Antibody-Mediated Rejection in Solid Organ Transplant

Within a little more than a decade, the transplant of human organs for end-stage organ disease became a reality. The early barriers to successful long-term graft and patient survival were related to the inability to effectively control the immune system such that it would not attack the donor tissue but would still recognize and destroy invading organisms and cells. As immunosuppressive therapy has been refined and proper matching of donors and recipients has been improved, hyperacute rejection has become a rare occurrence and acute rejection has been markedly controlled. However, antibody-mediated rejection remains an important impediment to increased survival of transplanted organs. This article provides readers with a broad overview of the immune system, discusses mechanisms of transplant rejection, and details prevention, detection, and treatment of antibody-mediated rejection in solid organ transplant.

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Predictors of Long-Term Health-Related Quality of Life in Adolescent Solid Organ Transplant Recipients

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsr007 ◽

2011 ◽

Vol 36 (8) ◽

pp. 891-901 ◽

Cited By ~ 32

Author(s):

Katie A. Devine ◽

Bonney Reed-Knight ◽

Kristin A. Loiselle ◽

Laura E. Simons ◽

Laura L. Mee ◽

...

Keyword(s):

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Health Related Quality ◽

Transplant Recipients ◽

Related Quality ◽

Health Related ◽

Solid Organ Transplant Recipients

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1738. Incidence and Outcomes of Hospitalization with Invasive Fungal Infection Among Solid-Organ Transplant Recipients: A Population-Based Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1601 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S636-S636

Author(s):

Kyla L Naylor ◽

Alexandra Ouédraogo ◽

Sarah E Bota ◽

Shahid Husain ◽

J Michael Paterson ◽

...

Keyword(s):

Cohort Study ◽

Graft Failure ◽

Organ Transplant ◽

Population Based ◽

Solid Organ Transplant ◽

Cumulative Probability ◽

Solid Organ ◽

Transplant Recipients ◽

All Cause Mortality

Abstract Background Invasive fungal infection (IFI) in solid-organ transplant (SOT) recipients is associated with significant morbidity and mortality. The long-term probability of post-transplant IFI is poorly understood. Methods We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada to determine the incidence rate, 1-, 5- and 10-year cumulative probability of IFI-related hospitalization, and 1-year post-IFI all-cause mortality in SOT recipients from 2002 to 2016. We also examined post-IFI death-censored graft failure in renal transplant patients. Results We included 9326 SOT recipients (median follow-up 5.35 years). Overall, the incidence of IFI was 8.3 per 1000 person-years (95% confidence interval [CI]: 7.5–9.1). The 1-year cumulative probability of IFI was 7.4% (95% CI: 5.8–9.3%), 5.4% (95% CI: 3.6–8.1%), 1.8% (95% CI: 1.3–2.5%), 1.2% (95% CI: 0.5–3.2%), and 1.1% (95% CI: 0.9–1.4%) for lung, heart, liver, kidney-pancreas, and kidney-only transplant recipients, respectively. Lung transplant recipients had both the highest incidence rate and the highest 10-year probability of IFI: 43.0 per 1,000 person-years (95% CI: 36.8–50.0) and 26.4% (95% CI: 22.4–30.9%), respectively. Lung transplantation was also associated with the highest 1-year cumulative probability of post-IFI all-cause mortality (40.2%,95% CI: 33.1–48.3%). Among kidney transplant recipients, the 1-year probability of death-censored graft failure after IFI was 9.8% (95% CI: 6.0–15.8%). Conclusion The 1-year cumulative probability of IFI varies widely among SOT recipients. Lung transplantation was associated with the highest incidence of IFI with considerable 1-year all-cause mortality. The findings of this study considerably improved our understanding of the long-term probability of post-transplant IFI. Disclosures All authors: No reported disclosures.

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Future of Solid Organ Transplantation: Organ-Specific Tolerance

KIDNEYS ◽

10.22141/2307-1257.10.3.2021.239589 ◽

2021 ◽

Vol 10 (3) ◽

pp. 130-136

Author(s):

Yusuf Ercin Sonmez

Keyword(s):

Immune System ◽

Solid Organ Transplantation ◽

Organ Transplant ◽

Immunological Tolerance ◽

The Body ◽

Solid Organ ◽

Donor Organ ◽

Organ Specific ◽

Specific Tolerance

A transplant between two people who are not genetically identical is called an allotransplant and the process is called allotransplantation. Donor organs and tissues can be from people who are living, or people who have died because of a significant brain injury or lack of circulation. Allotransplantation can create a rejection process where the immune system of the recipient attacks the foreign donor organ or tissue and destroys it. The recipient may need to take immunosuppressive medication for the rest of their life to reduce the risk of rejection of the donated organ. In general, deliberately induced immunosuppression is performed to prevent the body from rejecting an organ transplant. The adverse effects associated with these agents and the risks of long-term immunosuppression present a number of challenges for the clinician. Immune tolerance, or immunological tolerance, or immunotolerance, is a state of unresponsiveness of the immune system to substances or tissue that have the capacity to elicit an immune response in a given organism.

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