14 research outputs found
Immunosuppressive treatment for kidney transplantation
Razvoj novih imunosupresivnih lijekova i saznanja steÄena primjenom razliÄitih kombinacija
ovih lijekova u imunosupresivnim protokolima dovela su do znaÄajnog poboljÅ”anja rezultata
lijeÄenja presaÄivanjem bubrega. Cilj imunosupresivnog lijeÄenja smanjenje je neželjene imunosne
aktivnosti, no ono Äesto vodi u razvoj komplikacija kao Å”to su infekcije, metaboliÄki
poremeÄaji, arterijska hipertenzija, tumori, te druge neželjene pojave. U ovom radu prikazani su
mehanizmi djelovanja dostupnih imunosupresivnih lijekova, njihova primjena kod presaÄivanja
bubrega i neželjena djelovanja. Imunosupresivni protokol koji se koristi u veÄine bolesnika obuhvaÄa
inhibitor kalcineurina takrolimus ili ciklosporin, antimetabolit mikofenolat mofetil ili mikofenolnu
kiselinu, i kortikosteroid. U ranom razdoblju nakon presaÄivanja za suzbijanje reakcije
odbacivanja primjenjuje se jaÄa imunosupresija pomoÄu veÄih doza imunosupresivnih lijekova ili
dodavanjem indukcijskih agensa, monoklonskih ili poliklonskih antilimfocitnih protutijela. Uz navedene
lijekove jednogodiÅ”nje preživljavanje bubrežnih presadaka iznosi viÅ”e od 90 %, a uÄestalost
akutnih reakcija odbacivanja do 15 %. U lijeÄenju akutne reakcije odbacivanja posredovane
stanicama primjenjuju se intravenski pulsne doze metilprednizolona, a rjeÄe antilimfocitna protutijela.
Za suzbijanje akutne humoralne reakcije odbacivanja, koju oznaÄava karakteristiÄni patohistoloÅ”ki
nalaz i dokaz donor-specifiÄnih protutijela u serumu primatelja, koriste se visoke
doze intravenskih imunglobulina (IVIG) ili niske doze citomegalovirusnog hiperimunog globulina
(CMVIG) u kombinaciji s plazmaferezom, do zadovoljavajuÄeg smanjenja titra antidonorskih protutijela.
RjeÄe se primjenjuje imunoadsorpcija, rituksimab, alemtuzumab ili splenektomija. Ispitivanja
imunosupresivnih tvari i njihovih mehanizama djelovanja dovela su do otkriÄa velikog
broja potencijalnih lijekova, meÄutim, njihovoj primjeni u imunosupresivnom lijeÄenju kod presaÄivanja
bubrega moraju prethoditi velike randomizirane kontrolirane studije.The development of new immunosuppressive drugs and knowledge gained through
their usage in different combinations in immunosuppressive protocols, has significantly
improved results after renal transplantation. Immunosuppressive treatment aims at a
reduction of unwanted immune activity, but complications often arise in the form of
infections, metabolic disorders, arterial hypertension, tumors, and other side-effects. In this
paper, we describe the mechanisms of action of available immunosuppressive drugs, their
application for renal transplantation and their side-effects. In the majority of patients, the
immunosuppressive protocol includes a calcineurin inhibitor, tacrolimus or cyclosporin, the
antimetabolite mycophenolate mofetil or mycophenolic acid, and a corticosteroid. Early after
transplantation, acute rejection is suppressed with higher doses of immunosuppressive drugs
or an induction agent, monoclonal or polyclonal antilymphocytic antibodies. These drugs
allow a one-year survival of renal allografts in over 90 % of cases, and an incidence of acute
rejection reactions below 15 %. Acute cell-mediated rejection is treated with pulse doses of
methylprednisolone intravenously, less often with antilymphocytic antibodies. Acute humoral
rejection, characterized through specific pathohystologic changes and donor-specific
antibodies in the recipientās serum, is treated with high doses of intravenous immunoglobulines
(IVIG) or low doses of cytomegalovirus hyperimmune globuline (CMVIG) together with
plasmapheresis until a satisfactory reduction of anti-donor antibodies is obtained. Rarely,
immunoadsorption, rituximab, alemtuzumab or splenectomy are applied. Investigations of
immunosuppressive agents and their mechanisms of action have lead to the discovery of a
large number of potential drugs. However, their application in the immunosupressive treament
for renal transplantation has to be preceeded by large randomized controlled trials
Immunobiology of renal transplantation
Bubrežni presadak se u pravilu dobiva od genski neidentiÄnog darivatelja organa, Å”to
pobuÄuje imunosni sustav primatelja na razvoj transplantacijske reakcije. Ova reakcija usmjerena
je prvenstveno na strane MHC molekule, ali i na druge nepodudarne jake i slabe tkivne
antigene. Intenzitet imunosnog odgovora odreÄuju Äimbenici darivatelja, prvenstveno izražaj
nepodudarnih HLA antigena i prisustvo antigen predoÄnih stanica u presatku, dok je meÄu
Äimbenicima primatelja najvažnija ranija senzibilizacija i razvoj protutijela na AB0 i HLA antigene.
U ovom radu opisane su suvremene spoznaje o kliniÄkim znaÄajkama i temeljnim imunosnim
mehanizmima transplantacijske reakcije, koje Äine osnovu za provoÄenje imunosupresivnog
lijeÄenja kod presaÄivanja bubrega.Renal transplants are usually received from geneically non-identical donors, which
induces the recipientās immune system to develop a transplantation reaction. This reaction
is primarily directed against foreign MHC molecules, but also to other incompatible strong
and weak tissue antigens. The intensity of the immune response depends on donor-dependent
factors, primarily the expression of incompatible HLA antigens and the presence of
antigen presenting cells in the allograft. Among recipientās factors, the most important is an
earlier sensitation and development of antibodies against AB0 and HLA antigens. In this paper
we summarize the recent knowledge on clinical features and basic immune mechanisms
of the transplantation reaction, which represents the basis for imunosuppressive treatment
for renal transplantation
MFA11 (MFA 2011)
Catalogue of a culminating student exhibition held at the Mildred Lane Kemper Art Museum, May 6-Aug. 1, 2011. Content includes Introduction / Buzz Spector -- Patricia Olynyk -- Marshall N. Klimasewiski -- John Talbott Allen -- Meghan Bean -- Shira Berkowitz / Maggie Stanley Majors -- Darrick Byers, Bryce Olen Robinson -- Jisun Choi -- Zlatko ÄosiÄ -- James R. Daniels -- Kara Daving -- Andrea Degener -- Kristin Fleischmann / Randi Shapiro -- William Frank / Lawrence Ypil -- Nicholas Kania -- Katherine McCullough -- Jordan McGirk / Aditi Machado -- Zachary Miller -- Esther Murphy / Maggie Stanley Majors -- Kathryn Neale -- Christopher Ottinger / Melissa Olson -- Maia Palmer -- Nicole Petrescu / Melissa Olson -- Lauren Pressler / Randi Shapiro -- Whitney Sage / Aliya A. Reich -- Donna Smith.https://openscholarship.wustl.edu/books/1005/thumbnail.jp
Immunosuppressive treatment for kidney transplantation
mmunosuppressive treatment minimizes unwanted immune reactivity, but it also leads to complications such as metabolic disorders, cardiovascular diseases and malignant tumours. In this paper we summarise the recent developments in action mechanisms of available immunosuppressive drugs and their usage for renal transplantation. These drugs act at various levels of lymphocytic activation and proliferation, and they may have additive or synergic effects when combined. In the majority of patients, the immunosuppressive protocol includes a calcineurin inhibitor (tacrolimus or cyclosporin), an antimetabolite (mycophenolate mofetil or mycophenolic acid) and a corticosteroid. Most patients also receive induction with monoclonal or polyclonal antilymphocytic antibodies. These immunosuppressive drugs allow a one-year survival of renal allografts in over 90% of cases and an incidence of acute rejection episodes below 15%. In most cases, acute cell-mediated rejection can be reversed with pulse doses of methylprednisolone; less often antilymphocytic antibodies must be applied. Acute humoral rejection can be suppressed with high doses of intravenous immunoglobulines or low doses of cytomegalovirus hyperimmune globuline, in combination with plasmapheresis, to obtain a satisfactory reduction of anti-donor antibodies. This treatment also allows renal transplantation for sensitised recipients, or transplantation against a positive cross match or AB0 incompatibility. Less often, immunoadsorption, alemtuzumab, rituximab or splenectomy are applied. New immunosuppressive drugs and protocols are currently under investigation. Immunosuppressive agents and methods targeting the induction of immune tolerance to the donor organ are especially promising
Complications after kidney transplantation
Za veÄinu bolesnika presaÄivanje bubrega najbolje je nadomjesno lijeÄenje kod bubrežnog
zatajenja, no ono je Äesto povezano s razvojem komplikacija. VodeÄi uzroci zavrÅ”nog zatajivanja
bubrega (Å”eÄerna bolest, arterijska hipertenzija i ateroskleroza), starenje dijalitiÄke populacije
te Å”irenje kriterija za prihvaÄanje sve veÄeg broja primatelja i darivatelja organa znaÄajno poveÄavaju
morbiditet. U prvoj godini nakon presaÄivanja bubrega najÄeÅ”Äi su uzroci gubitka presatka
akutno odbacivanje, arterijska tromboza, primarna afunkcija presatka i smrt, dok se nakon prve
godine najviÅ”e presadaka gubi zbog smrti bolesnika s funkcionirajuÄim presatkom te kroniÄne nefropatije
presatka. Prema podacima naŔeg centra (KBC Rijeka), tijekom proteklog 25-godiŔnjeg
razdoblja srÄanožilne bolesti su uzrokovale smrt u 44,8 % primatelja, infekcije u 20,1 % i zloÄudni
tumori u 8,4 % sluÄajeva, s time da u 17,5 % primatelja nije bio poznat uzrok smrti. U ovom radu
opisane su najÄeÅ”Äe komplikacije nakon presaÄivanja bubrega, naÄini njihovog otkrivanja i lijeÄenja.
Reakcija odbacivanja presatka zauzima znaÄajno mjesto meÄu uzrocima kroniÄne nefropatije
i gubitka funkcije presatka. Akutna reakcija odbacivanja uz danaÅ”nje imunosupresivno lijeÄenje
javlja se u manje od 15 % bolesnika i veÄinom ima asimptomatski tijek, a porast koncentracije serumskog
kreatinina je kasni i nespecifiÄni pokazatelj. Radi ranog otkrivanja reakcije odbacivanja
te drugih uzroka oÅ”teÄenja presatka ispituju se metode imunosnog praÄenja koje, pored odreÄivanja
protutijela usmjerenih protiv stanica presatka i biljega staniÄne aktivacije, ukljuÄuju prikazivanje
gena te odreÄivanje bjelanÄevina i metabolita u krvi, mokraÄi i bioptatu presatka. Ove metode
mogle bi omoguÄiti individualizaciju imunosupresivnog lijeÄenja i pravodobno lijeÄenje
komplikacija, a time i poboljÅ”anje rezultata lijeÄenja presaÄivanjem bubrega.Renal transplantation is the best replacement therapy for renal failure in most patients,
but it is often associated with development of complications. The leading causes of
end-stage renal failure (diabetes mellitus, arterial hypertension and atherosclerosis), aging of
the population undergoing dialysis and widening of the acceptance criterias for both recipients
and donors, significantly increase morbidity. During the first year after transplantation,
most grafts are lost due to acute rejection, arterial thrombosis, primary graft non-function and
death. After the first year, most grafts are lost due to death from other causes, but with a functioning
graft, and chronic allograft nephropathy. According to the data collected in our institution
during the last twenty-five years, cardiovascular diseases caused death in 44.8 % recipients,
infection in 20.1 % and malignant tumors in 8.4 %, while in 17.5 % of cases, the cause of
death was unknown. This paper addresses the etiology of the most common complications after
renal transplantation. Acute allograft rejection is a significant cause of chronic nephropathy
and graft loss. With available immunosuppressive treatments, it occurs in less than 15 % of
patients, it is frequently asymptomatic and a rise in serum creatinine is a late and nonspecific
marker. For early diagnosis of rejection and causes of graft damage, several methods of immune
monitoring are investigated, including not only the determination of antibodies against
the allograft and markers of cell activation, but also gene profiling and determination of proteins
and metabolites in blood, urine and biopsy specimens. These methods could allow individualised
immunosuppressive treatments and timely treatment of complications, leading to
an improvement of results after renal transplantation