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Transplant rejection & graft-versus-host disease

Rejectio transplantati et morbus transplantati contra hospitem · Rejekce transplantátu a reakce štěpu proti hostiteli

What it is

Immune systems recognising 'not self' — in either direction.

Symptoms & signs

  • Graft dysfunction
  • fever
  • pain over the graft
  • rash, diarrhoea and jaundice in GVHD

🚩 Get help if…

  • call 112 / 911 now Fever over 38 °C
  • call 112 / 911 now Sudden breathlessness or much less urine
  • see a doctor soon Pain or swelling over the new organ
  • see a doctor soon Rash, diarrhoea or yellow skin after a stem-cell transplant

Where it strikes

Medical treatment

  • Tacrolimus, mycophenolate, steroids
  • ATG for severe rejection
  • ruxolitinib for GVHD
  • photopheresis
  • HLA matching

Natural & lifestyle

  • Strict medication adherence
  • infection prevention
  • sun protection (skin cancer risk)
  • dental and vaccination planning

Emerging & experimental

  • Tolerance induction protocols
  • regulatory T-cell therapy
  • donor-derived cell-free DNA monitoring
  • xenotransplantation

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • St John's wort — lowers tacrolimus and ciclosporin levels and has triggered rejection not confirmed in trials
  • Grapefruit — raises drug levels; avoid anecdotal / traditional
  • Vitamin D — small studies of fewer rejections early / small studies

ICD codes