Transforming growth factor beta1-modified donor cell transfusion induced allo-heart tolerance.

The therapeutic value of the transforming growth factor beta 1 (TGF-beta1) in transplantation has been reported; however, cell-mediated gene therapy using TGF-beta1 is not a widespread application in organ transplantation. This study was performed to evaluate whether TGF-beta1-modified donor spleen cell-specific transfusion could induce tolerogenicity and prolong allograft survival in rat heterotopic heart transplantation. Stable TGF-beta1-transduced spleen cells were established. Wistar rat splenic T-cell responses to donor spleen cells that received TGF-beta1-transduced were severely impaired. Survival of Sprague-Dawley cardiac allografts in Wistar rats given TGF-beta1-modified donor spleen cells (5 x 10(6), 7 days before transplantation), was extended modestly but significantly. Liposome transduction of donor spleen cells to overexpress TGF-beta1 is associated with marked impairment of their T-cell allostimulatory activity but only modest prolongation of allo-heart survival.

Rat model of orthotopic gastric transplantation.

INTRODUCTION: We tried to find a better surgical procedure of reconstruction after total gastrectomy. Seventy rats were operated to establish a model of orthotopic gastric transplantations which may also be important for abdominal multivisceral transplantation. OBJECTIVE: To establish a rat model of orthotopic gastric transplantation. METHODS: In the donor operation; after the spleen was resected and the proper hepatic artery ligated, the stomach was infused with cold (0 degrees C to 4 degrees C) sodium lactate Ringer's solution via the aorta. The stomach was resected with its peripheral blood vessels-the celiac trunk, the left gastric artery, the splenic artery, the common hepatic artery, the gastroepiploic artery, and the portal vein. In the recipient operation; after the stomach and the spleen were resected, the donor stomach was implanted. An end-to-side anastomosis was performed for the portal veins. After the end-to-end anastomosis between the donor celiac trunk and the recipient left gastric artery, the blood flow was opened. Then the anastomoses of the duodenum, and donor cardia to the recipient esophagus were performed in end-to-end style. RESULTS: Thirty five operations were performed, in which the success rate in the last 20 cases was 80% (16/20). The average operative time was 2.35 hours. The longest survival time was over 3 months. CONCLUSION: A rat model of orthotopic gastric transplantation was successfully established and provides a method to study abdominal multivisceral transplantation. It also provides a new way for reconstruction after the total gastrectomy.

Variation of haemorheological parameters in renal and pancreatic rejection.

Abnormalities of haemorheology were found in animal and human recipients of kidney and/or pancreas allografts during rejection episodes. Thirteen diabetic canines received solitary pancreatic transplantation and another 13 diabetic and uremic canines underwent combined pancreas and kidney transplantation. Determination of haemorheological parameters was performed before and after operation respectively. During rejection episodes of kidney or pancreas allografts, the values of plasma viscosity, blood reductive viscosity and fibrinogen were significantly higher than those without rejection. On the basis of animal experiments, the determination of haemorheological parameters had been performed on 33 patients (30 receiving renal transplant, 2 pancreatic transplant alone and the remaining 1 combined renal and pancreatic transplant). Consecutive monitoring on these patients showed that a rise in the values of plasma viscosity, blood reductive viscosity and fibrinogen could be demonstrated during rejection episodes. The changes appeared one to three days prior to clinical manifestations and were in accordance with the termination of rejection. Our studies suggest that variation of haemorheological parameters are associated with rejection and the abnormal haemorheology may be an essential factor contributing to graft dysfunction. Moreover, the use of these assays will be beneficial to early diagnosis and better management of rejection in the future.

Treatment of hemophilia A by living mother-to-son splenic transplantation. First case report in the world.

A case of severe hemophilia A was treated by living mother-to-son splenic transplantation. The recipient was a 9-year-old boy. After splenic transplantation, the level of blood factor VIII:C was increased, and no spontaneous hemorrhage occurred. The boy was followed up for over two years. This is a case of spleen allotransplantation with the longest function in the world.

Simultaneous pancreaticoduodenal and renal transplantation in one diabetic patient with end-stage renal disease.

The diabetic patient with renal failure underwent simultaneous pancreaticoduodenal and renal transplantation. Duodeno-cystostomy was performed for the drainage of exocrine secretion. Immediately after grafting, the pancreatic and the renal graft regained normal function, and there was no operative complication whatever. The patient had functioning pancreatic graft and became insulin-independent for more than 3 months, although two transplanted kidneys were rejected. Immunosuppression consisted of cyclosporine A, azathioprine and prednisone. Our results suggest that hemorrheological parameters may serve as early indicators of acute rejection and be used to estimate the efficacy of anti-rejection and anti-coagulation therapy.

Cordyceps Sinensis-I as an immunosuppressant in heterotopic heart allograft model in rats.

To investigate the inhibitory effects of Cordyceps Sinensis-I (CS-1) on the immune response responsible for the organ transplant rejection, we studied its effects of prolonging heterotopic heart allograft survival on rat model with heart graft; the effects of CS-1 were compared with those of cyclosporine A and glucocorticoid, and the possible pathological changes caused by CS-1 were observed. Our results showed that CS-1 can prolong the survival of grafted heart without causing infection, and it did not exert detrimental effects on vital organs. As a result, it proves to be a promising immunosuppressant in clinical organ transplantation in the future.

Orthotopic homotransplantation of vascularized composite mandibular tissue in rabbits immunosuppressed with cyclosporine A.

To develop the surgical model, composite mandibular tissue was transplanted at the same site. Revascularization was accomplished by end-to-end anastomosis of the facial vessels using standard microvascular techniques. A total of 33 vascularized composite mandibular tissue allografts were similarly performed between two incompatible strains of rabbit. In a control group of 9 animals, no immunosuppression was administered. All of these allografts were rejected acutely within 10 days after surgery. 7 allograft recipients were immunosuppressed with azathioprine and prednisone at 5 mg/kg.d and 2 mg/kg.d, respectively. Their allografts were also rejected acutely within 10 days. 17 allograft recipients were immunosuppressed with cyclosporine A (CsA). All allografts showed primary wound healing and hair growth and took on normal appearance. 8 of these recipients were given CsA at 5 mg/kg.d i.v. and their allografts were rejected at a mean time of 17.9 days. The remaining 9 recipients given CsA at 10 mg/kg.d i.v. rejected their allografts at a mean time of 36.1 days. In 3 of them, the rejection was reversed with CsA (20 mg/kg.d) injection for five days successfully, and one allograft survived more than 100 days. This pilot study suggests that the surgical model is reliable and that CsA will be useful as an immunosuppressive agent in the study of vascularized composite mandibular tissue allografts.

Laboratory and clinical diagnosis of human cytomegalovirus infection after transplantation.

Urine and blood specimens from 32 recipients of allograft organ transplant were investigated for human cytomegalovirus (HCMV) by conventional cell culture, indirect immunofluorescent assay subsequent to the rapid cell culture and DNA-DNA hybridization. The results showed that the rapid cell culture technique might be the best method for rapid detection of active HCMV infection after transplantation because it possesses the advantages of simplicity, speediness, sensitiveness, and high reliability of detecting productive HCMV infection. The major symptoms were prolonged or intermittent fever unresponsive to antibiotics, dysfunction or loss of function of the transplanted organ, pulmonary infiltrates and leukopenia. As our results suggested, reactivation of a latent infection appears to be the most probable etiologic factor contributing to HCMV infection after transplantation.

Clinical significance of hemorrheological parameters in patients with renal transplantation.

Hemorrheological studies carried out on 14 recipients of cadaveric kidney transplant regularly before and after transplantation showed very significant differences in plasma viscosity in the period of stable function after successfully transplanted kidney, dialysis before transplantation, and renal rejection (P less than 0.001). Significant difference was observed in fibrinogen level in cases with stable normal function and rejection (P less than 0.05). Significant positive correlation was found between plasma viscosity and fibrinogen level in patients on dialysis as well as after transplantation. The results in this series showed that abnormal changes in hemorrheology respond to the development of rejection episode and deterioration of renal function in patients after receiving cadaveric renal allografts.