Allograft survival

Most kidney transplant procedures are heterotopic, where the kidney is implanted above the pelvic bone and attached to the patient s iliac artery and vein. The ureter of the transplant kidney is attached directly to the recipient s bladder or native ureter. The native kidneys usually are not removed, and data have shown that under most circumstances, removal of the native kidneys does not influence patient survival and allograft survival. Special circumstances, however, such as renal cell carcinoma and PCKD, may necessitate native kidney removal.1,3 There were 16,477 (9914 deceased donors, 6563 living donors) kidney transplants and 903 simultaneous kidney-pancreas procedures done in 2005.3... 

Several studies have assessed the clinical efficacy of cyclosporine versus tacrolimus. Most of the studies have shown similar longterm patient and allograft survival, whereas some renal transplant studies have demonstrated improved renal function in tacrolimus-treated patients. The most significant difference between the two agents appears to be their adverse-reaction profiles (Table 52-4). 

Allograft survival After an organ transplant procedure, when the transplanted organ continues to have some degree of function, from excellent to poor. 

Chiba K, Hoshino Y, Suzuki C, et al. FTY720, a novel immunosuppressant possessing unique mechanisms. I. Prolongation of skin allograft survival and synergistic effect in combination with cyclosporine in rats. Transplant Proc 1996 28(2) 1056-1059. 

Beckmann JH, Yan S, Luhrs H, et al. Prolongation of allograft survival in ccr7-deficient mice. Transplantation 2004 77 1809-1814. 

C Newton, BM Gebhardt, HE Kaufman. (1988). Topically applied cyclosporine in azone prolongs corneal allograft survival. Invest Ophthalmol Vis Sci 29 208-215. 

Balgia, P. et al., CTLA4Ig prolongs allograft survival while suppressing cell-mediated immunity, Transplantation, 58, 1082, 1994. 

Shimizu, K. et al., Host CD40 ligand deficiency induces long-term allograft survival and donor-specific tolerance in mouse cardiac transplantation but does not prevent graft arteriosclerosis, J. Immunol., 165, 3506, 2000. 

Hall B, Jelbart ME, Gurley KE, Dorsch SE. 1990. Specific unresponsiveness in rats with prolonged cardiac allograft survival after treatment with cyclosporine. III. Further characterization of CD4+ suppressor cell and its mechanisms of action. J Exp Med. 171 141-157. 

Zhang Q, Chen Y, Fairchild RL, Heeger PS, et al. 2006. Lymphoid sequestration of alloreactive memory CD4 T cells promotes cardiac allograft survival. J Immunol. 176 770-777. 

Milani, J.K., et al. 1993. Prolongation of corneal allograft survival with liposome-encapsulated cyclosporine in the rat eye. Ophthalmology 100 890. 

T cell activation CTLA4-Ig Heart, liver, and pancreas Prolonged allograft survival Olthoff et al. (1998) Uchikoshi et al. (1999) Yangs et al. (1999)... 

Transgenic fl cell expression Prevention from insulitis and IDDM Kidney and liver Prolonged allograft survival... 

Islets Neutrophil-mediated destruction Islets Prolonged allograft survival Liver Reduction of cytotoxicity and apoptosis during cold ischemia fl cells in vitro Prevention of cytokine-induced apoptosis... 

Olthoff, K. M., Judge, T. A., Gelman, A. E., da Shen, X., Hancock, Turka, L. A. and Shaked, A. (1998). Adenovirus-mediated gene transfer into cold-preserved liver allografts Survival pattern and unresponsiveness following transduction with CTLA4Ig. Nat. Med. 4, 194-200. 

Tange S, Scherer MN, Graeb C, et al. The antineoplastic drug paclitaxel has immunosuppressive properties that can effectively promote allograft survival in a rat heart transplant model. Transplantation 2002 73(2) 216-223. 

Szczech, L. A., Berlin, J. A., and Feldman, H. I. (1997). Effect of anti-lymphocyte induction therapy on renal allograft survival A metanalysis. / Am. Soc. Nephrol. 8,... 

Whelchel JD, Shaw JF, Curtis JJ, Luke RG, Diethelm AG. Effect of pretransplant stored donor-specific blood transfusions on early renal allograft survival in one-haplo-type hving related transplants. Transplantation 1982 34(6) 326-9. 

Ono K, Hattori T, Kusaba A, Inokuchi K. Prolongation of rat heart allograft survival by thiamphenicol. Surgery 1972 71(2) 258-61. 

Attempts to minimize TAC-induced renal dysfunction by TAC switch to sirolimus [419, 744, 745] or use of low-dose maintenance TAC therapy associated with lymphocyte depleting agents, mycophenolate mofetil or sirolimus have been successfully achieved [746-750]. However, the association of TAC and sirolimus does not seem to be problem-free. Severe acute kidney injury in renal transplant recipients and thrombotic microangiopathy in intestinal transplant have been associated to combined use of TAC and sirolimus [751, 752], renal function improved in renal transplant recipients after conversion from TAC/ sirolimus to TAC/MMF therapy [753] and TAC/sirolimus combination was associated to worst renal allograft survival than TAC/MMF im-... 

Khanna AK, Plummer MS, Hilton G, Pieper GM, Ledbetter S. Anti-transforming growth factor antibody at low but not high doses limits cyclosporine-mediated nephrotoxicity without altering rat cardiac allograft survival potential of therapeutic applications. Circulation 2004 110 3822-3829. 

Meier-Kriesche HU, Schold JD, SrinivasTR, Howard RJ, Fujita S, Kaplan B. Sirolimus in combination with tacrolimus is associated with worse renal allograft survival compared to mycophenolate mofetil combined with tacrolimus. Am J Transplant 2005 5 ... 

Renkonen, R, Fukuda, M N, Petrov, L, Paavonen, T, Renkonen, J, Hayry, P, Fukuda, M, A peptide mimic of selectin ligands abolishes in vivo inflammation but has no effect on the rat heart allograft survival. Transplantation, 74, 2-6, 2002. 

Castanospermine also has been shown to have anti-inflammatory activity, modifies the expression of adhesion molecules and prolongs allograft survival in a dose dependent manner [117]. 

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