The use of light to prevent the rejection of transplanted hearts, the compatibility of kidney transplants from sibling donors, and outcomes involving placental-blood transplants from unrelated donors were the topics of recent studies published in The New England Journal of Medicine.
In a study of 205 patients who received kidney transplants from sibling donors with whom they were mismatched for one HLA haplotype, graft survival was higher five years and ten years after transplantation when the donors had maternal HLA antigens not inherited by the recipient than when the donors had paternal HLA antigens not inherited by the recipient. William J. Burlingham, PhD, of the University of Wisconsin and colleagues wrote that their finding "has immediate implications for the selection of a living kidney donor in cases in which only HLA-non-identical siblings are available" (1998;339:1657-1664).
In a pilot study of 60 recipients of heart transplants randomly assigned to received standard three-drug immunosuppressive therapy with or without photopheresis, the addition of photopheresis significantly decreased the risk of cardiac rejection without increasing the incidence of infection. About 82% and 52% of patients receiving photopheresis or standard therapy alone, respectively, had experienced either no or one rejection episode at six months of follow-up, Mark L. Barr, MD, of the University of Southern California and colleagues reported (1998;339:1744-1751).
Pablo Rubinstein, MD, of the New York Blood Center and coauthors found that placental-blood transplantations from unrelated donors "regularly engraft, cause GVHD [graft-versus-host disease] at a relatively low rate, and produce survival rates similar to those with transplantation of bone marrow from unrelated donors." The study was sponsored by the National Heart, Lung, and Blood Institute and was conducted at 98 transplant centers on 562 patients who had cord blood transplants since August 1992. The authors said their data represent "most of the placental-blood transplantations from unrelated donors performed in the world thus far" (1998;339:1565-1577).
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