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Transplant Rejection – Causes, Symptoms & Treatment

Transplant rejection is an immune response in which the body attacks a transplanted organ or tissue. It can occur after organ transplants and requires targeted medical treatment.

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Things worth knowing about "Transplant Rejection"

Transplant rejection is an immune response in which the body attacks a transplanted organ or tissue. It can occur after organ transplants and requires targeted medical treatment.

What Is Transplant Rejection?

Transplant rejection refers to the response of a recipient´s immune system against a transplanted organ, tissue, or cells. The immune system recognizes the foreign tissue and attempts to destroy it. This is one of the greatest challenges in modern transplantation medicine.

Causes

The main cause of transplant rejection is immunological incompatibility between the donor and the recipient. HLA antigens (Human Leukocyte Antigens), which are present on the surface of almost all body cells, play a central role. The greater the differences in HLA antigens between donor and recipient, the more likely rejection becomes.

Genetic differences between donor and recipient
Incompatible blood types
Inadequate immunosuppressive therapy
Infections that activate the immune system

Types of Transplant Rejection

Hyperacute Rejection

This form occurs within minutes to hours after transplantation. It is triggered by pre-existing antibodies against donor antigens and leads to immediate failure of the transplanted organ.

Acute Rejection

Acute rejection typically occurs within the first weeks to months after transplantation. It is the most common form and is primarily mediated by T-lymphocytes. With timely treatment, it is often reversible.

Chronic Rejection

Chronic rejection develops over months to years and leads to a gradual loss of function in the transplanted organ. It is more difficult to treat than acute rejection and is one of the main causes of long-term graft failure.

Symptoms

The symptoms of transplant rejection depend on the affected organ and can vary in severity:

Fever and general feeling of illness
Pain or swelling around the transplanted organ
Deterioration of organ function (e.g., rising creatinine levels after kidney transplantation)
Fatigue and exhaustion
Jaundice (in liver transplantation)
Shortness of breath (in lung transplantation)

Diagnosis

The diagnosis of transplant rejection involves several examinations:

Laboratory tests: Blood count, kidney and liver values, inflammatory markers
Imaging: Ultrasound, CT, or MRI to assess the organ
Biopsy: Tissue sampling from the transplanted organ is considered the gold standard for diagnosis
HLA antibody testing: Detection of donor-specific antibodies in the blood

Treatment

Treatment depends on the type and severity of the rejection reaction:

Immunosuppressive Therapy

To prevent and treat rejection, transplant recipients receive lifelong immunosuppressive medications, including drugs such as ciclosporin, tacrolimus, mycophenolate mofetil, and corticosteroids. These medications suppress the immune system so that it tolerates the transplant.

Treatment of Acute Rejection

Acute rejection is typically treated with high-dose corticosteroids (known as steroid pulse therapy). In severe cases, antibody preparations such as ATG (anti-thymocyte globulin) or monoclonal antibodies may also be used.

Treatment of Chronic Rejection

Chronic rejection is more difficult to treat. Therapy focuses on optimizing immunosuppressive treatment to slow the loss of organ function. In severe cases, retransplantation may become necessary.

Prevention

Careful tissue typing (HLA matching) and blood type compatibility testing before transplantation, combined with consistent intake of immunosuppressive medications, are the most important measures for preventing rejection. Regular follow-up examinations allow for early detection and timely treatment.

References

Halloran PF. - Immunosuppressive Drugs for Kidney Transplantation. New England Journal of Medicine, 2004.
Deutsche Transplantationsgesellschaft (DTG) - Guidelines on Transplantation Medicine, 2022.
Sayegh MH, Carpenter CB. - Transplantation 50 Years Later -- Progress, Challenges, and Promises. New England Journal of Medicine, 2004.

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