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Koh J, Chee HK, Kim KH, Jeong IS, Kim JS, Lee CH, Seo JW. Historical Review and Future of Cardiac Xenotransplantation. Korean Circ J 2023; 53:351-366. [PMID: 37271743 DOI: 10.4070/kcj.2022.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 06/06/2023] Open
Abstract
Along with the development of immunosuppressive drugs, major advances on xenotransplantation were achieved by understanding the immunobiology of xenograft rejection. Most importantly, three predominant carbohydrate antigens on porcine endothelial cells were key elements provoking hyperacute rejection: α1,3-galactose, SDa blood group antigen, and N-glycolylneuraminic acid. Preformed antibodies binding to the porcine major xenoantigen causes complement activation and endothelial cell activation, leading to xenograft injury and intravascular thrombosis. Recent advances in genetic engineering enabled knock-outs of these major xenoantigens, thus producing xenografts with less hyperacute rejection rates. Another milestone in the history of xenotransplantation was the development of co-stimulation blockaded strategy. Unlike allotransplantation, xenotransplantation requires blockade of CD40-CD40L pathway to prevent T-cell dependent B-cell activation and antibody production. In 2010s, advanced genetic engineering of xenograft by inducing the expression of multiple human transgenes became available. So-called 'multi-gene' xenografts expressing human transgenes such as thrombomodulin and endothelial protein C receptor were introduced, which resulted in the reduction of thrombotic events and improvement of xenograft survival. Still, there are many limitations to clinical translation of cardiac xenotransplantation. Along with technical challenges, zoonotic infection and physiological discordances are major obstacles. Social barriers including healthcare costs also need to be addressed. Although there are several remaining obstacles to overcome, xenotransplantation would surely become the novel option for millions of patients with end-stage heart failure who have limited options to traditional therapeutics.
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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung-Hee Kim
- Division of Cardiology, Incheon Sejong Hospital, Incheon, Korea
| | - In-Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Jung-Sun Kim
- Department of Pathology and Translational Genomics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Korea
| | - Jeong-Wook Seo
- Department of Pathology, Incheon Sejong Hospital, Incheon, Korea.
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Knatterud ME, Simmons RL, Payne W, Stock P, Chavers B, Ascher N, Kaufman D, Kirk A, Keshavjee S, Humar A, Ganesh S, Hughes C, Kandaswamy R, Matas AJ. The John S. Najarian symposium: The past, present, and future of surgery and transplantation, May 20, 2022, Minneapolis, MN. Clin Transplant 2023; 37:e14877. [PMID: 36528870 DOI: 10.1111/ctr.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Dr John S Najarian (1927-2020), chairman of the Department of Surgery at the University of Minnesota from 1967 to 1993, was a pioneer in surgery, clinical immunology and transplantation. A Covid-delayed Festschrift was held in his honor on May 20, 2022. The speakers reflected on his myriad contributions to surgery, transplantation, and resident/fellow training, as well as current areas of ongoing research to improve clinical outcomes. Of note, Dr Najarian was a founder of the journal Clinical Transplantation.
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Affiliation(s)
- Mary E Knatterud
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Richard L Simmons
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William Payne
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Peter Stock
- Department of Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Blanche Chavers
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Nancy Ascher
- Department of Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Dixon Kaufman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alan Kirk
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Abhinav Humar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Swaytha Ganesh
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher Hughes
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raja Kandaswamy
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Arthur J Matas
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Human leukocyte antigen matching in organ transplantation: what we know and how can we make it better (Revisiting the past, improving the future). Curr Opin Organ Transplant 2019; 23:470-476. [PMID: 29750676 DOI: 10.1097/mot.0000000000000538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW A renaissance for human leukocyte antigen (HLA) testing emerged with the understanding that donor-specific HLA antibodies play a significant role in long-term allograft survival. This renewed focus on donor/recipient histocompatibility led to a recent quest to decipher antibody responses or, as introduced into the transplantation lexicon, 'HLA-epitope matching'. RECENT FINDINGS Whether matching is at the antigen or the epitope level, in-depth understanding of how histo-incompatibility leads to activation of an immune response is required. HLA-DQ donor-specific antibody (DSA) has the highest association with poor graft survival. However, HLA-DQ antigens and antibodies are understudied and significant gaps still exist in understanding the function of HLA-DQ in immune activation. Much of our knowledge about HLA class-II molecules is derived from studies performed on HLA-DR, whether it is crystallography, antigen processing and presentation analysis, or activation of T-cell signal-transduction pathways. Indeed, HLA-DQ molecules are less amenable for laboratory testing, but the limited studies that were performed indicate that HLA-DQ might have, at least to some extent, a different role compared with HLA-DR. SUMMARY This review highlights qualities of HLA-DQ that may be associated with different pathways of activating an immune response. Understanding the consequences of such differences may lead to better appreciation and significance of HLA-DQ for matching purposes.
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Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection. J Immunol Res 2017; 2017:7903471. [PMID: 28373996 PMCID: PMC5360970 DOI: 10.1155/2017/7903471] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 12/13/2022] Open
Abstract
Consistent with Dr. Paul Terasaki's "humoral theory of rejection" numerous studies have shown that HLA antibodies can cause acute and chronic antibody mediated rejection (AMR) and decreased graft survival. New evidence also supports a role for antibodies to non-HLA antigens in AMR and allograft injury. Despite the remarkable efforts by leaders in the field who pioneered single antigen bead technology for detection of donor specific antibodies, a considerable amount of work is still needed to better define the antibody attributes that are associated with AMR pathology. This review highlights what is currently known about the clinical context of pre and posttransplant antibodies, antibody characteristics that influence AMR, and the paths after donor specific antibody production (no rejection, subclinical rejection, and clinical dysfunction with AMR).
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Hurst J. A modern Cosmas and Damian: Sir Roy Calne and Thomas Starzl receive the 2012 Lasker~Debakey Clinical Medical Research Award. J Clin Invest 2013. [PMID: 23193576 DOI: 10.1172/jci66465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Huber L, Lachmann N, Dürr M, Matz M, Liefeldt L, Neumayer HH, Schönemann C, Budde K. Identification and Therapeutic Management of Highly Sensitized Patients Undergoing Renal Transplantation. Drugs 2012; 72:1335-54. [DOI: 10.2165/11631110-000000000-00000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
1954 marked the most important year for modern transplantation. It represented the date in which the first successful live kidney transplant was performed by the devoted group of Joseph Murray, Hartwell Harrison, and their Peter Bent Brigham associates in Boston. Intense preparation and careful analysis was required for a long time to arrive at the resounding success manifested in the case of the Herrick twin brothers. Years later, only the discovery of chemical immunosuppression such as azathioprine and the use of radiation therapy permitted occasional good results in kidney transplantation. Great contributors of this period included Elion and Hitchings, Calne and Zukowski, Woodruff, Goodwin, and many others. In a few more years, the use of steroids and an antilymphocyte preparation by the committed team of Tom Starzl from Colorado improved the opportunities for patient outcome. The latter part of the 1960s witnessed the maturation of the Minnesota program with the arrival of John Najarian from California. The 1970s introduced different morbidity and mortality associated with immunosuppressive treatment, and required adjustments in patient management were necessary. New advances were to come in years ahead.
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Affiliation(s)
- Luis H Toledo-Pereyra
- Michigan State University/Kalamazoo Center for Medical Studies, Borgess Research Institute, USA
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Ehlers N, Ahrons S. The influence of histocompatibility upon the corneal immune reaction after interlamellar allotransplantation in rabbits. TISSUE ANTIGENS 2008; 1:23-31. [PMID: 4949392 DOI: 10.1111/j.1399-0039.1971.tb00073.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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History of Clinical Transplantation. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Liver transplantation radically changed the philosophy of hepatology practice, enriched multiple areas of basic science, and had pervasive ripple effects in law, public policy, ethics, and theology. Why organ engraftment was feasible remained enigmatic, however, until the discovery in 1992 of donor leukocyte microchimerism in long-surviving liver, and other kinds of organ recipients. Following this discovery, the leukocyte chimerism-associated mechanisms were elucidated that directly linked organ and bone marrow transplantation and eventually clarified the relationship of transplantation immunology to the immunology of infections, neoplasms, and autoimmune disorders. We describe here how the initially controversial paradigm shift mandated revisions of cherished dogmas. With the fresh insight, the reasons for numerous inexplicable phenomena of transplantation either became obvious or have become susceptible to discriminate experimental testing. The therapeutic implications of the "new immunology" in hepatology and in other medical disciplines, have only begun to be explored. Apart from immunology, physiologic investigations of liver transplantation have resulted in the discovery of growth factors (beginning with insulin) that are involved in the regulation of liver size, ultrastructure, function, and the capacity for regeneration. Such studies have partially explained functional and hormonal relationships of different abdominal organs, and ultimately they led to the cure or palliation by liver transplantation of more than 2 dozen hepatic-based inborn errors of metabolism. Liver transplantation should not be viewed as a purely technologic achievement, but rather as a searchlight whose beams have penetrated the murky mist of the past, and continue to potentially illuminate the future.
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Affiliation(s)
- Thomas E Starzl
- Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Starzl TE. The saga of liver replacement, with particular reference to the reciprocal influence of liver and kidney transplantation (1955-1967). J Am Coll Surg 2002; 195:587-610. [PMID: 12437245 PMCID: PMC2993503 DOI: 10.1016/s1072-7515(02)01498-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Thomas E Starzl
- Thomas E Starzl Transplantation Institute, Pittsburgh, PA, USA
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A History of Clinical Transplantation. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
The emergence of transplantation has seen the development of increasingly potent immunosuppressive agents, progressively better methods of tissue and organ preservation, refinements in histocompatibility matching, and numerous innovations in surgical techniques. Such efforts in combination ultimately made it possible to successfully engraft all of the organs and bone marrow cells in humans. At a more fundamental level, however, the transplantation enterprise hinged on two seminal turning points. The first was the recognition by Billingham, Brent, and Medawar in 1953 that it was possible to induce chimerism-associated neonatal tolerance deliberately. This discovery escalated over the next 15 years to the first successful bone marrow transplantations in humans in 1968. The second turning point was the demonstration during the early 1960s that canine and human organ allografts could self-induce tolerance with the aid of immunosuppression. By the end of 1962, however, it had been incorrectly concluded that turning points one and two involved different immune mechanisms. The error was not corrected until well into the 1990s. In this historical account, the vast literature that sprang up during the intervening 30 years has been summarized. Although admirably documenting empiric progress in clinical transplantation, its failure to explain organ allograft acceptance predestined organ recipients to lifetime immunosuppression and precluded fundamental changes in the treatment policies. After it was discovered in 1992 that long-surviving organ transplant recipients had persistent microchimerism, it was possible to see the mechanistic commonality of organ and bone marrow transplantation. A clarifying central principle of immunology could then be synthesized with which to guide efforts to induce tolerance systematically to human tissues and perhaps ultimately to xenografts.
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Affiliation(s)
- T E Starzl
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA 15213, USA
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Groth CG, Brent LB, Calne RY, Dausset JB, Good RA, Murray JE, Shumway NE, Schwartz RS, Starzl TE, Terasaki PI, Thomas ED, van Rood JJ. Historic landmarks in clinical transplantation: conclusions from the consensus conference at the University of California, Los Angeles. World J Surg 2000; 24:834-43. [PMID: 10833252 PMCID: PMC2967280 DOI: 10.1007/s002680010134] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The transplantation of organs, cells, and tissues has burgeoned during the last quarter century, with the development of multiple new specialty fields. However, the basic principles that made this possible were established over a three-decade period, beginning during World War II and ending in 1974. At the historical consensus conference held at UCLA in March 1999, 11 early workers in the basic science or clinical practice of transplantation (or both) reached agreement on the most significant contributions of this era that ultimately made transplantation the robust clinical discipline it is today. These discoveries and achievements are summarized here in six tables and annotated with references.
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Affiliation(s)
- C G Groth
- Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Sweden
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Starzl TE, Eliasziw M, Gjertson D, Terasaki PI, Fung JJ, Trucco M, Martell J, McMichael J, Scantlebury V, Shapiro R, Donner A. HLA and cross-reactive antigen group matching for cadaver kidney allocation. Transplantation 1997; 64:983-91. [PMID: 9381546 PMCID: PMC2967288 DOI: 10.1097/00007890-199710150-00009] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Allocation of cadaver kidneys by graded human leukocyte antigen (HLA) compatibility scoring arguably has had little effect on overall survival while prejudicing the transplant candidacy of African-American and other hard to match populations. Consequently, matching has been proposed of deduced amino acid residues of the individual HLA molecules shared by cross-reactive antigen groups (CREGs). We have examined the circumstances under which compatibility with either method impacted graft survival. METHODS Using Cox proportional hazards regression modeling, we studied the relationship between levels of conventional HLA mismatch and other donor and recipient factors on primary cadaver kidney survival between 1981 and 1995 at the University of Pittsburgh (n=1,780) and in the United Network for Organ Sharing (UNOS) Scientific Registry during 1991-1995 (n=31,291). The results were compared with those obtained by the matching of amino acid residues that identified CREG-compatible cases with as many as four (but not five and six) HLA mismatches. RESULTS With more than one HLA mismatch (> 85% of patients in both series), most of the survival advantage of a zero mismatch was lost. None of the HLA loci were "weak." In the UNOS (but not Pittsburgh) category of one-HLA mismatch (n=1334), a subgroup of CREG-matched recipients (35.3%) had better graft survival than the remaining 64.7%, who were CREG-mismatched. There was no advantage of a CREG match in the two- to four-HLA incompatibility tiers. Better graft survival with tacrolimus was observed in both the Pittsburgh and UNOS series. CONCLUSIONS Obligatory national sharing of cadaver kidneys is justifiable only for zero-HLA-mismatched kidneys. The potential value of CREG matching observed in the one-HLA-mismatched recipients of the UNOS (but not the Pittsburgh) experience deserves further study.
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Affiliation(s)
- T E Starzl
- The Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pennsylvania 15213, USA
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Starzl TE, Demetris AJ, Trucco M. Matching and the black recipient. Transplant Proc 1993; 25:2450-1. [PMID: 8356628 PMCID: PMC2975450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- T E Starzl
- Pittsburgh Transplant Institute, Pennsylvania
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Starzl TE, Trucco M, Rao A, Demetris A. The role of HLA typing in clinical kidney transplants: 30 years later. The blind-folding of HLA matching. CLINICAL TRANSPLANTS 1993:423-5. [PMID: 7918173 PMCID: PMC2995301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Starzl TE, Demetris AJ, Trucco M. HLA matching and the point system. Clin Transplant 1993; 7:353-356. [PMID: 21151745 PMCID: PMC3000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Thomas E Starzl
- Director of the Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, U.S.A
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Affiliation(s)
- D B Amos
- Duke University Medical Center, Department of Microbiology and Immunology, Durham, North Carolina 27710
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Starzl TE, Schroter GP, Hartmann NJ, Barfield N, Taylor P, Mangan TL. Long-term (25-year) survival after renal homotransplantation--the world experience. Transplant Proc 1990; 22:2361-5. [PMID: 2219402 PMCID: PMC2975983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A follow-up is provided for 64 patients treated with renal transplantation at the University of Colorado before 31 March 1964. The 25-year survival was 15/64 (23.4%) and 14 patients (22%) are still alive after 25 1/2 to 27 years. There are 9 other survivors in the world from this era, distributed in 4 American and 2 European centers. All of the 25-year survivors received their grafts from living related donors.
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Affiliation(s)
- T E Starzl
- Department of Surgery, University of Pittsburgh, PA
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Abstract
A family of 6 affective ill siblings is described. Two suffered from bipolar illnesses, 2 from recurrent unipolar illness, and the remainder showed alcoholism, depression and schizo-affective disorder. HLA typing revealed that all the tested members shared the antigens A3 and B7. Because only ill members were available for testing, there was insufficient information in the family to draw any definite conclusion as to whether these antigens were linked to the illness. However, the observation is of some interest in the light of other recent reports which have suggested that these 2 antigens are associated with affective disorder.
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Starzl TE, Weil R, Putnam CW. Kidney transplantation. Modern trends in kidney transplantation. Transplant Proc 1977; 9:1-8. [PMID: 325725 PMCID: PMC3008780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Trends in renal transplantation stem from recognition of the virtues and drawbacks of this kind of treatment and from a better appreciation of the interrelationship between transplantation and dialysis.
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van Rood JJ, van Leeuwen A, Bruning JW. [Significance of leukocytotic antigens in kidney transplantation]. LANGENBECKS ARCHIV FUR CHIRURGIE 1968; 322:496-509. [PMID: 4921819 DOI: 10.1007/bf02453867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Patel R, Mickey MR, Terasaki PI. Serotyping for homotransplantation. XVI. Analysis of kidney transplants from unrelated donors. N Engl J Med 1968; 279:501-6. [PMID: 4876470 DOI: 10.1056/nejm196809052791001] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Starzl TE, Brettschneider L, Martin AJ, Groth CG, Blanchard H, Smith GV, Penn I. Organ transplantation, past and present. Surg Clin North Am 1968; 48:817-38. [PMID: 4875039 PMCID: PMC2972678 DOI: 10.1016/s0039-6109(16)38585-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Thierfelder S. [The leukocyte and thrombocyte group antigens of the man]. KLINISCHE WOCHENSCHRIFT 1968; 46:1-10. [PMID: 4876530 DOI: 10.1007/bf01725290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Harlan WR, Holden KR, Williams GM, Hume DM. Proteinuria and nephrotic syndrome associated with chronic rejection of kidney transplants. N Engl J Med 1967; 277:769-76. [PMID: 4167288 DOI: 10.1056/nejm196710122771501] [Citation(s) in RCA: 48] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kiser WS, Kolff WJ. When is transplantation of organs feasible or practical? Dis Mon 1967:1-32. [PMID: 4864495 DOI: 10.1016/s0011-5029(67)80011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Marchioro TL, Terasaki PI, Hutchison DE, Brettschneider L, Cerilli GJ, Groth CG, Starzl TE. Renal transplantation at the University of Colorado. Transplantation 1967; 5:Suppl:831-6. [PMID: 4167455 PMCID: PMC2975951 DOI: 10.1097/00007890-196707001-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
From March 1962 to April 1966, 118 patients were treated with renal transplantation, 3 with kidneys from identical twins, 9 with cadaveric homografts, and 106 with homografts from volunteer donors. Sixty-two of the patients are still alive after nine months to almost five years. The only completely satisfactory group was that of the identical twin recipients. The results after homotransplantation have not materially improved during this time despite the acquisition of increased experience, adjustments of timing and dosage of azathioprine and prednisone, and attempts to identify biologically suitable donors in advance of operation by tissue typing. It is suggested that an impasse has been reached, beyond which further reduction in mortality and morbidity will depend primarily upon the effective application of new immunosuppressive techniques.
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Starzl TE, Marchioro TL, Iwasaki Y. Symposium on immunosuppressive drugs. Attributes of clinically used immunosuppressive drugs: possible future uses of antilymphoid sera. FEDERATION PROCEEDINGS 1967; 26:944-52. [PMID: 5337288 PMCID: PMC3007094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Iwasaki Y, Talmage D, Starzl TE. Humoral Antibodies in Patients After Renal Homotransplantation. Transplantation 1967; 5:191-206. [PMID: 21307964 PMCID: PMC3034375 DOI: 10.1097/00007890-196703000-00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Humoral antibodies have been demonstrated by antiglobulin consumption tests to be present in the serum of virtually all patients after renal homotransplantation. The most completely characterized was a γG immunoglobulin distinct from the Forssman antibody which reacts against sheep but not against human red cell antigens, and which absorbs selectively against panels of human liver, kidney or white blood cells. This antibody appeared within a few days or weeks after transplantation, usually shortly after a rejection episode, and was more or less continuously detectable thereafter. The antibody was found in all of 10 patients studied during the first 4 post-transplant months, and in 13 of 14 patients tested from 4 months to more than 2 years after operation. Preliminary observations are included on another humoral antibody which does not react with sheep RBC stromata, but which can also be measured with a modified antiglobulin consumption test. The latter antibody was less commonly demonstrable, but it also exhibited specific absorption characteristics when tested against a panel of leukocytes obtained from volunteers. The implications of these findings are discussed in relation to the possible value of such sera for histocompatibility typing, as well as the possible role of such antibodies in promoting homograft enhancement.
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Affiliation(s)
- Yoji Iwasaki
- Departments of Surgery and Immunology, University of Colorado School of Medicine, and the Denver Veterans Administration Hospital, Denver, Colorado
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Starzl TE, Marchioro TL, Porter KA, Iwasaki Y, Cerilli GJ. The use of heterologous antilymphoid agents in canine renal and liver homotransplantation and in human renal homotransplantation. SURGERY, GYNECOLOGY & OBSTETRICS 1967; 124:301-8. [PMID: 4163340 PMCID: PMC2675827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Terasaki PI, Vredevoe DL, Porter KA, Mickey MR, Marchioro TL, Faris TD, Herrmann TJ, Starzl TE. Serotyping for homotransplantation. V. Evaluation of a matching scheme. Transplantation 1966; 4:688-99. [PMID: 4866724 PMCID: PMC3008207 DOI: 10.1097/00007890-196611000-00004] [Citation(s) in RCA: 50] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
An attempt was made to determine whether 36 long-term kidney homograft recipients and their donors were compatible for 7 major leukocyte groups. It was found that 21 of these recipients were surviving 2 to 3 years in spite of incompatibility for 1 or 2 major leukocyte antigens. Survival of mismatched grafts does not itself indicate that the antigens being measured are not transplantation antigens, for it was shown that the 15 recipients with no groups of mismatch were clinically superior to those with group incompatibilities. Moreover, histopathologic scores given to biopsy specimens taken 2 to 3 years after transplantation were significantly correlated with the number of group mismatches. Because the leukocyte groups were determined by cytotoxicity reactions of peripheral blood lymphocytes, the results may have been influenced considerably by chimerism in chronically dialyzed uremic patients or change in lymphocyte antigenicity or susceptibility to lysis upon prolonged immunosuppressive treatment. Although the possibility of these complications could not be ruled out in all instances, it was shown that 52 dialyzed uremic patients and 49 patients who had been treated with immunosuppression for over 1 year did not possess more or less antigens than a random population of normal individuals. It is concluded that: (1) the major leukocyte antigens are histocompatibility antigens and (2) since survival can be attained at times despite mismatches for these groups, the antigens are of intermediate strength and kidney homograft rejection may occur if excessive numbers of antigens are incompatible or if particular combinations of antigens are mismatched.
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Starzl TE, Marchioro TL, Faris TD, McCardle RJ, Iwaski Y. Avenues of future research in homotransplantation of the liver with particular reference to hepatic supportive procedures, antilymphocyte serum, and tissue typing. Am J Surg 1966; 112:391-400. [PMID: 5331677 PMCID: PMC2962419 DOI: 10.1016/0002-9610(66)90209-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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