摘要:

An historical overview of kidney transplantation including the rehabilitation status of long–term survivors, the ethical issues related to current American transplant ation, and projections for the future are presente

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00325.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Two hundred and sixty–eight renal transplant operations were done in 244 children over the past 20 years. The donors were parents in 229 cases, living relatives in another 1 3 eases, and cadavers in the remaining 26 cases. There were 242 first grafts, 22 second grafts, and 4 third grafts. The initial 130 grafts were carried out with conventional immunosuppressive regimens and the subsequent 1 38 were done using immunosuppression including cyclosporin–A. In lanuary 19′)5, 186 recipients (76.2%) were alive with functioning grafts, 33 (1 3.5%) were alive on dialyses, and 25 (10.2%) were dead. The management results in terms of patient and graft survival, as well as the causes of graft failure and patient death are desc

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00326.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We investigated the effective mechanisms of donor–specific hlood transfusion (DST) using a sponge matrix allograft animal model. Sponges were harvested on various days postgrafting, and both the sponge infiltrating cells and sponge exudate fluid (SEF) were collected. DST completely suppressed cytotoxic T lymphocyte activity throughout the postgrafting period. SEF *N = O concentration (measured as nitrite) in DST mice was significantly lower than in ST mice. Conversely, the amount of PGE2in the SEF from DST mice was higher than in ST mice. L)ST may induce intragraft suppressor factors (such as PCE2), resulting in reduced immune activation with suppression of local immune respons

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00327.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Microchimerism in 23 female renal transplant recipients from male donors was studied using nested polymerase chain reaction (nPCR) and fluorescence in situ hybridization (FISH) to detect Y–chromosome. nPCR was a sensitive and specific assay enabling a detection rate of 1/106male/female cells, compared with a sensitivity of 1/102by standard PCR (sPCR). None of the 23 patients with a male allograft demonstrated Y–chromosome using sPCR. In contrast, 1 3 (56.5%) patients demonstrated Y–chromosome with nPCR. Of 9 patients proven to have microchimerism by nPCR, only 3 also demonstrated Y–chromosome using FISH. The existence of B cells and CD8 cells in donor chimeric cells were proved by separation with Dynabeads class I and class II. Dynamic changes of microchimerism occurred in 4 of 5 patients. Four patients were proven to have microchimerism within a year of transplantation and the microchimerism later disappeared in 3, although the sequential change was variable in individual patients. There was no correlation between microchimerism and patients'clinical factors such as donor–specific blood transfusion, HLA matching, immunosuppression, past history of acute rejection and chronic rejection. The degree of microchimerism in renal transplant recipients was relatively low, and its existence did not seem to be compatible with long–term graft acceptance. However, further studies are required to elucidate the immunological mechanism of microchimerism, and it might be an important clue to immunologica

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00328.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

When the concept of brain death is not widely accepted, the viability of renal allografts of non–heart–beating cadaveric donors is one of the serious concerns for transplant surgeons. At our center, 200 kidneys were harvested from cardiac arrest donors using the regional in situ cooling technique, and they were transplanted into recipients treated with cyclosporine (CS). The ages of donors ranged from 7 months to 67 years. At the bedside a specially designed double balloon catheter, 14F, was inserted into the aorta through the femoral artery just before or immediately after the cardiac arrest. A venous drainage tube was also placed in the vena cava. Following the cardiac arrest, both balloons of the aortic catheter were inflated, and regional in situ cooling with cold Lactate Ringer's solution started using the infusion pump at 20mL/kg/min. In the OR, both kidneys were removed en bloc and preserved in Collins'type solution. They were then transplanted into 200 patients treated with CS and steroid. After the transplant operations, 33 patients (16.5%) had immediate renal function, but 14 grafts (7.0%) were not successful and the patients have never had renal function. When several factors such as donor age, warm ischemic time (WIT; 12.3 ± 14.1 minutes), in situ cooling time (IST; 78.1 ± 18.0 minutes) and total ischemic time (TIT; 619 ± 340 minutes) were associated with the post–transplant renal function, only the donor age had significant correlation both with the posttransplant dialysis period and lowest serum creatine level, as follows: 10.5 days (≤ 40 years) vs. 14.6 days (>40 years);P50 years)P<0.001, respectively. Our findings indicate; 1) Due to the in situ cooling technique, the renal grafts of non–heart–beating cadavers can be expected to have relatively good function in the CS–treated recipients; 2) donor age is instrumental in predicting post–transplant renal function as well as the duration of ATN; 3) WIT, 1ST and TIT have no association with the post–transplant renal function if the duration of renal ischemia is withi

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00329.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY