Analysis of the motivation for hematopoietic stem cell donation.

The Italian Bone Marrow Donor Register is the institutional organization for management of unrelated hematopoietic stem cell donors. The law requires only a donor's clinical history, but not a psychosocial profile for registration. We have studied the donor's motivation for enlistment on the donor registry and the medical staff's need for this information to interact correctly with the donor. For this purpose we distributed a questionnaire to new donors at the 20 centers in the Lombardy Region over a period of 1 year. The analysis of the responses revealed a prevalence of extrinsic motivations that would not ensure continued registration for donation. Therefore, it is necessary that the donor be well informed and better educated about all aspects of donation, in order to produce a shift to an intrinsic motivation. This objective can be facilitated via professional training of health workers in communication.

A retrospective evaluation of HLA-A, B and -DRB1 matching in liver transplantation.

Studies on the influence of histocompatibility in liver transplantation have not produced clearcut results. We retrospectively studied the influence of HLA-A, B and -DRB1 matching on the survival of 517 liver-transplanted patients using univariate analysis. The following parameters were also considered in relation to transplant outcome: donor and recipient age, original disease, transplant center, and pretransplant blood transfusions. Twenty-four-month graft survival according to the number of HLA-A, B, DRB1 mismatches (MM) was 70.9% (n = 28) for zero to two MM, 76.6% (n = 248) for three to four MM, and 73.1% (n = 241) for five to six MM (P = 0.7). We obtained similar results when considering HLA-A, B MM alone. Survival rates according to HLA-DRB1 MM were 71.7% (n = 36) for zero MM, 73.7% (n = 236) for one MM, and 76.4% (n = 245) for two MM (P = 0.6). The same analyses, performed on cirrhotic patients alone, gave identical results. In conclusion, this study suggests, on a large series of patients, that HLA compatibility has no influence on liver transplant survival. On the contrary, an influence on transplant outcome was found for donor age, transplant center, and original disease.

Donor organ procurement in the North Italy Transplant program (NITp) in 1994: the beginning of a promising trend?

Donor organ procurement is a world-wide problem. In Italy it is particularly so and the reasons for this are investigated. An overall increase in the number of donors has been noted in 1994 and the first 8 months of 1995, and ways of continuing this encouraging trend should be pursued by improvements in education, legislation, and hospital organization.

Influence of a DLE-extracted lymphocytic suppressor factor on CsA-induced immunosuppression.

From dialyzable leucocyte extracts (DLE) we have purified a hydrophilic low-mol. wt. factor (about 1 kDa) which we have named lymphocytic suppressor factor (LSF) as it is able to suppress antigen- and mitogen-induced lymphocyte transformation and to prolong allograft survival in C57b/6N mice (H-2b) transplanted with fully mismatched skin from C3H/HeN mice (H-2k). At the molecular level LSF acts by inhibiting DNA replicational and transcriptional processes in activated lymphocytes, isolated rat hepatocyte nuclei, and cell-free systems. Amino acid analysis indicates that LSF is a peptide composed of Asp, Glu, Ser, Thr, Ala, Gly, Arg and probably Met, with the N-terminus blocked, possibly by pyroglutamic acid. When combined "in vitro" with cyclosporine A (CsA), LSF increased about 20 times the potency of CsA in inducing suppression of mitogen-stimulated lymphocytes. In C57b/6N mice with skin graft from C3H/HeN mice and undergoing immunosuppression with CsA (50 mg/kg/day), the splenocyte LSF content increased about 5 times. However, LSF values returned to normal in mice recovering normal responsiveness due to progressive withdrawal of CsA. These data show that LSF has an important role in the development and maintenance of CsA-induced immunosuppression. We suggest that, by influencing DNA replicational and transcriptional processes of lymphocytes, LSF may play a role also in the onset and progression of AIDS induced by retroviruses.

[A severe case of bronchial pneumonia due to Mycoplasma pneumoniae accompanied by immunosuppression, thrombophlebitis and hepatitis resolved with human immunoglobulins]. / Una grave broncopolmonite da Mycoplasma pneumoniae accompagnata da immunodepressione, tromboflebite ed epatite risolta con immunoglobuline umane.

We present a case of severe pneumonia by Mycoplasma pneumoniae, whose clinical course was complicated by immunodepression, hepatitis and deep venous thrombosis. Treatment with pepsin-treated human immunoglobulins was unsuccessful, whereas prompt recovery was obtained by infusion of human immunoglobulins treated at pH 4.

Detection of human mononuclear cell subsets by complement fixing monoclonal antibodies: evaluation of manual procedures.

Manual procedures to evaluate mononuclear cells reacted with monoclonal antibodies were evaluated with respect to reproducibility, ease of execution, and cost. The immunofluorescent technique and the complement-mediated cytotoxicity test produced very similar results; however, the latter was clearly preferable in terms of cost, time-consumption, and ease of execution. Evidence is also presented that purification of lymphocytes using gradient diffusion techniques may induce an uneven selectivity within the relative percentages of T cell subsets collected for analysis.

Blood transfusion and kidney transplantation: effect of small doses of blood on kidney graft function and survival.

A controlled clinical trial was started to evaluate whether small doses of blood given pretransplant determine a transfusion effect while reducing the risk of antibody production. For this purpose, 65 consecutive never transfused patients suffering from end-stage renal failure were assigned to one of two groups: the first group was transfused with 1 unit of packed red cells (containing a mean of 2350 x 10(6) leukocytes, 900 x 10(6) mononuclear cells) 3 times at 15-day intervals. The second group received one transfusion of about 30 ml of blood adjusted to contain 100 x 10(6) mononuclear cells. While no definitive conclusions are still possible, preliminary data indicate the following: (1) three small transfusions are capable of immunizing the recipient, but lymphocytotoxic antibodies tend to disappear rapidly; (2) in vitro lymphocyte response to lectins of patients receiving small transfusions is not significantly different from that of patients receiving standard transfusions; (3) the two groups of patients differ significantly as far as the T4+ /T8+ cell ratio is concerned: in fact while a decrease of the ratio is observed after standard transfusions, small transfusions determine an increase of the ratio, mainly due to a decrease in the number of T8+ cells; and (4) the clinical course and survival of the graft is worse in patients treated with small transfusions than in those treated with standard transfusions.