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At least 253 records · Page 14Linked to original sources

Successful transfusion of Chido-positive blood to two patients with anti-Chido.

Two cases are described in this report in which patients with anti-Chido in the serum were transfused with Chido-positive blood. Since there was evidence of normal survival of the transfused red blood cells, these findings do not support a suggestion that patients with anti-Chido may require transfusion with Chido-negative blood. In spite of the apparently normal survival of the Chido-positive blood, a previous report in which it was shown that weakly Chido-positive blood can stimulate the production of anti-Chido was confirmed.

Aged↗

Unresectable squamous cell carcinoma of donor origin treated with immunosuppression withdrawal and liver retransplantation.

Posttransplantation allograft malignancy of donor origin is a rare complication after liver transplantation. In the case described, subjective fevers and nonspecific abdominal complaints nearly 6 months following cadaveric liver transplantation in a young woman prompted an evaluation which was remarkable for a large central liver mass. A poorly differentiated squamous cell carcinoma was diagnosed, but was unresectable at exploration. The tumor was confined to the liver. Histocompatibility testing using polymerase chain reaction (PCR) amplification techniques identified both donor and recipient HLA alleles. The patient was treated with chemoembolization, systemic chemotherapy and cessation of immunosuppression. Repeat biopsy 2 months later showed the tumor to be completely necrotic. With decompensated liver disease, she was relisted and retransplanted. More than 2 years later she remains disease-free with complete pathological remission. This is the only reported case of squamous cell carcinoma of donor origin arising in a transplanted liver.

Adult↗

Successful hematopoietic reconstitution with transplantation of erythrocyte-depleted allogeneic human umbilical cord blood cells in a child with leukemia.

Cord blood, a potent source of hematopoietic stem cells, has been shown to successfully reconstitute hematopoiesis following allogeneic transplantation in a variety of disorders. A major drawback of cord blood has been the risk of transfusion reactions in ABO blood group incompatibility and drastic reduction in the stem cell pool if the cord blood is manipulated to remove red cells prior to cryopreservation or after thawing. This report describes an erythrocyte depletion method employing 3% gelatin-induced erythrocyte sedimentation for the selective removal of red cells from cord blood. The red cell-depleted fraction was shown to be enriched in progenitor cells and in cells secreting hematopoietic cytokines interleukin 3, granulocyte/macrophage colony-stimulating factor, and interleukin 6; a major source for cytokines was from cord T cells. This preparative technique was employed to separate out red cells from cord blood of an infant delivered by cesarean section who had an 8-year-old sibling with leukemia. Histocompatibility testing of cord cells revealed complete matching with the patient. A cord cell transplant of cryopreserved and thawed cells consisting of 4 x 10(7) nucleated cells per kg was administered to the patient following myeloablative chemotherapy. The patient's quick hematologic recovery and 9-month disease-free period to date suggest that 3% gelatin separation of erythrocytes is a simple method that can be successfully used for transplanting cord cells for malignant/nonmalignant diseases.

ABO Blood-Group System↗

The use of skin from a monozygotic twin combined with cultured epithelial autografts as coverage for a large surface area burn: a case report and review of the literature.

Definitive closure of a large burn may be a formidable task requiring a variety of techniques for success. This case report illustrates use of skin from a monozygotic twin to accomplish this goal. A 35-year-old woman ignited herself with gasoline after a domestic quarrel, which produced a burn involving 65% of her body surface area, predominantly full thickness in depth and associated with inhalation injury. After resuscitation, the patient underwent multiple burn excision procedures that used allograft coverage. Histocompatibility testing confirmed that use of her twin sister's skin was a viable strategy for burn wound closure, and ultimately, with use of this technique, the patient's anterior torso was covered. Her abdomen and anterior thighs were covered with cultured epithelial autografts, and her face and arms were autografted with the patient's donor sites. She was discharged on the one hundred sixth postburn day to a rehabilitation center. This is the fourteenth reported case of burn wound grafting with use of skin from an identical twin, and the first in which it was combined with cultured epithelial autografts. There were no adverse consequences of this procedure either for the patient or her donor twin.

Adult↗

A heterophile system in human renal transplantation. IV. Natural immunity and its genetic implications.

Natural heterophile immunity was studied in 949 individuals including 41 recipients and donors of renal transplants and 141 families. The prevalence and strength of the natural immunity was at its maximum during the first two decades of life and declined thereafter. The population could be divided into three groups: one with natural immunity to heterophile transplantation antigens (HT-A), one with a heterophile immunity which was not (anti-HT-A) (i.e., anti-HX-A), and one group which had no heterophile immunity. Transplantation among these groups yielded results which along with family studies and mathematical considerations suggest that the HT-A system is controlled by a single genetic locus comprised of one dominant and one recessive allele.

Absorption↗

The effect of donor blood on renal allograft survival in DL-A tissue typed beagle littermates.

A single transfusion of 200 ml of donor blood 14 days before renal transplantation in prospectively DL-A tissue typed beagle littermates appeared to have an effect on graft survival. Seventeen per cent of the recipients did respond to the transfusion with formation of lymphocytotoxic and haemagglutinating antibodies. These "responder dogs" rejected kidney grafts in an accelerated way, compared with the "nonresponders" and with the nontreated control dogs. Responsiveness appeared to occur in pairs of littermates, which suggests that responding potency is genetically determined. There was histological evidence of acute arteritis in the renal grafts of responders, whereas cell-mediated rejection was noted in nonresponders.

Animals↗

HLA-DR, DQ, and/or DP genotypic mismatches between recipient-donor pairs in unrelated bone marrow transplantation and transplant clinical outcome.

Sixteen recipient-donor pairs who underwent unrelated BMT were analyzed for their HLA-class II identity by DNA-RFLP, in order to evaluate the importance of the genotypic HLA-DR, DQ, DP identity in the clinical outcome of unrelated bone marrow transplantation. From our study, a clear correlation between the HLA-DR, DQ, and DP genetic identity and acute GVHD (aGVHD) is not obvious since the number of studied cases is still limited. Nevertheless, it seems that the genetic identity influence the clinical outcome and patient survival. Six patients out of the ten who experienced severe aGVHD (greater than grade II) differed from their respective donors by HLA-DP mismatch in the GVH direction. Two patients rejected their grafts, and both presented HLA-DP incompatibilities in both GVH and HVG directions. Hence, HLA-DP may function as a transplantation antigen like the other HLA-class II molecules (DR, DQ) in unrelated BMT. Accordingly, we propose considering it in the pretransplantation histocompatibility testing. Nevertheless, further studies with larger numbers of cases should be done in order to confirm the role of HLA-DP. No correlation was observed between the mixed lymphocyte reaction (MLR) reactivity and the incidence of aGVHD. Accordingly, MLR response seems to be an incomplete indicator of GVHD, and a functional test is still to be found.

Bone Marrow Transplantation↗

Chronic renal allograft loss.

The phenomenon of late renal allograft loss accounts for 80% of the patients listed as returning to end-stage renal disease after kidney transplantation. This recidivism problem, which is seen as an inexorable decline in actuarial graft survival following the first year after transplantation, has a number of causes. There is good evidence that both immunologic and nonimmunologic factors are important in late graft loss. Newer DNA-based methods for histocompatibility testing permit more accurate assessment of risk for ultimate graft survival. Nonimmunologic risk factors for chronic graft dysfunction and failure may include donor kidney size that is inadequate for the demands made be the recipient. Distinction should be made between the phenomenon of late acute graft loss due to noncompliance and true chronic renal transplant failure. Patient death is a significant confounding variable, which substantially changes interpretation of chronic graft loss associated with conditions that increase patient morbidity and mortality. Prospective multivariant studies of risk factors and intervention strategies for chronic allograft are in order.

Chronic Disease↗

Gastrointestinal manifestations of graft-versus-host disease: diagnosis and management.

The number of bone marrow transplantations performed to treat diseases such as leukemia, lymphoma, and aplastic anemia has been increasing during the past 2 decades. Improvements in histocompatibility testing, transfusion support, conditioning regimens, and antibiotics have dramatically improved survival after transplantation. As more patients survive the acute phase of bone marrow transplantation and leave major medical centers for their homes, healthcare providers across the country are caring for these patients and their transplantation-associated complications. Graft-versus-host disease (GVHD) of the skin, liver, and gastrointestinal tract are complications that patients may experience months after transplantation. As clinicians, advanced practice nurses encounter these patients in clinics, hospitals, and intensive care units, whether it be for specific GVHD-associated problems or other health conditions. This article reviews the current standards of care for the prevention, diagnosis, and treatment of GVHD of the gastrointestinal tract.

Bone Marrow Transplantation↗