Immunosuppression With CD40 Costimulatory Blockade Plus Rapamycin for Simultaneous Islet-Kidney Transplantation in Nonhuman Primates.

The lack of a reliable immunosuppressive regimen that effectively suppresses both renal and islet allograft rejection without islet toxicity hampers a wider clinical application of simultaneous islet-kidney transplantation (SIK). Seven MHC-mismatched SIKs were performed in diabetic cynomolgus monkeys. Two recipients received rabbit antithymocyte globulin (ATG) induction followed by daily tacrolimus and rapamycin (ATG/Tac/Rapa), and five recipients were treated with anti-CD40 monoclonal antibody (mAb) and rapamycin (aCD40/Rapa). Anti-inflammatory therapy, including anti-interleukin-6 receptor mAb and anti-tumor necrosis factor-α mAb, was given in both groups. The ATG/Tac/Rapa recipients failed to achieve long-term islet allograft survival (19 and 26 days) due to poor islet engraftment and cytomegalovirus pneumonia. In contrast, the aCD40/Rapa regimen provided long-term islet and kidney allograft survival (90, 94, >120, >120, and >120 days), with only one recipient developing evidence of allograft rejection. The aCD40/Rapa regimen was also tested in four kidney-alone transplant recipients. All four recipients achieved long-term renal allograft survival (100% at day 120), which was superior to renal allograft survival (62.9% at day 120) with triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil, and steroids). The combination of anti-CD40 mAb and rapamycin is an effective and nontoxic immunosuppressive regimen that uses only clinically available agents for kidney and islet recipients.

Impact of road traffic accidents on the elderly.

INTRODUCTION: Older adults are a vulnerable road user group with high mortality and morbidity in road crash. The aim of this study was to show pattern of road traffic injuries in this special aging group. METHODS AND MATERIALS: In a cross sectional study, pre-hospital emergency system reports, hospital and police records of all motor vehicle collisions injured above 60 years old who were admitted to Pour-Sina hospital from April 2011 to March 2012 were studied. Demographic data, characteristic of road traffic incidents and in-hospital medical profiles were derived. Data were analyzed with SPSS ver. 18. Differences between demographic and injuries situation were calculated by chi square test. A p-value of <0.05 was considered statistically significant. RESULTS: One thousand three-hundred six old injured were admitted during study period that this amount accounted for 8.7% of total road accident injured. Mean age of them was 70.9 ± 6.7 years. Most of them were male (74.7%). 40.5% were pedestrians, 22.1% were car occupants and 19.1% were motorcyclists.76.7% had multiple trauma. Head and neck were the most prevalent regions of injured. Total in-hospital mortality rate was 10.1% that was higher in old elderly pedestrians and motorcyclists in comparison to young elderly (16.1% vs. 7.9%) and other type of victims (ρ<0.000). RESULTS: One thousand three-hundred six old injured were admitted during study period that this amount accounted for 8.7% of total road accident injured. Mean age of them was 70.9 ± 6.7 years. Most of them were male (74.7%). 40.5% were pedestrians, 22.1% were car occupants and 19.1% were motorcyclists.76.7% had multiple trauma. Head and neck were the most prevalent regions of injured. Total in-hospital mortality rate was 10.1% that was higher in old elderly pedestrians and motorcyclists in comparison to young elderly (16.1% vs. 7.9%) and other type of victims (ρ<0.000). CONCLUSION: High mortality rate of road traffic injuries in this group especially in pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical examination and improvement of road structure and facilities.