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The lost chord: microchimerism and allograft survival - PubMed

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The lost chord: microchimerism and allograft survival

T E Starzl et al. Immunol Today. 1996 Dec.

Abstract

Recent evidence suggests that passenger leukocytes migrate after organ transplantation and produce persistent chimerism, which is essential for sustained survival of the allografts. Here, Thomas Starzl and colleagues argure that this hematolymphopoietic chimerism provides an important framework for the interpretation of basic and therapeutically oriented transplantataion research.

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Figures

Fig 1
Fig 1

(Upper panels) One-way paradigm in which transplantation is conceived as involving a unidirectional immune reaction: (a) host-versus-graft (HVG) with whole organs and (b) graft-versus-host (GVH) with bone marrow or other lymphopoietic transplants. (Lower panels) Two-way paradigm in which transplantation is seen as a bidirectional and mutually cancelling immune reaction that is (c) predominantly HVG with whole organ grafts, and (d) predominantly GVH with bone marrow grafts.

Fig. 2
Fig. 2

Simultaneous host-versus-graft (HVG) and graft-versus-host (GVH) reactions in the two-way paradigm of transplantation immunology. Following the initial interaction, the evolution of nonreactivity of each leukocyte population to the other is seen as a predominantly low-grade stimulatory stale that may wax and wane, rather than a deletional one.

Fig. 3
Fig. 3

The continuum of chimerism from observations of R. Owen in Freemartin cattle, which was rejected ns a mechanistic explanation of organ allograft acceptance from 1960 until the discovery in 1992 of microchimerism in organ recipients.

Fig. 4
Fig. 4

Time between cause (chimerism) and effect (donor specific tolerance) after liver allotransplantation in different species. Note that immunosuppression is not universally required in three of the five species shown,

Fig. 5
Fig. 5

Time on (green) and off immunosuppression (orange) of 12 (28%) of our 42 longest-surviving liver recipients (15–26 years post-transplant) who are receiving no treatment as of December 1995. These drug-free patients remain well in September 1996.

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