar host. Lesions at the site of the graft characteristically are infiltrated with large numbers of lymphocytes and macrophages that cause tissue damage. See: primary rejection.
Synonym(s): acute rejection

acute rejection

Etymology: L, rejicere, to throw back
after organ transplantation, the rapid reaction against allograft or xenograft tissue that is incompatible. It often occurs a week after treatment, during which the immune response increases in intensity.

rejection

Immunology An immune reaction evoked by allografted organs; the prototypic rejection occurs in renal transplantation, which is subdivided into three clinicopathologic stages. See Cyclosporin A, Graft rejection, Graft-versus-host disease, Second set rejection, Tacrolimus, Transplant rejection.
Rejection types  
Hyperacute rejection Onset within minutes of anastomosis of blood supply, which is caused by circulating immune complexes; the kidneys are soft, cyanotic with stasis of blood in the glomerular capillaries, segmental thrombosis, necrosis, fibrin thrombi in glomerular tufts, interstitial hemorrhage, leukocytosis and sludging of PMNs and platelets, erythrocyte stasis, mesangial cell swelling, deposition of IgG, IgM, C3 in arterial walls
Acute rejection Onset 2-60 days after transplantation, with interstitial vascular endothelial cell swelling, interstitial accumulation of lymphocytes, plasma cells, immunoblasts, macrophages, neutrophils; tubular separation with edema/necrosis of tubular epithelium; swelling and vacuolization of the endothelial cells, vascular edema, bleeding and inflammation, renal tubular necrosis, sclerosed glomeruli, tubular 'thyroidization' Clinical ↓ Creatinine clearance, malaise, fever, HTN, oliguria
Chronic rejection Onset is late–often more than 60 days after transplantation, and frequently accompanied by acute changes superimposed, increased mesangial cells with myointimal proliferation and crescent formation; mesangioproliferative glomerulonephritis, and interstitial fibrosis; there is in general a poor response to corticosteroids

acute rejection

The early destruction of grafted or transplanted material, usually beginning a week after implantation. Acute rejection is identified clinically by decreased function of the transplanted organ. High-dose corticosteroids are the first treatment of acute rejection; they are typically quite effective. Antilymphocyte globulin (ALG), the monoclonal antibody OKT 3, mycophenolate mofetil, and tacrolimus are used when corticosteroids are not effective. See: suppressive immunotherapy; macrophage processing; major histocompatibility complex; T cell
See also: rejection
References in periodicals archive ?
In our experience thus far with the 30 patients enrolled (as of 9/15/97), we believe the approach to dose individualization we are evaluating is practical and provides the ability to effectively individualize MMF dosage in the early posttransplant period, the period in which the risk for acute rejection is greatest.
Early Later Graft ischemia Rejection-acute and chronic Primary nonfunction Immunosuppressant side effects Hepatorenal syndrome Biliary stenosis Hepatopulmonary syndrome Disease recurrence Hepatic artery thrombosis Malignancy Immunosuppressant toxicity Hyperacute rejection Early acute rejection Portal vein thrombosis Infection and sepsis (a) (a) Can occur at any stage.
Rarely, inclusions are noted in stromal cells in cases with extensive epithelial denudation and acute and chronic inflammation resembling severe acute rejection.
16) declined that pretransplant obesity increased mortality without increasing the risk of acute rejection and allograft coronary artery disease.
Acute rejection, described previously, may occur at any time, although the majority of episodes occur within the first year (Figure 5).
In patients at high risk of acute rejection (defined as Black patients and/or patients receiving a repeat kidney transplant who lost a previous kidney transplant from rejection and/or patients with high levels of antibodies that may be directed against the kidney transplant), it is recommended that Rapamune be used in combination with cyclosporine and corticosteroids for the first year following transplantation.
Rates of biopsy-confirmed acute rejection (BCAR) were low, and there was no significant difference between treatment arms in the incidence of and time to first incidence of BCAR.
Individual dose adjustment of cyclosporine (CsA) [4] and tacrolimus (TAC), which are critical-dose drugs widely used in transplantation, is important not only to prevent acute rejection but also to prolong graft (and patient) survival.
Thymoglobulin, a drug that could prevent organ loss for kidney transplant recipients experiencing acute rejection, is marketed by SangStat in both the US and Europe and is the number one immunosuppressive antibody worldwide.
The new dosing recommendations also allow for the use of the drug in combination with antibody inductions therapy in the high risk patients, who have a greater likelihood of developing acute rejection than low to moderate risk kidney recipients.
At 4 years post-transplantation the difference in overall rates of biopsy- proven acute rejection was not significant (15.
As long as the adult kidney functions immediately in the child, there is no kidney loss from irreversible acute rejection after the first year," said Dr.

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