One of the major obstacle for hematopoietic stem cell transplantation (HSCT) to treat patients with beta-thalassemia is graft rejection (GR). The proportion of donor-derived cells continually declined in mixed chimerism (MC), finally leading to graft failure. Monitoring chimerism after transplant consecutively can early find unstable mixed chimerism and rejection, which provide the basis for donor lymphocyte infusion (DLI); for imminent risk of graft rejection, escalating doses of DLI is a feasible method for converting unstable MC towards stable MC or full donor chimerism. This review focuses on advancement of chimerism monitoring and DLI after HSCT for patients with β-thalassemia major.
Graft Rejection ; etiology ; Humans ; Lymphocyte Transfusion ; Thalassemia ; therapy ; Tissue Donors ; Transplantation Chimera

Chronic Disease ; Graft Rejection ; therapy ; Humans ; Integrative Medicine ; Kidney Diseases ; etiology ; therapy ; Kidney Transplantation ; adverse effects

Biliary Tract Diseases ; etiology ; surgery ; therapy ; Blood Loss, Surgical ; prevention & control ; Graft Rejection ; etiology ; therapy ; Humans ; Liver Transplantation ; adverse effects

OBJECTIVETo study the role of interleukin (IL)-10 in acute-graft-versus-host disease (aGVHD) and graft rejection.

METHODSSerum concentrations of IL-10 in 28 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were measured by enzymed-linked immunosorbent assay (ELISA). IL-10 gene expression in peripheral mononuclear cells was measured by reverse-transcriptase polymerase chain reaction (RT-PCR) after transplantation.

RESULTSSeven patients developed grade I GVHD, 7 patients developed grade II-IV GVHD, 4 patients had graft rejection. Before transplantation, the concentrations of IL-10 were higher in patients who later did not developed aGVHD. After transplantation, IL-10 levels increased in patients without aGVHD, but decreased in patients with aGVHD or graft rejection. And IL-10mRNA was more frequent in patients without aGVHD compared to those with aGVHD.

CONCLUSIONSIL-10 plays a negative role in the development of aGVHD and graft rejection.

Acute Disease ; Adult ; Child ; Graft Rejection ; etiology ; Graft vs Host Disease ; etiology ; Humans ; Interleukin-10 ; blood ; genetics ; physiology ; Middle Aged ; RNA, Messenger ; analysis

No abstract available.
Cytomegalovirus Infections/diagnosis/*etiology ; Graft Rejection/diagnosis/etiology ; Humans ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Nephritis, Interstitial/diagnosis/*etiology ; Ureteral Obstruction/diagnosis/*etiology

Bile Duct Diseases ; etiology ; pathology ; Diagnosis, Differential ; Graft Rejection ; etiology ; pathology ; Hepatic Artery ; pathology ; Humans ; Liver Transplantation ; adverse effects ; Thrombosis ; etiology ; pathology

In this study antigen-independent factor in the pathogenesis of chronic rejection of organ transplants was examined. Kidney isografts and allografts were transplanted orthotopically into bilaterally nephroectomized rat recipients and studied functionally, morphologically and immunohistologically, at serial intervals up to 52 weeks after transplantation. Allograft recipients developed progressive proteinuria after 12 weeks, with gradual renal failure ultimately leading to death. At the same time, morphological changes, including progressive arteriosclerosis and glomerulosclerosis, tubular atrophy and interstitial fibrosis, developed. Immunohistologically, macrophages infiltrated glomeruli during this period and cytokines became unregulated. Our results showed that antigen-independent functional and morphological changes occurred in long-term kidney isografts and mimicked those appearing much earlier in allografts that reject chronically. Initial injury and extent of functioning renal mass is suggested to be important factor for such late changes.
Animals ; Graft Rejection ; etiology ; immunology ; pathology ; Graft Survival ; physiology ; Kidney ; immunology ; pathology ; Kidney Transplantation ; immunology ; methods ; pathology ; Proteinuria ; etiology ; Rats ; Rats, Inbred Strains ; Time Factors ; Transplantation, Homologous ; Transplantation, Isogeneic

Graft Rejection ; Hepacivirus ; isolation & purification ; Hepatitis C, Chronic ; etiology ; immunology ; prevention & control ; Humans ; Liver Transplantation ; adverse effects ; RNA, Viral ; blood ; Risk Factors ; Secondary Prevention

INTRODUCTIONNew-onset diabetes after transplantation (NODAT) is an increasingly recognised metabolic complication of kidney transplantation that is associated with increased morbidity and mortality. This study aimed to determine the incidence of NODAT and identify risk factors for development of NODAT among kidney allograft recipients in a single centre.

MATERIALS AND METHODSWe retrospectively reviewed all kidney allograft recipients in our centre between 1998 and 2007. NODAT were determined using criteria as per American Diabetes Association guidelines. Logistic regression analyses were performed to identify predictors of NODAT.

RESULTSAmong 388 patients included in the analysis, NODAT was reported in 94 patients (24.2%) after a median follow-up time of 52.1 months. The cumulative incidence of NODAT was 15.8%, 22.8% and 24.5% at 1, 3, and 5 years following transplantation. Seven clinical factors were independent predictors of NODAT: older age, HLA B13 and B15 phenotypes, use of sirolimus, acute rejections, higher pre-transplant and post-transplant (day 1) plasma glucose levels. Patients with NODAT had poorer outcomes in both graft and patient survival.

CONCLUSIONOur study demonstrates a significant risk and burden of NODAT in an Asian transplant population. Risk stratification and aggressive monitoring of blood glucose early post-transplantation is necessary to identify high-risk patients so that appropriate tailoring of immunosuppression and early institution of lifestyle modifications can be implemented.

Adult ; Blood Glucose ; analysis ; Diabetes Mellitus ; etiology ; genetics ; Female ; Graft Rejection ; complications ; HLA-B Antigens ; analysis ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; adverse effects ; Male ; Middle Aged ; Risk Factors

OBJECTIVETo analyze the clinical features of mid- and long-term acute cardiac allograft rejection to improve the long-term clinical outcomes of the patients.

METHODSFourteen recipients (11 males and 3 females) underwent orthotopic heart transplantation with standard immunosuppressive therapy protocols (3 cases) or induction therapy protocols (11 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as the maintenance immunosuppressive regimen. Acute graft rejection episodes occurred within 3 to 6 months in 1 case, within 6 months to 1 year in 3 cases, within 1 to 2 years in 3 cases, within 2 to 5 years in 6 cases, and above 5 years in 1 case.

RESULTSNo significant difference was found in the incidence of late heart rejection between the patients receiving the two immunosuppressive therapy protocols. Immunosuppressants were withdrawn or spared in 8 recipients due to different causes. Nine recipients with steroid-sensitive acute cardiac allograft rejection were treated with steroid-pulse therapy, while the other 5 were treated with a short course of polyclonal antithymocyte antibodies because of steroid-resistant acute rejection; in 11 cases, azathioprine was converted to mycophenolate mofetil. Four of the 5 late deaths occurred in the recipients with steroid-resistant rejection. The surviving recipients had a good quality of life, and no recurrent episodes of rejection or infection were observed in the follow-up period.

CONCLUSIONSLate acute cardiac allograft rejection is associated mainly with patient compliance but not with early immunosuppressive therapy protocols. The episodes are rather severe and should be timely treated with steroid pulses or polyclonal antithymocyte antibodies.

Adolescent ; Adult ; Cyclosporine ; Female ; Graft Rejection ; etiology ; prevention & control ; Heart Transplantation ; adverse effects ; Humans ; Immunosuppression ; methods ; Male ; Middle Aged ; Mycophenolic Acid ; analogs & derivatives ; Young Adult