摘要:

Hepatitis C virus (HCV) infection is present in 2–50% of renal transplant recipients and patients receiving hemodialysis. Renal transplantation confers an overall survival benefit in HCV positive (HCV+) hemodialysis patients, with similar 5-year patient and graft survival to those without HCV infection. However, longer-term studies have reported increased liver-related mortality in HCV-infected recipients. Unfortunately, attempts to eradicate HCV infection before transplant have been disappointing. Interferon is poorly tolerated in-patients with end-stage renal disease and ribavirin is contraindicated because reduced renal clearance results in severe hemolysis. Antiviral therapy following renal transplantation is also poorly tolerated, because of interferon-induced rejection and graft loss. Although the prevalence of hepatitis B virus (HBV) infection has declined in hemodialysis patients and renal transplant recipients since the introduction of routine vaccination and other infection control measures, it remains high within countries with endemic HBV infection (especially Asia-Pacific and Africa). Renal transplantation is associated with reduced survival in HBsAg+ hemodialysis patients. Unlike interferon, lamivudine is a safe and effective antiviral HBV treatment both before and after renal transplantation. Lamivudine therapy commenced at transplantation should prevent early posttransplant reactivation and subsequent progression to cirrhosis and late liver failure. This preemptive therapy should also eradicate early liver failure from fibrosing cholestatic hepatitis. Because cessation of treatment may lead to severe lamivudine-withdrawal hepatitis, most patients require long-term therapy. The development of lamivudine-resistance will be accelerated by immunosuppression and may result in severe hepatitis flares with decompensation. Regular monitoring with liver function tests and HBV DNA measurements should enable early detection and rescue with adefovir. Chronic HCV and HBV infections are important causes of morbidity and mortality in renal transplant recipients. The best predictor for liver mortality is advanced liver disease at the time of transplant, and liver biopsy should be considered in all potential HBsAg+ or HCV+ renal transplant candidates without clinical or radiologic evidence of cirrhosis. Established cirrhosis with active viral infection should be considered a relative contraindication to isolated renal transplantation.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Immunogenicity of a graft depends on its expression of major histocompatability complex (MHC) antigens and adhesion molecules and on the amount of intragraft leukocytes, the so-called passenger leukocytes. Although long-term culture reduces passenger leukocytes, permanent acceptance is not necessarily observed after allogeneic transplantation. Because little is known about antigen expression on the surface of islet cells after long-term culture of islets, we investigated whether antigen expression of pancreatic &bgr; cells is influenced by long-term culture and whether long-term culture can counteract the increase of antigen expression induced by cytokines or by allogeneic lymphocytes. We also investigated whether long-term cultured islets were able to stimulate allogeneic lymphocytes to produce cytokines.Methods.Isolated LEW.1A (RT1a) rat islets of Langerhans were cultured for 14 and 28 days. Precultured and freshly-isolated islets were then incubated for 2 days with rat recombinant interferon (rIFN)-&ggr; (1,000 IU/mL), or were co-cultured for 4 days with LEW.1W (RT1u) splenic lymphocytes.Results.Long-term culture significantly reduced CD45+leukocytes within the islets and decreased the amount of &bgr; cells expressing intercellular adhesion molecule (ICAM)-1, whereas MHC antigen expression remained unchanged. After incubation of freshly isolated islets with IFN-&ggr; induction of MHC class II antigens on &bgr; cells, an increase of MHC class I antigen density and an enhancement of ICAM-1+&bgr; cells were observed. Similar results were found after co-culturing with allogeneic lymphocytes. Using precultured islets, the induction of MHC class II on &bgr; cells by IFN-&ggr; was still present but significantly lower and was absent after co-culture with allogeneic lymphocytes. Enhancement of ICAM-1+&bgr; cells by IFN-&ggr; or by allogeneic lymphocytes was markedly lowered because of preculturing. The proportion of MHC class I+&bgr; cells remained unchanged; however, antigen density of long-term cultured islets (28 days) could not be enhanced by allogeneic lymphocytes. Precultured islets were not able to stimulate allogeneic lymphocytes to produce and release normal amounts of cytokines (IFN-&ggr; or interleukin [IL]-2).Conclusions.In conclusion, in addition to reduction–depletion of passenger leukocytes, long-term culturing of islets also is able to counteract the IFN-&ggr;-induced or allogeneic lymphocyte-induced increase of antigen expression. Therefore, initiation of rejection and generation of cytotoxic cells might be altered or timely delayed when long-term cultured islets are transplanted. The variable and conflicting in vivo results after transplantation of long-term cultured islets might be explained by the possible indirect antigen presentation, which is not influenced by islet preculture.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.PG27 is an active fraction purified from an extract of a Chinese medicinal plant,Tripterygium wilfordiiHook f. We tested PG27 in murine allogeneic bone marrow transplantation (BMT) and investigated the mechanism of graft-versus-host disease (GVHD) suppression.Methods.Recipients in the C57BL/6 → BDF1 murine BMT model received oral or intraperitoneal PG27.Results.Fourteen days of PG27 given orally or intraperitoneally prevented GVHD development and produced extended disease-free survival (more than 300 days) for many animals. PG490–88, a semisynthetic derivative of PG490 (triptolide, present in PG27), was also efficacious. PG27 reduced day 7 splenic allospecific cytotoxic T lymphocyte levels by more than 99% compared with vehicle-treated mice. Compared with normals, spleens from control allogeneic BMT mice displayed significantly reduced mononuclear cell content, an increased percentage of CD8+ cells, fewer CD4+ cells, and more activated ([interleukin-2 receptor+], IL-2R+) CD8+ T cells. PG27 increased mononuclear cell recovery, and significantly reduced the day-14 percentages of CD3+ and IL-2R+ cells in allogeneic BMT mice, producing results similar to those for syngeneic BMT mice. PG27 significantly increased concanavalin A-stimulated in vitro IL-4 production by day-14 splenocytes, with a 7- to 8-fold higher level than that produced by control cells.Conclusions.PG27 treatment for only 14 days prevented GVHD induction and development and produced long-term survival. PG27 largely normalized splenic T lymphocyte subsets, reduced allospecific cytotoxic T lymphocyte activity, and increased IL-4 production capability. PG27 may suppress GVHD by the induction of anergy and a deviation away from a proinflammatory phenotype, which could be reflected in the increased potential for IL-4 production.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The benefit of Celsior in liver graft preservation is controversial. In the isolated perfused rat liver model, we compared the effects of Celsior, University of Wisconsin (UW), and histidine-tryptophan-ketoglutarate (HTK) preservation solutions on liver cell death.Methods.Rat livers were stored at 4°C for 0, 8, 16, or 24 hr in either Celsior, UW, or HTK and reperfused for 90 min (37°C). Bile secretion and perfusate levels of liver enzymes and histone-associated DNA fragments were measured. Apoptosis and oncotic necrosis were analyzed in biopsies by DNA gel electrophoresis, hematoxylin and eosin histology, and enzyme histochemistry for lactate dehydrogenase (LDH) and 5′-nucleotidase (5′-NT).Results.Perfusate flow rate through the liver during perfusion did not significantly differ among preservation solutions. Bile secretion was best preserved in UW livers after 16-hr (versus HTK livers) and 24-hr storage (versus HTK and Celsior livers). Enzyme leakage from UW livers was lower compared with HTK livers after 8-hr storage (serum glutamic oxaloacetic transaminase [SGOT], LDH) and with Celsior and HTK livers after 16-hr (SGOT, LDH) and 24-hr storage (SGOT, serum glutamic pyruvic transaminase, LDH, purine nucleoside phosphorylase). In situ LDH and 5′-NT activities were best preserved in UW livers (up to 24 hr), whereas enzyme activities declined remarkably in HTK livers (after 8 hr) and Celsior livers (after 16 hr of cold storage). Although perfusate DNA fragment levels were repeatedly lowest from Celsior livers, apoptotic DNA laddering and the number of fragmented nuclei in hematoxylin and eosin sections was not different among livers after 8, 16, or 24 hr of storage.Conclusions.Celsior and UW are equally effective in preventing rat liver cell death after 0–16 hr of cold preservation as compared with the less effective HTK solution. After 24-hr cold storage, rat livers were best preserved in UW. Furthermore, there was no significant difference in mode of cell death (apoptosis or oncotic necrosis) after storage in any of the three solutions.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Autologous graft-versus-host disease (autoGvHD) has been reported in patients and can be induced in rodents by syngeneic bone marrow transplantation (BMT) and a brief administration of cyclosporine A (CsA). To our knowledge, there is no previous large-animal model for this phenomenon, nor is there a model in which autoGvHD occurs spontaneously after autologous bone marrow transplant (autoBMT) in the absence of CsA induction. During our studies of autoBMT in miniature swine, performed without CsA treatment, we noted the frequent occurrence of a rash consistent with autoGvHD. We hypothesized that the extent of peripheral blood contamination of the bone marrow (BM) inoculum before transplant may have correlated with the incidence of such autoGvHD.Methods.Retrospective analysis of the prevalence of autoGvHD in swine was carried out in all animals that had become engrafted after autoBMT in our laboratory. Subsequent prospective experiments attempted to induce autoGvHD by transplanting autologous BM enriched with autologous peripheral blood into lethally irradiated animals.Results.Our data showed that autoGvHD frequently occurs in swine after autoBMT, with the most severe cases of the disease occurring in animals with the highest levels of peripheral blood contamination of the BM inoculum. Furthermore, mixed lymphocyte reactions (MLR) against self antigens were positive only in animals affected by autoGvHD.Conclusion.These findings provide the first evidence for autoGvHD without the use of CsA in a preclinical BMT model. The role of autologous T cells needs further delineation but may help to explain the occasional occurrences of autoGvHD that have been reported in humans after autoBMT.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Although many transplantation studies have implicated a graft-destructive role for T helper (Th)1 cytokines and a graft-protective role for Th2 cytokines, more recent studies have challenged this paradigm by showing that long-term allograft survival can actually require the presence of Th1 cytokines, such as interleukin 2 and interferon (IFN)-&ggr;. The purpose of this study was to examine the requirement for IFN-&ggr; in the induction of islet allograft acceptance after monoclonal antibody therapy targeting conceptually distinct molecular pathways: the costimulatory molecule CD154, the CD4 coreceptor, or the &bgr;2 integrin lymphocyte function-associated antigen (LFA)-1 (CD11a).Methods.Diabetic C57Bl/6 (B6; H2b) mice were grafted with fully MHC mismatched BALB/c (H2d) islets, or reciprocally, diabetic BALB/c mice underwent transplantation with B6 islets and were treated with anti-CD154, anti-CD4, or anti-LFA-1.Results.When IFN-&ggr; gene knockout mice were used as graft recipients, the requirement for IFN-&ggr; in allograft survival was found to be highly conditional, depending on both the host strain and the induction therapy used. In both strain combinations studied, anti-CD154 was effective in the presence or absence of IFN-&ggr;, whereas anti-CD4 lost therapeutic potential in the absence of this cytokine. Alternatively, the requirement for IFN-&ggr; for allograft prolongation by anti-LFA-1 therapy was noted only in B6 transplant recipients.Conclusions.IFN-&ggr; is not always requisite in islet allograft survival but rather varies according to the molecular target of induction therapy and the genetic background of the transplant recipient.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.These experiments evaluate the mechanisms associated with tolerance in mice treated with sirolimus, antilymphocyte serum (ALS), and donor-specific bone marrow (BM).Methods.Tolerance to fully MHC-incompatible skin allografts was induced as follows: C57Bl/10 (H2b) recipients received 0.5 mL of rabbit anti-mouse polyclonal ALS on days −1, +2, and +5 relative to B10.A (H2k) donor skin grafting on day 0. Sirolimus was given in a single dose (24 mg/kg intraperitoneally) on day 6. Freshly harvested B10.A (H2k) donor-specific BM was administered at a dose of 25×106(ALS/BM25/sirolimus) or 150×106(ALS/BM150/sirolimus) cells intravenously on day 7. Skin allograft survival was correlated with the recipient’s immunologic status. Recipients were assayed for suppressor cell activity (mixed lymphocyte coculture assays), clonal deletion (T-cell receptor V&bgr;11 assay), peripheral and thymic chimerism (flow cytometry and reverse transcriptase polymerase chain reaction), and anergy (response to exogenous interleukin 2).Results.Mice treated with ALS/BM25/sirolimus showed specifically prolonged but not indefinite allograft survival (median survival time 116 days). Allograft survival correlated with donor-specific clonal deletion and the presence of donor class II mRNA in the recipient’s thymus. Mice given the ALS/BM150/sirolimus protocol showed indefinite donor-specific tolerance. Tolerance could not be broken with the administration of high doses of interleukin 2. Splenocytes taken from mice 14 days after tolerance induction inhibited donor-specific and third-party mixed lymphocyte culture proliferation in a dose-dependent fashion. This suppression could be ablated by depleting splenocytes of cells of donor origin before use in coculture. Clonal deletion was detectable 30 days after tolerance induction in mice treated with ALS/BM150/sirolimus and was maintained indefinitely.Conclusion.Induction of tolerance by ALS, BM, and sirolimus results in a state of donor-specific tolerance, and multilineage chimerism evolves that is permanent and associated with clonal deletion of alloreactive T cells.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.BK virus (BKV) allograft nephropathy (BKVAN) is a complication in renal transplantation recipients. Histopathology is the gold standard for diagnosis. Quantitative polymerase chain reaction (PCR) assay for renal biopsy has not been evaluated as a diagnostic test. Determination of renal BKV load may identify patients at risk for disease before histologic nephropathy.Methods.Quantitative PCR assay for BKV DNA was performed in 28 biopsies of patients with BKVAN; 50 biopsies were performed before a diagnosis of BKVAN, and 126 control biopsies were from patients without a history of BKVAN.Results.BKV DNA was present in 19 of 50 (38%) biopsies performed 1 to 164 weeks before diagnosis of BKVAN. The viral load (mean 216 copies/cell) was lower than in biopsies of patients with BKVAN (mean 6063 viral copies/cell,P<0.05). In 10 of 127 (7.8%) control biopsies, a low level of BKV DNA (mean 3.8 copies/cell) was found in three biopsies from chronic allograft nephropathy patients; two biopsies with acute rejection; four biopsies with borderline change; and one biopsy with cytomegalovirus nephritis.Conclusion.BKV load exceeding 59 copies per cell identified all cases of BKVAN. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of quantitative PCR were 100%, 92.1%, 73.6%, and 100%, respectively. Lower levels of BKV DNA were identified in biopsies performed before viral nephropathy development. Future research will determine if earlier recognition of at-risk patients allows application of antiviral strategies to improve graft outcome.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.In a previously reported series of donor-specific bone marrow cell (DBMC) infusions in cadaver kidney transplant recipients, there appeared to be an improvement in long-term graft survival (6 years) and fewer chronic rejections, which correlated with increasing DBMC chimerism (≈1.4% in the iliac crest bone marrow compartment now at 6 years). Prompted by this, we embarked on a study of DBMC infusion in living-related donor (LRD) kidney transplant recipients.Methods.Between November 1996 and May 2000, 47 LRD kidney transplant recipients received donor iliac crest marrow (1.8×108±1.9×108cells/kg body weight±SD) in a single infusion 4 days postoperatively. Either OKT3 (n=26) or daclizumab (n=21) were used for induction therapy, with maintenance tacrolimus, mycophenolate mofetil, and methylprednisolone immunosuppression. These recipients were prospectively compared with 39 noninfused LRD kidney transplants (control group), which received equivalent immunosuppression in the same time period. Clinical follow-up ranged from 19.0 months to 61.6 months (mean 33.2 months). Polymerase chain reaction–flow chimerism analysis and in vitro assays of immunoregulatory activity of chimeric cells were performed.Results.The incidence of acute rejection over this period of time was 10.6% and 10.3%, respectively (i.e., did not differ between groups). Immunosuppressive dosages were somewhat (but not statistically) lower over time in the DBMC group. Four-year actuarial patient and graft survival for the DBMC-infused group was 98% and 98%, and 98% and 95% for the control group, respectively (P=NS). DBMC infusion was well tolerated, with no increase in infectious episodes. DBMC chimerism in recipient iliac crest marrow has increased more rapidly than might be predicted from results previously seen in the cadaver group, despite four times fewer DBMC infused. DBMCs and (donor) peripheral blood mononuclear cells purified by immunobeads from recipient blood or bone marrow (recipient-derived donor cells) inhibited mixed leukocyte responses of the recipient to the donor more strongly than freshly obtained peripheral blood cells drawn from the donors or even compared with bone marrow cells aspirated from the donors in a previously reported group of experiments. Additionally, similarly purified recipient-derived recipient cells from the same chimeric recipient more strongly inhibited the same mixed leukocyte response reactions autologously than a large group of nonchimeric (autologous) bone marrow modulating cells in similar reactions.Conclusions.These observations confirm that an immunoregulatory process appears to have been generated by DBMC infusion, encouraging a further decrease in immunosuppressive dosing using such assays in the future.

ISSN:0041-1337    

出版商:OVID    

年代:2002

数据来源: OVID