摘要:

Murine allograft models have been a major tool in the quest for transplantation tolerance. As the search for tolerance shifts toward larger animal models and humans, it becomes critical to determine which of the successful murine strategies hold the most promise for broad application. This requires clear criteria for treatment goals and a paradigm for meaningful comparison of the various organs, strains, and treatments used in the murine system.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Transplantation tolerance has become an experimental reality, yet the bridge from the laboratory to the clinic has only begun to be traversed. Many obstacles remain before patients will be able to benefit from the extraordinary advances in transplant immunology. This paper presents an overview of issues that will likely affect the clinical development of broadly applicable tolerance regimens. Biologic issues as well as issues related to drug development are discussed.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Despite refinements in immunosuppressive therapy, acute allograft rejection remains a major cause of mortality in heart transplant recipients. The high reliability, noninvasiveness, possibility of day-to-day monitoring, absence of interobserver variability, and cost effectiveness are essential components of the ideal diagnostic method for the detection of allograft rejection. This paper reviews the experimental and clinically established methods for the diagnosis of acute allograft rejection. The most promising tools seem to be electrophysiologic, because these tools provide the potential for continuous noninvasive distant rejection monitoring, and echocardiographic techniques that enable the safe assessment of changes in cardiac structure and function and further reduce the need for endomyocardial biopsy and, more importantly, provide a better definition of the threshold for antirejection treatment. Additional research and refinements of techniques and evaluation in prospective randomized multicenter studies are needed to further advance the use of noninvasive methods for diagnosis of heart graft rejection.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The use of ventricular assist devices (VADs) as a bridge to transplantation have improved the quality of life and decreased the morbidity and mortality in patients awaiting transplant. The use of VADs for long term support has been shown to be feasible and to offer survival rates comparable with those for transplantation. The viability of long term implantable support has led to new ambulatory programs. As such, there have been many advances in device technology and the management of VAD patients. The long term use of VADs has permitted the observation of myocardial recovery in some patients and the ultimate explant of the device without transplantation in a growing number of patients. The success of VADs for long term support in patients with heart failure and the need for alternative therapies for these patients have made the use of VADs for permanent cardiac assistance a promising therapy. These developments and a description of the VADs currently used for moderate to long-term support are reviewed.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

As increasing numbers of patients become eligible for heart transplantation, a large undersupply of suitable donor organs has developed. By matching recipient risk with donor risk, an effective expansion of the donor pool can occur while patient outcomes are maintained and organ wastage is minimized. As the safety of extended criteria is tested, the use of such organs can become more commonplace for certain recipients who might otherwise be excluded from transplantation. Future developments in organ preservation may allow for further use of marginal donor hearts.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The transplantation of organs and tissues from animals into humans, that is, xenotransplantation, has long been sought in order to allow transplantation to achieve its full impact in the clinical practice of medicine. Advances in a variety of fields have shed new light on the hurdles to xenotransplantation and have given rise to potential solutions and prospects for the clinical application of it, as are summarized in this article.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Pediatric heart transplantation has improved to the point that the initially restricted ages and indications have expanded considerably. The number of annual pediatric cardiac transplants has remained stable, but the number of centers performing transplants continues on a downward trend. Currently the half-life (50% still alive) for children who underwent transplantation in the early 1980s is 11.5 years, with a conditional half-life of more than 14 years. An era effect in improved survival is evident for the first time. There is an association between morbidity and the type of immunosuppression regimen employed. The early posttransplant period continues to be the highest risk time. Early rejection correlates with poor late outcome. Transplant coronary disease continues to be the most significant cause of late mortality. Detection of transplant coronary disease may be improved by adjunctive noninvasive imaging such as dobutamine stress echocardiography. There may be dramatic changes in clinical transplant protocols as a result of experience and new technology. This review focuses on key advances in knowledge reported in the past year.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

During the past 30 years, cardiac transplantation has been offered as therapy for a variety of inoperable heart conditions. This therapy remains palliative, however, and a certain number of recipients will need retransplantation. The use of scarce donor organs for cardiac retransplantation is controversial; and the overall retransplantation rate varies from 2.2% to 4.4%. Common indications for retransplantation include primary graft failure, intractable rejection, and graft coronary artery disease. Emergency retransplantation for rejection or acute graft failure is associated with poor results. In carefully selected patients, especially recipients with graft coronary artery disease, the outcome of elective retransplantation is comparable to that of primary transplantation. Cardiac retransplantation is a feasible and rational therapy with good results when applied to low-risk candidates.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Recently published studies have improved our understanding of the wide array of issues involved in cardiac transplantation. Organ implantation using a bicaval technique is the preferred method at most centers and may improve survival. Preoperative recipient risk factors such as pulmonary hypertension, morbid obesity, certain psychiatric disorders, and advanced age may not preclude successful transplantation. Conversely, poor compliance with medication, depression, and post traumatic stress disorder following transplantation were independent predictors of acute rejection, graft coronary disease, and mortality. Large randomized studies have reported similar survival following transplantation with Neoral (Sandoz, East Hanover, NJ, USA) compared with the Sandimmune (Sandoz, East Hanover, NJ, USA) formulation of cyclosporine. The patients receiving Neoral, however, experienced fewer infections and milder episodes of rejection. Mycophenolate mofetil significantly improved 3-year survival following heart transplantation, compared with azathioprine. Although progress is being made in cardiac transplantation, a key impediment in this field remains the shortage of donor organs.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID