Transplant immunology
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Transplant immunology · Jul 2009
ReviewExtracorporeal photopheresis: from solid organs to face transplantation.
Composite tissue allotransplantations (CTA), were introduced with the first successful hand transplantation and are now a part of reconstructive surgery armamentarium. These reconstructive procedures for non life-threatening indications remain rare due to adverse effects of the associated lifelong immunosuppressive therapy. Indeed, despite recent progress, immunosuppressive therapies remain non-specific to the type of donor and still bear significant risks of serious side effects. ⋯ ECP therapy, associated with maintenance immunosuppressive therapy and doses of methylprednisolone, and the control of viral infection, succeeded to reverse the rejection process without the development of other side effects. Despite the fact that the mechanism of action of ECP has not been fully elucidated, this therapy could be a useful supportive therapy during the treatment of acute rejection episodes in composite tissue allotransplantations. In this review, we introduce the interest of ECP implementation in CTA in face allotransplantations.
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Transplant immunology · Apr 2008
ReviewNatural killer cells and lung transplantation, roles in rejection, infection, and tolerance.
Despite improvements in surgical technique, organ preservation, immunosuppression, and management of infection, the long term survival following lung transplantation remains low, mainly due to immune mediated complications such as acute and chronic rejection. Almost all immunosuppressive agents used in the prophylaxis and treatment of rejection following lung transplantation are targets of T cell maturation, function or proliferation, which in theory should cause sufficient disruption of the adaptive immune system to prevent graft rejection. ⋯ More recent evidence suggests that NK cells may play a significant role in immune processes following lung transplantation. This article reviews the literature on the potential function of NK cells in rejection, infection, malignancy and tolerance following lung transplantation.
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Almost all identified acute and/or severe immunological reactions towards blood transfusions, reported by surveillance systems such as SHOT (Severe Hazards of Transfusion) in the UK are mediated by allo-antibodies. In contrast, the clinical effects of transfusion-induced cellular immunity are virtually unknown. Although alterations in lymphocyte responses and natural killer cell functions after blood transfusion has been reported in many publications, the relevance of these in vitro assays for in vivo immunity are lacking. ⋯ Since the UK and France introduced a transfusion vigilance system, severe immunological side-effects such as haemolytic reactions, TRALI (acute lung injury), PTP (post-transfusion purpura) and graft vs. host disease are registrated in these countries and their incidence can be estimated based on the national number of transfusions. However, every blood transfusion interferes with the immune system of the recipient. The available evidence of harm from immune responses not leading to severe transfusion reactions will be discussed.