What is Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)?
Transplant rejection happens when the body rejects a transplanted organ or tissue. This can happen in one of three ways: hyperacute, acute, or chronic. Hyperacute rejection happens very quickly, within minutes or hours of the transplant, and is usually caused by specific antibodies in the body that target the transplanted organ or tissue. Acute rejection happens a few days or weeks after the transplant. This is when certain cells in the body, called lymphocytes, recognize certain antigens in the transplanted organ or tissue and attack them. Lastly, chronic rejection happens a long time after the transplant, sometimes months or even years later. This involves various processes in the body, like chronic inflammation and immune reactions, all which play important parts in the development of chronic rejection.
What Causes Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)?
The exact cause of long-term organ rejection isn’t fully known. Researchers like Glinton and his team have found that one key factor in long-term complications after solid organ transplants can be blood vessel-related issues in the transplanted organ. However, their focus was specifically on heart transplants.
When it comes to chronic rejection of heart transplants, evidence suggests that built-up and activated white blood cells, which help fight infections, might play a role. These cells, including types called macrophages, monocytes and immature dendritic cells, are often found in cases of chronic heart transplant rejection. Moreover, these blood cells interact with B and T lymphocytes, other types of white blood cells, and also stimulate and activate cells in the blood vessel walls and fibrous cells. This can lead to a thickening of the inner lining of the blood vessel.
Meanwhile, chronic rejection of kidney transplants is typically defined as changes to the tissue of the kidney and the small tubes in the kidney that carry urine. This reflects the changes seen in the tissue and possible causes.
Nowadays, chronic rejection is identified as the main reason why a transplanted organ might be rejected.
Risk Factors and Frequency for Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
The rate at which people experience chronic allograft nephropathy (CAN), a condition affecting kidney transplant tissues, depends on when and why the transplant tissue samples are examined. For example, in the first year post-transplantation, the condition can be found in up to 94% of examinations and can eventually be found in all patients 10 years after transplantation.
In the United States, people undergoing long-term hemodialysis, a treatment for severe kidney disease, have a higher risk of death in the winter months compared to the summer. It’s unclear whether this same seasonal pattern exists for patients who have received a kidney transplant. However, a study suggested that there was a noticeable change in the number of deaths due to transplant failures throughout the year.
Signs and Symptoms of Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
When a person rejects a transplanted organ or tissue, it’s known as chronic transplant rejection. This condition typically occurs with people who have a history of receiving an organ or tissue transplant, such as a kidney, liver, or lung to treat chronic medical conditions. Depending on the type of organ transplanted, the symptoms of rejection can vary. For example, someone rejecting a kidney might have symptoms like fatigue, fever, flu-like signs, barely or no urine output, swelling all over the body, and pain or discomfort at the transplant site. There are many other symptoms that can indicate organ rejection as well, such as:
- Jaundice (yellowing of the skin)
- Dark urine
- Itching
- Nausea and vomiting
- Swelling or tenderness in the stomach area
- Cough, shortness of breath
- Repeated infections
- High blood pressure
- Protein in the urine
- Fatigue
- Weight gain
- Death occurring earlier than expected
- Loss of appetite
- Anemia (low red blood cell count)
- Growth of unhealthy cells or tumors in the body
- Fluid in the lungs (pulmonary edema)
In addition to the symptoms of organ rejection, these individuals may also develop atherosclerosis, a condition that leads to the hardening of the arteries.
Testing for Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
To test for chronic rejection, doctors may order a variety of lab tests including:
- Collecting urine over a 24-hour period
- Checking the levels of various substances in your blood
- Measuring the number of different cells in your blood
- A test that measures the electrical activity of your heart (an electrocardiogram)
- An x-ray of your chest
- A CT scan, which is a type of powerful x-ray that takes detailed pictures of your abdomen
- An abdominal ultrasound, which uses sound waves to create images of organs in your abdomen
- Examination of tissues under a microscope to look for disease (histological studies)
- A test to see how well the donor and recipient’s tissues match (HLA typing)
- Testing for certain diseases that could affect your health like HIV and hepatitis B and C (serology tests)
In kidney transplants, testing the urine can be very helpful. Doctors might look for different types of cells, like epithelial cells from the lining of the kidney, or other elements such as crystals, certain types of blood cells, or clusters of mixed cells. These could indicate that the body is rejecting the transplanted kidney.
Doctors might also look for specific types of cells in urine that could indicate a viral infection called CMV, which can resemble signs of rejection. Doctors could use additional blood tests to confirm a CMV infection.
Treatment Options for Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
The treatment for organ rejection usually depends on the type of damage and the root cause. For instance, in cases of chronic kidney rejection, complications like high blood pressure, fluid build-up in the lungs (pulmonary edema), and the build-up of waste substances in the blood (uremia) should be managed with a number of treatments. These treatments may include hemodialysis, hemofiltration (filtering of the blood), and the use of medications that increase urination (diuretics).
Infections should, as a rule, be treated with specific, targeted antimicrobial medicines, which are designed to fight harmful microorganisms.
To decide the best treatment for diabetic kidney disease, doctors may use something called the albumin to creatinine ratio. If this ratio is higher than 3, physicians normally suggest a class of medication that reduces chemicals known as renin and angiotensin, using either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). This medication is often recommended even if the patient’s blood pressure is normal, as it can help keep the donor kidney healthy.
High blood sugar levels should be controlled as tightly as possible. For type 1 diabetes, this is typically managed with insulin. For type 2 diabetes, treatment usually involves drugs like biguanides or sulfonylureas.
Finally, in severe cases where the organ is being rejected to the point of no return, the doctors might consider a second transplant of the organ or tissues.
What else can Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years) be?
When trying to diagnose chronic rejection, doctors have to look at a range of potential causes. These can include:
- Acute rejection, which is a sudden rejection of the transplant by the body
- Infections, such as those caused by the cytomegalovirus (CMV)
- The toxic effects of taking immunosuppressant medication, which are used to stop the body from rejecting the transplant
- Posttransplant lymphoproliferative disease, a rare condition where white blood cells grow too rapidly after the transplant
- Technical issues with the transplant, such as problems with the blood vessels or complications from surgical connections made during surgery
In other words, diagnosing chronic rejection involves ruling out these other potential issues.
What to expect with Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
About one-third of people who receive a kidney transplant from a deceased donor may experience graft loss, meaning the body rejects the transplanted kidney, within five years of the surgery.
Unluckily, the alterations made to immunotherapy treatments have mostly been ineffective in improving the outlook for patients struggling with a condition known as chronic allograft nephropathy, which is a common type of kidney transplant failure.
However, measures such as preventive healthcare, early diagnosis, managing accompanying health challenges, and complications related to chronic kidney disease can enhance the survival of patients who are experiencing transplant failure.
Possible Complications When Diagnosed with Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
Organ transplantation is made possible through the use of drugs that tame the body’s immune response. Typically, the drugs used in kidney transplantation include a blend of three different medications. These include a drug to slow down T-cell activation (like cyclosporin, tacrolimus, or sirolimus), a drug to hinder cell growth (like 6-mercaptopurine, or mycophenolic acid), and an anti-inflammatory drug (like corticosteroids).
However, a long-term issue that may arise down the line with organ transplantation is chronic organ rejection. This is a serious condition that can lead to high death rates and various complications such as liver failure, kidney failure, chronic lung disease, pancreatic insufficiency, hardening of the arteries, and blood disorders.
- Chronic organ rejection complications:
- Kidney failure
- Liver failure
- Chronic lung disease
- Pancreatic insufficiency
- Hardening of the arteries
- Blood disorders
Besides, transplant patients could be prone to develop CMV infection and several infectious diseases caused by different microbes. The excessive suppression of the immune system can lead to BK polyomavirus emergence, which may result in BK nephropathy; this condition contributes to a 1-10% rate of organ transplant failure.
A noteworthy complication with kidney transplantation can be the recurrence of the original disease such as diabetic nephropathy. There’s also an amplified risk of developing cancer, especially lymphoma, which is about 40 times more common in transplant recipients than in the general population. Other types of cancer, like skin cancer, Kaposi sarcoma, and lymphoma related to Epstein-Barr virus activation, might also occur.
Preventing Chronic Transplantation Rejection (Failiure of a Transplanted Organ After Months to Years)
Patients must make sure to take their immunosuppressive medicines regularly to prevent their body from rejecting a transplanted organ and to have a better quality of life. Likewise, it’s equally important for them to faithfully follow their doctor’s instructions for treating any other health conditions they may have.