Diagnosis and prevention of rejection

1 hyperacute rejection:Hyperacute rejection is an irreversible humoral rejection that occurs within a few minutes or hours after the recover

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1 hyperacute rejection:

Hyperacute rejection is an irreversible humoral rejection that occurs within a few minutes or hours after the recovery of the blood circulation, but also in 24-48h. Hyperacute rejection occurs, so far there is no effective treatment to reverse treatment measures for resection of renal transplantation, so as to avoid strong rejection of life-threatening crisis. Hyperacute rejection should be focused on the prevention, preoperative examination of the donor must be carefully examined whether there is an anti donor antibody. The main measures are as follows: (1) cross matching test between recipient and donor lymphocytes before transplantation was performed to select the donor recipient of the test of the lymph node test (10%). (2) ABO blood type must be at least compatible. (3) if there is a positive test in a tissue matching, should be particularly careful consideration. (4) for retransplantation, do not choose HLA antigen and the previous donor and the absence of the same recipient donor; multiple pregnancy also should avoid picking HLA with her husband and the lack of the same antigen as recipients of donor recipients. In order to reduce the possibility of pre-existing antibodies. (5) the immune response to highly sensitive patients, such as more than two transplant recipients before transplantation trial of plasma exchange. The elimination of specific anti HLA antibody, reduced antibody level, are likely to achieve a successful transplant.

2 accelerated rejection:

The accelerated rejection showed severe rejection after 3-5d. The course of disease was rapid and the graft function was rapidly lost. The pathological changes were mainly small vessel inflammation and necrosis. It is generally considered to be an acute humoral rejection. Accelerated rejection must be immediately treated with anti rejection therapy to control its progression. Is the preferred treatment of large dose methylprednisolone (methylprednisolone) 500mg shock treatment, often poor treatment effect, but this can estimate the prognosis. If the hormone shock 3 times after improvement, should be used with more than 3 times or more times the impact or increase in oral hormones. In addition, ALG or OKT3 should be used immediately to achieve a more effective immunosuppressive effect, the course of treatment should last for 12-20 days, the concentration of CsA before stopping treatment should reach the therapeutic window concentration. If the above treatment measures are not effective, plasma exchange or anticoagulation therapy may be used. There was no effect on the treatment of immunosuppression and removal of transplanted kidney. The preventive measures of accelerated rejection are the same as those of hyperacute rejection, and the importance of prevention should be emphasized.

3 acute rejection:

Acute rejection is the most common type of rejection, often occurring within 5D weeks after transplantation and within weeks, if it can be diagnosed in time. Acute rejection usually occurs after transplantation for 1 weeks to 3 months, the symptoms were fever, unexplained swelling and pain, renal allograft dysfunction, such as renal transplant ureteral segment or necrosis appeared intact hematuria, urinary tract obstruction or urinary leakage. Approximately 80%~90% of acute rejection can be reversed and controlled. The preferred corticosteroid therapy: acute rejection can be controlled in 80% months, specifically methylprednisolone 500mg+10% glucose solution 100ml, intravenous infusion, 1 times daily, 3 times. About 20% of the acute rejection unresponsive to corticosteroid therapy or hormone treatment started to improve, after discontinuation of recurrence, should use anti lymphocyte agents (such as ALG, ATG or OKT3), of which 50% cases can be reversed, the use of biological agents for 7~14 days time.

4 chronic rejection:

Occurred more than 6 months after surgery, especially after the past 1 years. The progression of the disease is slow, and the function of the graft is gradually decreased. There is no effective prevention and treatment for chronic rejection.

 

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