Organ transplantation rejection

The first two DES to be commercialized incorporated sirolimus (rapamycin Rapamune , Wyeth Pharmaceuticals, Inc, Collegeville, Pennsylvania, U.S.A.), an immunosuppressive agent used for the prevention of transplanted organ rejection, or paclitaxel (Taxol , Bristol-Myers Squibb, Princeton, New Jersey, U.S.A.) an agent with an extensive history as an anti-cancer therapy. 

Even where the grave consequences of noncompliance are understood (glaucoma blindness) (renal transplant organ rejection), significant noncompliance has been reported in as many as 20% of patients psychologists will be able to suggest explanations for this. 

Cyclosporine (Sandimmune) Inhibits T-Cell-mediated immunity by 1) i production of inter1eukin-ll by activated T-helper cells, 2) 4- the number of inteneukin receptors on cytotoxic-T cells, 3) allowing proliferation of T-suppressor cells. Agent of choice for preventing and treating transplanted organ rejection. Nephrotoxicity (presentation is similar to kidney rejection ), thromboembolism, neurotoxicity, reversible hepatotoxicity, hypertension. 

CVF has been used in the investigation of the role of complement in various immunologic reactions. The anticomplement action of the CVF has potential use in the prevention of transplanted organ rejection. CVF as an immunosuppressor has been investigated by a number of workers their results showed increased survival time of transplanted or grafted tissues. 

Decreases the production of lymphocytes and eosinophils in the blood by causing atrophy of the thymus gland blocks the release of cytokines, resulting in a decreased performance of T and B monocytes in the immune response. (This action, coupled with the anti-inflammatory action, makes the corticosteroids useful in delaying organ rejection in patients with transplants.)... 

The science of immunology not only encompasses the body s immune responses to bacteria and viruses but is extensively involved in tumour recognition and subsequent rejection the rejection of transplanted organs and tissues the elimination of parasites ftom the body allergies and autoimmunity (the condition when the body mounts a reachon agairrst its own tissues). 

Cyclosporine is a cyclic polypeptide immunosuppressant typically used to prevent organ rejection in transplant patients. Its use is restricted to patients with fulminant or refractory symptoms in patients with active IBD. Significant toxicides associated with cyclosporine are nephrotoxicity, risk of infection, seizures, hypertension, and liver function test abnormalities.1,13,14... 

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... 

In some surgical procedures, such as organ transplantation, the success of that procedure will be only as great as the course of pharmacotherapy that follows. Organ transplant recipients are required to continue drug therapy for the balance of their lives for control of their immune systems and to prevent organ rejection. 

Prophylaxis of acute organ rejection in allogeneic renal transplantation... 

Antibodies have and likely will find additional use in transplantation-related medicine. In general, cell-mediated immunological mechanisms are responsible for mediating rejection of transplanted organs. In many instances, transplant patients must be maintained on immunosuppressive drugs (e.g. some steroids and, often, the fungal metabolite cyclosporine). However, complications may arise if a rejection episode is encountered that proves unresponsive to standard immunosuppressive therapy. Orthoclone OKT-3 was the first monoclonal antibody-based product to find application in this regard. 

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. 

Cytotoxic agents Since proliferation of cells is essential for the immune response, agents that inhibit DNA synthesis have been used as immunosuppressive agents for many years. The first were used in the 1960s, particularly to prevent rejection of a transplanted organ, for example purine and pyrimidine analogues. These agents are not now used in autoimmune diseases but are stiU used in cancer chemotherapy (Chapter 21). 

Novartis. (2010). Novartis receives US FDA approval for zortress (everolimus) to prevent organ rejection in adult kidney transplant recipients. Press release http //www.novartis.com. 

Class I MHC proteins occur in almost all nucleated cells. They mainly interact with cytotoxic T cells and are the reason for the rejection of transplanted organs. Class 1 MHC proteins are heterodimers (a 3). The p subunit is also known as P2-microglobulin. 

Basiliximab is a mouse/human chimeric monoclonal antibody with specificity and high affinity for the a-subunit of the IL-2 receptor. The antibody acts as an lL-2Ra antagonist and inhibits lL-2-mediated activation and proliferation of T l)unphocytes. It is indicated for the prevention of acute organ rejection in adult and paediatric renal transplant recipients in combination with other immunosuppressive agents like cyclosporin, azathioprine, mycophenolate mofetU... 

Organ rejection prophylaxis Prophylaxis of organ rejection in patients receiving allogeneic liver or kidney transplants. It is recommended that tacrolimus be used concomitantly with adrenal corticosteroids. Because of the risk of anaphylaxis, reserve the injection for patients unable to take the capsules orally. 

Organ rejection Prophylaxis of organ rejection in patients receiving renal transplants. It is recommended that sirolimus be used in a regimen with cyclosporine and corticosteroids. In patients at low to moderate immunological risk, cyclosporine should be withdrawn 2 to 4 months after transplantation and sirolimus dose should be increased to reach recommended blood concentrations. 

Renal, cardiac, and hepatic transplant Mycophenolate is indicated for the prophylaxis of organ rejection in patients receiving allogeneic renal, cardiac, or hepatic transplants. Use mycophenolate concomitantly with cyclosporine and corticosteroids. 

Organ rejection, prophylaxis Prophylaxis of acute organ rejection in patients receiving renal transplants. It is used as part of an immunosuppressive regimen that includes cyclosporine and corticosteroids. 

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... 

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