[Chronic rejection: Differences and similarities in various solid organ transplants].

Area of Science:

• Transplantation immunology
• Graft rejection mechanisms
• Organ-specific allograft dysfunction

Background:

• Chronic allograft dysfunction (CAD) significantly impacts patient survival and quality of life post-transplantation.
• Pathophysiological mechanisms of CAD vary considerably among different organs.

Purpose of the Study:

• To describe chronic rejection in lung, heart, liver, and kidney transplantation.
• To highlight the importance of early diagnosis and management of CAD.

Main Methods:

• Review of existing literature on chronic rejection in major solid organ transplants.
• Discussion of diagnostic criteria and therapeutic strategies for organ-specific CAD.

Main Results:

• Chronic lung allograft dysfunction (CLAD) diagnosis relies on lung function decline (FEV1), with azithromycin and photopheresis as treatments.
• Cardiac allograft vasculopathy (CAV) development involves immune and non-immune factors; prevention via mTOR inhibitors is key.
• Liver transplant graft dysfunction diagnosis is challenging; chronic ductopenic rejection, idiopathic posttransplant hepatitis, and de novo autoimmune hepatitis are key concerns.
• Chronic allograft nephropathy involves fibrosis and remodeling, necessitating early diagnosis and therapy based on donor-specific antibodies and histology.

Conclusions:

• Effective management of CAD requires organ-specific approaches.
• Early detection, prevention, and timely intervention are critical for improving long-term transplant outcomes and patient survival.