Transplant
Chapters
page 1 of 3 pages | next »Analyzing Graft Failure in the Scientific Registry of Transplant Recipients: The Sources and Nature of the Data Available
David M. Dickinson, Gregory N. Levine, Douglas E. Schaubel and Robert A. Wolfe
This chapter uses information from a series of articles published in previous editions of the SRTR Report on the State of Transplantation and the OPTN/SRTR Annual Report to assemble a practical background useful for a researcher becoming familiar with data available for analysis of transplant outcom...
Assessment and Management of Rejection in Hand Transplantation
Stefan Schneeberger and Raimund Margreiter
In 18 hand transplant recipients, 25 rejection episodes have been observed within the first year and two hands have been lost due to rejection. Acute rejection therefore represents the major threat in this novel field with unknown effects on long term graft function. Hence, prevention, early d...
Cardiac Allograft Vasculopathy
Jignesh K. Patel and Jon A. Kobashigawa
Over the last four decades, cardiac transplantation has been the preferred therapy for select patients with end‑stage heart disease. Improvements in immunosuppression, donor procurement, surgical techniques and posttransplant care over this period have resulted in a substantial decrease in acu...
Cellular and Molecular Biology in Organ Ischemia‑Reperfusion Injury
Shohachi Suzuki
Ischemia‑reperfusion injury (IRI) is a multifactorial disorder which leads to cellular damage and organ dysfunction. A vast number of studies on IRI have shown that this critical pathophysiological condition is a result of inflammatory response with polymorphonuclear neutrophil‑endotheli...
Chronic Allograft Dysfunction—Liver
Susan Lerner, Pauline Chen and Paul Martin
In the United States, more than six thousand patients undergo liver transplantation (LT) annually with generally excellent outcomes reflected in patient survival of 88% at one year and 80% at three years and graft survival of 83% and 74%. Advances in immunosuppression have made acute cellular reject...
Chronic Allograft Enteropathy
Gonzalo P. Rodriguez-Laiz and Kishore R. Iyer
Current immunosuppression has made small bowel transplantation the standard of care for patients with short bowel syndrome who face complications of total parenteral nutrition (TPN). With standardization and refinement of operative techniques and improvements in rates and outcomes of acute cellular ...
Chronic Allograft Failure: Past, Present and Future
Basit Javaid and John D. Scandling
Transplantation is the treatment of choice for irreversible organ damage. According to United Network for Organ Sharing (UNOS) data, by the end of June 2007, 400,291 solid organ transplants had been performed in the United States since 1988.1 In 2006, a total of 28,933 solid organ transplants includ...
Chronic Pancreas Allograft Failure
Elizabeth K. Gross and Rainer W.G. Gruessner
Apancreas transplant is the only treatment of diabetes mellitus that establishes long‑term insulin independence. As of December 31, 2006, about 20,000 pancreas transplants had been performed in the United States, with 1‑year graft survival rates of >80% and patient survival rates of >95%...
Clinico-Pathological Correlations of Chronic Allograft Nephropathy
Jeremy R. Chapman
Despite, or perhaps because of, common usage “CAN” is a poorly defined term. At Westmead we combine both pathology and physiology to arrive at the following definition: “Progressive graft dysfunction accompanied by chronic interstitial fibrosis, tubular atrophy, vascular occlusive changes and glomer...
Cytomegalovirus and Allograft Failure after Solid Organ Transplantation
Hugo Bonatti, Walter C. Hellinger and Raymund R. Razonable
Allograft rejection and infections are the two major complications of solid organ transplantation. These clinical entities are intimately interrelated, with one predisposing to the other, in a bidirectional relationship. Allograft rejection and its treatment predisposes to various infections, most c...
Decision Analysis in Hand Transplantation
Stephen E. Edgell
Hand transplantation, as with all medical procedures, provides to the patient the possibility of an improved life along with risks. A decision to have or to not have a hand transplant is one that a patient must make carefully; the decision must be made through rational thinking. It is genera...
Dendritic Cell‑Based Approaches to Organ Transplantation
Andrea Meinhardt and Giuseppe Vassalli
Dendritic cells (DCs) take up antigens at peripheral sites and migrate to T‑cell areas of lymph nodes and spleen, where they present antigenic peptides to T‑cells. As such, DCs initiate innate and adaptive immune responses to microorganisms and other antigens, including alloantigens in o...
Diagnosis of Chronic Graft Failure after Lung Transplantation
David B. Erasmus, Andras Khoor and Cesar A. Keller
Since 1984, when bronchiolitis obliterans (BO) was recognized as the main factor influencing long‑term survival after lung and heart‑lung transplantation, this condition has remained the main cause of morbidity and mortality one year after transplant. It is characterized by submucosal ly...
Ethical Criteria for Evaluating Hand Transplantation
Mark A. Rothstein and Heather Hinds
Abuses in biomedical research involving human subjects provided a major impetus to establish the field of interdisciplinary, critical inquiry now known as bioethics,1 and regulation of research remains a prime focus of the field. Historically, the main ethical concern of research ethics has been...
Experimental Gene Therapy of Heart Transplantation
Giuseppe Vassalli, Charles Seydoux, Pierre Vogt, Manuel Pascual and Ludwig K. von Segesser
Maintenance of a functional graft requires life‑long immuno-suppression to prevent rejection by the immune system. Unfortunately, current immunosuppressive agents do not effectively prevent chronic rejection and are associated with significant comorbidity. Therefore, improved strategies that t...
Graft Loss due to Vascular Complications
Barbara Stange, Matthias Glanemann and Natascha C. Nüssler
Vascular complications occur in about 10% of patients undergoing orthotopic liver transplantation. Depending on the involved vessels and the time point after liver transplantation, the clinical course of these patients may vary considerably, ranging from complete absence of symptoms to acute or chro...
Heat Shock Protein 47 in Chronic Allograft Nephropathy
Takashi Taguchi and Mohammed Shawkat Razzaque
Chronic allograft nephropathy (CAN), associated with late allograft dysfunction is caused by alloantigen‑dependent and ‑independent mechanisms that eventually progresses to irreversible interstitial fibrosis. Heat shock protein 47 (HSP47) is a collagen‑specific molecular chaperone ...
Hepatic Allograft Loss: Pathogenesis, Diagnosis and Management
Mohammad Ali
Liver transplantation is the established therapeutic modality for the treatment of both acute and chronic end stage liver disease. After successful transplantation 85% recipients usually survive one year, 69% for five years and 61% for ten years. Well functioning liver allograft is the prime issue o...
Hepatitis C Virus Infection as a Risk Factor for Graft Loss after Renal Transplantation
José M. Morales and B. Dominguez-Gil
Liver disease is an important complication after renal transplantation and Hepatitis C virus (HCV) infection is the most frequent cause of liver disease. Clinical course is irrelevant in the short‑term, excepting rare cases of fibrosing cholestatic hepatitis. However, in the long run, HCV infe...
Introducing Chronic Graft Failure
Harold C. Yang
Over the past 50 years the short‑term improvement in one year graft survival in solid organ transplantation has improved dramatically. The latest statistics from the Scientific Registry of Transplant Recipients (SRTR) for 2006 demonstrate graft survivals in kidney, liver, lung and heart transp...
Ischemia‑Reperfusion Injury: Pathophysiology and Clinical Approach
Maria Teresa Gandolfo and Hamid Rabb
Significant ischemia‑reperfusion injury (IRI) occurs in every deceased donor organ transplant and in some live donor ones. In renal transplants, it remains the leading contributor to delayed graft function (DGF), which in turn predisposes to increased acute rejection and worse long‑term ...
Islet of Langerhans: Cellular Structure and Physiology
Amanda Jabin Gustafsson and Md. Shahidul Islam
Islets of Langerhans, named after their discoverer Paul Langerhans, constitute a unique endocrine organ of critical importance in the metabolism of nutrients and energy homeostasis. Individual islets consist of three major types of electrically excitable cells, namely b‑cells that secrete insu...
Islet Transplantation
Breay W. Paty and A.M. James Shapiro
Islet transplantation restores endogenous insulin secretion in individuals with type 1 diabetes by infusing insulin‑secreting islet cells, isolated from cadaveric pancreata, into the liver. The immune mediated destruction of insulin‑secreting beta cells within pancreatic islets that occu...
Late Allograft Failure: Liver
Jeffrey S. Crippin
Dysfunction and subsequent loss of a liver allograft can have dire consequences for the recipient. Acute and chronic rejection, an ongoing risk for the lifetime of the allograft in the vast majority of liver transplant recipients, is a minor problem, except when levels of immunosuppression fall. The...
Liver Allograft Failure Due to Recurrent Disease: Pathology
Urmila Khettry and Atoussa Goldar-Najafi
Liver transplantation (LT) is an acceptable mode of therapy for end‑stage liver diseases of varying etiology. With the exception of certain disorders of genetic and toxic etiology, most other diseases can recur in the liver allograft. The recurrent diseases can share clinicopathological featur...
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