Outcome Analysis of 71 Clinical Intestinal Transplantations

Todo, Satoru; Reyes, Jorge; Furukawa, Hiroyuki; Abu‐Elmagd, Kareem; Lee, Randall G.; Tzakis, Andreas G.; Rao, Abdul S.; Starzl, Thomas E.

doi:10.1097/00000658-199509000-00006

Cited by 296 publications

(163 citation statements)

References 42 publications

(13 reference statements)

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“…By contrast, Schwartz ascribed the tumors to a lymphoproliferative response by the dominant immune apparatus to the persistent subclinical GVH counter-attack of the minority leukocyte population. The relevance of this conclusion, of 'Schwartz's rules' of pathogenesis, and of their therapeutic implications could not be appreciated until three decades later in the context of the two-way paradigm 29 .…”

Section: Cause or Effect?mentioning

confidence: 94%

The lost chord: microchimerism and allograft survival

et al. 1996

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Recent evidence suggests that passenger leukocytes migrate after organ transplantation and produce persistent chimerism, which is essential for sustained survival of the allografts. Here, Thomas Starzl and colleagues argure that this hematolymphopoietic chimerism provides an important framework for the interpretation of basic and therapeutically oriented transplantataion research.Medawar's characterization of rejection 1 as a host-versus-graft (HVG) reaction (Fig. 1a) was the cornerstone of transplantation immunology. A decade later, this concept was transposed in the context of a graft-versus-host (GVH) reaction (Fig. 1b), in which histoincompatible hematolymphopoietic grafts rejected the immunologically defenseless recipients 2,3 . The resulting assumption that allograft acceptance or rejection could be understood by studying HVG or GVH immunologic responses in isolation led to prompt acceptance of the one-way in vitro tests of immune reactivity as 'minitransplant' surrogates. However, this assumption did not provide a blanket explanation for observations made in animal and human allograft recipients. The one-way paradigmUntil 1959, preparatory donor leukocyte infusion into cytoablated organ recipients was an expected natural extension of the neonatal tolerance model of Billingham, Brent and Medawar 4 and its adult cytoablation analogues 3 . However, when long-term survival of human kidney allografts was accomplished in a few sublethally irradiated recipients without donor leukocyte infusion, and then regularly without cytoreduction under continuous pharmacologic immunosuppression, the need either for chimerism or host preconditioning lost favor.The identification of 'passenger leukocytes' as the primary antigenic component of organs 6,7 led to the belief that their destruction by the host immune system was essential for organ engraftment. When these cells were found to be migratory 8 , including dendritic cells (DCs) 9 , their sensitization effects and presumed elimination at peripheral and intragraft sites was taken for granted. Bone marrow transplantationMajor histocompatibility complex (MHC)-restricted models of acquired tolerance were widely considered to have validated Burnet's prediction that developing lymphocytes could be purged of self-reactive cells before they achieved functional maturity, even following bone marrow transplantation. The alternative possibility that donor and recipient immunecell populations coexisted in neonatally tolerant animals in a mutually nonreactive state while retaining the ability to function collaboratively (e.g. in a joint immune response to infection) was abandoned when no direct experimental support could be found 10 it has since been learned that the outcome in the neonatal tolerance model is highly variable and that a state approaching permanent clonal deletion is uncommon 11 . Recently, it has been shown that the ability of donor-derived leukocyte subsets to proliferate in response to a skin graft challenge was a more critical determinant of neonatal tole...

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Section: Cause or Effect?mentioning

confidence: 94%

The lost chord: microchimerism and allograft survival

et al. 1996

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“…Treatment of short bowel syndrome by lengthening the bowel or slowing peristalsis to increase absorptive surface area or intestinal transit time is problematical 3,4 . Small bowel transplantation is a promising alternative for patients with life-threatening complications from TPN but it is still limited by unsolved immunological problems, a shortage of donors and secondary malignancies 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Intestinal regeneration by a novel surgical procedure

Jwo

Chiu

et al. 2008

British Journal of Surgery

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“…5 It was noted that rejection of the different splanchnic organs transplanted with the liver was much less severe than the rejection of the individual organs transplanted alone,71 an observation that was validated much later in rodent studies 72 ,73 and in humans. 74 In addition, the recipients had histopathological evidence of a widespread graft-versus-host reaction in their tissues, but without overt graft-versus-host disease (GVHD). This was the first clue that GVHD might not blight intestinal or liver transplantation, or both, if such procedures were ever to become feasible.…”

Section: Variant Liver Transplant Proceduresmentioning

confidence: 99%