Liver transplant rejection

ORTHOCLONE OKT 3 Muronomab-CD3 Ortho Biotech Reversal of acute kidney transplant rejection, reversal of heart and liver transplant rejection... 

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

Barnes, D., Talenti, D., Cammell, G., Goormastic, M., Farqnhar, L., Henderson, M., Vogt, D., Mayes, J., Westveer, M.K., Carey, W A randomized clinical trial of ursodeoxycholic acid as adjuvant treatment to prevent liver transplant rejection. Hepatology 1997 26 853-857... 

Tacrolimus, a macrolide derivative, has similar immunosuppressive properties to ciclosporin and has effects on T lymphocytes by inhibiting interleukin-2 production. On a weight basis, tacrolimus is about 100 times more potent than ciclosporin. In view of the outcome of several multicenter trials, it has been used as an alternative to ciclosporin as a baseline regimen for the prophylaxis of renal and liver transplant rejection and in the treatment of acute rejection (SED-13,1130) (SEDA-21, 390) (1). The clinical pharmacology, clinical use, and adverse effects profile of tacrolimus in organ transplantation have been extensively reviewed (2). 

Orthoclone OKT3, muromonab-CD3 Murine IgGza CD3 Prevention of acute kidney, heart, and liver transplant rejection Ortho Biotech ... 

Nephrotoxicity Nephrotoxicity has been noted in 25% of cases of renal transplantation, 38% of cases of cardiac transplantation, and 37% of cases of liver transplantation. Mild nephrotoxicity was generally noted 2 to 3 months after transplant and consisted of an arrest in the fall of the preoperative elevations of BUN and creatinine at a range of 35 to 45 mg/dL and 2 to 2.5 mg/dL, respectively. These elevations are often responsive to dosage reductions. More overt nephrotoxicity was seen early after transplantation and was characterized by a rapidly rising BUN and creatinine. Because these events are similar to rejection episodes, care must be taken to differentiate between them. This form of toxicity is usually responsive to cyclosporine dosage reduction. 

Organ transplants The safety and efficacy of peginterferon alfa-2b alone or in combination with ribavirin capsules for the treatment of hepatitis C in patients who have received liver or other organ transplants have not been studied. Preliminary data indicate that interferon alpha therapy may be associated with an increased rate of kidney graft rejection. Liver graft rejection also has been reported, but a causal... 

The drugs like azathioprine and cyclosporine A are used chiefly to prevent transplant rejection and in the treatment of autoimmune diseases. They are used to prevent graft rejection after kidney, liver, lung, pancreas transplant or bone marrow transplantation. 

Muromonoab-CD3 is used for the treatment of acute organ transplant rejection. It is effective in preventing graft rejection after kidney, heart or liver transplantation. Muromonoab-CD3 is effective in patients who after acute cardiac or liver allograft rejection do not respond to steroid therapy. It is administered intravenously and with a dose of 5 mg/day, a general concentration range of 400-1500 ng/ml can be achieved. A serum concentration of 600-1150 ng/ml in renal transplant patients produces desirable immunosuppressive effects. The levels of CD3 expression, their production and antibodies to the drug determine its rate of clearance. In the absence of antibodies to muromonoab-CD3, its half-life is about 18 h. 

There are only a few reports of hyperacute rejection after liver transplantation. This may be due to the ability of the Kupffer cells to remove cytotoxic antibodies formed against the graft because of their reticuloendothelial function. Acute rejection is the more common form of rejection, which is manifested within 7-10 days after liver transplantation and exhibits symptoms of fever, malaise, pain, tachycardia and hepatomegaly. Mental disorientation in patients has also been reported during acute rejection. Liver biopsy is performed to confirm acute rejection that is generally mild in nature, and lymphocytic infiltration is observed in the portal tracts under the endothelium of the sinusoids. 

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... 

Basiliximab Simulect Treatment of the acute rejection of kidney, heart and liver transplants 1998... 

Snover, D.C., Sibley, R.K., Freese, D.K., Sharp, H.L., Bloomer, J.R., Najarian, J.S., Ascher, N.L. Orthotopic liver transplantation a pathological study of 63 serial hver biopsies from 17 patients with special reference to the diagnostic features and natural history of rejection. Hepatology 1984 4 1212-1222... 

Scintigraphic assessment of liver transplants is helpful (e.g. perfusion, rejection, bile-duct obstruction or bile leakage). (28)... 

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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