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PubMed1999

Antifungal prophylaxis during the early postoperative period of lung transplantation. Valencia Lung Transplant Group.

INTRODUCTION: Fungal infections occur frequently in lung transplant patients, with the highest risk being in the early postoperative period (the initial hospitalization after lung transplantation). Aspergillus is responsible for more than half of all fungal infections, and Aspergillus has even been considered a contraindication for lung transplantation because of its difficult therapy and frequently fatal outcome. The aim of this article is to evaluate the success of an antifungal prophylaxis protocol to prevent fungal infection in the immediate postoperative period in lung transplant recipients. MATERIAL AND METHODS: From March 1994 to March 1997, we performed 52 lung transplants in 31 men and 21 women who received antifungal prophylaxis with fluconazole, 400 mg/d, and aerosolized amphotericin B, 0.6 mg/kg/d, during the postoperative period. RESULTS: The mean (+/- SD) postoperative period duration was 49 +/- 27.5 days. No fungal infections were observed during this period, and all patients provided negative cultures. We also found no toxicity related to antifungal drugs. The dose of cyclosporine was easily adjusted in every recipient according to blood levels so that effective immunosuppression was not compromised. DISCUSSION: In our study, the removal of the lungs and antifungal prophylaxis with fluconazole and aerosolized amphotericin B prevented fungal infection in the postoperative period in all 52 lung transplant recipients.

Adolescent↗
PubMed1989

Single lung transplantation for severe chronic obstructive pulmonary disease. Washington University Lung Transplant Group.

Single lung transplantation (SLT) has been considered physiologically inappropriate for patients with chronic obstructive pulmonary disease (COPD). It has been postulated that the high static compliance and elevated pulmonary vascular resistance of the native lung functioning in parallel with the more normal allografted lung could cause unacceptable ventilation-perfusion mismatching and/or overinflation of the native lung with encroachment on the expansion of the transplanted lung. While some degree of ventilation-perfusion imbalance may be physiologically obligatory after SLT for COPD, a significant disruption in gas exchange may not occur unless a complication, such as rejection or infection, arises in the transplanted lung. A 60-year-old man with COPD who underwent successful SLT is presented and discussed. In spite of scintigraphic evidence of ventilation-perfusion mismatching between the native lung and the allograft during the first six postoperative weeks, the recipient had normal resting gas exchange on room air after the second postoperative week. Fourteen weeks after transplantation, his maximum oxygen uptake was 37.3 percent of the predicted maximal value, and no evidence of ventilatory limitation was detected. His functional status and lifestyle have been markedly improved by SLT. The role of SLT for COPD should be reconsidered. It may be a reasonable transplantation alternative for selected patients with COPD who are not candidates for double lung transplantation (DLT).

Exercise↗
PubMed1997

A randomized study comparing three cyclosporine-based regimens in cadaveric renal transplantation. Italian Multicentre Study Group for Renal Transplantation (SIMTRe).

Whether it is better to treat renal transplant patients with cyclosporine alone, combined with steroids, or combined with steroids and azathioprine is still unclear. After initial therapy with cyclosporine and steroids, 354 cadaver renal transplant recipients were randomly assigned at the post-transplant day 5 to cyclosporine alone (monotherapy), cyclosporine plus steroids (double therapy), or cyclosporine plus steroids plus azathioprine (triple therapy). Monotherapy patients, after a second acute rejection, were switched to either of the two alternative therapies. According to intention-to-treat (ITT) analysis, the 4-year patient survival was 97% in monotherapy, 91% in double therapy, and 96% in triple therapy; the graft survival including death was 84%, 77%, and 88%, respectively; and the pure graft survival was 87%, 85% and 91%, respectively (P = not significant). Acute rejections were diagnosed in 79 patients in monotherapy, 58 in double therapy, and 59 in triple therapy (P < 0.01). Of the patients on monotherapy, 52% were switched to double or triple therapy. In these patients, the 4-year graft survival including death was 68%, and the pure graft survival was 72%, in comparison with 93% and 94%, respectively, for patients who continued on cyclosporine alone. Patients with renal polycystic disease as a cause of renal failure and with low plasma creatinine at the time of randomization (5 days after transplant) had a higher probability of remaining on monotherapy, wherease those with glomerulonephritis or systemic lupus erythematosus (SLE) and with high plasma creatinine levels at randomization had a higher probability of being switched to double or triple therapy. According to ITT analysis, there were fewer ocular (P < 0.0001), osteomuscular (P < 0.002) and cardiovascular complications (P = 0.05) and fewer patients with hypercholesterolemia (P < 0.0028) in the monotherapy group, with no difference between double and triple therapy. Creatinine clearance at 3 years was lower in monotherapy, but no attrition of renal function was seen over the years in any of the groups. Cyclosporine, however used, provided good results in cadaveric renal transplantation. Triple therapy and monotherapy offered a nonsignificantly better patient and graft survival than double therapy. Patients on monotherapy had a higher risk of acute rejection but had fewer adverse events than those on double or triple therapy. Patients maintained on cyclosporine alone had the best graft survival, whereas those who were assigned to monotherapy and had to add steroids because of multiple rejections had the worst outcome. Therefore, it seems reasonable to limit the choice of monotherapy to patients without immune-mediated renal diseases and with good graft function in the early post-transplant period.

Adolescent↗
PubMed2004

Does variant hepatic artery anatomy in a liver transplant recipient increase the risk of hepatic artery complications after transplantation?

OBJECTIVE: Our aim was to determine whether variant hepatic artery anatomy in a liver transplant recipient increases the risk of hepatic artery complications after liver transplantation. MATERIALS AND METHODS: The study group consisted of 84 patients who underwent gadolinium-enhanced 3D MR angiography before orthotopic liver transplantation in which a branch patch arterial anastomosis at the gastroduodenal takeoff was used. MR angiography studies were retrospectively reviewed and assessed for the presence and type of variant hepatic artery anatomy. The diameter of the distal common hepatic artery was measured. The incidence of posttransplantation hepatic artery stenosis or thrombosis was assessed. RESULTS: Seven (8.3%) of the 84 patients developed hepatic artery complications after transplantation. Of the 24 patients with variant hepatic artery anatomy, five (20.8%) had posttransplantation/ hepatic artery complications. In contrast, only two (3.3%) of the 60 patients with classic hepatic artery anatomy had complications. The higher complication rate in patients with variant hepatic artery anatomy was statistically significant (p < 0.05). The odds ratio was 7.6 (95% confidence interval, 1.4-42.6). The diameter of the distal common hepatic artery was smaller in patients with variant hepatic artery anatomy compared with those with classic hepatic artery anatomy (range, 4.3-7.1 mm [mean, 5.8 mm] vs 4.0-8.9 mm [mean 6.3 mm], p < 0.05), and it was also smaller in patients who had posttransplantation hepatic artery complications compared with those who had no complications (range, 4.2-6.3 mm [mean, 5.2 mm] vs 4.0-8.9 mm, [mean, 6.2 mm], p < 0.01). CONCLUSION: Variant hepatic artery anatomy in a liver transplant recipient increased the risk of hepatic artery complications after transplantation. The smaller caliber of the native common hepatic artery may contribute to the higher risk.

Adolescent↗
PubMed1990

Survival after liver transplantation of patients with primary biliary cirrhosis in the Nordic countries. Comparison with expected survival in another series of transplantations and in an international trial of medical treatment.

Until December 1988, 38 patients with primary biliary cirrhosis (PBC) had been transplanted in the Nordic countries. The observed survival probability in accordance with Kaplan-Meier analysis was around 75% 2-3 months after surgery, with few deaths during the next 3 years. The observed survival curve was compared with the expected survival calculated from the experience of a recent English PBC transplant series; the patterns are very similar. Secondly, the observed survival was compared with the expected survival curve, calculated from the survival experience of an international trial of medical treatment--that is, the expected survival had the patients not been transplanted; after the first 2-3 months the observed survival stayed better than the expected survival. Finally, the merits of transplantation for each particular patient was evaluated by means of the ratio of probability of survival when transplanted to probability of survival when medically treated 3, 6, and 8 months after surgery. The ratio increased with time, indicating a relative increase in the benefit of transplantation with time after surgery.

Denmark↗
PubMed1999

[Pathology of heart transplantation.(Morphological study of 1246 endomyocardial biopsies from 167 transplanted hearts). Causes of early, intermediate, and late deaths].

From January 1988 through October 1997, 167 cardiac transplants were performed. 1246 endomyocardial biopsies (EMBs) from 138 cardiac allograft recipients were investigated and graded according to the Working Formulation (WF) criteria. The specimens were inadequate in 44 EMBs (3.5%), while 598 (48%) showed no rejection. The grade of rejection was: mild (grade 1A and 1B) in 531 EMBs (42.6%), mild/moderate (grade 2) in 38 (3.1%), and moderate (grade 3A and 3B) in 35 (2.8%). The indications for transplantation were: dilated cardiomyopathy (46.1%); ischemic disease (37.1%); valvular disease (12%); hypertrophic cardiomyopathy (1.8%); myocarditis (1.2%); congenital cardiopathy (0.6%), restrictive cardiomyopathy (0.6%) and chronic rejection (0.6%). The most reliable histologic feature of acute rejection was the myocyte necrosis or damage in presence of pironinophilic mononuclear cell infiltrate, so our protocol requires multifocal or diffuse myocyte damage (rejection grade 3A and 3B) to perform an additional treatment, which was required in 35 cases (2.8%). An intermediate grade mild/moderate 2, was introduced from the WF to classify the EMBs in which the myocyte necrosis was scant or not clear; this grade in our series generally resolves without any additional treatment; in order to monitor the rejection another EMB was performed 5 days after in these patients. The EMBs showed also the following lesions other than acute rejection: Quilty A (79 patients; 57.25%), Quilty B (24 pts; 17.39%), early ischemic necrosis (43 pts; 31.15%) and late ischemic necrosis (5 pz; 3.62%). Quilty B and late ischemic necrosis were correlated with acute rejection (grade 2), furthermore the patients with graft vascular disease showed 3 or more episodes of acute rejection. These findings confirm the relationship between acute and chronic rejection. Furthermore, a relationship between chronic rejection (4 pts) and infection from hepatitis C (antibodies positive 3 pts/4) and cytomegalovirus (antibodies positive 4 pts/4) was found in our series. In the follow-up period (117 months), a 30.72% death rate was recorded; the main causes of death were: early failure of the transplanted heart (30 pts) in 4 of them associated with pulmonary hypertension, infections (6 pts), sudden death (4 pts), graft's vasculopathy (4 pts), acute pancreatitis (1 pts) pulmonary embolism (1 pts), lung (1 pts) and ovary (1 pts) carcinoma, acute rejection (1 pts), others (2 pts). In the early period (< 1 month), the most frequent cause of death was the early failure of the transplanted heart, while in the late period (> 1 year) the chronic rejection following by sudden death and tumours. The actuarial survival curve drops to 83.13% after the first post-operative month, abates to 75.30 at the end of the first year, and progressively decreases to 70.48% at the end of the fifth follow-up year. The mortality rate was 38.7% in pts transplanted for ischemic disease and 24.7% for dilated cardiomyopathy. Cardioplegia seems to play an important role in the success of the heart transplant.

Actuarial Analysis↗
PubMed1999

[Infectious complications of heart transplantation. A prospective study for the first 6 years of a transplantation program].

OBJECTIVE: To study the infectious complications, mortality, and associated factors in heart transplant recipients. METHODS: Prospective study of the first 69 heart transplantations performed from January 1991 until December 1996 in a university hospital. Description of clinical features of infectious complications during the first year after transplantation. Univariate and multivariate analyses of the risk factors associated with mortality and development of infectious complications. RESULTS: Seventy-three percent of patients had at least one infectious complication; the incidence was 1.13 episodes per patient-year. The etiology of complications was bacterial (50%), viral (31%), Pneumocystis carinii (5%), fungal (4%), and protozoal (4%). The opportunist organisms accounted for 42% of cases. Pneumonia was the most common complication (28%), followed by mucocutaneous herpetic reactivation (19%), bacteremia (13%), urinary tract infection (13%), cytomegalovirus disease (11.5%), pleural empyema (5%) and surgical wound infection (5%). Nosocomial pneumonia accounted for 50% of cases. Gram-negative rods accounted for 41% of pneumonia cases. A total of 62.5% of deaths were directly related to infectious complications. Factors independently associated with mortality were hospital origin at transplantation (RR = 4.5 [2-9], p = 0.034), development of infectious complications in the post-heart transplantation period (RR = 3.2 [1.2-12], p = 0.04) and a more prolonged hospital stay at ICU (p = 0.0004). The factor which was independently associated with the development of infectious complications was one or more severe episodes of acute rejection (RR = 1.5 [1.1-2.2], p = 0.04). Patients who developed infectious complications had a more prolonged accumulated annual hospital stay (p = 0.004) than those without infectious complications. CONCLUSIONS: Infectious complications are very common, prolong hospital stay, and are the first cause of mortality during the first year after transplantation. Bacteria are the most common etiology and pneumonia is the most common infection.

Adolescent↗
PubMedDate not supplied

[Neural transplants en Parkinson disease: clinical results of 10 years of experience. Group of Neural Transplants of the CPH].

INTRODUCTION: At the end of the 1970s people considered the possibility that transplants might be useful to replace degenerate specific cell populations, such as the mesencephalic dopaminergic neurones in Parkinson's disease (PD). Since then this has become an experimental alternative treatment for patients with degenerative diseases. The history of transplants of catecholamine producing tissues within the brain of patients with PD started in 1985, when Backlund et al published the results of the first implants of autologous adrenal medulla in two patients with Parkinsonism. Since then, many patients throughout the world have benefited from the results obtained using this method. Two main types of tissue have been used in this method: autologous adrenal medulla and human foetal ventral mesencephalic tissue. DEVELOPMENT: In this paper we first review the clinical effects of the diverse types of transplant done to date. Then in the second part we give a summary of the clinical results obtained by our group with the different types of transplant carried out. We explain their evolution, original hypothesis and justify the reasons which led us to use three different types of donor material: autologous adrenal medulla, fetal tissue and adrenal medulla co-incubated with peripheral nerve. Then, after showing that the clinical improvement is different depending on the type of tissue transplanted, we comment on the probable reason for the improvement seen in patients with implants. CONCLUSION: The transplantation of nervous tissue seems to us to be no longer an experimental alternative for the treatment of PD but has become an effective, lasting treatment for patients with Parkinson's disease.

Adrenal Medulla↗
PubMed2002

[Treatment of severe caustic injuries of the anterior segment of the eye with limbal stem cell transplantation, penetrating keratoplasty and amnionic membrane transplantation].

The concept of limbal stem cells (LSC) opened new possibilities for the treatment of severe caustic damage of the anterior segment. These possibilities include transplantation of LSC, perforating keratoplasty, possibly transplantation of the amniotic membrane. In three patients with severe caustic damage of the anterior segment of the eye the authors implemented transplantation of LSC, perforating keratoplasty and in one patient also transplantation of the amniotic membrane. Where only one eye was damaged LSC for transplantation were obtained from the sound eye (autotransplantation, in case of damage of both eyes LSC were obtained in one case from a close relative in the second case from a cadaverous eye from a corneal bank (Allotransplantation). In the patient with autotransplantation of LSC, perforating keratoplasty and transplantation of the amniotic membrane the result was very good. The corneal disc remained clear 1.5 years after operation, the conjunctival sac was free from synbleropharons and vision improved from movement of the hand to 0.5. In the two patients with allotransplantation of LCS and perforating keratoplasty, LCS did not become incorporated despite immunosuppressive treatment and the corneal disc became turbid. Restored activity of LCS in severe caustic damage of the anterior segment opened new therapeutic opportunities.

Amnion↗
PubMed2001

Report from the national transplantation pregnancy registry (NTPR): outcomes of pregnancy after transplantation.

The NTPR continues to analyze the safety of pregnancy in female transplant recipients as well as outcomes of pregnancies fathered by male transplant recipients. With regard to female recipients, pregnancy does not appear to adversely affect graft function, when the function of the transplanted graft is stable prior to pregnancy. A small percentage of recipients with each transplanted organ develops rejection, graft dysfunction or graft loss. These events may occur in recipients with pre-pregnancy graft dysfunction or on occasion, occur unpredictably. Female cyclosporine-treated kidney recipients with both shorter and longer intervals from transplant to conception have been analyzed, with favorable outcomes noted. It appears sensible to continue to advise recipients to wait one to 2 years after transplant to allow for stable graft function as well as stabilization of immunosuppressive medications. However, given that favorable outcomes can occur with either shorter or longer intervals, these recipients need to be counseled and followed on a case-by-case basis. Newer agents and more potent regimens are under continued surveillance. Two cases with structural malformations have been noted in female recipient offspring with exposure to MMF during pregnancy. Data remain limited and are insufficient to determine a specific malformation incidence. The risk of graft rejection as well as graft dysfunction must be weighed against the risk of potential teratogenicity when maintaining female recipients on MMF during pregnancy. For male recipients maintained on MMF, there have been no patterns of problems noted in their offspring. The structural malformation incidence in newborn of cyclosporine-treated recipients is in the range expected for the general population without any specific predominance of malformations. It remains to be seen whether or not any specific pattern of problems will become apparent in the newborn with newer regimens. Controversy surrounding breastfeeding continues, although it has become an option that some recipients choose to consider. Data have accrued in liver, heart, pancreas-kidney and lung recipients. Among lung recipients, there appears to be poorer maternal survival postpartum, which may be related to pregnancy or may be inherent in this population. Continued entries to the registry, especially in light of newer combinations of immunosuppressive agents, should help to provide the guidelines for management. All centers are encouraged to participate.

Child, Preschool↗
PubMedDate not supplied

[Malignant neoplasia and kidney transplantation. Retrospective analysis of data on the population having kidney transplantation with de novo neoplasia in the setting of the AIRT].

BACKGROUND: In transplanted patients undergoing immunossuppressive therapy the incidence of malignant neoplasia is 3-4 times higher than in the general population. Aim of the present study was to evaluate the prevalence of different tumours and the links between modulation of immunosuppressive therapy and patient and graft survival. PATIENTS: We evaluated 2029 kidney-transplanted patients from four Transplant Centres (Bari, Bologna, Modena, Novara) belonging to the Associazione InterRegionale Trapianti (AIRT). RESULTS: The incidence of neoplastic disease after transplantation was 3.9% in our population with a median time between transplantation and clinical onset of 23 months. We demonstrated a significant difference in the geographical distribution of different tumours. We did not observe any correlation with specific immunosuppressive drugs. Finally, dramatic reduction of the immunosuppression levels did not modify either the patients' or the graft's survival. CONCLUSIONS: Several factors can influence the post-transplant onset of neoplastic diseases with immunosuppressive therapy playing a pivotal role. The implementation of a National Registry would be the first step in an attempt to optimise immunosuppression in this particular group of patient's.

Humans↗
PubMed2000

[Transplantation of the heart--indications, complications, therapy--our experience from investigations of 100 patients after cardiac transplantation].

Transplantation of the heart has become an accepted method for the treatment of terminal cardiac failure. Despite obvious advances in the care of patients after trasplantation a number of problems exist. The authors summarize their experience with the long-term follow-up of 100 adult patients with transplantations made in the Brno Centre of Cardiovascular and Transplantation Surgery. One-year survival in the group of patients is 80%, three-year survival 69%. The authors discuss indications and contraindications of cardiac transplantations, necessary preoperative and postoperative examinations, they follow-up the most serious complications during the posttransplantation period. They mention therapeutic possibilities and outline briefly the perspectives of care of patients after cardiac transplantation. Despite the number of problems encountered transplantation of the heart is for indicated patients with cardiac failure a unique chance to improve the prognosis of survival and the quality of life.

Adult↗
PubMed2005

[Establishment of rat model of transplantation of kidney containing adrenal implants and its protective effects on the transplanted kidney].

OBJECTIVE: To establish a rat model of transplantation of kidney containing adrenal implants and to explore the protective effects of the adrenal implants on the transplanted kidney. METHODS: Fragments of adrenal cortex of the left adrenal gland were obtained and implanted into the left kidneys of the same would-be donor rats. Twenty-four Lewis rats were transplanted with the left kidneys containing adrenal gland implants of SD rats (Group I), and another Lewis rats were transplanted with the unprepared left kidneys of 24 SD rats (Group II). Seven days after the implantation the right kidneys of the recipient rats were resected. No immunosuppressant was used. The survival time was observed. Blood samples were collected at different time points to examine the serum corticosterone, creatinine, and urea nitrogen. Light microscopy was used to observe the morphology of the implanted kidneys and the adrenal implants. RESULTS: Histological examination showed that the adrenal gland implants survived well with good blood supply. Seven days after the resection of the right kidneys microscopy showed atrophy of the adrenal implants. There were no significant differences in serum corticosterone, creatinine, and urea nitrogen between the levels before and 7 days after transplantation and between the 2 groups. The survival time of Group I was 10.2 d +/- 2.2 d, significantly longer than that of Group II (7 d +/- 2 d, P < 0.05). CONCLUSION: Adrenal implants that survive and recover their endocrinal function have protective effect on the transplanted kidney in early period.

Adrenal Glands↗
PubMed2006

[Kidney transplantation: prevention and treatment for bone loss after transplantation].

Despite the ability of renal transplantation to restore many of the excretory metabolic and hormonal abnormalities of chronic renal failure and dialysis implicated in the development of renal osteodystrophy, osteoporosis remains a frequent and serious complication affecting renal transplant recipients. Short-term studies of bone loss following renal transplantation have indicated rapid bone loss within the first 12 months after transplantation. Cross-sectional data suggest that beyond 3 years after transplantation, the bone mineral density does not change or may increase slightly, but remains less than normal population of reference values. In renal transplant patients, in addition to known risk factors for bone loss in healthy populations, other abnormalities could negatively affected the bone metabolism, including the pretransplant renal osteodystrophy, persistent hyperparathyroidism and use of immunosuppressive drugs. Osteoporosis that is induced by steroid administration is an inevitable side effect and develops more frequently in the elderly recipients. Vitamin D analogues and calcium have beneficial effects in the prevention of glucocorticoid-induced bone loss. Bisphosphonate, which inhibit bone resorption, have been shown in many studies.

Bone Density↗
PubMed1991

The evolution of single lung transplantation for emphysema. The Washington University Lung Transplant Group.

Classic transplantation dogma mandated bilateral lung replacement for lung transplant candidates with end-stage emphysema to avoid air trapping in the native lung and subsequent crowding of the newly transplanted lung. During a recent 12-month period 11 patients with emphysema received a single lung transplant. There was no hospital mortality and only one patient had any notable degree of air trapping in the native lung. Substantial improvement in pulmonary function was seen as early as 2 weeks after transplantation, with significant functional improvement seen by 6 weeks, despite some residual ventilation-perfusion mismatch. We have demonstrated the utility and safety of single lung transplantation for patients with end-stage emphysema, and it is our operation of choice in recipients more than 50 years of age.

Exercise Test↗
PubMed1991

[Noninvasive monitoring of rejection in heart transplant patients. An overview of current status and use at a small transplant center].

In view of the numerous techniques known for noninvasive rejection monitoring for heart transplant recipients, it is important, especially for small transplant centres, to select suitable parameters for routine monitoring. We verified the methods for rejection monitoring and on the basis of the good results after orthotopic heart transplantation in our unit (33 patients, 78% overall survival, no death later than 6 months after transplantation), consider the following parameters useful for small transplant centres: heart/thorax ratio, echocardiography and neopterin. The Fast-Fourier analysis should prove of great value for small transplant units, given the availability of suitable apparatuses.

Biopsy↗
PubMed1990

[Allogenic transplantation of bone marrow in hematologic diseases. Preparation and completion of transplantation at the Hematology Clinic in Novi Sad].

The paper deals with the results of clinical preparations for the application of allogenic bone marrow transplantation at the Clinic of Hematology in Novi Sad. The obligation of the definite treatment of patients below 45 years by allogenic and autologous bone marrow transplantation results from the acceptance of the Yugoslav protocols for acute leukaemia treatment. Thus immunogenotypical analyses, so far performed in patients with severe aplastic anaemia have been extended to patients with acute leukaemia as well and then to patients with chronic myelogenous leukaemia, high risk lymphocYtic lymphoma and myeloma multiplex with resistance to standard chemotherapy and their potential sibling donors. The bone marrow transplantation Unit has been set up, the team of specialists has been formed and educated and the protocol for allogenic transplantation with Busulfan and cyclophosphamide combination for pretransplant conditioning has been adopted. In research work concerning the field of bone marrow transplantation a particular emphasis has been put on the working out of a mathematical model for optimal timing of bone marrow transplantation in patients with acute myelogenous leukaemia.

Adult↗
PubMed1990

[Transplantation of embryonal cerebral cortex to the adult rat cerebellum: the fiber connections made by cortical transplants and the cerebellum].

Fifteen-day-old embryonic neocortical tissue was transplanted into the mature cerebella of normal adult rats (Fischer 344) heterotopically. After 5-8 months, WGA-HRP was injected into the host inferior olivary nucleus, pontine raphe, pontine nuclei, and neocortical transplants, 0.3 microliter, 0.2 microliter and 0.05 microliter respectively. The animals were sacrificed 48 hours later, and the HRP positive neuron and nerve fibers were examined in the transplants and host brain stem. Other animals were sacrificed for anti-dopamine-beta-hydroxylase immunohistochemical study and electron microscopic observation. Anterograde and retrograde tracing methods with the HRP method revealed on the light microscopic level that the transplants had received afferents from the host's locus coeruleus, and the inferior olivary nucleus. In one case, HRP injected into the host inferior olive was almost limited within the inferior olivary nucleus. Therefore, HRP-labelled fibers in the cerebellum were thought to be climbing fibers. The climbing fibers from the host inferior olivary nucleus entered the transplant from the host cerebellar medullary layers and branched in the transplant. The fiber ingrowth was limited within 300-500 microns for the distance. In another case, HRP injected into the inferior olive extended to the lateral reticular and the pontine nuclei. HRP labelled fibers entered the graft from the host medullary layers and many granular patterns like axon terminals were observed in the graft. In cases, in which HRP was injected into the pontine raphe and pontine nuclei, HRP labelled fibers did not grow into the graft. Retrograde tracing method with HRP injected into the graft showed labelled neurons in the host locus coeruleus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic Fibers↗