tailieunhanh - Ebook Kidney transplantation (6/E): Part 2

Part 2 book “Kidney transplantation” has contents: Approaches to the induction of tolerance, chronic allograft nephropathy, vascular complications after kidney transplantation, urological complications after kidney transplantation, cardiovascular complications after renal transplantation, neurological complications after renal transplantation, kidney transplantation in children, and other contents. | X3343-Ch23 4/8/08 2:58 PM Page 361 Chapter 23 Approaches to the Induction of Tolerance Satish N. Nadig • Gregor Warnecke • Kathryn J. Wood Historical Perspective Definition of Tolerance Need for Tolerance in Clinical Transplantation Understanding the Immunological Mechanisms behind Tolerance Induction Overview of T Cell Activation Mechanisms of Tolerance to Donor Antigens Methodology of Tolerance Induction and Maintenance Information from Analyzing Tolerant Recipients Current Strategies Used to Induce Immunological Tolerance to an Allograft Mixed Chimerism Costimulation Blockade Targeting CD3 and Accessory Molecules Leukocyte Depletion at the Time of Transplantation Effect of Immunosuppression on Tolerance Induction HISTORICAL PERSPECTIVE In 1951, Billingham and Medawar18 published a landmark article entitled “The Technique of Free Skin Grafting in Mammals” in the Journal of Experimental Biology. In it, Billingham and Medawar provided the foundation for what would become the field of transplant immunology. Classic experimental observations, which included a noticeable acceleration in rejection responses after transplanting a second full-thickness allogeneic skin graft harvested from the same donor as the initial graft, set the standard for what eventually would become the groundwork for immunological Further work that was based on earlier writings of Owen187 involved skin grafting dizygotic mammalian twin calves. The observations that these grafts are accepted by both hosts led to the hypothesis that a phenomenon of tolerance to the grafts was achieved secondary to “foreign” blood cells persistent in each twin owing to placental These breakthroughs in research translated to the clinic in 1954, when Murray and colleagues performed the first successful kidney transplant between monozygotic twins at the Peter Bent Brigham Hospital in Boston, Massachusetts. The success of this operation was partly due to the lack of immunosuppression .