Remarkable 107-year-old kidney with a 49-year of long-term allograph survival through continuous azathioprine monotherapy.

BACKGROUND: The main goal of kidney allograft transplantation is to improve survival in patients with end-stage kidney failure. Herein, we report a 49-year long-term allograft survival with non-identical human leukocyte antigens (HLA). The purpose of this study was to report the successful clinical outcome of 49 years of transplant survival in a 79-year-old patient with a 107-year-old kidney undergoing continued immunosuppressive monotherapy. MATERIAL AND METHODS: The patient was evaluated clinically and immunologically with HLA typing and anti-HLA antibodies before transplantation. Post-transplant, the patient's clinical and immunological survival were monitored for 49 years. The state of the chimerism was assessed using the polymerase chain reaction to amplify 24 short tandem repeats using a DNA thermocycler and DNA analyzer. RESULTS: The patient and donor were haploidentical and the patient was treated with azathioprine monotherapy. Donor-specific antibodies were detected only for the HLA-DPB1* 03:01 mismatch. This patient developed multiple skin tumors 26 years after transplant, which were successfully treated with topical therapy or surgical removal. The patient developed an intestinal adenocarcinoma 43 years after kidney transplantation, which was surgically removal; six years later, adenocarcinoma was diagnosed in a finger, followed by axillar and hepatic metastases. After 49 years of graft survival of a kidney of 107 years old in a patient with 79 years of age, the patient's health worsened with severe dehydration, anemia, and bacterial infection. The patient was hospitalized with a serum creatinine level of 3.45 mg/dL, urea level of 188 mg/dL, and estimated glomerular filtration rate of 22 mL/1.72 m2; septicemia developed and was treated with antibiotics. The patient had poor clinical progress, was intubated, and later died due to septic shock. CONCLUSIONS: To the best of our knowledge, this is the first case of a 107-year-old kidney, transplanted into a recipient who was treated with azathioprine monotherapy for 49 years.

Natural killer cells and immune surveillance.

OBJECTIVES: To analyze the importance of natural killer cells, their killer immunoglobulin-like receptors (KIR) and genes in autoimmunity and in the immune surveillance against infectious agents and stem cells transplantation. The characteristics and polymorphisms of the KIR genes and receptors in the Brazilian population is described. SOURCES: Textbooks, review articles and recent scientific articles are cited and listed in the references. SUMMARY OF THE FINDINGS: KIR genes and haplotypes within a Brazilian Caucasian population were surveyed and analyzed to assess the future relationship of this system with diseases. Of 116 voluntary bone marrow donors, we identified 32 genotypes with frequencies of A and B haplotypes of 51 and 49%, respectively. A comparative analysis was performed between these genotypes and those from other populations. CONCLUSIONS: Innate immunity is an important anti-infectious barrier in newborns. It is independent of both cellular and humoral immunity, can be faster and confers great advantage in early age. At the same time, it stimulates CD8 T lymphocytes to act and amplify the immunological protection network. Nevertheless, as in the majority of situations in which immunity is activated, it can also be harmful, damaging the body through autoimmune mechanisms or even, through its absence, creating space for infectious agents to act free. Our study of a control group for KIR genotype and haplotypes in Brazilian Caucasoids could be used in future analyse of diseases related to these genes.

Células natural killer e vigilância imunológica: [revisão] / Natural killer cells and immune surveillance: [review]

OBJETIVOS: Analisar a importância das células natural killer, de seus receptores killer immunoglobulin-like receptors e correspondentes genes (KIR) na vigilância imunológica do organismo contra agentes infecciosos, transplantes de células-tronco hematopoiéticas, assim como sua participação na auto-imunidade. As características e o polimorfismo dos genes e receptores KIR na população brasileira serão descritos. FONTES DOS DADOS: Livros, artigos de revisão e artigos científicos recentes são citados e listados na bibliografia. A experiência pessoal é também apresentada. SÍNTESE DOS DADOS: Identificamos o perfil de genes e haplótipos KIR na população caucasóide brasileira, sendo de importância esse conhecimento para a análise da relação desse sistema com doenças. Examinamos 116 indivíduos doadores voluntários de medula óssea, identificando-se 32 genótipos e a presença de 51 e 49 por cento de haplótipos A e B, respectivamente. Foi realizado estudo comparativo entre os nossos genótipos e os de outras populações. CONCLUSÕES: A imunidade inata é uma barreira antiinfecciosa de importância em pediatria. Ela atua de maneira independente da imunidade celular e humoral, sendo mais rápida que as demais fontes de proteção do organismo. Ao mesmo tempo, ela estimula os linfócitos T CD8 a agirem e amplificarem a rede de proteção imunológica. Entretanto, como na maioria das vezes em que a imunidade atua, ela também pode ser prejudicial, agredindo o organismo por mecanismos auto-imunes ou mesmo, na sua ausência, oferecer espaço aos agentes infecciosos para agirem de forma impune.

OBJECTIVES: To analyze the importance of natural killer cells, their killer immunoglobulin-like receptors (KIR) and genes in autoimmunity and in the immune surveillance against infectious agents and stem cells transplantation. The characteristics and polymorphisms of the KIR genes and receptors in the Brazilian population is described. SOURCES: Textbooks, review articles and recent scientific articles are cited and listed in the references. SUMMARY OF THE FINDINGS: KIR genes and haplotypes within a Brazilian Caucasian population were surveyed and analyzed to assess the future relationship of this system with diseases. Of 116 voluntary bone marrow donors, we identified 32 genotypes with frequencies of A and B haplotypes of 51 and 49 percent, respectively. A comparative analysis was performed between these genotypes and those from other populations. CONCLUSIONS: Innate immunity is an important anti-infectious barrier in newborns. It is independent of both cellular and humoral immunity, can be faster and confers great advantage in early age. At the same time, it stimulates CD8 T lymphocytes to act and amplify the immunological protection network. Nevertheless, as in the majority of situations in which immunity is activated, it can also be harmful, damaging the body through autoimmune mechanisms or even, through its absence, creating space for infectious agents to act free. Our study of a control group for KIR genotype and haplotypes in Brazilian Caucasoids could be used in future analyse of diseases related to these genes.