Allografting

Inhibition of immunomodulatory cytokines (Fig. 1) Anti-T-cell receptor antibodies Muromonab (OKT3, Orthoclone ) binds to the CD3 complex of the T-cell receptor and induces depletion of T-lymphocytes. It is applied to prevent acute rejection of kidney, liver, and heart allografts. Rapid side effects (within 30-60 min) include a cytokine release syndrome with fever, flu-like symptoms, and shock. Late side effects include an increased risk of viral and bacterial infections and an increased incidence of lymphproliferative diseases due to immunosuppression. 

Humanized recombinant anti-IL-2 receptor antibodies (Basiliximab, Simulect , and Daclizumab Zenapax ). These antibodies bind with high affinity to the IL-2 receptor on T-lymphocytes and prevent activation and clonal expansion of anti-allograft T-lymphocytes by endogenous IL-2. They are used to prevent kidney allograft rejection. The main side effect is immunosuppression. 

Golshayan D, Buhler L, Lechler RI et al (2007) From current immunosuppressive strategies to clinical tolerance of allografts. Transpl Int 20 12-24... 

Changelian PS, Flanagan ME, Ball DJ et al (2003) Prevention of organ allograft rejection by a specific Janus kinase 3 inhibitor. Science 302 875-878... 

First clinical trials with OKT3 (therapy of renal allograft rejection)... 

Skin has also been stored for use as a covering of wounds in bum victims. Preserved skin (allograft) serves as a mechanical and physiological barrier decreases loss of water, protein, and heat and provides strata for the regeneration of viable skin by the victim. The storage medium is usually a tissue culture solution and the skin is wrapped up in gauze that is soaked in this solution and kept for about one week. 

Scarborough, N.L. (1992). Current procedures for banking allograft human bone. Orthopedics 15, 1161-1167. 

Besecker B, Hart CG (1999) A new treatment option for acne scars allograft dermis. Dermatol Nurs 11 111-114... 

Caine, KT., White, D.J.G., Thiru, S. etal. (1978). Cyclosporin A in patients receiving renal allografts from cadaver donors. Lancet ii, 1323-1327. 

Clavien, P. and Harvey, P.R.C. (1992). Preservation and reperfusion injuries in liver allografts. Transplantation 53, 957-978. 

Bradley, B., Prowse, S.J., Bauling, P. and Lafierty, K.J. (1986). Desferrioxamine treatment prevents chronic islet allograft damage. Diabetes 35, 550-555. 

Discuss the desired therapeutic outcomes and appropriate pharmacotherapy used to avoid allograft rejection. 

O T cells are the chief components initiating the immune response against the allograft. The activity of T cells is mediated largely through the synthesis and release of interleukin-2 (IL-2). 

Retransplantation after a previous graft (allograft) failure... 

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... 

Direct pathway. Donor APCs migrate out of the allograft into the recipient s lymph nodes and present donor MHC molecules to the TCRs of the recipient s T cells. 

Also known as antibody-mediated rejection, humoral rejection is the process of creating graft-specific antibodies.1,4 This type of rejection occurs less frequently than cell-mediated acute rejection. Humoral rej ection is characterized by deposition of immunoglobulins and complement in allograft tissues. Treatment for this type of rejection is not well defined, yet several reports have shown that treatments such as plasmapheresis, immunoglobulin therapy, rituximab, and/or antithymocyte globulin maybe effective. 

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