Transplantation programs

The immunosuppressive effects of corticosteroids are employed in organ transplantation programs in combination with other immunosuppressive modalities, for the management of a variety of autoimmune diseases and to suppress allergic reactions. 

Azathioprine can be administered both orally and intravenously. It is well absorbed orally and after its rapid conversion to 6-mercaptopurine it is inactivated by xanthine oxidase which converts 6-mercaptopurine to 6-thiouric acid. This final metabolite is then excreted in the urine. In combination with the xanthine oxidase inhibitor allopurinol dose adjustments of azathioprine are needed. Renal disease also raises 6-mercaptopurine concentrations and can make dose adjustments necessary. Azathioprine is still used in organ transplantation programs and for the management of several autoimmune diseases. Its adverse effects include nausea, vomiting, diarrhea and, more seriously, bone marrow suppression and hepatotoxicity. Azathioprine is not thought to cause fetal malformation. 

Clinical Director, Bone Marrow Transplant Program, Banner Good Samaritan Hospital, Phoenix... 

Antisera directed against lymphocytes have been prepared sporadically for over 100 years. With the advent of human organ transplantation as a therapeutic option, heterologous antilymphocyte globulin (ALG) took on new importance. ALG and antithymocyte globulin (ATG) are now in clinical use in many medical centers, especially in transplantation programs. The antiserum is usually obtained by immunization of large animals such as horses or sheep with human lymphoid cells. 

Ron Kline is a pediatric oncologist and director of the bone marrow transplant program at the University of Louisville. In 1989 Kline published the following essay, arguing the necessity of animals in medical research experiments, in Newsweek magazine s My Turn section, a column of opinion written by readers of the magazine. 

We thank our colleagues and members of the Madrenas and McCormick laboratories for helpful discussions and ideas. This work was supported by the Canadian Institutes of Health Research (CIHR), the Kidney Foundation of Canada, and the London Health Sciences Centre Multi-Organ Transplant Program. C.B. was supported by a fellowship from the Ontario Research and Development Fund, J.K.M. is a recipient of a CIHR New Investigator Award, and J.M. holds a Canada Research Chair in Transplantation and Immunobiology. 

To date, it is entirely unclear why these side-effects occur. They could be due to certain properties in parts of the patient population, they could be related to immunosuppression or to the fact that a cell mixture rather than one uniform cell line was transplanted, or they could simply reflect the fact that transplanted neurons can grow into the host brain and form synapses, but that they do not always form the correct connections to the surrounding brain tissue. There is little chance for the embryonic transplantation programs to resume before these questions have been answered. 

From the experience with fetal mesencephalic brain transplantation programs, where hundreds of patients were treated in open trials before investigators became aware of serious side-effects prohibiting the program continuation, it is clear that obtaining controlled data is mandatory from the beginning of a clinical development program. 

Sury MR, Hatch DJ, Deeley T, Dicks-Mireaux C, Chong WK (1999) Development of a nurse-led sedation service for paediatric magnetic resonance imaging. Lancet 353 1667-1671 Sze DY, Esquivel CO (2002) The role of interventional radiology in a pediatric liver transplant program. Pediatr Transplant 6 1-4... 

The Rocky Mountain blood and marrow transplant program (RMBMTP), Initial patients... 

Radiology is an essential part of a successful transplantation program. Careful donor selection and... 

Professor of Medicine, Director, Clinical Hematology and Hematopoietic Transplantation Program, Hospital de la Santa Creu i Sant Pau, Universitat Autdnoma de Barcelona, Barcelona, Spain... 

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