PubMed · 318781
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P A Gammelgaard. 1977. [Urology].. https://pubmed.ncbi.nlm.nih.gov/318781/
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The growing gap between organ demand and clinical availability has renewed interest in immune-evasive graft strategies, yet rejection and lifelong immunosuppression remain major barriers to durable success. Advances in genome editing enable immune-evasive cell platforms designed to avoid immune recognition while replacing missing function in allogeneic settings. This review summarizes current strategies for engineering immune-evasive grafts that simultaneously suppress adaptive and innate immune responses. We discuss how coordinated modulation of antigen presentation and immune checkpoint pathways can protect transplanted allogeneic cells and tissues from T, NK, and macrophage-mediated rejection. We also present the emerging concept of integrating hypoimmune engineering with genetically modified porcine donors, where extensive genome editing has reduced, but not eliminated, xenogeneic immune barriers. Combining donor genome modification with immune-evasive graft design represents a promising conceptual advance toward xenograft survival, though whether full elimination of systemic immunosuppression is achievable remains to be established clinically. We further examine how the regulatory landscape for these products is evolving across major jurisdictions, and how differences in approval pathways, manufacturing standards, and long-term surveillance requirements shape the path to clinical translation. Finally, we outline the safety considerations and remaining limitations in immune evasion that must be addressed to enable clinical implementation.
Two 5- and 17-days old neonates with hypoplastic left heart syndrome respectively underwent orthotopic heart transplantation. The donor-recipient weight ratio was +58 percent and +88 percent; ischemic time was 144 and 167 min. The immunosuppressive protocol included thymoglobulin during the induction period and a classical 3-drug therapy, with a rapid tapering off of prednisone over 3 weeks. No infectious complication was observed; each infant experimented one episode of acute rejection, successfully treated with prednisolone. Forty-three months and 10 months later, the 2 children are doing well, with normal renal function and normal growth. No late rejection episode was observed. Heart transplantation in neonates is feasible, the short-term and mid-term results are good. Despite important ethical problems, heart transplantation represents a great hope for neonates with inoperable congenital heart defects.
If ultrasound imaging and image-directed Doppler examination of the renal allograft is to provide information with respect to graft complications and graft failure, then a clear understanding of normal characteristics is required. Criteria for abnormality of a graft will include change in size, in parenchymal pattern, and in blood flow characteristics in the main and branch renal arteries and within the renal vein. Normal measurements for the renal allograft are presented as well as morphological and numerical data relating to cortico medullary differentiation. A wide range of values for indices quantifying Doppler data is recorded in the literature. Mean values and standard deviations from the mean are presented. The importance of different parameters as potential indicators of disease are stressed, but the limitations, usually as a result of normal variation and lack of specificity, are presented. The normal features of color-coded Doppler vascular supply, perfusion, and drainage are described.