Management of recurrent allograft rejection is a risky proposition, especially in the presence of infections. Both steroids and antibody therapy worsen the infection risk. We successfully treated steroid-resistant rejection with intravenous immunoglobulin (IVIG) in two patients who had concomitant infections. IVIG should be considered the treatment of choice for management of steroid-resistant rejection in the presence of serious infection.
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http://dx.doi.org/10.1097/01.tp.0000122415.08639.53 | DOI Listing |
J Pediatr Gastroenterol Nutr
November 2024
HPB Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
This study aimed to report our experience with the use of Sirolimus (SRL) in pediatric liver transplant patients with chronic rejection or steroid-resistant rejection with hepatic fibrosis, focusing on their histological evolution. All pediatric liver transplant recipients who received off-label treatment with SRL for chronic ductopenic rejection or cortico-resistant rejection between July 2003 and July 2022 were included in the study. All nine patients included in the study showed improvement in liver enzymes and cholestasis parameters as soon as 1-month after post-SRL introduction.
View Article and Find Full Text PDFWorld J Transplant
December 2023
Department of Renal Medicine, Manchester University NHS Foun dation Trust, Manchester M13 9WL, United Kingdom.
Anti-thymocyte globulin (ATG) is a pivotal immunosuppressive therapy utilized in the management of T-cell-mediated rejection and steroid-resistant rejection among renal transplant recipients. Commercially available as Thymoglobulin (rabbit-derived, Sanofi, United States), ATG-Fresenius S (rabbit-derived), and ATGAM (equine-derived, Pfizer, United States), these formulations share a common mechanism of action centered on their interaction with cell surface markers of immune cells, imparting immunosuppressive effects. Although the prevailing mechanism predominantly involves T-cell depletion the com plement-mediated pathway, alternate mechanisms have been elucidated.
View Article and Find Full Text PDFPediatrics
December 2023
Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany.
We report the case of a male patient who had a history of early-onset protein-losing enteropathy, chronic diarrhea, and repeated thrombotic events since early childhood. He developed Budd-Chiari syndrome with consequent acute liver failure that required liver transplantation when he was 12 years old. The initial graft failed to function and he required retransplantation.
View Article and Find Full Text PDFPediatr Transplant
December 2023
Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea.
Background: Schimke immuno-osseous dysplasia (SIOD) is a rare systemic disease characterized by short stature, proteinuria, and recurrent infections. Patients usually have spondyloepiphyseal dysplasia, and progressive steroid-resistant nephropathy that leads to kidney failure. However, their clinical course after kidney transplantation (KT) is not yet well known.
View Article and Find Full Text PDFJ Clin Med
July 2023
Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Despite significant advancements in immunosuppressive therapies, kidney transplant rejection continues to pose a substantial challenge, impacting the long-term survival of grafts. This article provides an overview of the diagnosis, current therapies, and management strategies for acute T-cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR). TCMR is diagnosed through histological examination of kidney biopsy samples, which reveal the infiltration of mononuclear cells into the allograft tissue.
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