Figure 912

Treatment of acute rejection. A, Typical antirejection therapy regimens. B, Treatment algorithm. A biopsy should be performed whenever possible. The first-line treatment for acute rejection in most centers is pulse methylprednisolone, 500 to 1000 mg, given intravenously daily for 3 to 5 days. The expected reversal rate for the first episode of acute cellular rejection is 60% to 70% with this regimen [15-17]. Steroid-resistant rejection is defined as a lack of improvement in urine output or the plasma creatinine concentration within 3 to 4 days. In this setting, OKT3 or polyclonal anti-T-cell antibodies should be considered [18]. The use of these potent therapies should be confined to acute rejections with acute components that are potentially reversible, eg, mononuclear interstitial cell infiltrate with tubulitis or endovasculitis with acute inflammatory endothelial infiltrate [19,21]. ATG—antithymocyte globulin; ICAM-1—intercellular adhesion molecule-1; LFA-1—leukocyte function-associated antigen-1.

TCR signal

TCR signal

0 0

Post a comment