Liver 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... 

Unlabeled Uses Prophylaxis of liver transplant rejection, treatment of alcoholic cirrhosis, biliary atresia, chronic hepatitis, gallstone formation, sclerosing cholangitis... 

Chronic rejection after liver transplant is rare (<3%), which is attributed to the recognition of acute rejection and the ability of the liver to regenerate itself. During chronic rejection, there is progressive failure of liver function, and humoral immune... 

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. 

Chronic rejection of the liver is characterized by an obliterative arte-riopathy and the loss of bile ducts, which has been referred to as the vanishing bile duct syndrome. These patients experience an asymptomatic rise in the canalicular liver enzymes (alkaline phosphatase and Y -glutamyl transpeptidase) and become j aundiced. These changes are considered the result of immunologic and ischemic injmy and can be seen in patients who have not responded adequately to therapy for acute rejection. 

Currently, since the safety and efficacy of SRL has not been established in liver or lung transplants, it is recommended that its use be avoided in these populations immediately following transplant. In contrast, limited data on the use of SRL in heart transplantation indicate benefit in reversing acute rejection in patients who do not respond to antilymphocyte therapy. Furthermore, SRL may slow the progression of vasculopathy, which may have an impact on chronic rejection and long-term patient survival after heart transplantation. ... 

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. 

Wright, H.L., Bon-Abbond, C.F., Hassanein, T., Block, G.D., Demetris, A.J., Starzl, T.E., van TMel, D.H. Disease recurrence and rejection following liver transplantation for autoimmune chronic active liver disease. Transplantation 1992 53 136-139... 

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