Acute rejection

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and organ shortage. The aim of the study was to analyse whether old age of donors affects the outcome of renal transplantation and the long term safety of retrieval for the donors. We present data of 335 consecutive living related kidney transplants, performed in our centre the last 10 years, where in 174 patients the donor was less than 60 years of age, while in the rest 161 patients the donor was more than 60 years of age. No statistical difference was noted in either group at the incidence of irreversible acute rejections, early acute tubular necrosis, vascular complications and patient deaths. The graft survival was 86.7%, 80.4% and 78.1% for the 3rd, the 5th and the 8th year for the younger group of donors, while it was 83.6%, 78.2% and 67.8% for the older group (p = 0.13). Patient survival of the younger group was 95.9%, 94.7% and 94.7%, while for the older was 94.4%, 92.0% a...

Although innate immunity is crucial to pulmonary host defense and can initiate immune and inflammatory responses independent of adaptive immunity, it remains unstudied in the context of transplant rejection. To investigate the role of innate immunity in the development of allograft ...

A sensitive and quantitative flow cytometry method for detecting antileucocyte antibodies was developed to study retrospectively samples from candidates using frozen donor cells and frozen recipient sera. This immunofluorescence method was used to compare levels of reactivities of serum antibodies before and after donor specific blood transfusion treatment and after renal transplantation. The results demonstrate that the flow cytometry crossmatch is a sensitive and accurate method which should be used prospectively before precluding transplantation in the presence of a positive B cell standard crossmatch. Antibodies detected by flow cytometry before transplantation could be responsible for an early acute rejection episode. Finally, combination of flow cytometry crossmatch and standard crossmatch assays might thus be useful before precluding transplantation in living related donors.

Patient and graft survival following renal transplantation have improved markedly over the past decade, meaning that physician attention has turned more towards minimizing short- and long-term toxicities associated with immunosuppressive regimens. Gastrointestinal (GI) adverse events are common following renal transplantation and all immunosuppressive regimens have been associated with such events. Mycophenolate mofetil (MMF) or enteric-coated mycophenolate sodium (EC-MPS) are potential components of immunosuppression regimens, and are associated with the most successful outcomes in kidney transplantation. The effects of MMF and EC-MPS are likely mediated via the active metabolite mycophenolic acid (MPA). The GI events caused by both MMF and EC-MPS may, in part, be related to MPA, independent of the formulation or route of administration. MPA may produce GI events either through direct action or through the action of it metabolites. However, many other factors may cause GI events observed following renal transplantation. These include the surgery itself and concurrent diseases such as diabetes, and bacterial, viral, fungal and parasitical infections. Additionally, numerous concomitant non-immunosuppressive agents, including antibiotics hypoglycaemic and proton-pump inhibitors, can be associated with GI events. In a recent trial in renal transplant patients with severe diarrhoea, approximately 50% of patients achieved resolution of diarrhoea through methods other than altering their immunosuppressive regimens. Indeed altering of the immunosuppressive regimen may lead to the risk of acute rejection. Thus, in order to reduce the risk of rejection and subsequent damage to the graft, it is important to consider other causes of GI events in renal transplant patients before altering immunosuppressive regimens.

Objectives: To analyze the in situ expression of perforin, granzyme B, FAS-L and FAS in renal allograft biopsies by means of immunohistochemistry and correlate these findings with the degree of histologic rejection and allograft outcome. Methods: Ninety-six allograft biopsies were divided into three groups: acute rejection (n = 56), chronic rejection (n = 31), and cases with stable renal function