Despite significant accomplishments to date, kidney transplantation is a relatively young field in medicine. Due to the armamentarium of agents available to effectively suppress the immune system, the past decade has seen a shift in focus from prevention of rejection to a focus on extending the life of the allograft and novel strategies to increase the organ donor pool. This book covers basic concepts in kidney transplantation while also addressing ways to manage kidney transplant recipients in order to maximize patient and graft survival.
Pneumocystis jiroveci pneumonia, once seen in 5–10% of patients, can be prevented by treating patients with oral trimethoprim-sulfamethoxazole for 1 week pretransplant and resuming the treatment once patients have engrafted.
The risk of infection diminishes considerably beyond 3 months after transplant unless chronic Most GVHD transplant develops, centers requiring recommend continuous continuing
trimethoprim-sulfamethoxazole prophylaxis while patients are receiving any immunosuppressive drugs and also recommend careful monitoring for late CMV reactivation.
unabsorbed polyphenols may play a role in the protection of the GI tract against RONS
prior to their fecal excretion. In contrast to native polyphenols, less data exists on the
antioxidant activity of bioavailable polyphenol phase II metabolites (conjugated
(BQ) Part 2 book "Basic immunology functions and disorders of the immune system" presents the following contents: Effector mechanisms of humoral immunity, immunological tolerance and autoimmunity, immune responses against tumors and transplants, hypersensitivity, congenital and acquired immunodeficiencies.
Therefore, ex vivo expansion of BMSCs is required to obtain a
sufficient number of transplantable cells. Since BMSCs require several kinds of supportive
factors for their growth, it is standard practice to use fetal bovine serum (FBS), while
autologous human serum (HS) and pooled allogeneic HS have also been used. It has been
suggested that FBS may not be favorable for clinical applications due to the possible risk of
contamination (prions, viruses, zoonosis) or immunological reactions against xenogeneic
serum antigens (Agata et al., 2009).
Strategies for Stem Cell Replacement Stem cell transplantation is not a new concept and it is already part of established medical practice. Hematopoietic stem cells (HSCs) (Chap. 68) are responsible for the long-term repopulation of all blood elements in bone marrow transplant recipients. HSC transplantation is now the gold standard against which other stem cell transplantation therapies will be measured. Transplantation of differentiated cells is also a clinical reality, as donated organs (e.g., liver, kidney) and tissues (i.e.
Immune-Mediated Injury The recovery of marrow function in some patients prepared for bone marrow transplantation with antilymphocyte globulin (ALG) first suggested that aplastic anemia might be immune-mediated. Consistent with this hypothesis was the frequent failure of simple bone marrow transplantation from a syngeneic twin, without conditioning cytotoxic chemotherapy, which also argued both against simple stem cell absence as the cause and for the presence of a host factor producing marrow failure.
Laboratory data support an important role for the immune system in aplastic anemia.