Трансплантационные технологии и исследования

Ganciclovir-resistant cytomegalovirus (CMV) infection is an emerging problem in solid organ transplant (SOT) recipients. Treatments such as foscarnet and cidofovir are fraught with serious side effects that may limit their use in this condition. The aim of this paper is to elucidate the mechanisms on how resistance occurs, when to suspect it clinically and what special tests are necessary to diagnose it. Based on recent literature, the paper also brings to light two medications, maribavir and leflunomide, which have been described to have anti-CMV activity.

Purpose: An association between peripheral arterial disease (PAD) and end-stage renal disease (ESRD) was suggested. We discuss the cases of two kidney transplant patients of different etiologies, and management outcomes.

Case Report: The first case was for a patient with long-standing complicated type 2 diabetes who suffers from advanced atherosclerotic disease involving both femoro-iliac arterial axes. The patient had successful kidney transplantation (KT) to atherosclerotic external iliac artery after endarterectomy, with a smooth early post operative course and a two-year follow up with no significant morbidity. The second case is for a patient who underwent KT, and who had previously undergone an endovascular bifurcated aortic bi-iliac stent (EVBAIS) for an infra-renal abdominal aortic aneurysm.

Conclusions: The decision concerning the presence of extensive atherosclerosis, endovascular stenting and/or endarterectomy, pre-transplantation assessment, and post-operative course will be presented. The literature is also reviewed to assess practices for detecting PAD in kidney transplant patients, and subsequent management options.

We present a review in the different capacities and features of Cadaver Stem Cells (CSCs). CSCs could be an innovative and interesting option in the near future for Regenerative Medicine and Transplantation procedures. This provocative topic has not been fully addressed before. The isolation of viable and functional CSCs from humans up to many days post mortem is possible today. There is a real chance to obtain culture and expand viable stem cells for cell therapy from the plentiful source of cadaver donors. Therefore, it seems that it will be possible to routinely obtain CSCs from almost any human cadaver organ or tissue as desired. This could open a new universe of strategies and research in order to find out their real potential as a routine therapeutic procedure for many diseases.

Objectives: The main objectives of this clinical case presentation was to determine the real cause of a 50 year patient that presented into emergency service for an episode of lipothymia and arterial hypotension (BP=60/40 mmHg).

Description of the methods: I am presenting the clinical case of a 50 year old patient that come at the emergency service for an episode of lipothymia and arterial hypotension (BP=60/40 mmHg). The objective examination revealed: pale skin and mucous, tachycardia (HR=105/min), normal vesicular sound, BP=60/40 mmHg. Palpation of the abdomen was insensitive, soft, elastic, participating at the respiratory movements. No presented rebound tenderness (without clinical signs of peritoneal irritation). Normal rectal touch–brown aspect of feces without pain during the maneuver. The paraclinical investigations have shown: EKG sinus tahycardia (105 bates/minutes), ESR=24/42, fibrinogen=580 mg/dl, Hb=11 g/dl, Ht=42%, erythrocytes=4 500000 per cubic millimeter, white blood cell=5200 per cubic millimeter, platelets=200000 per cubic millimeter, TGO=12 UI/l, TGP=10 UI/l TroponinT=0,05 μg/L, CPKMB=10 mcg/L. Echocardiography was normal. In this stage, with a diagnosis of lipothymia and arterial hypotension a treatment with injectomat with dopamine with a rhythm of administration 0.2 ml per hour was initiated, but the value of blod pressure decreased:BP=50/30 mmHg. An emergency abdominal ultrasaound was performed, which reveals an increased quantity of intraabdominal fluid, which does not allow the visualization of the internal organs. A paracentesis was performed and surprisingly - the liquid was fresh blood, so the patient had hemoperitoneum. The patient was transferred in the General Surgery Department for emergency laparotomy. The real diagnosis was: broken and bleeding right ovarian tumor with hemoperitoneum. A haemoperitoneum suction drainage was performed and a right ovarian resection, with favorable evolution and the saving of the patient’s life.

Summary of the results: The onset of this clinical case was surprisingly through with a vital risk complication, the apparition of the hemoperitoneum, which clinically it manifested through lypothymia and hypotension (BP=60/40 mmHg).

Conclusions: Principal particularity of this clinical case report was the sudden onset with a vital risk complicationhemoperitoneum and a hemorrhagic shock tendency. The hemoperitoneum is the single situation of acute surgical abdomen, in wich the clinical signs of peritoneal irritation is possible do not appear.

Background: Mixed chimerism induced by hematopoietic stem cell transplantation is useful in the treatment of autoimmune diseases, but the details of the mechanism by which mixed chimerism reverses the autoimmune state have not been determined. Here, we propose a potential mechanism in which newly developed T cells positively selected by the recipient’s thymus are able to regulate auto-reactive B cells. To test this hypothesis, we investigated whether major histocompatibility complex (MHC)/T cell receptor (TCR) cognate interaction was important for the regulation of auto-reactive B cells. We induced an auto-cross-reactive Antibody (Ab) by immunization using a foreign antigen with a homolog to an auto-antigen in a BXSB lupus mouse strain and achieved MHC-matched or mismatched mixed chimerism.

Methods: Stable multi-lineage mixed chimeric BXSB mice were established with non-lymphoablative conditioning. In order to induce auto-cross-reactive Ab, a foreign antigen Pigeon Cytochrome C (PCC) was immunized in these chimeric BXSB mice with various MHC combinations. Anti-PCC and anti-Mouse Cytochrome C (MCC: cross-reactive with PCC) Abs were measured by ELISA.

Results: In normal mice and MHC-matched/haplo-identical chimeric mice, the titer of the anti-MCC Ab reached plateau at low levels. In BXSB and fully MHC-mismatched chimeric mice, however, both anti-PCC and MCC Ab levels were higher.

Conclusion: These results suggest that the regulatory mechanism selectively suppresses auto-reactive Ab production through cognate interaction. Dysfunction of this suppression system is one possible cause of lupus; the induction of BM mixed chimerism may allow us to reconstruct the system.

Kidney transplantation remains the most effective modality for the treatment of end-stage renal disease. The development of induction therapy has significantly reduced the incidence of acute rejection within the first six months following kidney transplantation. As a result, induction therapy is typically administered in the majority of kidney transplants. Moreover, early graft function has also improved with the advent and routine administration of induction therapy. Effective induction therapy has also expanded the donor pool as it allows for more effective utilization of marginal donor kidneys including expanded criteria donors and donors after cardiac death. It may also benefit higher immunologic risk recipients such as highly sensitized, African American, and repeat transplant patients. Poly- and monoclonal antibody agents are available for use as induction agents, including rabbit Anti-thymocyte globulin, interleukin-2 receptor antagonists, and alemtuzumab each of which have proven efficacy but have discrete advantages and disadvantages. Tailoring induction therapy to individual patient profiles provides the best opportunity for both short and long-term outcomes of the patient and allograft. Moreover, we explore the role of induction therapy with long-term steroid avoidance immunosuppression regimens in modern kidney transplantation. Overall, we review the safety and efficacy of this important group of induction agents and discuss an approach to tailoring their use for specific patients undergoing kidney transplantation.