Thoracic Organ Transplantation: Laboratory Methods

Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.
Source: Springer protocols feed by Immunology - Category: Allergy & Immunology Source Type: news

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Sirolimus (SRL) attenuates cardiac allograft vasculopathy (CAV) progression following heart transplantation (HT) but often results in hyperlipidemia. We investigated the differential effects of SRL- and calcineurin inhibitor (CNI)-based immunosuppression on CAV progression and clinical outcomes in HT recipients.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
ConclusionsECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early use of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
AbstractPurpose of ReviewThe first human lung transplant surgery in the world was done in 1963, followed by the first heart transplant in 1967, making this year its 50th anniversary. Since then, there has been great advancement in immunotherapy, with the adoption of calcineurin inhibitors (CNI), mycophenolate mofetil, and proliferation signal inhibitors (PSI). However, while these medications are crucial to maintenance of allograft function and prevention of allograft rejection, they have many toxicities and side effects, which make therapeutic dose monitoring and recognition of drug-drug interactions of critical importanc...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research
ConclusionsECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early use of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
AbstractLung transplantation is increasingly practiced for patients with end-stage lung disease. The successful outcome of solid organ transplantation today is severely impeded by the production of alloantibodies, mainly directed against the protein products of the HLA complex of the organ donor. While the association between antibody mediated rejection and allograft damage has been well established in renal and heart transplantation, it has not yet been well characterized in lung transplantation. This review addresses the question of HLA matching in lung transplantation and current knowledge of the allogenicity of differe...
Source: Frontiers of Medicine - Category: General Medicine Source Type: research
Identification of heart transplant rejection currently rely on immunohistologic and immunohistochemistry. We aimed to identify specific sets of microRNAs (miRNAs) to characterize acute cellular (ACR), antibody-mediated (pAMR) and mixed (MR) rejections in monitoring formalinfixed paraffin-embedded (FFPE) endomyocardial biopsies (EMBs) in heart transplant (HTx) patients.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Conclusions We show in this retrospective study that specific donor HLA class II types are important in lung transplantation, because they are associated with either protection from or susceptibility to development of severe BOS.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
Conclusions ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early use of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Abstract Exosomes are extracellular vesicles that express self-antigens (SAgs) and donor human leukocyte antigens. Tissue-specific exosomes can be detected in the circulation following lung, heart, kidney and islet cell transplantations. We collected serum samples from patients who had undergone lung (n=30), heart (n=8), or kidney (n=15) transplantations to isolate circulating exosomes. Exosome purity was analyzed by Western blot, using CD9 exosome-specific markers. Tissue-associated lung SAgs, collagen V (Col-V) and K-alpha 1 tubulin (Kα1T), heart SAgs, myosin and vimentin, and kidney SAgs, fibronectin and ...
Source: Human Immunology - Category: Allergy & Immunology Authors: Tags: Hum Immunol Source Type: research
Background: We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients. Methods and Results: We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severi...
Source: Circulation: Heart Failure - Category: Cardiology Authors: Tags: Nuclear Cardiology and PET, Transplantation, Mortality/Survival Emerging Investigators Source Type: research
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