[Corticoid-resistant rejection and humoral rejection. The diagnostic criteria and therapeutic management].
The standard treatment of rejection episodes post-heart transplantation is based on high dose of steroids followed by monoclonal or policlonal antibodies directed against T lymphocytes like ATG or OKT3. When this treatment is insufficient it can be used other drugs like metothrexate, ciclofosfamide and another procedures such as total lymphoid irradiation, plasmapheresis or photopheresis. Cardiac allograft rejection is defined by histologic features that include the presence of lymphocytic infiltration of the myocardium with or without necrosis and this histologic pattern is termed cellular rejection. However there is a second form of acute rejection, associated with capillary injury, usually mediated by humoral immune response and without interstitial infiltrates which has been named vascular or humoral rejection. Vascular allograft rejection is commonly resistant to standards forms of immunosuppressive therapy and may result in irreversible allograft dysfunction and reduced patient survival.
Crespo Leiro
M G
MG
Servicio de Cardiología, Hospital Juan Canalejo, La Coruña.
Portela Torrón
F
F
Vázquez González
N
N
Vázquez Rodríguez
J M
JM
Yebra Pimentel
M T
MT
González Cuesta
M
M
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000037:antagonists & inhibitors*; D000917:Antibody Formation; D002908:Chronic Disease; D003131:Combined Modality Therapy; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans
D000305:Adrenal Cortex Hormones
Rechazo corticorresistente y rechazo humoral. Criterios diagnósticos y manejo terapéutico.