Kidney transplantation chronic rejection

Allogeneic transplants For prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants. Gengraf and A/eora/have been used in combination with azathioprine and corticosteroids. Sanc//n n nne always is to be used with adrenal corticosteroids. Sandimmune a so may be used in the treatment of chronic rejection in patients previously treated with other immunosuppressive agents. Because of the risk of anaphylaxis, reserve Sandimmune injection for patients who are unable to... 

Azuma H, Tilney NL. 1995. Immune and nonimmune mechanisms of chronic rejection of kidney allografts. J Heat Lung Transplant. 14 S136-S142. 

The effect of ketoconazole in ciclosporin-treated kidney transplant recipients has been the subject of a prospective randomized study (37). In 51 ketoconazole-treated patients and 49 controls there was a similar frequency of acute rejection episodes. However, in the control group, rejection episodes were more recurrent, with a poorer response to treatment. Acute ciclosporin nephrotoxicity was more common in the ketoconazole group, but this was encountered more at induction and rapidly reversed on further reduction of the dose of ciclosporin. Chronic graft dysfunction was significantly less in... 

It is almost impossible to individualize the exact role of CSA-induced chronic nephrotoxicity in renal allograft outcomes. From the moment of implantation, the transplanted kidney will suffer from mechanical manipulation, ischemic injury and immunologic attack. Later on acute rejection, recurrent or de novo renal disease, hypertension, chronic viral infection, metabolic derangements (dyslipidemia, diabetes, and hyperuricemia), chronic rejection and aging may work in various combinations causing progressive structural damage and functional impairment. 

Chronic rejection is a major cause of late graft loss and is one of the most important problems that remains to be resolved. While chronic rejection simply may be a slow and indolent form of acute cellular rejection, the involvement of the humoral immune system and antibodies against the vascular endothelium appear to play a role. Persistent perivascular and interstitial inflammation is a common finding in kidney, liver, and heart transplantation. Owing to the complex interaction of multiple drugs and diseases over time, it is difficult to dehneate the true nature of chronic rejection. For example, cytomegalovirus is associated with the development of chronic rejection in both liver and heart transplant recipients. Unlike acute rejection, chronic rejection is not reversible. 

Two kidney transplant patients on ciclosporin developed acute renal failure 10 to 42 days after starting to take enalapril 5 to 10 mg twice daily. Recovery was complete when the enalapril was stopped in one of the patients, and when both enalapril and ciclosporin were stopped in the other. The latter patient had no problems when the ciclosporin was restarted. Both recovered renal function after 10 to 30 days. Neither had any previous evidence of renal artery stenosis or chronic rejection, which are conditions known to predispose to renal failure during ACE inhibitor treatment. Two other patients appeared to tolerate concurrent use well. Two further kidney transplant patients developed acute renal failure when given enalapril. Neither had renal arterial stenosis or acute rejection. The manufacturer briefly mentions that transient oliguria was seen in a kidney transplant patient given ciclosporin and captopril. ... 

Among kidney transplant recipients, the 5%-10% who experienced immunological complications (acute then chronic graft rejection) and, as a consequence, were exposed to intense immunosuppressive therapy during the first year become more susceptible to developing opportunistic infections (Pneumocystis proved, Listeria monocytogenes, Nocardia asteroides. Cryptococcus neoformans or Aspergillus). Tberefore, it is extremely important to take preventive measures, i.e., vaccinations and prophylaxis. 

ESRD secondary to PCKD and failed previous transplant. One prior renal transplant that occurred in 1995 (received kidney from husband), which failed secondary to chronic allograft nephropathy in 2004 (presumably from multiple rejection episodes within the first few years after transplant). For the previous transplant, the patient was maintained on cyclosporine, mycophenolate, and prednisone. 

A 30-year-old male with a two-year history of chronic renal failure requiring dialysis consents to transplantation. A donor kidney becomes available. He is given cyclosporine to prevent transplant rejection just before surgery What is the most likely adverse effect of this drug ... 

Uses. Ciclosporin is used to prevent and treat rejection of organ transplants (kidney, liver, heart-lung) and bone marrow transplants. It may be given orally or i.v. In the context of transplantation, administration continues indefinitely and must be carefully monitored, including measurement of plasma concentration and renal function. It is generally stopped after 6 months in patients who have received a bone marrow transplant unless there is ongoing chronic graft-versus-host disease. 

A 29-year-old woman, who had received a cadaveric kidney and pancreas transplant, had stable organ function with ciclosporin when she decided to take St. John s wort (25). Subsequently her ciclosporin concentrations became subtherapeutic and she developed signs of organ rejection. St. John s wort was withdrawn and her ciclosporin concentrations returned to the target range. However, she developed chronic kidney rejection and had to return to dialysis. 

Serum MMP-1 levels in kidney failure patients with chronic transplant nephropathy or during acute kidney rejection have been reported to be significantly higher ( 250%) than patients with stable graft function and a... 

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