[Waiting list management]. / Wartelistenpflege.

Listing a patient on the Eurotransplant waiting list for a kidney transplantation obliges transplant centers to ensure that an allocated organ can also be transplanted, as long as there are no acute recipient-specific medical or personal contraindications. Assessing the ability for transplantation over a period of up to 10 years between initiation of dialysis and an organ offer represents a major challenge in manpower and logistic efforts. The present article reviews specific aspects regarding waiting list management on the basis of current guideline recommendations and literature data.

Effective prevention of GVHD using in vivo T-cell depletion with anti-lymphocyte globulin in HLA-identical or -mismatched sibling peripheral blood stem cell transplantation.

To investigate the impact of anti-lymphocyte globulin (ATG-Fresenius) as part of the HLA-sibling transplantation, we evaluated 238 patients (median age 48 years) with different diagnoses (AML, ALL, CML and lymphoproliferative disorders). A total of 79 patients received ATG and 159 patients did not. In the ATG group, there were more HLA-mismatched donors (6% vs 1%, p=0.02), bad risk patients (70% vs 55%, P=0.04), reduced intensity conditioning (RIC) regimens (65% vs 34%, P=<0.001) and older patients (median age 51 vs 48 years, P=0.002). The median time to leukocyte engraftment was significantly faster in the non-ATG group (13 vs 15 days, P < 0.001). EBV reactivation was more often seen in the ATG group (9% vs 2%, P=0.05). Cumulative incidence of acute and chronic GVHD was less observed in the ATG group (27% vs 40%, P=0.004, and 33% vs 54%, P=0.002). The cumulative incidence rates of non-relapse mortality and of relapse at 5 years were 20 and 34%, respectively, for ATG and 34 and 29%, respectively, for non-ATG (P=0.06 and P=0.3). ATG can prevent GVHD without an obvious risk of relapse but should be confirmed in a randomized study.

Mechanism of replacement of non-parenchymal liver cells (NPLC) in murine radiation chimeras.

The mechanism of cell replacement of non-parenchymal liver cells (NPLC) was investigated in an attempt to answer the question: to what extend are NPLC replaced by proliferation of local resident cells and to what extend by cells originating from the bone-marrow. The bone-marrow of mice was used, and H2k positive cells from F1 (B10.BR X B10.D2) hybrid mice were transplanted into irradiated H2k negative parent animals. Their NPLC were isolated and tested immunocytochemically with a monoclonal anti-H2k antibody for the presence of H2k positive cells. During the whole of the experiment (from the 5th to the 20th week following transplantation) H2k positive cells (macrophages and non-macrophages) were present, and made up an average of nearly one third of the NPLC. The H2k positive (immigrant) non-macrophages showed essentially more active DNA synthesis than these H2k negative cells. To increase cell turnover, we injected one group of animals with endotoxin. At the time of maximum replacement, more than 50% of the NPLC (macrophages and non-macrophages) were recruited from cells of bone-marrow origin. Note-worthy here was the proportionate level of the H2k positive macrophages (more than 70% of all liver macrophages). The DNA synthesis of both the H2k positive macrophages and non-macrophages was more than twice that of the H2k negative NPLC during the regeneration process following administration of endotoxin. Our observations suggest that the bone-marrow contributes significantly to the replacement of macrophages and non-macrophages of NPLC in both health and disease.

Identification and percentage frequency of isolated non-parenchymal liver cells (NPLC) in the mouse.

The aim of the present study was to identify non-parenchymal liver cells (NPLC) in B10.D2 mice and to determine their percentage frequency. The isolation of NPLC was carried out using the collagenase/pronase technique. Using functional techniques (latex phagocytosis, immunocytochemical detection of surface-bound and intracytoplasmic antigens) and morphological methods (light and electron microscopy), the following cell types were identified, and their percentage frequency in the NPLC determined: endothelial cells (50%), macrophages (23%), desmin-positive cells (14%), immunocompetent cells (10%, including T-, B-cells, pit and large vacuolated cells-both immunopositive to the asialo-GM 1 antigen) and unidentified cells (3%). These results show that, apart from the more familiar varieties of NPLC, two groups of cells exist in the liver which have not yet been fully identified and in which the immunocompetent cells predominate numerically.