Corneal Graft Rejection Medication

Updated: Oct 16, 2018
  • Author: Michael Taravella, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Corticosteroids are the mainstay of treatment of acute graft rejection. They can be given topically, via subconjunctival injection, or systemically.

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Corticosteroids

Class Summary

These agents provide anti-inflammatory activity to suppress the natural immune response that leads to acute graft rejection.

Prednisolone acetate 1% (Omnipred, Pred Forte)

Most commonly used topical corticosteroid. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Dexamethasone (Decadron)

For various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Also used for subconjunctival injections.

Prednisone (Deltasone, Rayos)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Methylprednisolone (Solu-Medrol, Medrol, Depo-Medrol)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Single pulsed dose of IV steroids prior to PO steroids may improve final outcome.

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Immunosuppressants

Class Summary

Agents in this category inhibit key factors involved in the immune response. They may be used when graft rejection is not controlled adequately by systemic corticosteroids. 

Tacrolimus (Astagraf XL, Envarsus XR, Prograf)

Tacrolimus suppresses humoral immunity (T-cell activity). It is a calcineurin inhibitor with 2-3 times the potency of cyclosporine. Tacrolimus can be used at lower doses than cyclosporine can, but it has severe adverse effects, including renal dysfunction, diabetes, and pancreatitis. Levels are adjusted according to renal function, hepatic function, and adverse effects.

Cyclosporine (Gengraf, Neoral, Sandimmune)

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft-versus-host disease for various organs.

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