Acute rejection in the elderly recipient: Influence of age in the outcome of kidney transplantation

Since the immune response in older recipientsis weaker they should be less likely to rejecta transplanted organ and should need lessaggressive immunosuppressive treatment. Our aimwas to record the incidence and severity ofepisodes of acute rejection (AR), estimate theinfluence of these events on graft survival ofelderly recipients (60) and to comparethese with that in younger ones.We performed 363 kidney transplants between1/94 and 12/98, and recorded clinical andimmunological data, incidence-severity of ARand cause of graft loss. Patients were dividedinto two groups, according to the age attransplantation: A (<60, n = 281/77.4%) and B( 60, n = 82/22.6%). The percentage ofaging recipients and mean age of donors andrecipients increased throughout the period.Although the incidence of ATN was higher in theolder group (29% vs.19%, p < 0.0001) thenumber of graft biopsies was equal in bothgroups. The incidence of AR was similar, 33.4%vs. 26.8%, pNS. The number of AR episodes perpatient was 0.44 and 0.41 respectively. Theseverity of AR was: Banff grade I: A (40.3%)/B (45.7%) pNS; grade II: A (44.1%)/B(48.57) pNS; grade III: A (15.5%)/B (5.7%)pNS. Younger recipients presented a higherlevel of panel-reactive antibodies (PRA) (4.3%vs. 2.07%, p = 0.01). One-year patient survivalwas 96%/91% (p<0.05) and graft survivalwas 81%/78% (pNS) respectively.The age of recipient does not seem to haveinfluenced the incidence-severity of AR or thegraft survival. Thus immunosuppression shouldbe individualised for each patient and shouldnot depend on the age at transplantation.     

Transplantation of EGF-responsive neurospheres from GFP transgenic mice into the eyes of rd mice

The isolation of stem cells from various regions of the central nervous system has raised the possibility of using them as a donor cell source for cell transplantation, where they offer great promise for repair of the diseased brain, spinal cord, and retina. Here, we have studied the migration, integration, and differentiation of EGF-responsive neurospheres isolated from the brains of green fluorescent protein transgenic mice and transplanted into the eyes of mature rd mice, a model of retinitis pigmentosa. While grafts of freshly isolated postnatal day 8 retina expressed many markers characteristic of mature retina (e.g. rhodopsin, protein kinase C), very few of the grafted cells migrated into host retina. EGF-responsive neurospheres, conversely, readily migrated into and integrated with the remaining host retina, but showed a very limited ability to differentiate into mature retinal neurons. While the progenitor cells used here show remarkable ability to integrate with host retina and develop some attributes of retinal cells, the failure to fully differentiate into retinal cells suggests that they already express some level of terminal commitment that precludes using them to replace lost photoreceptors.     

中青年肾移植者服环孢素A后尿酸及肌酐等指标的三维图像

目的：研究中、青年肾移植患者服用环孢素天数、血红蛋白、总胆红素、直接胆红素、尿酸、肌酐、尿素氮的三维图像，使临床指标形象化，为预测疾病提供信息。方法：将40-59岁中年患者（n=219）与小于40岁的青年患者（n=145）的这7个指标分成三组：（血红蛋白＋总胆红素＋直接胆红素）组，（服药天数＋总胆红素＋尿酸）组，（服药天数＋肌酐＋尿素氮）组，采用MATLAB7．0分别作中年、青年组的三维图像，分析图像特征与对中年、青年组图像比较。结果：三维图像显示出各项指标间存在内在关系与个体差异。结论：体内指标与服药天数相关，体内指标对临床预防疾病具有重要意义。     

开放性跟腱断裂的治疗

目的了解开放性跟腱断裂手术方法及其疗效.方法对开放性跟腱断裂56例患者行改良津下（Tsuge）缝合法吻合跟腱或辅助游离深筋膜环行修复.结果56例患者均获随访,随访期9个月至2年,结果优良52例,中等3例,差1例（切口边缘皮肤坏死并轻度感染）.结论改良津下缝合法吻合跟腱或辅助游离深筋膜环行修复治疗开放性跟腱断裂具有良好的疗效.     

Medical management of Aspergillus flavus endocarditis

An 11-year-old boy underwent a matched unrelated bone marrow transplant for refractory acute myeloid leukemia. He developed invasive aspergillus pneumonia and endocarditis post-transplant. The fungal endocarditis was successfully eradicated with liposomal amphotericin at the dose of 10 mg/kg/day. Surgical intervention was not required and no serious side effects of liposomal amphotericin were observed at this dose.     

T cells or active epstein-barr virus infection in the development of lymphoproliferative disease in human B cell-injected severe combined immunodeficient mice

Background: Severe combined immunodeficient (SCID) mice develop Epstein-Barr virus (EBV) containing human lymphoproliferative disease (LPD) tumors when reconstituted with human peripheral blood leukocytes (PBLs) from EBV-seropositive donors, but LPD tumors do not develop in the presence of immunosuppressive agents, such as cyclosporine A or corticosteroids. Methods: Therefore, LPD development in SCID mice was used as a model to explore the relationship among B cells, T cells, and EBV in vivo. SCID mice were engrafted with PBLs isolated by leukapheresis from a single EBV-seropositive donor. Purified populations of CD3⁺ lymphocytes (T cells) or CD19⁺ lymphocytes (B cells) were isolated and engrafted into SCID mice. Results: SCID mice engrafted with purified CD3⁺ lymphocytes (T cells) or CD19⁺ lymphocytes (B cells) did not develop LPD. In contrast, mice engrafted with purified B cells developed LPD if they were co-engrafted with purified T cells or if they were inoculated with infections EBV. Conclusions: This study confirms the requirement of T cells or active EBV infection in the development of LPD in animals engrafted with B cells latently infected with EBV. A greater understanding of the cellular and viral interactions leading to transformation and malignancy may allow the development of specific interventional therapies for malignancies in the immunosuppressed host. Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Removal of therapeutic anti-lymphocyte antibodies from human sera prior to anti-human leukocyte antibody testing

Both monoclonal (e.g. Orthoclone (OKT3®), rituximab) and polyclonal (e.g. ATGAM®, Thymoglobulin® (Thymo)) anti-lymphocyte Abs (ALAs) are used extensively in organ transplantation for immunosuppression induction, desensitization, and treatment of acute rejection. ALAs often interfere with post transplant immunologic monitoring. We describe a method that uses magnetic beads to selectively remove ALAs from patient serum. Rabbit anti-mouse Fc-specific (180 μg), or rabbit anti-mouse Fab-specific (180 μg), or rabbit anti-horse heavy and light chain-specific and rabbit anti-horse F(ab')₂ (200 μg) (Jackson Immunoresearch) was adsorbed to 6.7 × 10⁸ Dynabeads M-280 conjugated with sheep anti-rabbit IgG (Dynal Biotech). Fifty microliters of normal human serum (NHS) with 2 μg/ml of OKT3 or 100 μg/ml ATGAM, Thymo, or rituximab were incubated with conjugated beads for several incubations. NHS containing ALAs before and after treatment by the protocol were incubated with human lymphocytes and labeled with FITC-antibody to immunoglobulin of the species used to produce the particular ALA. Residual ALA was determined using flow cytometry. Average median channel for serum with or without ALA was 11.1 and 0.120, respectively for OKT3; 64.4 and 0.344 for ATGAM; 108.5 and 0.200 for Thymo; and 1022.5 and 11.4 for rituximab. Treatment lowered the median channel for serum with OKT3 to 0.103, 0.309 for ATGAM, 0.199 for Thymo, and 12.1 for rituximab. ALAs can be effectively removed from serum by the use of magnetic beads conjugated with Ab specific for ALA thereby permitting immunologic monitoring without interference.     

Skin infections in renal transplant recipients and the relation with solar ultraviolet radiation

BACKGROUND: Ultraviolet radiation (UVR) is an important risk factor for skin cancer in transplant recipients. In view of the potential suppressive effect of UVR on host resistance it was examined whether exposure to UVR was also associated with the occurrence of various skin infections. METHODS: In a cohort of renal transplant recipients (n = 137), lifetime exposure was assessed by means of a retrospective questionnaire on cumulative sunlight exposure. Diagnosed skin infections since renal transplantation were extracted from the patient's medical charts. Season of diagnosis was regarded as indicative of short-term exposure. RESULTS: In comparison with winter a high rate of herpes simplex infections was found in spring [rate ratio (RR) = 4.09, 95% confidence interval (CI) 1.2-14.5], and high rates of herpes zoster infections (RR = 1.6, 95% CI: 0.8-3.5) and fungal/yeast infections in summer (RR = 2.1, 95% CI: 1.3-3.4). A higher lifetime exposure (RR = 2.31, 95% CI: 1.04-5.1) and a greater cumulative number of reported sunburns (RR = 2.3, 95% CI: 1.1-5.1) were independently associated with a higher risk of bacterial infections. CONCLUSIONS: The seasonal association with the occurrence of clinical herpes infections indicates an effect of short-term UVR. Our data suggest that the number of sunburn episodes in the past is also relevant for the susceptibility to certain skin infections.     

Factors influencing the adaptation of the Spanish Model of organ donation

Spain is the only existing example of a large country (40 million inhabitants) with a continuous increase in cadaveric organ donation for a period of over 10 years, and, in parallel, with an increase in the overall number of solid organ transplantations. A proactive donor detection program performed by well-trained transplant coordinators, the introduction of systematic death audits in the hospitals combined with a positive social atmosphere, adequate management of mass media relations, and adequate economic reimbursement for the hospitals accounted for this success. Some regions of Italy, for example Tuscany, have successfully adapted this approach with excellent results. We can conclude that the "Spanish Model" can be partially or totally adapted to other countries or regions if basic conditions are guaranteed. An adequate and careful study of the local characteristics that influence organ donation directly or incirectly should be carried out before planning any specific action to improve organ donor rates.