RESUMEN
The purpose of the present study was to evaluate the mixed lymphocyte culture as a predictive assay of acute and chronic graft-versus-host disease (GVHD). We studied 153 patients who received a first bone marrow transplantation from human leukocyte antigen-identical siblings. Acute GVHD was observed in 26 of 128 (20.3 percent) patients evaluated and chronic GVHD occurred in 60 of 114 (52.6 percent). One-way mixed lymphocyte culture (MLC) assays were performed by the standard method. MLC results are reported as the relative response (RR) from donor against patient cells. The responses ranged from -47.0 to 40.7 percent, with a median of 0.5 percent. The Kaplan-Meier probability of developing GVHD was determined for patients with positive and negative MLC. There was no significant difference in incidence of acute GVHD between the groups studied. However, the incidence of chronic GVHD was higher in recipients with RR >4.5 percent than in those with RR <=4.5 percent. The Cox Proportional Hazards model was used to examine the effect of MLC levels on incidence of chronic GVHD, while adjusting for the potential confounding effect of others suspected or observed risk factors. The relative risk of chronic GVHD was 2.5 for patients with positive MLC (RR >4.5 percent), 2.9 for those who received peripheral blood progenitor cells as a graft, and 2.2 for patients who developed previous acute GVHD. MLC was not useful for predicting acute GVHD, but MLC with RR >4.5 percent associated with other risk factors could predict the development of chronic GVHD, being of help for the prevention and/or treatment of this late complication
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Enfermedad Aguda , Brasil , Enfermedad Crónica , Enfermedad Injerto contra Huésped , Antígenos HLA , Incidencia , Prueba de Cultivo Mixto de Linfocitos , Valor Predictivo de las Pruebas , Factores de Riesgo , Trasplante HomólogoRESUMEN
The survical of 502 kidney grafts (458 first-grafts and 44 seconda-grafts) performed at Hospital das Clínicas, Faculdade de Medicina, Universidade de Säo Paulo, was analyzed in relation to the degree of HLA compatibility. The actuarial graft survival for first-transplants, at 1 and 5 years, was a follows: a) HLA-identical donor: 90 and 83%; b) one-haplotype identical donor: 68 and 54%; c) unrelated living donor: 61 and 37.5% and d) cadaver donor: 52.5 and 32%. These survival data are similar to those reported by other transplantation groups and confirm the important role of the HLA antigens in the outcome of renal transplantation