Solid organ transplant rejection

Wilde Ml, Goa KL (1996) Muromonab CD3 a reappraisal of its pharmacology and use as prophylaxis of solid organ transplant rejection. Drugs 51 865-894. 

Cyclosporine A (CsA) is an inhibitor of intracellular calcineurin, thereby inhibiting the production and release of interleukin-2 (IL-2) which subsequently limits clonal activation and expansion of T-lymphocytes. CsA is FDA-approved for the prevention of solid organ transplant rejection (kidney, liver) and keratoconjunctivitis sicca. Non-FDA labeled indications include, but are not limited to, the autoimmime diseases systemic lupus erythematosus rheumatoid arthritis myasthenia gravis. 

After these initial approaches in animal models, ECP has been used in humans for the prevention and/or treatment of several solid organ transplant rejections, including kidney, heart, lung, pancreas, and liver. The year of introduction of ECP for treating rejection of each type of transplant is indicated in Table 5. Importantly, ECP is effective for patients resistant to conventional treatment, particularly if started early. Besides reversal of allograft rejection, a reduction in immunosuppressive therapy has also been frequently achieved [173,174]. 

Successful outcomes in solid-organ transplantation generally are measured in terms of several separate end points (1) preventing acute rejection (2) increasing 1-year graft survival ... 

Solid organ transplant recipients have a blunted immune response to vaccines because the immunosuppressive regimens used to prevent organ rejection inhibit both T- and B-cell proliferation. Many of these patients will also have secondary hypogammaglobulinemia post-transplantation. Prior to transplant, children should complete primary immunization schedules if possible accelerated schedules may be used. Adults should have all vaccinations updated prior to transplantation.16... 

What immunosuppressive drugs are used to prevent allograft rejection in solid organ transplantation ... 

The introduction of CSA signiflcantly improved the outcomes of transplantation. Since its approval and widespread use, patient and graft survival rates have improved secondary to a lower incidence of acute rejection episodes and severe infectious complications. In heart transplant recipients, for example, 1 -year survival rates increased from 56% to 85%, and 5-year survival rates increased from 31% to 15%P The efficacy of CSA is well established in aU types of solid-organ transplants. Currently, CSA is approved for use in kidney, liver, and heart transplantation. 

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