Transplanting the Highly Sensitized Patient: The Emory Algorithm

Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (approximately 25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation.     

Small proportions: what to report for confidence intervals?

The original article to which this Erratum refers was published in Pharmacoepidemiology and Drug Safety 2005; 14: 239–247.     

同种异体黑素细胞移植治疗白癜风

0　引言　白癜风患者免疫紊乱 ,黑素细胞 (melanocyte,MC)异体移植有可能不被排斥 ,治疗如成功将有很大临床前景 [1 ] .探索同种异体黑素细胞移植后的效果很有意义 .1　病例报告　女 ,2 7岁 ,确诊白癜风 (稳定期 ) ,患者皮肤自幼出现色素脱失斑 ,逐渐增多扩大 . 1996年外用“敏白灵”,前2 mo有效 . 1999- 0 7外用补骨酯酊 ,日服 5 g· L- 1 硫酸铜 10m L和中药 1剂 ,转移因子 4m L ,sc,1· 2 d- 1 .皮损缩小 ,4mo后稳定 .用健康男青年环切的包皮培养 MC,第 4代大约80 %融合时 ,用 2 .5 g· L- 1 胰酶消化 5 min,加入含 2 0 0 g·L- 1小…     

Antigenic specificity of antibody reactive in the antiglobulin-augmented lymphocytotoxicity test

The addition of an antihuman immunoglobulin (AHG) reagent to the basic complement-dependent cytotoxicity (CDC) test markedly increases the frequency of lymphocyte-reactive antibodies in many alloantisera. The extra reactivity has been previously identified as associated with alloantigens coded by the HLA complex, but definitive evidence establishing the antigenic specificity of the antibodies reactive by AHG-CDC has been lacking. We determined the nature and specificity of AHG-reactive alloantibodies through parallel testing (CDC +/- AHG) of a large battery of HLA alloantisera against panel cells composed of unrelated individuals and genotypic HLA-identical sibling pairs, and by means of differential platelet absorption and elution of alloantibody. We conclude that the AHG-CDC procedure, relative to "standard" CDC, detects subthreshold levels of alloantibody with specificity for the HLA-A, B, and C locus alloantigens. Most importantly, the AHGG-CDC technique consistently converts cytotoxicity-negative absorption-positive (CYNAP) HLA alloantibody to direct cytotoxic antibody, thus providing a more accurate assessment of the complete specificity of antibodies in complex alloantisera and patients' sera without having to resort to more cumbersome binding assays. These data should be of assistance in improving the characterization of HLA alloantisera used for serological and biochemical studies of the HLA molecules and in delineating the specificity of AHG-CDC antibody in clinical allotransplantation and single-donor platelet transfusion.     

糖尿病与甲状腺

在我们颈部甲状软骨下端，有一个长得像蝴蝶一样的腺体，横跨于气管前方，这个腺体叫做甲状腺。甲状腺属于内分泌器官，它的作用是调整机体代谢。一旦甲状腺功能失常，就会引起疾病。在1型或2型糖尿病患者之中，甲状腺疾病的发病率都比常人要高。