Organ Transplantation: A Clinical Guide by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen

By Andrew A. Klein, Clive J. Lewis, Joren C. Madsen

Organ Transplantation: A scientific consultant covers all elements of transplantation in either grownup and pediatric sufferers. Cardiac, lung, liver, kidney, pancreas and small bowel transplantation are mentioned intimately, in addition to rising components comparable to face and pancreatic islet cellphone transplantation. for every organ, chapters hide easy technological know-how of transplantation, recipient choice, the transplant method, anesthetic and post-operative care, and long term follow-up and administration of issues. very important matters in donor choice and administration also are mentioned, together with recruitment and allocation of strength donor organs and increasing the donor pool. precis tables and illustrations increase the textual content, and long term final result information are supplied the place on hand. Written by way of professional transplant surgeons, anesthetists and physicians, Organ Transplantation: A medical consultant is a useful multidisciplinary source for any clinician concerned about transplantation, supplying in-depth wisdom of expert components of transplantation and masking the entire variety of administration options

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Antigenspecific recognition and costimulatory signaling from activated CD4+ T cells is required for the activation and differentiation of primary and memory B-cell responses that result in plasma cell generation and the production of alloantibodies. This results in B-cell–induced antibody-mediated rejection (AMR), a phenomenon that is increasingly recognized as problematic in transplantation. AMR appears to be contributory in 20–30% of acute transplant rejection episodes and up to 60% of chronic allograft dysfunction cases.

The Nobel Prizes awarded to Hitchings and Elion, Medawar, Murray, and Dausset bear witness to the interplay of surgical skill, immunological understanding, and bold therapeutics that still resides at the core of clinical transplantation. To the newly initiated struggling to understand the whys and wherefores of current immunosuppression, lessons learned in the past help simplify the process. Furthermore, future therapies are likely to evolve from equally important experience acquired in the present.

However, one kidney transplant was lost due to acute AMR, leading to a modification in the trial protocol to include B-cell depletion with rituximab. Although the attainment of tolerance is an ideal solution, whether this can be achieved in each and every transplant recipient is unknown. For the major- 18 ity of patients, reducing immunosuppression to a minimal level would offer many advantages in terms of reduced complications of long-term drug therapy. This state, in which graft function is maintained in the presence of low doses of non-toxic immunosuppression, has been termed prope tolerance and may represent a more realistic goal.

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