Transplant rejection

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's weight loss doctor NYC
Philadelphia GLP-1 weight loss and GLP-1 clinic NYC

Transplant rejection
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, graft dysfunction, pain at transplant site
Complications	Graft failure, chronic rejection
Onset	Varies (can be acute or chronic)
Duration	Varies
Types	Hyperacute rejection, Acute rejection, Chronic rejection
Causes	Immune response against transplanted organ
Risks	HLA mismatch, non-adherence to immunosuppressive therapy
Diagnosis	Biopsy, blood tests, imaging studies
Differential diagnosis	N/A
Prevention	N/A
Treatment	Immunosuppressive drugs, plasmapheresis, antibody therapy
Medication	N/A
Prognosis	Depends on type and severity
Frequency	Common in transplant recipients
Deaths	N/A

Introduction

Transplant rejection is a physiological response wherein the recipient's immune system identifies and attacks the transplanted tissue or organ, perceiving it as a foreign entity. It is a common challenge in the field of transplantation medicine and can have severe implications for the recipient.

Illustration depicting the immune response during transplant rejection.

Understanding the Immune Response

The human body has a robust immune system designed to ward off foreign invaders such as bacteria, viruses, and other pathogens. However, this system can also recognize transplanted organs or tissues as foreign, leading to rejection.

Types of Rejection

Transplant rejection can be categorized into several types based on the onset and severity:

• Hyperacute Rejection: Occurs within minutes to hours post-transplant. It is primarily due to pre-existing antibodies in the recipient against the donor tissue.
• Acute Rejection: Emerges days to weeks after the transplant. It's the most common type and is mainly caused by T cells of the immune system.
• Chronic Rejection: Manifests over months to years and is less understood. It is believed to be an antibody-mediated response leading to gradual loss of graft function.

Reducing the Risk of Rejection

Molecular Compatibility

One of the primary strategies to reduce the risk of transplant rejection is to ensure molecular compatibility between the donor and the recipient. This is achieved through:

• HLA Typing: A test that identifies the human leukocyte antigen (HLA) molecules on the cells of both donor and recipient. A close HLA match can significantly reduce the risk of rejection.

A depiction of HLA typing procedure.

Immunosuppressive Therapy

Post-transplant, recipients are typically prescribed immunosuppressant drugs. These drugs:

• Dampen the immune response, reducing the risk of rejection.
• Require careful monitoring, as they can lead to increased susceptibility to infections and other side effects.

Conclusion

Transplant rejection is a complex interplay between the graft and the recipient's immune system. With advancements in molecular testing and the development of effective immunosuppressants, the outcomes for transplant recipients have substantially improved over the years. Still, continuous research is vital to further understand the mechanisms of rejection and devise strategies to prevent it.