Operational tolerance to class I disparate lungs can be induced despite pretransplant immunization with class I allopeptides

BACKGROUND: Using a class I-disparate swine lung transplant model, we examined whether an intensive course of tacrolimus could induce operational tolerance and whether preoperative allopeptide immunization would prevent the development of tolerance. METHODS: Left lung grafts were performed using class I-disparate (class II-matched) donors. Recipients were treated with 12 days of postoperative tacrolimus. Three recipients were immunized prior to transplantation with class I allopeptides. Three other recipients were not immunized. RESULTS: The nonimmunized recipients maintained their grafts long term (>497, >451, and >432 days), without developing chronic rejection. The immunized swine also maintained their grafts long term (>417, >402, >401 days), despite developing a variety of in vitro and in vivo responses to the immunizing peptides, as well as having strong mixed lymphocyte reactions to donor cells prior to transplantation. CONCLUSIONS: Using only a brief course of tacrolimus, we have been able to induce a state of operational tolerance in a class I-disparate preclinical lung transplant model. Moreover, preoperative alloimmunization did not block tolerance induction or induce chronic rejection. These data show that it is possible to create a state of operational tolerance to lung allografts even in the presence of donor-sensitized cells.     

Spirituality in palliative care: what language do we need?

This article considers the language of spirituality in palliative care (Byrne, 2002; 2007), and focuses on the concepts of metaphor and story, demonstrated in practice by the art project and publication at The Prince & Princess of Wales Hospice (PPWH), Glasgow, UK. Metaphors have been used in everyday speech and literature throughout history. The word 'cancer' is a metaphor itself traced back to Hippocrates in the 5th century BC. Stanworth (2004) concluded that metaphor can draw attention to aspects of the patient's experience that might otherwise be overlooked. In palliative care the metaphor of the journey is often used to describe the experience of illness. Cicely Saunders (2000) described it as a spiritual journey, demonstrating opportunities for growth and development, hope and discovery. As professionals we share that journey. Stories often include metaphoric images and give an understanding of the uniqueness of individual fear and inner need. Cullen and Alcock describe creative expression as the process of unraveling a story (2007).The creative arts project at PPWH bears witness to this.