Transplant Rejection

Aka: Transplant Rejection, Transplanted Organ Rejection, Graft Rejection, Hyperacute Graft Rejection, Acute Graft Rejection, Chronic Graft Rejection, Graft Versus Host Disease

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II. Definitions

  1. Graft Versus Host Disease (GVHD)
    1. Donor transplant contains T-Cells that react against the recipient's host Antigens
    2. Results in inflammatory cascade with risk of Graft Rejection

III. Types: Hyperacute Graft Rejection

  1. Onset within hours to days of Transplantation
  2. Caused by pre-existing host Antibody (inadequately cross-matched graft)
    1. ABO Incompatibility (Blood Transfusion Reaction)
    2. HLA incompatibility
  3. Mechanism
    1. Antibodies bind graft endothelium, activating complement
    2. Endothelial inflammation and ultimately graft thrombosis results

IV. Types: Acute Graft Rejection

  1. Onset within days to weeks of Transplantation (<100 days after transplant)
  2. Mechanism
    1. CD8+ T Cell activation and graft destruction
    2. Monocyte activation (by T Cells) results in delayed type Hypersensitivity
    3. B-Cell Antibody production against graft vessel wall Antigens
  3. Findings
    1. Gastrointestinal symptoms
      1. Nausea and Vomiting
      2. Diarrhea
      3. Jaundice (with Total Bilirubin increase)
    2. Maculopapular rash
      1. Lesions may involve palms and soles
      2. Pain and Pruritus
      3. May appear similar to Stevens Johnson Syndrome
      4. May progress to Erythroderma or Bullous Disease

V. Types: Chronic Graft Rejection

  1. Onset within months to years of Transplantation (>100 days after transplant)
  2. Mechanism
    1. Immune response with graft chronic inflammation
    2. Results in vessel intimal thickening and gradual vessel narrowing (Arteriosclerosis) to Occlusion
  3. Findings: Chronic Autoimmune Effects
    1. Sclerosis
    2. Sicca syndrome and Conjunctivitis
    3. Lichenoid skin lesions
    4. Esophageal Webs and strictures
    5. Mucositis and mucous membrane ulcerations
    6. Bronchiolitis Obliterans (Shortness of Breath, cough, Wheezing)

VI. References

  1. Claudius, Ruttan and DeFabio in Swadron (2022) EM:Rap 22(11): 13

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