RESUMO
Introducción: En el trasplante renal con HLA idéntico los episodios de rechazo agudo son menores y tienen mejores tasas de supervivencia del injerto, comparado con los receptores con HLA no idéntico; a pesar de esto, persiste el dilema en cuanto al retiro o la disminución de la dosis de inmunosupresión. El objetivo de este trabajo es describir la experiencia de los trasplantes renales con HLA idéntico de donante vivo y cadavérico que se han realizado en la Fundación Valle del Lili desde 1995 hasta 2014. Material y métodos. De los 1.462 trasplantes renales realizados se incluyeron aquellos con HLA idéntico. Se hizo un análisis estadístico descriptivo para todas las variables consideradas y, para subgrupos seleccionados, el análisis de supervivencia y de rechazo agudo se hizo con el método de Kaplan-Meier. Para el análisis se usó Stata 12.0®. Resultados. Se practicaron 29 trasplantes renales con HLA idénticos. La mayoría fueron en hombres de raza mestiza y lo más frecuente fue una etiología desconocida de la enfermedad renal terminal. Dos pacientes presentaron rechazo agudo, y la supervivencia de los injertos a 1, 5, 10 y 15 años, fue de 100%, 93,7 %, 75 % y 75 %, respectivamente; la supervivencia de los pacientes a los 1, 5, 10 y 15 años, fue de 100%, 93,7 %, 84,3 % y 84,3 %, respectivamente. Conclusiones. Los receptores HLA idénticos poseen una supervivencia prolongada del injerto con menos tasas de rechazo agudo.
Introduction: Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD). Graft rejection is much lower in terms of acute rejection and improved graft survival in renal transplantation with HLA-identical compared to non-identical HLA receptors. The aim of this work is to describe the experience of HLA identical kidney transplantation from live and deceased donors that have been performed at Valle de Lili Foundation since 1995 to 2014. Material and methods. From the 1,462 kidney transplants performed those with HLA-identical were identified, a descriptive statistical analysis was performed for all variables considered in the analysis and for selected subgroups, the analysis of survival and acute rejection was made with the Kaplan-Meier method. Stata 12.0 was used for the analysis. Results: A total of 29 HLA-identical kidney transplants were performed. Most were men of mixed race; the main etiology of ESRD was unknown. Two patients had acute rejection and graft survival at five, ten and fifteen years was 93.7%, 75% and 75% respectively, patient survival at five, ten and fifteen years was 93.7%, 84.3% and 84.3% respectively. Conclusion: HLA-identical receptors have a prolonged survival of the graft with less acute rejection rates.
Assuntos
Transplante de Rim , Transplante Isogênico , Antígenos de Histocompatibilidade , Antígenos HLARESUMO
BACKGROUND:Mesenchymal stem cells are found to have the immunoregulatory activities and a potential application prospect in the treatment of autoimmune diseases. OBJECTIVE:To explore the mechanism of transplanting mesenchymal stems cells on the treatment of multiple sclerosis. METHODS:The mouse mesenchymal stems cells were prepared, and injected into the al ogenic and syngenic normal mice, to detect the frequency of CD4+CD25+Foxp3+T cells in the spleen, thymus, and lymph nodes by flow cytometry, and to detect the Foxp3, transforming growth factor-β1, and interleukin-10 mRNA in the spleen, thymus, and lymph nodes by reverse transcription-PCR. RESULTS AND CONCLUSION:Transplantation of mesenchymal stem cells on normal mice led to a significant up-regulation of CD4+CD25+Foxp3+T cells, Foxp3, transforming growth factor-β1, and interleukin-10 mRNA in the spleen, thymus, and lymph nodes both in the al ogenic and syngenic transplant groups. Transplantation of mesenchymal stem cells may be an available method in the treatment of autoimmune diseases, and CD4+CD25+Foxp3+T cell, Foxp3, transforming growth factor-β1, and interleukin-10 may be involved in this process.
RESUMO
Objective To induce the immune tolerance of heart grafts with infusion of isogeneic bone marrow mesenchymal stem cells (BMSCs) in heart transplant rats.Method Donor Wistar rats and recipient F344 rats were randomly divided into 4 groups:acute rejection group (group A),Wistar rats as the donors and F344 rats as the recipients for heart transplantation; low dose cyclosporin A(CsA) group (group B),recipient F344 rats given low dose CsA; BMSCs group (group C),recipient F344 rats given isogeneic BMSCs; BMSC and low dose CsA group (group D),the recipient F344 rats given isogeneic BMSCs and low dose CsA.The serum cytokine levels were determined,and the donor heart pathological changes and survival were observed postoperatively.The relative level of Foxp3 mRNA expression in the spleen of the recipient F344 rats was also observed.Result The blood levels of interleukin-2 (IL-2) and interferon-γ(INF-γ) were significantly reduced,but IL-4 and IL-10 levels were increased (P＜0.05),and the survival time of donor heart was significantly prolonged in group D as compared with groups A,B and C (P＜0.05 for all).Heart pathological examination revealed a mild acute rejection in group D,moderate acute rejection in groups B and C group,and severe acute rejection in group A respectively.The expression of Foxp3 mRNA was significantly lower in group A than in groups B,C and D (P＜0.05 for all),and that in group D was significantly higher than in groups B and C (P＜0.05 for both),but there was no significant difference between between groups B and C (P＞0.05).Conclusion Intravenous administration of BMSCs can alleviate immunorejection in heterotopic rat heart transplantation.Low-dose CsA acts synergistically with BMSCs to significantly inhibit acute rejection after heart transplantation.The partial mechanisms involve the suppressive effect of BMSCs on the expression of Foxp3 mRNA and modulation on cytokine.