摘要:

In a series of 123 renal transplants performed in the presence of a positive crossmatch (either peak positive-current positive or peak positive—current negative), we have analyzed the immunoglobulin class and specificity of the donor-reactive antibodies. The immunoglobulin class was determined by dithiothreitol reduction and the specificity by cytotoxicity inhibition using mono-morphic antibodies specific for HLA class I, DR, and DQ antigens. There was good primary graft and regraft survival in the presence of peak positive and current positive crossmatches due to IgM non-HLA antibodies.There was also acceptable primary graft and regraft survival with peak positive—current negative cross-matches due to T and B cell IgM HLA class I antibodies, but not with IgG HLA class I antibodies. Positive B cell crossmatches due to IgM or IgG HLA antibodies were associated with good primary graft survival but poor regraft survival.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Although flow cytometry crossmatching is now per formed by many kidney transplant centers, it yields a high false-positive rate, as evidenced in the present series by a 71 % one-month success rate despite a positive crossmatch. In an attempt to reduce false-positive re actions while retaining the sensitivity of the flow cytometer, platelets were tested as targets. Whereas flow cytometry with T cells was not correlated with one-month failure rates, retrospective platelet crossmatching by flow cytometry showed that kidney failure within one month occurred in 53% of 19 patients with a positive platelet crossmatch compared with 15% of 48 patients with a negative platelet crossmatch. (P<0.002). Statistical significance in one-month outcome was also obtained when only first transplant patients were analyzed (P< 0.04). The present results suggest that crossmatching with platelet targets may be a simpler way to avoid early primary nonfunction while minimizing false-positive reactions.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Renal transplant patients commonly receive triple-drug immunosuppression with standardized doses of cyclosporine, azathioprine, and methylprednisolone. Although cyclosporine may decrease the clearance of oral prednisone, data are lacking for methylprednisolone, a glucocorticoid commonly prescribed via a standardized protocol for intravenous therapy and during periods of acute rejection. The disposition of methylprednisolone (doses: 10–60 mg/day) was examined in nine renal transplant patients during the post-transplant period (0.8–14 months). Plasma samples were collected over 24 hr and analyzed for methylprednisolone via HPLC. Pharmacokinetic parameters were determined by non-compartmental analysis. The mean total clearance of methylprednisolone was 379 ml/hr/kg (range 105–672) and the volume of distribution was 1.4±0.5 L/kg. The mean plasma half-life was 2.7±1.1 hr. When normalized to a 1 mg dose of methylprednisolone, the mean peak concentration at 1 hr was 10.0±3.5 ng/ml with an 8 hr concentration ranging from 0.3 to 5.5 ng/ml. An appreciable variability in methylprednisolone metabolism thus exists in renal transplant recipients receiving tri ple-drug immunosuppression. This may partially ex plain the variable response to steroid therapy during acute rejection episodes and chronic immunosuppression as well as the unpredictable occurrence of chronic steroid toxicity.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Cyclosporine-treated renal allograft recipients frequently suffer CsA-related nephrotoxicity and hypertension. This study demonstrates that glomerular filtration rate is reduced acutely by 13% (P< 0.02) and renal vascular resistance increased by 30% (P< 0.05), immediately after patients take their CsA dose. The reduction in GFR is directly related to their trough CsA level (r = 0.82; P<0.01). The lower the trough CsA level the greater the fall in GFR after the CsA dose. Plasma renin activity does not increase after the CsA dose (pre-CsA 0.6±0.2 ng/L/sec vs. post-CsA 0.4±0.1 ng/L/sec; P = NS), and therefore cannot be responsible for the reduction in renal function.Short-term nifedipine treatment is effective in pre venting the acute reduction in GFR (P< 0.05). This occurred despite no apparent effect of nifedipine in altering trough or post-dose CsA levels. Furthermore nifedipine was effective in lowering both the mean arterial blood pressure (109 mmHg to 94 mmHg;P< 0.01) and the elevated renal vascular resistance (25% reduction;P< 0.02) observed in these patients.These results suggest that nifedipine may be a suitable agent for limiting acute CsA nephrotoxicity and for treating CsA-associated hypertension in renal allograft recipients.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Acute graft-versus-host disease (aGVHD) of the liver was studied with fine-needle aspiration biopsies of thirty-four bone marrow transplant recipients. White cell differentials of liver FNABs and simultaneously taken blood samples were performed, and the increment and corrected increment methods were used to quantitate the inflammatory reaction in the liver. Biopsies taken before transplantation were used as the baseline. During aGVHD, the percentage of lymphoid cells and monocytes increased in the liver. The appearance of immunological blasts, together with a high proportion of activated lymphocytes in the FNABs, were typical findings during aGVHD. In patients with apparent pro longed liver graft-versus-host disease small lymphocytes were the predominating cell type. After initiating corticosteroid treatment, the number of blasts and the proportion of activated lymphocytes decreased. There was no significant difference in the proportions of CD4-and CD8-positive lymphoid cells in FNABs during or after aGVHD.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Heart-lung transplant recipients represent a unique population who experience episodic lung injury caused by infection or rejection. We hypothesized that the proteins in the respiratory lining fluids of these patients might reflect and provide insights into the in vivo immunologic and inflammatory events that occur in the transplanted lung. Structural, inflammatory, and immune proteins were quantitated in 57 samples of BAL fluid recovered from 17 heart-lung recipients when infections, rejection, or neither was present. Protein levels were compared with those of normal subjects and between the clinical transplant groups. When neither infection nor rejection was present, levels of albumin, fibronectin, and immunoglobulins G, M, and A were all higher in the transplanted lungs as compared with the normal lungs. These findings suggest that a new steady state of these proteins is established in the transplanted lungs. When infection or rejection was present, there was a further significant increase in albumin, fibronectin, IgG, and especially C5a in the transplanted lungs. These findings suggest that at least some elements of host defense remain intact in the posttransplantation period despite the use of immunosuppressive drugs and a HLA-incompatible microenvironment. The profiles of recovered alveolar proteins did not, however, help to differentiate infection from rejection. This is disappointing because distinguishing between infection and rejection without examination of lung tissue remains an unresolved and important clinical problem. Nevertheless these data provide new insights into organ tolerance and defense of the newly transplanted lung from infection or rejection.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A technique for preparation of pancreatic juice for cytological examination, which was applied in 35 consecutive recipients of a pancreas allograft, is described. Pancreatic juice cytology (PJC) was performed daily, giving a total of 1116 cytological specimens. In these 35 pancreas grafts, 26 acute cellular and two vascular rejections were diagnosed on the basis of exocrine and endocrine graft function, perfusion scans, and clinical course and outcome, and were retrospectively compared with PJC findings. Histology was available only for vascular-type rejections. In uncomplicated cases, mainly neutrophil granulocytes with some ductal epithelial cells and 2–3% lymphocytes were seen. During 96% of acute cellular rejections an increase of lymphocytes was detected to more than 5% of all cells counted. In two-thirds of these episodes, eosinophil granulocytes and/or necrotic epithelial cells were found. The total number of cells was significantly increased in 60% of the cases. A minimum of two of these criteria was necessary for diagnosis of rejection. Rejections were correctly diagnosed in 234 slides (23 episodes) and missed in 36 (three episodes). PJC gave a false-positive result in 27 examinations (three rejections), but a correct negative result in the remaining 819 examinations. This gives a sensitivity of 86.6% and a specificity of 96.8%. With the exception of viral pancreatitis, where no specific changes were seen, PJC also proved very helpful in diagnosing other complications after pancreas trans plantation, such as pancreatitis, bacterial or fungal contamination of the juice, and even cyclosporine toxicity.PJC facilitated the detection of isolated rejection episodes of the pancreas graft in recipients of a combined renal pancreatic graft, which happened in six instances. PJC has proved to be a simple but most helpful method for the detection of cellular rejection of pancreas allografts, as well as other complications.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Transplantation of unmatched allogeneic corneas into highly vascularized recipient eyes under the cover of short-term immunosuppression with cyclosporine enables permanent engraftment (2). The aim of this study was to further elucidate the mechanism(s) underlying this tolerant state. In eight “high-risk” cornea recipients the clone sizes of donor-specific and third-party reactive cytotoxic T cell precursors were assessed by limiting dilution analyses before and at three and six months after transplantation. Acquired allograft tolerance in these patients was not accompanied byclonal reduction of donor-specific CTL-p, whereas in the case of an irreversible rejection the donor-specific CTL pool size was significantly enlarged. This donor-specific CTL-p in crease could already be seen two months before clinical manifestation. These patterns differed from that of tolerant renal transplant patients, in whom marked and donor-specific reduction of CTL-p was observed (2).During rejection identical patterns with increasing do nor-specific CTL-p frequencies were seen in both groups of patients.We conclude that induction of tolerance by short-term CsA to unmatched cornea grafts is not caused by clonal reduction of the effector precursor cell pool.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In earlier work we demonstrated that CMV immediate early antigens can be detected in peripheral blood leukocytes of patients with active CMV infection. We now report a comparison of the antigenemia assay and an anti-CMV ELISA in a prospective longitudinal study of 130 renal transplant recipients who were monitored for active CMV infection during the first 3 months after transplantation. Active CMV infection developed in 56 patients. The antigenemia assay had a sensitivity of 89% and a specificity of 93% in the diagnosis of active CMV infection; for the ELISA these figures were 95 and 100%, respectively. In 22 of the 56 patients a CMV syndrome occurred. Antigenemia was demonstrated in all 22 patients while an antibody response occurred in 21 of them. The antigenemia assay became positive 8 ± 7 days before the onset of symptoms while the antibody response was observed 4±9 days after the onset of symptoms. The pattern of antigenemia was helpful for monitoring the course of the infection. The maximum level of antigenemia was significantly higher and its duration significantly longer in symptomatic than asymptomatic infection.We conclude that CMV antigenemia is a sensitive, specific, and early marker of CMV infection. The antigenemia assay is of great value in monitoring patients with a high risk of CMV infection.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Serum levels of F protein, a 44 kD cytoplasmic protein mainly found in hepatocytes, become elevated during episodes of graft dysfunction following orthotopic liver transplantation. In a study of 27 liver transplant recipients, the rise in F protein did not precede rises in the other conventional biochemical indices of hepatic dysfunction. Serum F protein concentration significantly correlated with serum levels of aspartate aminotransferase, gammaglutamyltransferase, alkaline phosphatase, and bilirubin (allP< 0.001) and also with the prothrombin time (P = 0.048). Despite its high concentration in liver cells, this marker does not provide any additional benefit in the diagnosis of graft dysfunction or in monitoring liver allograft function following transplantation.

ISSN:0041-1337    

出版商:OVID    

年代:1989

数据来源: OVID