Immunologic tolerance to renal allografts after bone marrow transplants from the same donors

Article Abstract:

In recent years, organ transplants have become more common due to increased understanding of the immune system and how rejection of transplanted organs can be prevented. In some cases of leukemia, a patient's cancerous bone marrow is entirely destroyed, and the patient receives transplanted bone marrow from a genetically similar donor. Because the bone marrow is the source of the white blood cells that are responsible for the immune response of rejection, the recipient, whose bone marrow is destroyed can often tolerate the transplant. Of greater danger is the possibility that the donor's bone marrow will fail to 'recognize' the recipient's tissue and mount an immune response to its host. This is known as graft-versus-host disease. With increased survival of bone marrow transplant recipients, unanticipated late complications are surfacing, along with unique means of treating them. Two cases are described of leukemia patients who had received successful bone marrow transplants from a relative. Several years later, both patients developed kidney failure. Each then underwent kidney transplant, with a kidney from the same relative who donated the bone marrow. Because the transplant recipients were living with their relatives' bone marrow, the bone marrow 'recognized' the transplanted kidney, and no medication was required to prevent rejection. One of the recipients developed a mild case of graft-versus-host disease, which resolved spontaneously. One to two years after their kidney transplants, both patients were doing well, with no evidence of rejection of the kidneys. This phenomenon is described as immunologic tolerance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Complications and side effects, Prednisone, Immunological tolerance, Immunologic tolerance, Acute leukemia

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High-dose weekly intravenous immunoglobulin to prevent infections in patients undergoing autologous bone marrow transplantation or severe myelosuppressive therapy: a study of the American Bone Marrow Transplant Group

Article Abstract:

Intravenous immunoglobulin (IVIG) may not improve the survival rate of patients undergoing autologous bone marrow transplants. Of 170 patients who underwent autologous bone marrow transplants or therapy to inhibit the production of blood cells in their bone marrow, 82 were treated with 500 milligrams of IVIG per kilogram every week and 88 were not. The two groups had similar incidences of infections. The IVIG-treated group had a survival rate of 86.6% while the control group had a survival rate of 96.6%. The higher death rate in the group that received IVIG was caused by adverse effects of the treatment. Bone marrow transplants are often used to treat patients with acute leukemia and other cancers. IVIG is often used after bone marrow transplant to reduce the development of graft-versus-host disease, and it often reduces infection as well. However, it does not seem to be as effective in patients who receive their own (autologous) bone marrow.

Health aspects, Infection, Prevention, Immunoglobulins

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Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines

Article Abstract:

The survival rate may be on the rise for patients who need mechanical ventilation after receiving bone marrow transplants, and predictors of death among such patients could prevent wasting resources. Researchers compared 53 survivors of mechanical ventilation following bone marrow transplantation to 106 nonsurvivors to define predictors of death. Patients who experienced lung injury and either dropping blood pressure or liver and kidney failure died. Survival rates have increased from 5% to 16% in the last five years. Guidelines for discontinuing mechanical ventilation based on known predictors of death could save resources and costs.

Usage, Patient outcomes, Mortality, Organ transplant recipients, Life support systems (Critical care), Life support care

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