Evaluation of Pre- And Posttransplant Donor-Specific Transfusion/Cyclosporine a in Non-Hla Identical Living Donor Kidney Transplant Recipients

Jw, Alexander; Ja, Light; La, Donaldson; Fl, Delmonico; Ag, Diethelm; Wilkinson, Anne; Jt, Rosenthal; Thistlethwaite,; Lg, Hunsicker; Aj, Matas; Mr, First; Reinsmoen, N.; Sm, Rose

doi:10.1097/00007890-199910270-00010

Cited by 21 publications

(8 citation statements)

References 15 publications

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“…114 However, in non-HLA identical living donor kidney transplants, administration of DST 24 hr before and 7 to 10 days after transplantation had no valuable influence on patient or graft survival for up to 2 years. 122…”

Section: Experimental Studiesmentioning

confidence: 99%

Role of Blood Transfusion in Transplantation: A Review

Siemionow¹,

Ağaoğlu²

2005

J reconstr Microsurg

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The ultimate goal of transplantation immunology is induction of donor-specific tolerance without the need for chronic immunosuppression. A number of strategies have been used to induce tolerance, including donor-specific blood transfusion (DST). A large number of experimental and clinical studies have evaluated the ability of DST to induce tolerance in solid organ transplantation. In contrast, a limited number of experimental studies have been reported evaluating the effect of DST in induction of tolerance in composite tissue allograft transplants. DST applications include cadaveric and living-related graft recipients in humans, leading to achievement of microchimerism. Although the mechanism of action is still uncertain, microchimerism with the concomitant persistence of soluble donor HLA antigen is considered to be the most significant contributing factor. In this article, the experimental and clinical applications, as well as the immunomodulatory mechanism of DST, are reviewed.

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Section: Experimental Studiesmentioning

confidence: 99%

Role of Blood Transfusion in Transplantation: A Review

Siemionow¹,

Ağaoğlu²

2005

J reconstr Microsurg

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“…DST were introduced with the aim to induce unresponsiveness to allografts by modulation of the immune system [1,2]. After the introduction of cyclosporine, the beneficial effects of DST became controversial and were often not detectable [3–7]. Therefore, most transplant centers have abandoned such protocols.…”

Section: Introductionmentioning

confidence: 99%

Effect of donor-specific transfusions on the outcome of renal allografts in the cyclosporine era

Marti¹,

Henschkowski²,

Laux³

et al. 2006

Transplant Int

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Summary Despite the introduction of new immunosuppressive agents, a steady decline of functioning renal allografts after living donation is observed. Thus nonpharmacological strategies to prevent graft loss have to be reconsidered, including donor‐specific transfusions (DST). We introduced a cyclosporine‐based DST protocol for renal allograft recipients from living‐related/unrelated donation. From 1993 to 2003, 200 ml of whole blood, or the respective mononuclear cells from the potential living donor were administered twice to all of our 61 recipient candidates. The transplanted subjects were compared with three groups of patients without DST from the Collaborative Transplant Study (Heidelberg, Germany) during a 6‐year period. Six patients were sensitized without delay for a subsequent cadaveric kidney. DST patients had less often treatment for rejection and graft survival was superior compared with subjects from the other Swiss transplant centers (n = 513) or from Western Europe (n = 7024). To diminish the probability that superior results reflect patient selection rather than effects of DST, a ‘matched‐pair’ analysis controlling for relevant factors of transplant outcome was performed. Again, this analysis indicated that recipients with DST had better outcome. Thus, our observation suggests that DST improve the outcome of living kidney transplants even when modern immunosuppressive drugs are prescribed.

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“…There were three treatment groups tested sequentially which involved two immunosuppressive protocols (1): IV cyclosporin, azathioprine, prednisone and a single marrow cell transfusion on day 1 post‐transplant (2); OKT3 induction with triple drug maintenance therapy and a single marrow cell transfusion on day 1 (3); OKT3 induction with triple drug maintenance therapy and marrow cell infusions on day 1 and again between days 10–12 post‐transplant. For each treatment strategy, the marrow infusion and control arms received the same immunosuppression.…”

Section: Treatment Armsmentioning

confidence: 99%

“…The CCTT group had previous experience with perioperative donor specific transfusions administered concurrently with immunosuppression in living donor–recipient pairs (1). Furthermore, several CCTT centres had prior laboratory or clinical experience with strategies to induce allograft tolerance with donor bone marrow (2–9).…”

mentioning

confidence: 99%

“…Since it was not completely clear whether either acute graft vs. host disease (GVHD) or acute rejection might be precipitated by our bone marrow transfusion strategy, a series of sequential pilot studies were designed. The initial study used an immunosuppression protocol identical to the one used in our DST trial (1). Subsequent studies used OKT3 for CD3+ lymphocyte depletion.…”

mentioning

confidence: 99%

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