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Management of Cellular and Humoral Rejection: Prevention, Diagnosis, and Treatment

  • Erika D. Lease
  • Ganesh Raghu
Chapter

Abstract

Acute cellular and antibody-mediated (humoral) rejections are two forms of acute rejection seen following lung transplantation. The management of acute cellular and antibody-mediated rejection is complex and may be individualized based on the unique situation of each patient. The prevention of acute cellular rejection starts with induction immunosuppression and frequent clinical monitoring as well as through the management of potential risk factors such as gastroesophageal reflux disease and various infections. Antibody-mediated rejection is less understood and requires further study. The mainstay of treatment for acute cellular rejection as well as antibody-mediated rejection is through the augmentation of immunosuppression through a variety of medical strategies. The management of acute cellular rejection and antibody-mediated rejection is important due to the associations with the development of chronic lung allograft dysfunction, the primary cause of mortality following lung transplantation. With optimal management and further study, the goal is for improved survival and quality of life for all lung transplant recipients.

Keywords

Lung transplant Acute cellular rejection Antibody-mediated rejection Prevention Treatment 

Abbreviations

ACR

Acute cellular rejection

AMR

Antibody-mediated rejection

ATG

Antithymocyte globulin

BAL

Bronchoalveolar lavage

BOS

Bronchiolitis obliterans syndrome

CDC

Complement-dependent cytotoxicity

CLAD

Chronic lung allograft dysfunction

CMV

Cytomegalovirus

cPRA

Calculated panel reactive antibody

DSA

Donor-specific antibody

ELISA

Enzyme-linked immunosorbent assay

FEV1

Forced expiratory volume in 1 second

FVC

Forced vital capacity

GERD

Gastroesophageal reflux disease

HLA

Human leukocyte antigen

HRCT

High-resolution computed tomography

ISHLT

International Society for Heart and Lung Transplantation

IVIG

Intravenous immunoglobulin

MFI

Mean fluorescent intensity

OKT3

Muromonab-CD3

PRA

Panel reactive antibody

TBBX

Transbronchial biopsy

UNOS

United network of sharing

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Copyright information

© The Author(s) 2018

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleUSA
  2. 2.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine University of WashingtonSeattleUSA
  3. 3.Center for Interstitial Lung Disease, ILD, Sarcoid and Pulmonary Fibrosis Program, University of Washington MedicineSeattleUSA
  4. 4.Scleroderma Clinic, University of Washington MedicineSeattleUSA

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