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Transplant Rejection

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

  • 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
  • Types
  • Acute Graft Rejection
  1. Onset within days to weeks of Transplantation
  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
  • Types
  • Chronic Graft Rejection
  1. Onset within months to years of Transplantation
  2. Mechanism
    1. Immune response with graft chronic inflammation
    2. Results in vessel intimal thickening and gradual vessel narrowing (arteriosclerosis) to Occlusion
  • Types
  • Graft Versus Host Disease (GVHD)
  1. Mechanism
    1. Donor transplant contains T-Cells that react against the recipient's host Antigens
    2. Results in inflammatory cascade with risk of Graft Rejection
  2. Subtypes
    1. Acute Graft Versus Host Disease
      1. Onset <100 days post-Transplantation
    2. Chronic Graft Versus Host Disease
      1. Onset >100 days post-Transplantation
      2. More prolonged course that may persist years
  3. Symptoms (vary by severity, organ)
    1. Nausea and Vomiting
    2. Diarrhea
    3. Jaundice
    4. Skin Rash