One of the complications of organ transplantation is transplant rejection. Because the transplanted organ is a foreign tissue, the immune system tends to reject it. It should be noted that our immune system is designed to fight any external factors. The body’s immune system does not understand the difference between an infectious agent such as a bacterium or virus, a foreign body or a transplanted organ, and will deal with all of them.
The issue of transplant rejection has been one of the primary challenges of organ transplantation. The first successful kidney transplant between two identical twin brothers took place in 1954 at Harvard University in the United States. Anti-transplant drugs were not needed due to the textual concordance of the two brothers. Later, when the kidney transplant was performed between an inconsistent donor and recipient, the success rate was very low due to the rejection of the transplant. In the 1960s, whole-body electrocution (radiation) or steroid drugs (corticosteroids) were used to prevent transplant rejection.
Transplant rejection in that decade was about 80% and transplant success was at best 40%. With the introduction of new anti-transplant drugs, the rate of kidney transplant rejection today has reached about 10% and its success has reached more than 90%. In other links, the rejection of the link has decreased and the success of the link has increased.
Today, transplant rejection rarely causes transplant failure, and many transplant rejections are treatable and reversible.
In terms of transplant rejection time, it is divided into three states: acute, acute and chronic. Rejection of a super-acute transplant usually occurs immediately or a few minutes after the transplant. Today, with tissue matching tests performed before the donor-recipient transplant, this transplant rejection is very rare.
Acute transplant rejection usually occurs a few days to a few months after the transplant. The discovery of new drugs has reduced the rate of acute transplant rejection and its successful treatment.
Chronic transplant rejection usually occurs several years after transplantation. Unfortunately, new rejection drugs have little effect on this type. Chronic transplant rejection usually leads to organ failure and the need for re-transplantation. Transplant rejection in terms of its process is divided into two types of cell rejection rejection and rejection due to antibodies.
In cell transplant rejection, the body’s defense cells, such as lymphocytes, enter the organ and destroy tissue. Newer anti-transplant drugs are very effective in treating this type, so this type of transplant is well treatable and rarely leads to organ failure, but it should be noted that each time the organ is rejected by a cell transplant, some tissue damage remains. . Therefore, with the success of the transplant, each time the transplant is rejected, the performance of the member is slightly reduced compared to the member who does not reject the transplant. In antibody rejection due to antibodies, tissue destruction is due to the effect of antibodies. An antibody is a protein secreted by B lymphocytes against foreign tissue or a transplanted organ. These antibodies attach to the organ and activate the immune system against the transplanted organ. It should be noted that this type of transplant rejection is difficult to treat and if it occurs, the possibility of organ function returning to pre-transplant rejection is reduced. It is hoped that with the discovery of new drugs, this type of transplant rejection can be prevented or treated more successfully. Because transplant rejection is a constant threat to the transplanted limb, it is important for the transplant medical team to regularly and accurately assess the individual for the complication. Transplant rejection is usually more common in the first year after transplantation. Therefore, in the first year, the patient should take a higher level of anti-transplant drugs. After the first year, the need for this drug decreases but does not disappear, so patients should take these drugs for the rest of their lives and be under the supervision of a doctor. Long-term use of anti-transplant drugs is not without its complications, and it is necessary for regular physicians to evaluate the patient for these side effects. Common side effects of anti-transplant drugs include high blood pressure, diabetes, and high blood fats.
Another important issue is the cost of these drugs. However, it should be noted that despite these issues, the connection is still in the interest of the patient and the community in various ways.
Dr. Reza Saidi Firoozabadi – Transplant surgeon