ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The success of transplantation is such that it is now the treatment of choice for many of those requiring renal replacement therapy. The use of other solid organs, including liver, pancreas, heart and lung, continues to progress. This article reviews some recent advances in our understanding of the immunological response to alloantigen and xenoantigen.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The immunosuppressant cyclosporine A revolutionized treatment of graft rejection. Two newer agents, FK506 and rapamycin, show great clinical potential. These drugs suppress the immune system by forming protein-drug complexes that interact with and inhibit key components of the signal transduction pathways required for T-cell activation. The target of the cyclophilin A-cyclosporine A and FKBP12-FK506 complexes is calcineurin, a protein phosphatase required for signaling via the T-cell receptor. Cyclosporine A and FK506 nephrotoxicity may reflect renal-specific functions of calcineurin. The target of the FKBP12-rapamycin complex is TOR, a lipid and protein kinase homolog that is likely to be required for T-cell proliferation in response to interleukin-2. The identification of cyclosporine A, FK506, and rapamycin targets reveals much concerning T-cell signaling and provides the means to design novel immunosuppressants with reduced toxicity.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Renal transplantation in children is now a well established mode of optimal therapy for children with end-stage renal disease. The cooperative endeavors of the pediatric renal transplant physicians in the USA and Canada have generated a large volume of data that lends itself to rigorous scientific analysis. With changing practice patterns, the percentage 1− and 2-year graft survivals for cadaveric donor pediatric renal transplants have increased to 83 and 78%, respectively, in 1991 compared with 72 and 65% in 1987. Craft failure from acute irreversible rejection continues to take its toll in children under the age of 6 years. With funding from the National Institutes of Health a major cooperative effort has been organized by the North American Pediatric Renal Transplant Cooperative Study to determine the mechanisms that lead to heightened immune response in young children. Surveillance biopsies done in the early post-transplant days will attempt to identify the molecular mediators of acute rejection. Rehabilitation of children will not be satisfactory without accelerated growth after transplantation. Unfortunately, the longitudinal studies of the natural histories of growth after transplantation demonstrates that catch up growth occurs only in a subset of young children and that for the majority of older children, intervention with recombinant growth hormone is necessary. However, concern regarding the potential of recombinant growth hormone to induce chronic rejection necessitates a controlled trial.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Rapamycin is a novel immunosuppressive agent that is undergoing clinical trials for use in allograft rejection therapy. This paper reviews its in-vitro biological properties, the current state of knowledge concerning its mechanism of action, and its therapeutic applications.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Mechanisms causing loss of lean body mass in uremia include an inability to activate metabolic adaptations to a low-protein diet caused by anorexia, or other factors. The adaptations include decreased degradation of essential amino acids and protein. Metabolic acidosis activates specific pathways which increase catabolism by mechanisms that include stimulation of genes. The inability to adapt to dietary protein restriction causes loss of lean body mass.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Beta2-microglobulin has been demonstrated to be a major constituent of amyloid fibrils in dialysis-related amyloidosis. However, the molecular pathogenesis of this complication remains unknown. Several lines of evidence suggest that P2-microglobulin is not an innocent bystander, but plays an active role in the development of dialysis-related amyloidosis. The evidence remains inconclusive, however, as to whether it is intact or modified P2-microglobulin which is amyloidogenic and contributes to bone and joint destruction. Recent biochemical and immunohistological studies have revealed a new modification of (32-microglobulin in amyloid fibrils, the advanced glycation end products formed nonenzymatically between aldoses and proteins. Further study has suggested that the interaction of advanced glycation end product-modified P2-microglobulin with monocytes/macrophages gives a plausible, albeit incomplete, explanation for the mechanism of bone and joint destruction in dialysis-related amyloidosis. This review focuses on new aspects of the pathogenesis of dialysis-related amyloidosis.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Economic, social, racial and age-related considerations in dialysis and transplantation beg the question: how successful are different countries in addressing the problem of distribution of scarce resources, in making tragic choices' on who gets treated when not everyone can get what they need? They broach the issues of distributive justice. Whereas the literature mainly addresses these questions in the developed Western world, this review also includes issues that involve the developing world.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID