Renal acute rejection

Bohmig GA, Exner M, Watschinger B, Regele H. Acute humoral renal allograft rejection. Curr Opin Urol 2002 12 95-99. 

Ishikawa A, Flechner SM, Goldfarb DA, et al. Quantitative assessment of the first acute rejection as a predictor of renal transplant outcome. Transplantation 1999 68 1318-1324. 

Ruster M, Sperschneider H, Funfstuck R, Stein G, Grone HJ. Differential expression of beta-chemokines MCP-1 and RANTES and their receptors CCR1, CCR2, CCR5 in acute rejection and chronic allograft nephropathy of human renal allografts. Clin Nephrol 2004 61 30-39. 

Grone HJ, Weber C, Weber KS, et al. Met-RANTES reduces vascular and tubular damage during acute renal transplant rejection blocking monocyte arrest and recruitment. FASEB J 1999 13 1371-1383. 

Panzer U, Reinking RR, Steinmetz OM, et al. CXCR3 and CCR5 positive T-cell recruitment in acute human renal allograft rejection. Transplantation 2004 78 1341-1350. 

Kanmaz T, Feng P, Torrealba J, et al. Surveillance of acute rejection in baboon renal transplantation by elevation of interferon-gamma inducible protein-10 and monokine induced by interferon-gamma in urine. Transplantation 2004 78 1002-1007. 

Hauser I A, Spiegler S, Kiss E, et al. Prediction of acute renal allograft rejection by urinary monokine induced by IFN-gamma (MIG). J Am Soc Nephrol 2005 16 1849-1858. 

Segerer S, Regele H, Mack M, et al. The duffy antigen receptor for chemokines is up-regulated during acute renal transplant rejection and crescentic glomerulonephritis. Kidney Int 2000 58 1546-1556. 

Abdi R, Tran TB, Sahagun-Ruiz A, et al. Chemokine receptor polymorphism and risk of acute rejection in human renal transplantation. J Am Soc Nephrol 2002 13 754-758. 

IE 8. A 2. >-year-old female post-renal transplant shows signs of acute renal allograph rejection. Of the following agents, which should be administered ... 

Jamil, B. et al., Impact of acute rejection therapy on infections and malignancies in renal transplant recipients, Transplantation, 68, 1597, 1999. 

Everolimus, a derivative of sirolimus, is a novel macrocyclic immunosuppressant. Risk of acute rejection increases when the everolimus trough level falls below 3 fig/L in renal transplant patients.46... 

Knight SR, Russell NK, Barcena L, Morris PJ. (2009) Mycophenolate mofetil decreases acute rejection and may improve graft survival in renal transplant recipients when compared with azathioprine A systematic review. Transplantation 87 785-794. 

Renal allograft rejection Treatment of acute allograft rejection in renal transplant patients. 

Renal allograft rejection, acute 5 mg/day for 10 to 14 days. Begin treatment once acute renal rejection is diagnosed. 

Mycophenolate mofetil is used together with cyclosporine and corticosteroids for the prophylaxis of acute organ rejection in patients undergoing allogeneic renal, or hepatic transplants. Compared with azathioprine it is more lymphocyte-specific and is associated with less bone marrow suppression, fewer opportunistic infections and lower incidence of acute rejection. More recently, the salt mycophenolate sodium has also been introduced. Mycophenolate mofetil is rapidly hydrolyzed to mycopheno-lic acid, its active metabolite. Mycophenolic acid is a reversible noncompetitive inhibitor of inosine monophosphate dehydrogenase, an important enzyme for the de novo synthesis of purines. As lymphocytes have little or no salvage pathway for purine... 

Sirolimus (Rapamune) is structurally related to tacrolimus. It is approved for use as an adjunctive agent in combination with cyclosporine for prevention of acute renal allograft rejection. It blocks IL-2-dependent T-cell proliferation by inhibiting a cytoplasmic serine-threonine kinase. This mechanism of action is different from those of tacrolimus and cyclosporine. This allows sirolimus to augment the immunosuppressive effects of these drugs. 

Sanstat Human thymocytes Treatment of acute rejection in renal transplant... 

H. Other considerations Daclizumab has been designated an orphan product for use in the prevention of acute renal allograft rejection. 

Keown, P, and D. Niese, Cyclosporine microemulsion increases drug exposure and reduces acute rejection without incremental toxicity in de novo renal transplantation. International Sandimmun Neoral Study Group. Kidney Int, 1998. 54(3) 938-44. 

Ortho Multicentre Transplant Study Group. (1985). A randomized clinical trial of OKT3 monoclonal antibody for acute rejection of cadaveric renal transplants. N. Engl. J. Med., 313, 337-342. 

Indication Treatment of acute renal allograft rejection in combination with other immunosuppressants... 

Antithymocyte globulin (rabbit) is approved for the reversal of acute rejection. A double-blind, randomized trial of thymoglobulin vs ATGAM was conducted in 163 renal recipients with rejection. Thymoglobulin had a higher reversal rate than ATGAM (88% vs 76%, p=0.027). Transplantation 66 29-37, July 15, 1998. 

Mycophenolate mofetil reduces the risk of first acute rejection by 50%. Toxicity is minor, but includes bone marrow suppression and gastrointestinal complaints. A higher incidence of CMV disease compared to azathioprine control wxs observed in the clinical trials. Recent registry studies appear to indicate that renal transplant recipients receiving mycophenolate have improved long-term outcomes. 

Indications Prophylaxis of acute renal allograft rejection when used as part of an immunosuppressive regimen that includes steroids and cyclosporine... 

Mycophenolic acid (MPA) was isolated from cultures of Penicillium spp. in 1896 and was purified in 1913. Initially the compound was studied for its antifungal and antibacterial effects and later for its antitumor effects. Many years later, its immunosuppressive activities were recognized and after further developmental work, an ester prodrug mycophenolate mofetil was developed, which was approved by the United States Food and Drug Administration for the prevention of acute renal allograft rejection in 1995 and for heart transplant recipients in 1998. Mycophenolate mofetil is a cytotoxic agent now used for immunosuppressive therapy and is the mofetil ester of MPA, which is the active immunosuppressive agent. 

Boratynska M, Banasik M, Patrzalek D, Klinger M. 2006. Conversion from cyclosporine-based immunosuppression to tacrolimus/mycophenolate mofetil in patients with refractory and ongoing acute renal allograft rejection. Ann Transplant. 11 51-56. 

Vincenti F, Kirkman R, Light S, Bumgardner G, et al. 1998. Interleuin-2 receptor blockade with daclizumab to prevent acute rejection in renal transplantation. NEJM. 338 161-165. 

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