Transplantation globulin

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Managing viral hepatitis involves both prevention and treatment. Prevention of hepatitis A and B (and indirectly for hepatitis D) can be achieved with immune globulin or vaccines. There is no specific pharmacologic treatment for acute viral hepatitis A, B, C, D, or E only supportive care is available. Individuals with mild to moderate symptoms rarely require hospitalization. Occasionally, hospitalization is required in individuals experiencing significant nausea, vomiting, diarrhea, and encephalopathy. Liver transplantation may be required in rare instances if fulminant hepatitis develops. 

Vaccines Yes. Wyeth Vaccine, called VIG or vaccinia immune globulin, one dose by scarification. (Pre- and post-exposure vaccination recommended if greater than three years passed since last vaccine.) Persons who are pregnant, have clinical immunosuppression (such as persons who have undergone heart and other transplant operations and take medicines to control rejection of their new, transplanted organ), eczema, and/or leukemia/ lymphoma would be contraindicated for such vaccine. As one example, the fatality rate for immunosuppressed persons taking such vaccine could be as high as 75 percent or more. 

ANTI THYMOCYTE GLOBULINE ALLOWS FOR SUCESSFUL TRANSPLANTATION FROM HLA MISMATCHED UNRELATED DONORS... 

The final chapter comprises two reports on clinical haematopoietic stem cell transplantation (HSCT). Viktor Khomenko shares the experience of the Kiev center for stem cell transplantation. The final article in this book by Axel Zander and colleagues summarises data with the use of Antithymocyte globuline (ATG) in (HLA-mismatched) allogeneic transplantation, an approach which was promoted in the Hamburg Clinic for HSCT. 

Therapy for WAS is directed to reducing bleeding and control of infection. Splenectomy usually restores the platelet count and size. Antibiotic and intravenous immune globulin treatment has been successful in controlling infections. Bone marrow transplantation has been successful in treating a number of patients with WAS (118). 

Anti-lymphocyte globulin (ALG) has been prepared as an highly purified solution of y-globulins with antilymphocyte activity by immunizing horses with human lymphocytes. It activates complement-mediated destruction of lymphocytes and thus decreases cellular immunity with only a limited effect on humoral immunity. Anti-lymphocyte globulin suppresses delayed type hypersensitivity reactions. It is used for the prevention and treatment of rejection episodes of transplanted organs. It also has some indication for the management of idiopathic aplastic anemia. Adverse effects include pain at the site of injection, erythema, serum sickness and rarely anaphylactic shock and thrombocytopenia. 

Therapy, when replacement of the marrow by allogeneic haematopoietic stem cell transplantation is not possible, comprises 500 mg of methylpred-nisolone by 8 hour intravenous infusion repeated for five consecutive days. Concurrently 15 mg/kg of antilymphocyte or antithymocyte globulin is given... 

Intravenous gamma globulin preparations are available for replacement therapy for patients with congenital agammaglobulinaemia and hypogammag-lobulinaemia, idiopathic thrombocytopenic purpura and Kawasaki syndrome. It is also used for prophylaxis of infection following bone marrow transplantation. 

Antisera directed against lymphocytes have been prepared sporadically for over 100 years. With the advent of human organ transplantation as a therapeutic option, heterologous antilymphocyte globulin (ALG) took on new importance. ALG and antithymocyte globulin (ATG) are now in clinical use in many medical centers, especially in transplantation programs. The antiserum is usually obtained by immunization of large animals such as horses or sheep with human lymphoid cells. 

Vo AA et al Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med 2008 359 242. [PMID 18635429]... 

Bone marrow transplantation Immune globulin (intravenous [IV])2 500 mg/kg IV on days 7 and 2 prior to transplantation and then once weekly through day 90 after transplantation. Prophylaxis to decrease the risk of infection, interstitial pneumonia, and acute graft-versus-host disease in... 

Cytomegalovirus (CMV) Cytomegalovirus immune globulin (IV) Consult the manufacturer s dosing recommendations. Prophylaxis of CMV infection in bone marrow, kidney, liver, lung, pancreas, heart transplant recipients. 

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. 

Giebel S, Wojnar J, Krawczyk-Kulis M, Markiewicz M, et al. 2006. Treosulfan, cyclophosphamide and antithymocyte globulin for allogeneic hematopoietic cell transplantation in acquired severe aplastic anemia. Ann Transplant. 11 23-27. 

Kreis H. 1992. Antilymphocytic globulins in kidney transplantation. Kidney Int. 42 S188-S192. 

Brennan DC, Daller JA, Lake KD, Cibrik D. 2006. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. NEJM. 355 1967-1977. 

Antithymocyte globulin — Treatment of rejection of kidney, heart, liver, lung, pancreas, and bone marrow transplants... 

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