On the crossroad between tolerance and posttransplant lymphoma.

The role of the Epstein-Barr virus in the development of post-transplant lymphomas is well established. However, not all lymphomas that arise in these patients contain Epstein-Barr virus, suggesting that other cofactors are involved in tumor pathogenesis. We propose that immunologic interactions that result from the introduction of immunocompetent donor cells during transplantation contribute to a lymphomagenic environment in the host. Murine models of lymphoma that arises following transfer of allogeneic hematopoietic cells are discussed and are related to the transplant setting. One contemporary viewpoint of transplantation immunology holds that interactions between the host and donor components of the immune system determine the ultimate degree of tolerance or reciprocal immunoreactivity (eg, rejection, graft-versus-host disease) within the transplant patient. We conclude that host-donor immunologic microchimerism may also be an over-looked factor in the development of posttransplant lymphomas

On the unlikelihood of specific long range forces in immunologic and enzymatic reactions

In the past few years, a great many experiments have been performed by Rothen (24, 25) which he has interpreted as suggesting that antigen and antibody, and enzyme and substrate proteins, can react specifically, although separated by distances of hundreds of angstroms. This hypothesis seems to conflict with evidence accumulated from many other investigations indicating that short range interactions, involving distances usually associated with electrostatic and van der Waals’ forces, and hydrogen bonds, of the order of 5 A, operate in these reactions. We have therefore engaged in a critical analysis of the experimental techniques used by Rothen to determine whether some interpretation other than that invoking the existence of specific long range forces could be found to explain his experimental results

Autoimmune lymphoproliferative syndrome in pregnancy: a case of favorable mother - fetal outcome in a well-controlled disease

The autoimmune lymphoproliferative syndrome(ALPS)is a disorder of abnormal lymphocyte survival caused by the dysregulation of theFasapoptotic pathway. The Fas geneis expressed at the maternal–fetal interface and is involved in the regulation of immune response and implantation. Altered Fas expression may result in altered apoptosis and, ultimately, affect both the immune response and implantation; it is in fact associated with recurrent pregnancy loss, preterm premature rupture of membranes and pre-eclampsia. Currently, there are over 500 cases of ALPS reported worldwide from various racial and ethnic backgrounds. Up to date, the published work contains no specific reports on pregnancy outcome in women affected by ALPS. We present a case of full-term uneventful pregnancy in a patient affected by ALPS. A specific clinical follow-up in a pregnant woman with primary immunologic disease is suggested

Infections Complicating Orthotopic Liver Transplantation: A Study Emphasizing Graft-Related Septicemia

In 93 recipients of 102 orthotopic liver homografts, the incidence of bacteremia or fungemia exceeded 70%. The graft itself was usually an entry site for systemic infection after both immunologic and nonimmunologic parenchymal injury, especially if there was defective biliary drainage. The role of the homograft itself as the special infectious risk factor has prompted increased use of defunctionalized jejunal Roux limbs to reduce graft contamination. It has also stimulated very aggressive postoperative diagnostic efforts to rule out remedial mechanical complications of the transplant. © 1976, American Medical Association. All rights reserved

Malignant lymphomas in transplantation patients: a review of the world experience.

Malignant lymphomas developed in 9 renal homograft recipients treated at widely separated transplantation centers. The development of these tumors appears to be an indirect complication of organ transplantation and/or the measures taken to prevent rejection. A further complication may be an increased incidence of epithelial tumors. It also seems likely that immune paralysis may accelerate the growth of metastases