OJCIUS, D. M.; DELABRE, C.; KOURILSKY, P.; GACHELIN, G.  MHC and MHC-related proteins as pleiotropic signal  molecules  The FASEB Journal, v.16, 202-206, 2002.

 MHC and MHC-related proteins as pleiotropic signal molecules

Palavras chave: interações proteína-proteína, MHC classe I, homeostase.

ABSTRACT

Class I molecules of the major histocompatibility complex (MHC) have been studied primarily for their role in presenting peptide antigens to conventional T lymphocytes. An increasing body of evidence suggests that MHC and newly characterized MHCrelated molecules have a much more varied function in the body. Many of these molecules are involved in pleiotropic interactions with other proteins, which initiate signal transduction cascades and contribute to cellular and tissue homeostasis.

 Renal function as a predictor of long-term graft survival in renal transplant patients 

FIRST, M. R.  Renal function as a predictor of long-term graft survival in renal transplant patients  Nephrol. Dial. Transplant, v.18, s.18, 3-6, 2003.

Palavras chave: rejeição, transplante renal, sobrevida, tacrolimus.

Abstract

Acute rejection is a major risk factor for kidney graft failure. However, as acute rejection has been progressively reduced by recent immunosuppressive regimens, other risk factors are becoming increasingly important. Evidence is accumulating that early renal function predicts long-term outcome. A recent registry survey ofmore than 100 000 kidney transplants found that 6- and 12-month serum creatinine levels, as well as the change between 6 and 12 months, are strongly associatedwith long-term graft survival. A survey of paediatric renal transplant recipients showed that poor creatinine clearance (<50 ml/min) as early as  30 days post-transplant predicted an annual rate of graft loss of 13% compared with <3% in patients with 30-day clearance >50 ml/min. This association between early renal function and long-term outcome was confirmed in multicentre studies. Renal transplant recipients (n=572) with 6-month serum creatinine levels >1.5 mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients with levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with ciclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study (n=436) found that while glomerular filtration rate (GFR) at 6 months post-transplant had remained stable over the last decade, the rate of loss of renal function had decreased. A lower rate of GFR loss was associated with absence of rejection, use of mycophenolate mofetil rather than azathioprine and use of tacrolimus rather than ciclosporin (P<0.01). In conclusion, early measures of renal function allow identification of those patients at highest risk of graft failure and provide an invaluable tool for improvingoutcomes by tailored immunosuppression. The choice of such immunosuppression should be guided not only by its ability to prevent rejection, but also by itsimpact on renal function.

HANCOCK, W. W.; TURKA, L. A.  Transplantation Immunobiology  Immunological Reviews, v.196, 5-6, 2003.

The act of transplantation provides the opportunity to replace a damaged organ or tissue and return to normal health. However, there are many twists and turns and pitfalls and pratfalls before that happens in many cases, and for some it never happens. Understanding the immune response to an allograft and how to control remain works in progress, despite the clear success of clinical transplantation currently being performed in hundreds of centers worldwide. We still need drugs to control rejection, and each agent brings its own toxicity and side effects. Given too much immunesuppression, the patient is at risck of infection or malignance. Given too little, the patient may reject the graft. Hence there are many and varied problems and potencial solutions in transplant immunobiology.