移植免疫进展全解.ppt

Immunosuppresive Therapy Immunosuppresive Therapy Downsides Must be maintained for life Toxicity Susceptibility to infections Susceptibility to tumors （四）诱导免疫耐受 建立中枢嵌合体 移植前输血 胸腺内注射供者抗原 阻断共刺激信号 移植物的预处理 免疫隔离 Blood transfusion and graft survival 阻断共刺激信号 Removal of T cells from marrow graft Magnet Magnetic antibodies 移植存在的问题 排斥反应 移植物短缺 原发疾病对移植物的损坏 免疫抑制手段的副作用 花费高昂 Hoops for Xenotransplantation +PERVs * Common manifestations of GVH reaction are diarrhea, erythema, weight loss, malaise, fever, joint pains, etc. and ultimately death. * PROCEDURES TO ENHANCE GRAFT SURVIVAL In clinical practice, the most successful transplantation programs have been with kidneys and corneas. However, other organs are being transplanted with increasing frequency. The success in these programs has been due to a better understanding of immunological mechanisms, definition of MHC antigens and development of more effective immunosuppressive agents. Donor selection: Based on extensive experiences with renal transplants certain guidelines can be followed in donor selection and recipient preparation for most organ transplants. The most important in donor selection is the MHC identity with the recipient; an identical twin is the ideal donor. Grafts from HLA-matched sibling have 95?100% chance of success. One haplotype?identical parent or sibling must match at HLA D region, and hence have low MLR reactivity. Two haplotype-distinct donor with low MLR is next suitable candidate. Nonetheless, organ from two or one DR matched cadaver has been used with some success. In every case, an ABO compatibility and screening for absence of donor-specific anti-HLA antibodies is essential. * Recipient preparation: The recipient must be infection free and must not be hypertensive. One to five blood transfusion of 100?200 ml whole blood from the donor at 1?2 week intervals often improves the graft survival. * Strategies for bone marrow transplantation: In bone marrow transplantation, the m