#07#
Revisiones-Clínica-Complicaciones
*** Reviews-Clinical-Complications
INMUNOSUPRESIÓN
*** IMMUNOSUPPRESSION
(Conceptos
/ Keywords: Immunosuppression; Immunosuppressive ag.; Transpl. immunol.; GVH;
Antirejection therapy; Lymphocyte depletion; Transpl. conditioning; etc).
Enero /
January 2001 --- Marzo / March 2004
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Only articles written in Spanish and/or English are included.
[1]
TÍTULO / TITLE: - Routes to transplant
tolerance versus rejection; the role of cytokines.
REVISTA
/ JOURNAL: - Immunity 2004 Feb;20(2):121-31.
AUTORES
/ AUTHORS: - Walsh PT; Strom TB; Turka LA
INSTITUCIÓN
/ INSTITUTION: - University of Pennsylvania, 700 Clinical
Research Building, 415 Curie Boulevard, Philadelphia, PA 19104, USA.
RESUMEN
/ SUMMARY: - The alloimmune response can be divided
into specific junctures where critical decisions between tolerance and immunity
are made which define the outcome of the transplant. At these “decision nodes”
various cytokines direct alloresponsive T cells to develop either a
proinflammatory response aimed at graft destruction or an immunoregulatory
response facilitating graft acceptance. This review will focus on the role of
these cytokines in influencing the progression of an alloimmune response
leading ultimately to either allograft survival or rejection. N. Ref:: 97
----------------------------------------------------
[2]
TÍTULO / TITLE: - Skin cancers after
organ transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2003 Apr 24;348(17):1681-91.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra022137
AUTORES
/ AUTHORS: - Euvrard S; Kanitakis J; Claudy A
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Edouard Herriot
Hospital, Lyons, France. sylvie.euvrard@numericable.fr N. Ref:: 100
----------------------------------------------------
[3]
TÍTULO / TITLE: - Haematopoietic cell
transplantation as immunotherapy.
REVISTA
/ JOURNAL: - Nature 2001 May 17;411(6835):385-9.
●●
Enlace al texto completo (gratuito o de pago) 1038/35077251
AUTORES
/ AUTHORS: - Appelbaum FR
INSTITUCIÓN
/ INSTITUTION: - Clinical Research Division, Fred
Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-310, PO Box
19024, Seattle, Washington 98109-1024, USA.
RESUMEN
/ SUMMARY: - The graft-versus-tumour effect seen after
allogeneic (genetically different) haematopoietic cell transplantation for
human malignancies represents the clearest example of the power of the human
immune system to eradicate cancer. Recent advances in our understanding of the
immunobiology of stem-cell engraftment, tolerance and tumour eradication are
allowing clinicians to better harness this powerful effect. N. Ref:: 60
----------------------------------------------------
[4]
TÍTULO / TITLE: - Chronic graft-vs-host
disease.
REVISTA
/ JOURNAL: - JAMA. Acceso gratuito al texto completo.
●●
Enlace a la Editora de la Revista http://jama.ama-assn.org/search.dtl
●●
Cita: JAMA: <> 2003 Nov 19;290(19):2599-603.
●●
Enlace al texto completo (gratuito o de pago) 1001/jama.290.19.2599
AUTORES
/ AUTHORS: - Bhushan V; Collins RH Jr
INSTITUCIÓN
/ INSTITUTION: - Hematopoietic Cell Transplantation
Program, Department of Internal Medicine, University of Texas Southwestern
Medical Center, Dallas 75390-8852, USA.
N. Ref:: 26
----------------------------------------------------
[5]
TÍTULO / TITLE: - Ex vivo selection of
recipient-type alloantigen-specific CD4(+)CD25(+) immunoregulatory T cells for
the control of graft-versus-host disease after allogeneic hematopoietic
stem-cell transplantation.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S32-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106470.07410.CA
AUTORES
/ AUTHORS: - Trenado A; Fisson S; Braunberger E;
Klatzmann D; Salomon BL; Cohen JL
INSTITUCIÓN
/ INSTITUTION: - Biologie et Therapeutique des Pathologies
Immunitaires, Hopital Pitie-Salpetriere, Paris, France.
RESUMEN
/ SUMMARY: - Allogeneic hematopoietic stem-cell
transplantation (HSCT) is the treatment of choice for many malignant and
nonmalignant hematologic disorders. Donor T cells present in the hematopoietic
stem-cell transplant improve engraftment and immune reconstitution and
contribute to the graft-versus-leukemia effect, but are also responsible for
the life-threatening graft-versus-host disease (GVHD). CD4(+)CD25(+)
immunoregulatory T cells, which play a pivotal role in preventing
organ-specific diseases, can also modulate GVHD if administered in equal
numbers of T cells at the time of grafting. In this article, the authors
describe a procedure of ex vivo selection and expansion of regulatory T cells
specific for recipient-type alloantigens. These expanded regulatory T cells
controlled GVHD. Their therapeutic use in HSCT should allow specific
suppression of the activation of donor alloreactive T cells involved in GVHD
while preserving the beneficial effects of other T cells. N. Ref:: 27
----------------------------------------------------
[6]
TÍTULO / TITLE: - Hemochromatosis gene
modifies course of hepatitis C viral infection.
REVISTA
/ JOURNAL: - Gastroenterology 2003 May;124(5):1509-23.
AUTORES
/ AUTHORS: - Pietrangelo A
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Centre
for Hemochromatosis and Metabolic Liver Diseases, University of Modena and
Reggio Emilia, Modeno, Italy. antonello@unimore.it N. Ref:: 161
----------------------------------------------------
[7]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[8]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[9]
TÍTULO / TITLE: - Tolerogenic dendritic
cells induced by vitamin D receptor ligands enhance regulatory T cells
inhibiting allograft rejection and autoimmune diseases.
REVISTA
/ JOURNAL: - J Cell Biochem 2003 Feb 1;88(2):227-33.
●●
Enlace al texto completo (gratuito o de pago) 1002/jcb.10340
AUTORES
/ AUTHORS: - Adorini L; Penna G; Giarratana N;
Uskokovic M
INSTITUCIÓN
/ INSTITUTION: - BioXell, SpA, 20132 Milano, Italy. luciano.adorini@bioxell.com
RESUMEN
/ SUMMARY: - Dendritic cells (DCs) not only induce but
also modulate T cell activation. 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)]
induces DCs with a tolerogenic phenotype, characterized by decreased expression
of CD40, CD80, and CD86 costimulatory molecules, low IL-12 and enhanced IL-10
secretion. We have found that a short treatment with 1,25(OH)(2)D(3) induces
tolerance to fully mismatched mouse islet allografts that is stable to
challenge with donor-type spleen cells and allows acceptance of donor-type
vascularized heart grafts. This effect is enhanced by co-administration of
mycophenolate mofetil (MMF), a selective inhibitor of T and B cell
proliferation that has also effects similar to 1,25(OH)(2)D(3) on DCs. Graft
acceptance is associated with an increased percentage of CD4(+)CD25(+)
regulatory cells in the spleen and in the draining lymph node that can protect
100% of syngeneic recipients from islet allograft rejection. CD4(+)CD25(+)
cells, able to inhibit the T cell response to a pancreatic autoantigen and to
significantly delay disease transfer by pathogenic CD4(+)CD25(-) cells, are
also induced by treatment of adult nonobese diabetic (NOD) mice with
1,25-dihydroxy-16,23Z-diene-26,27-hexafluoro-19-nor vitamin D(3) (BXL-698).
This treatment arrests progression of insulitis and Th1 cell infiltration, and
inhibits diabetes development at non-hypercalcemic doses. The enhancement of
CD4(+)CD25(+) regulatory T cells, able to mediate transplantation tolerance and
to arrest type 1 diabetes development by a short oral treatment with VDR
ligands, suggests possible clinical applications of this approach. N. Ref:: 41
----------------------------------------------------
[10]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver and
human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Depletion of host
reactive T cells by photodynamic cell purging and prevention of graft versus
host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Nov;44(11):1871-9.
AUTORES
/ AUTHORS: - Goggins TF; Chao N
INSTITUCIÓN
/ INSTITUTION: - Hematology-Oncology, Duke University
Medical Center, 2400 Pratt Street, Ste. 1100, Durham, NC 27710, USA. goggi002@mc.duke.edu
RESUMEN
/ SUMMARY: - Graft versus Host Disease (GVHD) is the
principal cause of morbidity and mortality in patients undergoing allogeneic
stem cell transplant. T cell depletion has been recognized as a method of
reducing the incidence of GVHD in allogeneic transplants. Until recently, most
T cell depletion methods were non-selective in reducing lymphocytes. Rhodamine
purging is one method, which selectively reduces alloreactive T cells
preventing GVHD. We review here the methods of non-selective and selective T
cell depletion, particularly the newer method of photodynamic purging utilizing
rhodamine. N. Ref:: 129
----------------------------------------------------
[12]
- Castellano -
TÍTULO / TITLE:Guia de consenso sobre tuberculosis
y tratamiento de la enfermedad inflamatoria intestinal con infliximab.
Consensus guideline on tuberculosis and treatment of inflammatory bowel disease
with infliximab. Spanish Working Group on Crohn Disease and Ulcerative Colitis.
REVISTA
/ JOURNAL: - Gastroenterol Hepatol. Acceso gratuito al
texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Gastroenterología & Hepatología: <> 2003 Jan;26(1):29-33.
AUTORES
/ AUTHORS: - Obrador A; Lopez San Roman A; Munoz P;
Fortun J; Gassull MA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Digestivo. Hospital Son
Dureta. Palma de Mallorca. España. N.
Ref:: 19
----------------------------------------------------
[13]
TÍTULO / TITLE: - Acute and chronic
graft-versus-host disease after allogeneic peripheral-blood stem-cell and bone
marrow transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Clin Oncol 2001 Aug 15;19(16):3685-91.
AUTORES
/ AUTHORS: - Cutler C; Giri S; Jeyapalan S; Paniagua D;
Viswanathan A; Antin JH
INSTITUCIÓN
/ INSTITUTION: - Division of Hematologic Oncology,
Dana-Farber Cancer Institute, and Harvard School of Public Health, Boston, MA
02115, USA. corey_cutler@dfci.harvard.edu
RESUMEN
/ SUMMARY: - PURPOSE: Controversy exists as to whether
the incidence of graft-versus-host disease (GVHD) is increased after
peripheral-blood stem-cell transplantation (PBSCT) when compared with bone
marrow transplantation (BMT). We performed a meta-analysis of all trials
comparing the incidence of acute and chronic GVHD after PBSCT and BMT reported
as of June, 2000. Secondary analyses examined relapse rates after the two
procedures. METHODS: An extensive MEDLINE search of the literature was
undertaken. Primary authors were contacted for clarification and completion of
missing information. A review of cited references was also undertaken. Sixteen
studies (five randomized controlled trials and 11 cohort studies) were included
in this analysis. Data was extracted by two pairs of reviewers and analyzed for
the outcomes of interest. Meta-analyses, regression analyses, and assessments
of publication bias were performed. RESULTS: Using a random effects model, the
pooled relative risk (RR) for acute GVHD after PBSCT was 1.16 (95% confidence
interval [CI], 1.04 to 1.28; P=.006) when compared with traditional BMT. The
pooled RR for chronic GVHD after PBSCT was 1.53 (95% CI, 1.25 to 1.88; P
<.001) when compared with BMT. The RR of developing clinically extensive
chronic GVHD was 1.66 (95% CI, 1.35 to 2.05; P <.001). The excess risk of
chronic GVHD was explained by differences in the T-cell dose delivered with the
graft in a meta-regression model that did not reach statistical significance.
There was a trend towards a decrease in the rate of relapse after PBSCT (RR = 0.81;
95% CI, 0.62 to 1.05). CONCLUSION: Both acute and chronic GVHD are more common
after PBSCT than BMT, and this may be associated with lower rates of malignant
relapse. The magnitude of the transfused T-cell load may explain the
differences in chronic GVHD risk.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Chemokines, chemokine
receptors, and allograft rejection.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):377-86.
AUTORES
/ AUTHORS: - Nelson PJ; Krensky AM
INSTITUCIÓN
/ INSTITUTION: - Medizinishe Poliklinik, Klinikum
Innenstadt, Ludwig-Maximilians-University, Schillerstrasse 42, 80336, Munich,
Germany. nelson@medpoli.med.uni-muenchen.de N. Ref:: 40
----------------------------------------------------
[15]
TÍTULO / TITLE: - Alpha E: no more
rejection?
REVISTA
/ JOURNAL: - J Exp Med. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jem.org/
●●
Cita: J. Exp Med: <> 2002 Oct 7;196(7):873-5.
AUTORES
/ AUTHORS: - Kilshaw PJ; Higgins JM
INSTITUCIÓN
/ INSTITUTION: - The Babraham Institute, Cambridge, CB2
4AT, United Kingdom. peter.kilshaw@bbsrc.ac.uk N. Ref:: 25
----------------------------------------------------
[16]
TÍTULO / TITLE: - Chronic rejection.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):387-97.
AUTORES
/ AUTHORS: - Libby P; Pober JS
INSTITUCIÓN
/ INSTITUTION: - Division of Cardiovascular Medicine,
Brigham and Women’s Hospital, Boston, MA 02115, USA. plibby@rics.bwh.harvard.edu N. Ref:: 60
----------------------------------------------------
[17]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients representing
0.84% of all reported malignancies. We identified 7 renal transplant recipients
with bladder cancer at our institution. Invasive transitional cell carcinoma
developed in 5 patients at a median of 2.8 years after transplant. Three
patients underwent uncomplicated radical cystectomy and preservation of the
renal allograft. Overall survival at 48 months was 60%. CONCLUSIONS: Bladder
cancer after renal transplantation is not common. For patients who present with
invasive disease, traditional extirpative surgery should be considered.
Moreover, the allograft is rarely the source of transitional cell carcinoma and
can be preserved. In our experience the cancer and urinary outcomes compare
favorably with nontransplant patient outcomes after treatment. N. Ref:: 21
----------------------------------------------------
[18]
TÍTULO / TITLE: - IL-6: a magic potion
for liver transplantation?
REVISTA
/ JOURNAL: - Gastroenterology 2003 Jul;125(1):256-9.
AUTORES
/ AUTHORS: - Selzner M; Graf R; Clavien PA N. Ref:: 42
----------------------------------------------------
[19]
TÍTULO / TITLE: - Patient and graft
survival following liver transplantation for hepatitis C: much ado about
something.
REVISTA
/ JOURNAL: - Gastroenterology 2002 Apr;122(4):1162-5.
AUTORES
/ AUTHORS: - Charlton M N. Ref:: 20
----------------------------------------------------
[20]
TÍTULO / TITLE: - The immunological
barrier to xenotransplantation.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):437-46.
AUTORES
/ AUTHORS: - Cascalho M; Platt JL
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Mayo Clinic,
Rochester, MN 55905, USA. N.
Ref:: 55
----------------------------------------------------
[21]
TÍTULO / TITLE: - Gene therapy progress
and prospects: gene therapy in organ transplantation.
REVISTA
/ JOURNAL: - Gene Ther 2003 Apr;10(8):605-11.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.gt.3302020
AUTORES
/ AUTHORS: - Bagley J; Iacomini J
INSTITUCIÓN
/ INSTITUTION: - Transplantation Biology Research Center,
Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129,
USA.
RESUMEN
/ SUMMARY: - One major complication facing organ
transplant recipients is the requirement for life-long systemic immunosuppression
to prevent rejection, which is associated with an increased incidence of
malignancy and susceptibility to opportunistic infections. Gene therapy has the
potential to eliminate problems associated with immunosuppression by allowing
the production of immunomodulatory proteins in the donor grafts resulting in
local rather than systemic immunosuppression. Alternatively, gene therapy
approaches could eliminate the requirement for general immunosuppression by
allowing the induction of donor-specific tolerance. Gene therapy interventions
may also be able to prevent graft damage owing to nonimmune-mediated graft loss
or injury and prevent chronic rejection. This review will focus on recent
progress in preventing transplant rejection by gene therapy. N. Ref:: 47
----------------------------------------------------
[22]
TÍTULO / TITLE: - Suppression of
graft-versus-host disease by naturally occurring regulatory T cells.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S9-S11.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106475.38978.11
AUTORES
/ AUTHORS: - Zeng D; Lan F; Hoffmann P; Strober S
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology and Immunology,
Department of Medicine, Stanford University School of Medicine, Stanford, CA
94305, USA.
RESUMEN
/ SUMMARY: - Studies of graft-versus-host disease after
allogeneic bone marrow transplantation have shown that there are subsets of
freshly isolated donor T cells that induce the disease and subsets that
suppress the disease. The balance of subsets in the graft determines disease
severity. The authors’ work on the nature of the regulatory-suppressor T cells
and their mechanisms of action is summarized in this article. N. Ref:: 24
----------------------------------------------------
[23]
TÍTULO / TITLE: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[24]
TÍTULO / TITLE: - Cytolytic pathways in
haematopoietic stem-cell transplantation.
REVISTA
/ JOURNAL: - Nat Rev Immunol 2002 Apr;2(4):273-81.
●●
Enlace al texto completo (gratuito o de pago) 1038/nri775
AUTORES
/ AUTHORS: - van den Brink MR; Burakoff SJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Memorial
Sloan-Kettering Cancer Center, New York, New York 10021, USA. vandenbm@mskcc.org
RESUMEN
/ SUMMARY: - The remarkable activity of donor T cells
against malignant cells in the context of an allogeneic haematopoietic
stem-cell transplantation (HSCT) is arguably, at present, the most potent
clinical immunotherapy for cancer. However, alloreactive donor T cells are also
important effector cells in the development of graft-versus-host disease
(GVHD), which is a potentially lethal complication for recipients of an
allogeneic HSCT. Therefore, the separation of the GVHD and graft-versus-tumour
(GVT) activity of donor T cells has become a topic of great interest for many
investigators. Recent studies have shown that donor T cells make differential
use of their cytolytic pathways in mediating GVHD and GVT effects. Therefore,
the selective blockade or enhancement of cytolytic pathways provides an
intriguing therapeutic opportunity to separate the desired GVT effect from the
potentially devastating GVHD. N.
Ref:: 96
----------------------------------------------------
[25]
TÍTULO / TITLE: - Preliminary guidelines
for diagnosing and treating tuberculosis in patients with rheumatoid arthritis
in immunosuppressive trials or being treated with biological agents.
REVISTA
/ JOURNAL: - Ann Rheum Dis 2002 Nov;61 Suppl 2:ii62-3.
AUTORES
/ AUTHORS: - Furst DE; Cush J; Kaufmann S; Siegel J;
Kurth R
INSTITUCIÓN
/ INSTITUTION: - UCLA Medical School, Los Angeles, USA
Presbyterian Hospital, Dallas, USA.
----------------------------------------------------
[26]
TÍTULO / TITLE: - Clinical consequences
of iron overload in hemochromatosis homozygotes.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2003 May 1;101(9):3351-3; discussion 3354-8.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-11-3453
AUTORES
/ AUTHORS: - Ajioka RS; Kushner JP
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology, Department of
Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
84132, USA. N. Ref:: 58
----------------------------------------------------
[27]
TÍTULO / TITLE: - The influence of
environment and experience on neural grafts.
REVISTA
/ JOURNAL: - Nat Rev Neurosci 2001 Dec;2(12):871-9.
●●
Enlace al texto completo (gratuito o de pago) 1038/35104055
AUTORES
/ AUTHORS: - Dobrossy MD; Dunnett SB
INSTITUCIÓN
/ INSTITUTION: - School of Biosciences, Cardiff University,
Museum Avenue Box 911, Cardiff CF10 3US, Wales, UK. dobrossymd@cardiff.ac.uk N. Ref:: 106
----------------------------------------------------
[28]
TÍTULO / TITLE: - Glucocorticoids and
invasive fungal infections.
REVISTA
/ JOURNAL: - Lancet 2003 Nov 29;362(9398):1828-38.
AUTORES
/ AUTHORS: - Lionakis MS; Kontoyiannis DP
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases,
Infection Control and Employee Health, University of Texas MD Anderson Cancer
Center, Houston, TX 77030, USA.
RESUMEN
/ SUMMARY: - Since the 1990s, opportunistic fungal
infections have emerged as a substantial cause of morbidity and mortality in
profoundly immunocompromised patients. Hypercortisolaemic patients, both those
with endogenous Cushing’s syndrome and, much more frequently, those receiving
exogenous glucocorticoid therapy, are especially at risk of such infections.
This vulnerability is attributed to the complex dysregulation of immunity
caused by glucocorticoids. We critically review the spectrum and presentation
of invasive fungal infections that arise in the setting of hypercortisolism,
and the ways in which glucocorticoids contribute to their pathogenesis. A
better knowledge of the interplay between glucocorticoid-induced immunosuppression
and invasive fungal infections should assist in earlier recognition and
treatment of such infections. Efforts to decrease the intensity of
glucocorticoid therapy should help to improve outcomes of opportunistic fungal
infections. N. Ref:: 135
----------------------------------------------------
[29]
TÍTULO / TITLE: - Hemophagocytic syndrome
in renal transplant recipients: report of 17 cases and review of literature.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):238-43.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107285.86939.37
AUTORES
/ AUTHORS: - Karras A; Thervet E; Legendre C
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie et Transplantation
Renale, Hopital Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - BACKGROUND: Hemophagocytic syndrome (HPS)
combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and liver
dysfunction. It is defined by bone marrow and organ infiltration by activated,
nonmalignant macrophages phagocytizing blood cells. HPS is often caused by an
infectious or neoplastic disease and has rarely been described in renal
transplant recipients. METHODS: We retrospectively analyzed 17 cases of HPS
after cadaveric renal transplantation (13 men and 4 women, age 41+/-8 years).
The median time between transplantation and hemophagocytosis was 52 days.
Eleven patients (64%) had received antilymphocyte globulins during the 3 months
before presentation. RESULTS: Fever was present in all patients, and
hepatosplenomegaly was present in 9 of 17 patients. Other nonspecific clinical
findings included abdominal, neurologic, and respiratory symptoms. Laboratory
tests showed anemia (hemoglobin 6.1+/-1.3 g/dL), thrombocytopenia (34,000+/-32,000/mm3),
and leukopenia (1,700+/-1,400/mm3). Elevated liver enzymes were present in 12
of 17 patients, and cholestasis was present in 10 of 17 patients. Elevated
triglycerides and ferritin were noted in 75% and 86% of cases, respectively.
HPS was related to viral infection in nine patients (cytomegalovirus,
Epstein-Barr virus, human herpesvirus 6, and human herpesvirus 8), bacterial
infection in three patients (tuberculosis and Bartonella henselae), and other
infections in two patients (toxoplasmosis and Pneumocystis carinii pneumoniae).
Posttransplant lymphoproliferative disease was present in two patients. Despite
large-spectrum anti-infectious treatment and dramatic tapering of
immunosuppression, death occurred in eight patients (47%). Graft nephrectomy
was performed in four of the nine surviving patients. CONCLUSIONS: We report
here the largest series of HPS after renal transplantation. This rare disease
is usually secondary to herpes viridae infections, mostly cytomegalovirus and
Epstein-Barr virus in severely immunocompromised patients. Despite aggressive
treatment, the prognosis remains poor. N.
Ref:: 22
----------------------------------------------------
[30]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma,
antiviral treatment with acyclovir, valacyclovir or ganciclovir may be initiated
for at least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[31]
TÍTULO / TITLE: - Regulatory (suppressor)
T cells in peripheral allograft tolerance and graft-versus-host reaction.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107184.18562.FC
AUTORES
/ AUTHORS: - Rifle G; Herve P
INSTITUCIÓN
/ INSTITUTION: - UPRES EA563, Faculte de Medecine, Universite
de Bourgogne and Department of Nephrology-Intensive Care-Transplantation,
Hopital du Bocage, Dijon, France. gerard.rifle@chu-dijon.fr.
RESUMEN
/ SUMMARY: - Among the mechanisms capable of inducing peripheral
tolerance, regulatory (suppressor) T cells (Treg) probably play a key role in
the control of both reactivity to self-antigens and alloimmune response.
Augmentation or manipulation of Treg could improve organ allograft survival or
control graft-versus-host disease, thus resulting in operational tolerance. The
role of this immunomanipulation as one method of inducing tolerance has yet to
be clearly defined. N.
Ref:: 14
----------------------------------------------------