COPD (chronic obstructive pulmonary disease) is one of the leading causes of morbidity and mortality worldwide and imparts a substantial economic burden on individuals and society. Some of the risk factors for COPD are well-known and include smoking, occupational exposures, air pollution, airway hyperresponsiveness, asthma, and certain genetic variations. Precise definitions of COPD vary and are frequently dependent on an accurate diagnosis of the problem by a physician. These differences in the definition of COPD can have large effects on the estimates of COPD in the population. In most of the world, COPD prevalence and mortality are still increasing and likely will continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention, COPD education and early detection, and better treatment will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.
Adolescent ; Air Pollution ; Asthma ; Diagnosis ; Education ; Epidemiology* ; Female ; Genetic Variation ; Humans ; Mortality ; Occupational Exposure ; Prevalence ; Pulmonary Disease, Chronic Obstructive* ; Risk Factors ; Smoke ; Smoking ; Smoking Cessation

COPD(chronic obstructive pulmonary disease) is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, the most common of which worldwide is tobacco smoke. The characteristic symptoms of COPD are cough, sputum production, and dyspnea upon exertion. COPD is not only a disease of the lungs but is also a systemic inflammatory disorder. Muscular weakness, increased risk for artherosclerotic vascular disease, depression, osteoporosis, and abnormalities in fluids and electrolyte balance may all be consequences of COPD. The staging of COPD is based on airway limitation as measured by spirometry, which is essential for diagnosis and provides a useful description of the severity of patholoical changes in COPD. Specific FEV(1) cut-points (e.g., FEV(1) < 80% predicted) are used for purposes of simplicity: these cut points have not been clinically validated. The current GOLD and ATS/ERS definition for airflow limitation is an FEV(1):FVC ratio of < 70%. The GOLD and ATS/ERS criteria classify COPD into four stages: stage 1 (FEV(1) > or = 80% predicted), stage 2 (FEV(1) 50 to < 80% predicted), stage 3 (FEV(1) 30 to < 50% predicted), and stage 4 (FEV(1) < 30% predicted). In addition, an "at risk" stage consists of patients with chronic respiratory symptoms(cough, sputum, or dyspnea) and normal lung function. COPD can coexist with asthma, the other major chronic obstuctive airway disease characterized by an underlying airway inflammation. However, the inflammation characteristic of COPD is distinct from that of asthma. Pulmonary tuberculosis may affect lung function and symptomatology and, in areas where tuberculosis is prevalent, can lead to confusion in the diagnosis of COPD. Some of these factors including fat-free body mass, functional status, exercise capability, respiratory symptoms other than cough or sputum, depression, and heart failure are clearly important both clinically and epidemiologically and need to be considered in the evaluation of patients.
Asthma ; Cough ; Depression ; Diagnosis ; Dyspnea ; Gases ; Heart Failure ; Humans ; Inflammation ; Lung ; Muscle Weakness ; Osteoporosis ; Pulmonary Disease, Chronic Obstructive* ; Smoke ; Spirometry ; Sputum ; Tobacco ; Tuberculosis ; Tuberculosis, Pulmonary ; Vascular Diseases ; Water-Electrolyte Balance

The development of immunosuprressants has had a significant influence on inhibition of acute allograft rejection. However, long-term graft survival has not been achieved by immunosuppressants, probably because of their nonspecific suppression of T cell activity and nonimmune side effects. The ideal way to overcome the limitations of current immunosuppressants is to induce allograft-specific immune tolerance. Transplant immunologists are exerting their efforts in achieving transplantation tolerance using four different approaches; costimulatory blockade, mixed hematopoietic chimerism, T cell depletion, and regulation by regulatory T cells. It is expected that transplantation tolerance will soon be established as a standard immunosuppressive regimen with little side effects in preventing and reversing allograft rejection.
Allografts ; Chimerism ; Graft Survival ; Immune Tolerance ; Immunosuppressive Agents ; T-Lymphocytes, Regulatory ; Transplantation Tolerance*

Pancreas islet cell transplantation has been regarded as an ideal method to treat the type I diabetes mellitus. However, it could not be the method of choice because of poor graft survival rate after transplantation. Recently, the outcome of pancreas islet cell transplantation has been improving, especially since the Edmonton group has succeeded in controlling the glucose metabolism in 7 consecutive type I diabetes mellitus patients. Returning to diabetic status in a substantial portion of transplanted patients, however, has revealed that lots of hurdles, such as primary non-function of the islet from non-specific inflammation, immunologic destruction of islets from either allogenic or autoimmune process, and shortage of donor source, remained to be solved in the near future, if pancreas islet cell transplantation is to be a practical clinical treatment modality for diabetic patients. We herein discuss on the current status and future of pancreas islet cell transplantation.
Diabetes Mellitus ; Glucose ; Graft Survival ; Humans ; Inflammation ; Islets of Langerhans* ; Metabolism ; Pancreas* ; Tissue Donors ; Transplantation

Pancreas transplantation is the best option for the cure of insulin dependent diabetes. Simultaneous pancreas kidney transplantation (SPK), pancreas transplantation alone (PTA), or pancreas transplantation after kidney transplantation (PAK) is performed according to the renal failure status. The best survival result comes from SPK. Donor selection is much more important than the type of transplantation since the purpose of transplantation is mainly to improve quality of life and poor quality pancreas may result in severe life threatening complications. In the majority of pancreas transplantations, systemic venous drainage is performed and this does not seem to increase the risk of atherosclerosis. Bladder drainage of exocrine secretion may result in several side effects and is not frequently performed in SPK recently. With the development of good immunosuppression regimen, the patient and graft survival rates have improved. Pancreas transplantation should be considered for the insulin dependent diabetes patients who meet the inclusion criteria.
Atherosclerosis ; Donor Selection ; Drainage ; Graft Survival ; Humans ; Immunosuppression ; Insulin ; Kidney Transplantation ; Pancreas Transplantation* ; Pancreas* ; Quality of Life ; Renal Insufficiency ; Urinary Bladder

The immune response of transplanted grafts has been considered to be within the realm of the adaptive immune system. Recently, with the discovery of the Toll-like receptors (TLRs), the role of innate immune responses in the control of adaptive immunity has become a new area of interest. Emerging evidence suggests that in addition to responding to pathogen-associated molecular patterns of microorganisms, TLRs can be activated by endogenous ligands, expressed by mammalian cells. These 'danger signals' may participate in ischemia-reperfusion related organ damage and the toxicity of immunosuppressant subsequently influence the function and survival of transplanted grafts. Furthermore, it has been suggested that adaptive immune responses can enhance the acute inflammatory responses controlled by innate immunity in organ transplantation. This review addresses the potential role of innate immunity in organ transplantation.
Adaptive Immunity ; Immune System ; Immunity, Innate* ; Ligands ; Organ Transplantation* ; Toll-Like Receptors ; Transplantation ; Transplants*

Even with improved immunosuppressive therapies, graft rejection remains the major cause of failure. Renal biopsy is the most sensitive tool and gold standard for the diagnosis of rejection and other causes of graft dysfunction. Because of the large number of conditions that can affect the allograft, sometimes in combination, renal transplantation pathology is one of the most challenging areas for the renal pathologist. The major causes of allograft dysfunction include rejection, postoperative acute tubular necrosis, perfusion injury, drug toxicity, obstruction, major vascular occlusion, infection, allergic interstitial nephritis, recurrent or de novo glomerular disease, and post-transplant lymphoproliferative disease. The criteria for grading rejection by the Banff 97 schema and the new concept of acute antibody-mediated rejection are introduced.
Allografts ; Biopsy ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Graft Rejection ; Kidney Transplantation* ; Necrosis ; Nephritis, Interstitial ; Pathology* ; Perfusion ; Transplants

Renal transplantation is the optimal treatment for end stage renal disease and it has significantly improved the quality and length of life of transplant recipients. It has led to an increasing number of transplant recipients with failed primary allografts due to rejection or other causes and the recipients must decide whether to return to dialysis or seek retransplantation. Although recently, the frequency of retransplantation has begun to increase gradually and retransplantation have presumed to be a favorable option in some articles, there are limitations (little data) to support this. The results of retransplantation is dependent on recipients, such as patients with recurrent renal disease, recipient comorbidities, previous transplant graft outcome, and the expected wait time to retransplant operation. The use of potent and appropriate immunosuppression and surgical technique for retransplantation could help to improve results.
Allografts ; Comorbidity ; Dialysis ; Humans ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Longevity ; Transplantation ; Transplants

The field of renal transplantation has undergone continual evolution to become the standard treatment for patients with end-stage renal diseases. The attempts to improve organ shortage, studies for clinical and basic science, empirical trial of new immunosuppressive drugs and technical challenges are very important for the development of renal transplantation medicine and improved patient outcome. This review will focus on the recent advancement and current hot issues of living donor renal transplantation worldwide.
Humans ; Kidney Transplantation* ; Living Donors*

Since the past several decades, remarkable improvements in the management of pediatric liver transplantation was achieved and pediatric transplant surgeons have transformed a once hopeless end-stage liver disease in children into a treatable disease with limited mortality. Biliary atresia, the most common indication of liver transplantation, needs judicious selection of patients and timing of transplantation in order to achieve best results. In fulminant hepatic failure, laboratory data and neurological signs help decide the need for transplantation and determine the prognosis. Various types of transplantation methods are possible, but the living donor liver transplantation using the left lateral section is currently the most widely used. Therapeutic interventions, such as percutaneous transhepatic biliary drainage or balloon angioplasty can be used to manage post-transplant complications with minimal morbidity. Vigilant prophylaxis against viral infections with careful use of balanced immunosuppressive medications can prevent deleterious diseases such as cytomegalovirus infection or post-transplant lymphoproliferative disease. Despite the improved results, more study needs to be done to elucidate the long-term outcome of these young liver recipients.
Angioplasty, Balloon ; Biliary Atresia ; Child ; Cytomegalovirus Infections ; Drainage ; Humans ; Liver Diseases ; Liver Failure, Acute ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Prognosis