RESUMEN
Allograft rejection reaction must be integrated within the general framework of alloreactivity, i.e. involving a huge T cell repertoire with a high number of alloreactive precursors. This reaction is modulated by the particular immunological state induced by chronic renal insufficiency, haemodialysis and primary kidney disease. The inefficiency of current immunosuppressive drugs is illustrated by the tendency towards chronic rejection, involving many growth factors. It must be noted that allo-stimulating cells are different from target cells. Therapeutical armamentarium currently involves corticosteroids and serotherapy, but it is hoped that new immunosuppressive drugs will increase the efficiency of rejection crisis treatment.
Asunto(s)
Rechazo de Injerto/diagnóstico , Trasplante de Riñón/efectos adversos , Enfermedad Aguda , Rechazo de Injerto/patología , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/uso terapéutico , Riñón/inmunología , Riñón/patología , Factores de TiempoRESUMEN
The cyclosporine era started 10 years ago in organ transplantation, especially in renal transplantation. Following the pioneering works showing the efficacy and its synergism with other immunosuppressors, a second step consisted in a better use by decreasing the induction dose and a closer definition of its side effects. A major improvement in the results (increase of 5 to 10% in patient survival and of 10 to 20% in graft survival), a decrease in the number of acute rejection episodes, in the cumulative doses of steroids, in the duration of hospitalization and in the total cost of transplantation made this drug as the worldwide used agent, now considered as the milestone in immunosuppression. Over all, organ transplantation is needing a more specific immunological agent, deprived if possible of major side effects. In these regards, each new agent should be considered only if compared to the "gold standard", namely cyclosporine.
Asunto(s)
Ciclosporina/uso terapéutico , Trasplante de Riñón/métodos , Protocolos Clínicos , Ciclosporina/administración & dosificación , HumanosAsunto(s)
Citocinas/genética , Trasplante de Riñón/inmunología , Secuencia de Bases , ADN/genética , Expresión Génica , Rechazo de Injerto , Humanos , Hibridación in Situ , Interleucina-2/genética , Interleucina-6/genética , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , ARN Mensajero/genéticaRESUMEN
Allograft rejection reaction must be integrated in the broader sense of alloreactivity, i.e. involving a huge T cell repertoire with a high number of alloreactive precursors. This reaction is modulated by the particular immunological state induced by chronic renal insufficiency, by haemodialysis and by the primary kidney disease. The imperfect effect of current immunosuppressive drugs is illustrated by a sizeable proportion of grafts undergoing a chronic rejection process where many growth factors are involved. It has to be noted that allostimulating cells are different from target cells. At present, the therapeutical rejection involves corticosteroids and serotherapy, but it is hoped that new immunosuppressive drugs will increase the efficacy of the rejection crisis treatment.
Asunto(s)
Rechazo de Injerto/inmunología , Enfermedades Renales/inmunología , Trasplante de Riñón/efectos adversos , Lesión Renal Aguda/inmunología , Rechazo de Injerto/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéuticoRESUMEN
From January 1976 to June 1989, 138 renal artery stenoses (RAS) occurred in a population of 1,200 renal transplantations in a single center (11.5 percent). An interventional procedure was performed in 89 patients: surgery in 39 and transluminal angioplasty in 50. Six other patients were excluded from the study because of complications and RAS spontaneously disappeared in 3 patients. Finally, 40 patients were treated medically with a mean follow-up of 57.6 months (range 12 to 116 months). In this group, the actuarial graft survival rate did not significantly differ from that of the 2 other groups. One patient only lost his graft from renal artery thrombosis. The mean serum creatinine level at the time of RAS diagnosis (140 +/- 8.6 mumol/l) was not significantly different from the mean serum creatinine level at the last follow-up (146 +/- 14.6 mumol/l). The degree of hypertension, graded on the number of anti-hypertensive drugs, was not different at the time of diagnosis and at the end of follow-up. In conclusion, in our experience, the spontaneous course of RAS does not result in an increased rate of graft failure or impaired long-term renal function.
Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Trasplante de Riñón/efectos adversos , Obstrucción de la Arteria Renal/mortalidad , Adulto , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/etiología , Masculino , Persona de Mediana Edad , Remisión Espontánea , Obstrucción de la Arteria Renal/complicaciones , Factores de TiempoRESUMEN
We report the incidence of urological complications in a series of 1,200 kidney transplant: 3.8 percent of the patients developed a urinary fistula, due to ureteral necrosis in 48 percent of cases, and 6.5 percent had urinary obstruction. Urinary fistulas are early complications appearing 20 days after the transplantation, while obstructions appear about one year after grafting. These complications are now usually treated by percutaneous and/or endoscopic techniques.