摘要:

The fundamental principles of organ allocation are equity (synonymous with access) and utility (synonymous with outcome). Plans for organ allocation must balance each of these components to ensure that cadaver organs donated altruistically are being distributed ethically.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

With advances in solid organ transplantation, combined heart–kidney and liver–kidney transplantation have evolved as separate entities. Both procedures share the similarities of unmatched kidney grafts with short, cold ischemic time, reduced rejection rates of the kidney, pretransplant exclusion of reversible renal dysfunction due to terminal heart or liver failure, and the operative procedure being performed synchronously with organs from the same donor. Generally, both combinations result in short-and intermediate-term survival rates comparable with those of respective single-organ transplants. Both organs have been shown to be rejected independently from each other and this fact is implemented in surveillance strategies. When accurately evaluated and indicated, heart–kidney and liver–kidney transplants are justified as a routine procedure for a selected group of patients with double organ failure and do not mean wasting of valuable resources.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Laparoscopic live donor nephrectomy was first performed clinically in 1995. The original hypothesis that provided the impetus for the development of this operation was that the reduction of postoperative pain and recuperative time would decrease logistical and financial disincentives to live kidney donation, thus increasing the number of live donors and the organ supply. Its introduction sparked a contentious debate over its appropriateness and safety. However, over the past 5 years a growing body of literature has accumulated that now supports this original hypothesis. Laparoscopic live donor nephrectomy has been shown by a variety of centers to be safe and advantageous for the donor. Refinement of the operation and a better understanding of the renal effects of pneumoperitoneum have yielded recipient results that are comparable to those seen with the open donor operation. Largely driven by patient demand, a large number of centers have now adopted this procedure. Laparoscopic live donor nephrectomy is on the verge of evolving into the new standard for live donor surgery.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The dramatic shortage of cadaver kidneys and the increasing waiting time on the cadaver transplant list make living donation more important then ever. Knowledge of the long-term results of living donation is crucial; potential donors must be fully informed when deciding whether to accept the risks. Our review shows that donors have excellent long-term function of the remaining kidney and do not have an increased risk for hypertension. The vast majority of donors enjoy excellent health and quality of life. In addition, donation has a positive effect on family relationships as well as on the relationship with the recipient. Finally, most donors state that, if it were possible, they would donate again.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This review discusses the past year’s literature on pediatric kidney transplantation. It begins with a review of recent registry reports and then discusses selected single-center studies. It then describes recent experiences with newer immunosuppressive agents, including monoclonal antibodies, tacrolimus, and mycophenolate mofetil. A single-center report on ABO-incompatible kidney transplantation is discussed, followed by a review of papers describing complications after kidney transplantation in children, including post-transplant lymphoproliferative disorders, post-transplant diabetes mellitus, and cosmetic side effects associated with cyclosporine. It ends with a discussion of recurrent disease after kidney transplantation and chronic rejection. Taken together, the recent literature suggests that, while the field of pediatric renal transplantation has been relatively slow to embrace the new immunosuppressive agents, there remains an ongoing interest in a number of programs. Outcomes are approaching those seen in adult recipients, while selected centers have described outstanding results. As in adult renal transplantation, complications have continued to occur, but have in general been associated with relatively favorable outcomes.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

With the recent introduction of a number of new immunosuppressive drugs there is an unprecedented interest in therapeutic drug monitoring of immunosuppressive drugs. Most published data on therapeutic drug monitoring in transplantation come from retrospective studies and show a correlation between drug concentrations and toxicity or between concentrations and efficacy. No randomized studies have compared traditional dosing (dose reduction if side effects occur, dose increase if insufficient efficacy is shown) with concentration-controlled dosing. Nevertheless, for a number of immunosuppressive drugs pharmacokinetic monitoring, based on trough levels, is routine practice. Pharmacodynamic monitoring of immunosuppressive drugs has not reached the stage of widespread clinical application. Prospective investigations on the contribution of therapeutic drug monitoring may result in further improvement in the safety and efficacy of our immunosuppressive regimens and more refined methods for therapeutic drug monitoring.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

During the past 10 years, the success of renal allograft transplantation has remarkably increased. Today, chronic rejection or chronic allograft nephropathy (CAN) is the major obstacle to long-term allograft survival. Chronic allograft nephropathy is characterized by renal fibrosis with vascular obliteration and replacement of normal tissues with excessive matrix deposition. Although the cause of CAN is not clear, most likely transforming growth factor-β, a powerful prosclerotic cytokine/growth factor, plays an important role in its pathogenesis. Transforming growth factor-β is the major intercellular signal responsible for increased production of matrix components, such as collagen and fibronectin, and inhibitors of matrix degradation, such as plasminogen activator inhibitor. Many factors, including cyclosporine, increase the expression of transforming growth factor-β within renal tissues, promoting the expression of CAN. This review focuses on current advances in understanding the biology, signaling mechanisms, and genetics of transforming growth factor-β as they relate to development of CAN.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Approximately 300 cases of various autoimmune diseases have been transplanted worldwide. Diversity in clinical manifestations and variability in disease course are important factors in considering a patient for stem cell transplantation. The pros of considering hematopoietic stem cell transplant (HSCT) for autoimmune disorders are: 1) high disease-related morbidity and mortality; 2) ability to offer disease-remitting therapy, 3) as a model to understand disease pathogenesis, and 4) if successful, limiting the societal and individual costs of debilitating autoimmune disorders. Conversely, the cons of performing HSCT for autoimmune diseases are: 1) mortality from HSCT, 2) expectation bias inherent to phase I/II studies, 3) unknown long-term efficacy, and 4) cost of transplant.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Graft-versus-host disease is the major complication after allogeneic hemopoietic stem cell transplantation. Graft-versus-host disease is destructive by itself and sets the stage for other sequelae, in particular overwhelming infections. Recent investigations, predominantly in murine models, have improved our understanding of the underlying pathophysiology. There are now compelling data on the role of host tissue destruction as the initial insult, extensive interactions of cellular donor and host components, a complex network of cytokines including interleukin-1, -2, -10, -11, -12, and -15, tumor necrosis factor-&agr;, interferon-γ, and ligands and receptors such as Fas/Fas-ligand, CD40/CD40L, CD28, CTLA-4, adhesion molecules, and other components in the development of graft-versus-host disease. The improved understanding of interactions between various signals is likely to allow for new prophylactic strategies. Numerous agents developed in experimental models are finding their way into clinical trials. There may be a need for new design structures in prophylactic and therapeutic trials that take into consideration individual donor and host characteristics as well as the kinetics of graft-versus-host disease development.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

During the past decade, umbilical cord blood has emerged as a widely used source of stem cells for children and adults undergoing transplantation for a wide variety of malignant and nonmalignant diseases. Although large, prospective clinical trials have not yet been published demonstrating the true engraftment rate and incidence and severity of acute and chronic graft-versus-host disease, results suggest reliable engraftment and perhaps a lower incidence of severe graft-versus-host disease than anticipated with comparably matched bone marrow. Investigators continue to examine the biologic properties of umbilical cord blood. During the past year, important advances have been made in our understanding of the ontogeny of cord blood stem cells, migratory capacity, the ability to expand cord blood stem cellsin vitro, the alloreactivity of cord blood, and immune recovery after the transplantation of cord blood. It is anticipated that clinical advances in cord blood transplantation will soon follow as a result of these advances in cord blood biology.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID