both groups) but IVIg generated fewer is a challenging and evolving area, despite the side effects (Casadei et al 2001). significant adverse impact of chronic AbMR, there is limited literature to guide clinical practice and no widely accepted standard of care. (Cooper 2014, Gupta 2014). Indications Pre - transplant where donor specific Immediate pre-transplant where donor specific The first indication has been amended slightly antibody/ies prevent transplantation antibody/ies prevent transplantation (HLA or to distinguish longer desensitisation from (HLA or anti-blood group) in highly blood group). short term Ig use immediately pre-transplant. sensitised patients Post-transplant - acute antibody mediated Post-transplant - acute anti-body rejection mediated rejection Treatment or prevention of graft rejection where Two additional indications have been Treatment or prevention of graft conventional immunosuppressive therapies is developed to support eligible patient access to rejection where conventional contraindicated or pose a threat to the graft or treatment for up to six months. immunosuppressive therapies is patient contraindicated or pose a threat to the De-sensitisation of patients to improve the graft or patient likelihood of transplantation Treatment of ongoing active antibody mediated rejection Transplant rejection occurs when a Transplant rejection occurs when a recipient’s Description This section has been updated following recipient’s immune system attacks a immune system attacks a transplanted organ or and further consideration of more recent transplanted organ or tissue. Despite tissue. Despite the use of immunosuppression, Diagnostic literature. the use of immunosuppressants, one or rejection occurs in a significant number of Criteria more episodes of rejection can occur recipients and may impact on long term graft after transplantation. Both cellular and survival. Both cellular and humoral humoral (antibody-mediated) effector effector mechanisms may play a role. mechanisms can play a role. Rejection is diagnosed histologically on tissue The presence and pattern of rejection biopsy, with contributory information from clinical need to be established by biopsy. assessment, radiological and laboratory tests
both groups) but IVIg generated fewer side effects (Casadei et al 2001). is a challenging and evolving area, despite the significant adverse impact of chronic AbMR, there is limited literature to guide clinical practice and no widely accepted standard of care. (Cooper 2014, Gupta 2014). Indications Pre - transplant where donor specific antibody/ies prevent transplantation (HLA or anti-blood group) in highly sensitised patients Post-transplant - acute anti-body mediated rejection Treatment or prevention of graft rejection where conventional immunosuppressive therapies is contraindicated or pose a threat to the graft or patient Immediate pre-transplant where donor specific antibody/ies prevent transplantation (HLA or group). Post-transplant - acute antibody mediated rejection Treatment or prevention of graft rejection where conventional immunosuppressive therapies is contraindicated or pose a threat to the graft or patient De-sensitisation of patients to improve the likelihood of transplantation Treatment of ongoing active antibody mediated rejection The first indication has been amended slightly to distinguish longer desensitisation from short term Ig use immediately pre-transplant. Two additional indications have been developed to support eligible patient access to treatment for up to six months. Description and Diagnostic Criteria Transplant rejection occurs when a recipient’s immune system attacks a transplanted organ or tissue. Despite the use of immunosuppressants, one or more episodes of rejection can occur after transplantation. Both cellular and humoral (antibody-mediated) effector mechanisms can play a role. The presence and pattern of rejection need to be established by biopsy. Transplant rejection occurs when a recipient’s immune system attacks a transplanted organ or tissue. Despite the use of immunosuppression, rejection occurs in a significant number of recipients and may impact on long term graft survival. Both cellular and humoral effector mechanisms may play a role. Rejection is diagnosed histologically on tissue biopsy, with contributory information from clinical assessment, radiological and laboratory tests This section has been updated following further consideration of more recent literature. blood