Clinical strategy for induction of transplantation tolerance through mixed chimerism.
In conclusion, our studies have shown that immunosuppression-free renal allograft survival can be achieved in both HLAmatched and mismatched donor-recipient pairs, with follow up times now of greater than 14 years after induction of transient chimerism through CKBMT.
PMID: 25095501 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Statins in heart transplantation.
Authors: Kittleson MM, Kobashigawa JA
Abstract
Over the last four decades, cardiac transplantation has become the preferred therapy for select patients with end-stage heart disease. Critical to the success of heart transplantation are the continual investigational efforts to optimize immunosuppressive regimens. One of the major advances over the past few decades has been the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (commonly referred to as statins) to reduce the risk of rejection and allograft vasculopathy in heart transplant recipients. This chapter will focus on the advances of s...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
HLA identical non-chimeric and HLA disparate chimeric renal transplant tolerance.
Authors: Leventhal JR, Mathew JM, Ildstad S, Salomon DR, Kurian SM, Suthanthiran M, Tambur A, Friedewald J, Gallon L, Charette J, Levitsky J, Kanwar Y, Abecassis M, Miller J
Abstract
In this chapter, we describe studies on non-chimeric human leukocyte antigen (HLA) identical tolerance and chimeric HLA disparate tolerance brought about by infusions of hematopoietic stem cells from the renal donor (DHSC). In our HLA identical series, 4 DHSC infusions were administered during the first 9 months posttransplant in a highly immunoregulatory environment using alemtuzumab induction and rapid conversion from early ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Reflections on the unique tolerogenicity of bone marrow, the enigma of chimerism and clinical tolerance.
Authors: Monaco AP
Abstract
Since the discovery of acquired immunological tolerance, chimerism has always been associated with tolerance. There is, however, a frequent dichotomy between chimerism and tolerance. Many experimental strategies that produce chimerism do not induce tolerance. In addition, some types of chimerism frequently occur after solid organ transplantation, but rarely result in tolerance. In experimental models of transient lymphocyte depletion with antilymphocyte serum, bone marrow cells exhibit a unique ability to induce allograft tolerance that is superior to that of other lymphoid cell...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
HLA in anthropology: the enigma of Easter Island.
Authors: Sanchez-Mazas A, Thorsby E
Abstract
In this article, we first present four significant cases where human leukocyte antigen (HLA) studies have been useful for the reconstruction of human peopling history on the worldwide scale; i.e., the spread of modern humans from East Africa, the colonization of East Asia along two geographic routes, the co-evolution of genes and languages in Africa, and the peopling of Europe through a main northward migration. These examples show that natural selection did not erase the genetic signatures of our past migrations in the HLA genetic diversity patterns observed to...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Transplantation in Turkey.
Authors: Haberal M
Abstract
The cornerstone events of transplantation history in Turkey are summarized herein. In 1975, we performed the first living-related renal transplant in Turkey. We followed this in 1978 with the first deceased donor kidney transplantation, using an organ supplied by Eurotransplant. In 1979, the law on harvesting, storage, grafting, and transplantation of organs and tissues was enacted; later that year, the first local deceased donor kidney transplantation was performed by our team. In 1988, another groundbreaking event in Turkey was successfully achieved: the first cadaveric liver ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
View from a living donor.
Authors: Fehrman-Ekholm I
Abstract
Living kidney donors were analyzed in different respects in our long-term study. There were important findings, which include the following: 1. Kidney donors live longer, most likely due to a selection of healthy individuals. 2. Remnant kidney function increases for a long period, both in younger and older donors. There is a subsequent decrease in function that is more apparent in the elderly. 3. Hypertension is a common long-term finding, suggesting the need for regular blood pressure check-ups after donation. 4. Altruistic reasons were the most common motives for donati...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
2013 report from the Center for International Blood and Marrow Transplant Research (CIBMTR): current uses and outcomes of hematopoietic cell transplants for blood and bone marrow disorders.
Authors: Pasquini M, Wang Z, Horowitz MM, Gale RP
Abstract
Data reported herein indicate increasing use of hematopoietic cell transplants for persons with blood and bone marrow disorders. Recent trends include increasing use of alternative donors including human leukocyte antigen (HLA)-matched unrelated persons and HLA-matched umbilical cord blood cells, increasing use of blood cell rather than bone marrow grafts, and increasing use of reduced-intensity pretransplant conditioning regimens. Many of these shifts are driven by logistical considerations such as the need for donors in persons without an HLA-ide...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Injury-induced allograft rejection: A rendezvous with evolution.
Authors: Land WG
Abstract
Modern immunology, in many ways, is based on three major paradigms: the clonal selection theory, the pattern recognition theory, and the danger/injury theory. The last theory holds that any cell stress and tissue injury, including allograft injury, via induction of damage-associated molecular patterns, induces immunity, including alloimmunity, leading to allograft rejection. On the other hand, the concept precludes that non-self per se induces immunity as proposed by the two former theories. Recently, the danger/injury model has gained considerable acceptance by immunologists, in ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Exchange donor renal transplantation.
Authors: Kim SJ, Kim MS, Park K
Abstract
Nearly 20 years of experience at Severance Hospital has shown that utilizing exchange donors increases the donor pool safely, with outcomes comparable to living related donor grafts. The exchange donor program is invaluable for incompatible donor-recipient pairs to consecutively proceed to transplantation. Recently, newer desensitization protocols have been devised to approach incompatible donor-recipient pairs, but not without risks. These desensitization protocols may be an alternative when confronting the limitations in the exchange program. Therefore, the exchan...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Living donor kidney transplantation: "beauty and the beast"!
This article, entitled metaphorically "Beauty and the Beast", describes the dramatic change in the practice of living donor transplantation that followed. In the ensuing two decades, biologically unrelated living donor transplantation became commonplace in the developed world and reached its apotheosis in cross-country living donor paired exchange programs that have made transplantation accessible to many whose donors were deemed "incompatible". Such exchanges can indeed be thought of as a "thing of beauty". Sadly, the same observation was abused to exploit vulnerable donors, and the "beast" in the form of transplant touri...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
A regulated system of incentives for living kidney donation: why can't we agree to do a trial?
Authors: Matas AJ
Abstract
In 1980, when there was approximately a one-year wait for a standard criteria donor kidney (young trauma victim), there was little rationale for considering incentives for donation. Today, however, in the United States, there are over 100,000 candidates on the waiting list for a deceased donor kidney transplant. Yet, in spite of numerous attempts to increase the donation rate, there has not been an increase in the last seven years. As a result, the waiting list and the resultant waiting time continue to grow, leading to an increased number of deaths (or removals from the list bec...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Desensitization in the era of kidney paired donation: the Mayo Foundation 3-site experience.
In this study, we seek to devise a balance between waiting for a paired donor and combining desensitization with KPD.
PMID: 25095513 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
A common blood gene assay predates clinical and histological rejection in kidney and heart allografts.
Authors: Sarwal M, Sigdel T
Abstract
We assayed our recently defined blood gene panel, diagnostic for kidney and cardiac acute rejection (AR), for its ability to predict biopsy-confirmed renal and cardiac AR prior to clinical or histological AR detection. We utilized a subset of 63 patients from our recent studies with biopsy-confirmed AR (n=40 kidney AR, n=23 cardiacAR) who had paired blood samples collected within 6 months before and after AR. Blood samples were analyzed by quantitative polymerase chain reaction (QPCR) for 10 genes, modeled across differing panels of 5 genes for kidney and heart AR to cl...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Immunoregulation and allogenicity in cardiac stem cell regenerative therapy.
Authors: Charron D, Al-Daccak R
Abstract
Stem cell based strategies are fast track, novel, alternative therapies to repair damaged tissues of chronic diseases and have raised great hopes for incurable heart failure in particular. Various stem/progenitor populations are being put forward as potential therapies to achieve cardiac repair/regeneration. The recently described cardiac-derived progenitor/stem cells (CPC) received intensive investigation given their inherent programming to reconstitute the damaged myocardium. Clinical application of autologous cells provided convincing evidence of feasibility and ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
