NEJM â Collection Updates for Transplantation

CLINICAL PROBLEM-SOLVING: Under Pressure

Thu, 04Â FebÂ 2010 00:00:00 -05:00

A 25-year-old woman presented to her local hospital with dyspnea. She described a 2-year history of progressive shortness of breath on exertion. One year earlier she was able to walk...

EDITORIAL: Immune Evasion by Chimeric Trachea

Megan Sykes, M.D. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

The types of allogeneic organs and tissues that can be transplanted have expanded considerably in the past three decades. In addition to organs such as liver, heart, lungs, and pancreas,...

ORIGINAL ARTICLE: Tracheal Allotransplantation after Withdrawal of Immunosuppressive Therapy

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Reconstruction of long-segment tracheal defects requires a vascularized allograft. We report successful tracheal allotransplantation after indirect revascularization of the graft in a heterotopic position. Immunosuppressive therapy was administered before the...

ORIGINAL ARTICLE: Allogeneic Hematopoietic Stem-Cell Transplantation for Sickle Cell Disease

Thu, 10Â DecÂ 2009 00:00:00 -05:00

Background: Myeloablative allogeneic hematopoietic stem-cell transplantation is curative in children with sickle cell disease, but in adults the procedure is unduly toxic. Graft rejection and graft-versus-host disease (GVHD) are additional...

EDITORIAL: Interleukin-10 in Inflammatory Bowel Disease

Brian Kelsall, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

In this issue of the Journal, Glocker et al.1 provide the first substantial support for a functional role for the immunosuppressive cytokine interleukin-10 in the pathogenesis of inflammatory bowel disease...

ORIGINAL ARTICLE: Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Background: The molecular cause of inflammatory bowel disease is largely unknown.

Methods: We performed genetic-linkage analysis and candidate-gene sequencing on samples from two unrelated consanguineous families with children who were affected...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Dr. Peter P. Moschovis (Medicine and Pediatrics): A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal...

CORRESPONDENCE: Indigenous Australians and Living Kidney Donation

Natasha M. Rogers, M.D., Paul D. Lawton, M.D., and Matthew D. Jose, M.D., Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

To the Editor: Indigenous Australians comprise 2.5% of the total population of Australia, but like other minority groups worldwide, rates of chronic kidney disease are higher among this indigenous group...

ORIGINAL ARTICLE: Recurrence of Bile Salt Export Pump Deficiency after Liver Transplantation

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Severe bile salt export pump (BSEP) deficiency is a hereditary cholestatic condition that starts in infancy and leads to end-stage liver disease. Three children who underwent orthotopic liver transplantation for...

REVIEW ARTICLE: Renal Failure in Cirrhosis

Pere GinÃ¨s, M.D., and Robert W. Schrier, M.D. — Thu, 24Â SepÂ 2009 00:00:00 -05:00

Renal failure is a challenging complication of cirrhosis12 and is one of the most important risk factors when liver transplantation is being considered. Patients with cirrhosis and renal failure are...

REVIEW ARTICLE: Intestinal Transplantation

Thomas M. Fishbein, M.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

The results of intestinal transplantation have improved over the past decade. During this period, the number of intestinal transplant procedures performed in North America has increased by a factor of...

EDITORIAL: Genetic Trickery â Escape of Leukemia from Immune Attack

John Barrett, M.D., and Bruce R. Blazar, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

It is increasingly clear that neoplastic cells and the immune system are locked in a struggle in which each attempts to outmaneuver its opponent. One tactic that tumors use to...

ORIGINAL ARTICLE: Loss of Mismatched HLA in Leukemia after Stem-Cell Transplantation

Thu, 30Â JulÂ 2009 00:00:00 -05:00

Background: Transplantation of hematopoietic stem cells from partially matched family donors is a promising therapy for patients who have a hematologic cancer and are at high risk for relapse. The...

BOOK REVIEW:

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Research on umbilical-cord blood has revolutionized the field of hematopoietic stem-cell transplantation, and umbilical-cord blood is now used in about 28% of all bone marrow and stem-cell transplants from unrelated...

BOOK REVIEW:

Thu, 16Â JulÂ 2009 00:00:00 -05:00

This captivating memoir tells the story of an extraordinary life lived against the backdrop of one of the most cataclysmic events of modern times. Leslie Brent, a world-renowned immunologist and...

CORRESPONDENCE: B-CellâDepleting Induction Therapy and Acute Cellular Rejection

Thu, 18Â JunÂ 2009 00:00:00 -05:00

To the Editor: B-cell depletion is an effective treatment for a number of autoimmune diseases in which B cells were not previously considered to be important, such as multiple sclerosis.1...

CLINICAL THERAPEUTICS: Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

Jean-Luc Harousseau, M.D., and Philippe Moreau, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

A previously healthy 59-year-old man presents with persistent pain in his lower back and fatigue. A complete blood count reveals a hemoglobin level of 9.8 g per deciliter. A monoclonal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2009 â A 25-Year-Old Man with Coma after Cardiac Arrest

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Dr. Mathias Lichterfeld (Infectious Disease): A 25-year-old man was admitted to this hospital because of coma after cardiac arrest.

He had been well until 4 hours before admission, when he was...

CORRESPONDENCE: Outcome of Renal Transplantation from Very Old Donors

Thu, 02Â AprÂ 2009 00:00:00 -05:00

To the Editor: The use of kidneys from elderly donors may permit more transplantations, but it has been associated with poorer outcomes than transplantations performed with kidneys from younger donors.1...

ORIGINAL ARTICLE: A Nonsimultaneous, Extended, Altruistic-Donor Chain

Thu, 12Â MarÂ 2009 00:00:00 -05:00

We report a chain of 10 kidney transplantations, initiated in July 2007 by a single altruistic donor (i.e., a donor without a designated recipient) and coordinated over a period of...

ORIGINAL ARTICLE: C3 Polymorphisms and Allograft Outcome in Renal Transplantation

Thu, 26Â FebÂ 2009 00:00:00 -05:00

Background: Complement activation plays a role in the development of chronic allograft nephropathy, a common cause of late allograft loss. The role of two complement component 3 (C3) allotypes, called...

EDITORIAL: Not an HIV Cure, but Encouraging New Directions

Jay A. Levy, M.D. — Thu, 12Â FebÂ 2009 00:00:00 -05:00

The history of infectious diseases frequently includes people who were resistant to a pathogen. Such a phenomenon helped the Spanish, who had resistance to smallpox, in their conquest of South...

ORIGINAL ARTICLE: Long-Term Control of HIV by Delta32/Delta32 Stem-Cell Transplantation

Thu, 12Â FebÂ 2009 00:00:00 -05:00

Infection with the human immunodeficiency virus type 1 (HIV-1) requires the presence of a CD4 receptor and a chemokine receptor, principally chemokine receptor 5 (CCR5). Homozygosity for a 32-bp deletion...

CORRESPONDENCE: Eculizumab for Atypical HemolyticâUremic Syndrome

Thu, 29Â JanÂ 2009 00:00:00 -05:00

To the Editor: Atypical hemolyticâuremic syndrome is a disease of uncontrolled complement activation associated with a high mortality rate, and most cases progress to end-stage renal disease.1 About 50% of...

EDITORIAL: Cautious Optimism Concerning Long-Term Safety of Kidney Donation

Jane C. Tan, M.D., Ph.D., and Glenn M. Chertow, M.D., M.P.H. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

Kidney transplantation remains the preferred therapeutic option for patients with end-stage renal disease (ESRD), since survival and health-related quality of life are better after kidney transplantation than after dialysis therapy....

ORIGINAL ARTICLE: Long-Term Consequences of Kidney Donation

Thu, 29Â JanÂ 2009 00:00:00 -05:00

Background: The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that...

BOOK REVIEW:

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Since the first successful kidney transplant was performed â on identical twins in Boston in 1954 â kidney transplantation has become the indicated therapy for end-stage renal disease. During the...

EDITORIAL: Organ Procurement and Perfusion before Transplantation

Stefan G. Tullius, M.D., Ph.D., and Guillermo GarcÃa-CardeÃ±a, Ph.D. — Thu, 01Â JanÂ 2009 00:00:00 -05:00

Organ transplantation is one of the great success stories of modern medicine. Living-donor kidney transplantations between identical twins during the early 1950s first demonstrated the overall feasibility of this procedure...

ORIGINAL ARTICLE: Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Background: Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation, but few sufficiently powered prospective studies have addressed...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Boosting Beta-Cell Numbers

Harry Heimberg, Ph.D. — Thu, 18Â DecÂ 2008 00:00:00 -05:00

The restoration of functional beta-cell mass by cell therapy is possibly the most realistic current option for curing type 1 diabetes mellitus. The transplantation of human islet cells has been...

CORRESPONDENCE: Successful Pregnancy after Microsurgical Transplantation of an Intact Ovary

Sherman J. Silber, M.D., Gedis Grudzinskas, M.D., and Roger G. Gosden, Ph.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

To the Editor: Successful human ovarian transplantation was first reported with the use of a cortical-tissue grafting technique in monozygotic twins who were discordant for premature ovarian failure.1 Subsequently, six...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Dr. Abner Louissaint (Pathology): A 58-year-old man with hemophilia was admitted to this hospital because of hepatitis C infection, hepatocellular carcinoma, and recurrent bleeding.

A diagnosis of hemophilia A (factor VIII...

CORRESPONDENCE: Osteosarcoma Derived from Donor Stem Cells Carrying the Norrie's Disease Gene

Thu, 04Â DecÂ 2008 00:00:00 -05:00

To the Editor: There have been few reports of osteosarcoma after allogeneic bone marrow transplantation.1 We report the development of osteosarcoma in a recipient 17 years after stem-cell transplantation.

A 23-month-old...

CORRESPONDENCE: Triglyceride Deposit Cardiomyovasculopathy

Thu, 27Â NovÂ 2008 00:00:00 -05:00

To the Editor: A 41-year-old man was admitted to our hospital with ventricular tachycardia in 2003. Biopsy specimens obtained from the right ventricle showed neutral lipid deposition in cardiomyocytes. In...

BOOK REVIEW:

Thu, 13Â NovÂ 2008 00:00:00 -05:00

The development of intravenous nutrition that enables patients to survive for months or years, even when they are completely dependent on it, should be considered one of the major medical...

EDITORIAL: Polymorphisms and the Risk of Invasive Fungal Infections

Eric G. Pamer, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

Allogeneic hematopoietic stem-cell transplantation is a potentially lifesaving cancer therapy that, at least temporarily, renders patients highly immunocompromised and vulnerable to infection. Aspergillus fumigatus, a common environmental fungus that causes...

ORIGINAL ARTICLE: Toll-like Receptor 4 Polymorphisms and Aspergillosis in Stem-Cell Transplantation

Thu, 23Â OctÂ 2008 00:00:00 -05:00

Background: Toll-like receptors (TLRs) are essential components of the immune response to fungal pathogens. We examined the role of TLR polymorphisms in conferring a risk of invasive aspergillosis among recipients...

CORRESPONDENCE: Long-Term Results of Rabbit Antithymocyte Globulin and Basiliximab Induction

Daniel C. Brennan, M.D. and Mark A. Schnitzler, Ph.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

To the Editor: In our recently reported prospective, randomized, international clinical trial comparing rabbit antithymocyte globulin and basiliximab in renal transplantation (ClinicalTrials.gov number, NCT00235300),1 we observed that induction treatment with...

BOOK REVIEW:

Thu, 04Â SepÂ 2008 00:00:00 -05:00

The transfer of blood components, solid tissues, or organs from one person to another is basic to the practice of modern medicine and surgery. Because the only source of blood...

EDITORIAL: Predicting Mortality in Cirrhosis â Serum Sodium Helps

AndrÃ©s CÃ¡rdenas, M.D., and Pere GinÃ¨s, M.D. — Thu, 04Â SepÂ 2008 00:00:00 -05:00

Liver transplantation is widely accepted as a standard method of treatment for many patients with advanced cirrhosis, and survival rates among patients who have undergone liver transplantation approach 80% at...

ORIGINAL ARTICLE: Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

Thu, 04Â SepÂ 2008 00:00:00 -05:00

Background: Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death.

Methods: Using data derived from all adult candidates for primary liver transplantation who...

CORRESPONDENCE: Widespread Amyloid Deposition in Transplanted Human Pancreatic Islets

Thu, 28Â AugÂ 2008 00:00:00 -05:00

To the Editor: We report on a patient with type 1 diabetes mellitus, diagnosed at 16 years of age, in whom widespread amyloid deposits developed many years later in transplanted...

EDITORIAL: Cardiac Transplantation in Infants

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

For children born with inoperable congenital heart disease or advanced cardiomyopathy, cardiac transplantation is the only therapeutic option. Each year in the United States, approximately 400 heart-transplantation procedures are performed...

ORIGINAL ARTICLE: Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death

Thu, 14Â AugÂ 2008 00:00:00 -05:00

In three infants awaiting orthotopic cardiac transplantation, transplantation was successfully performed with the use of organs from donors who had died from cardiocirculatory causes. The three recipients had blood group...

PERSPECTIVE: The Dead Donor Rule and Organ Transplantation

Thu, 14Â AugÂ 2008 00:00:00 -05:00

Since its inception, organ transplantation has been guided by the overarching ethical requirement known as the dead donor rule, which simply states that patients must be declared dead before the...

PERSPECTIVE: Donating Hearts after Cardiac Death â Reversing the Irreversible

Thu, 14Â AugÂ 2008 00:00:00 -05:00

Once, all transplantable organs were procured after a donor's heart had stopped irreversibly. Assuming that one accepted the dead donor rule, irreversible heart stoppage triggered organ procurement. Around 1970, the...

PERSPECTIVE: The Boundaries of Organ Donation after Circulatory Death

Thu, 14Â AugÂ 2008 00:00:00 -05:00

Organ donation after circulatory (or cardiac) death has become an accepted medical practice over the past 15 years.1 Programs permitting such donations satisfy two needs: they provide organs in addition...

BOOK REVIEW:

Thu, 17Â JulÂ 2008 00:00:00 -05:00

As one who works in the field of transplantation, I find it hard not to be positively predisposed to a book that begins with the dedication, âTo all living donors...

EDITORIAL: Reducing Antibody Levels in Patients Undergoing Transplantation

Ron Shapiro, M.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

The advent of solid-organ transplantation for the treatment of patients with end-stage organ failure has been one of the most exciting medical advances in the late 20th and early 21st...

ORIGINAL ARTICLE: Rituximab and Intravenous Immune Globulin for Desensitization during Renal Transplantation

Thu, 17Â JulÂ 2008 00:00:00 -05:00

Background: Few options for transplantation currently exist for patients highly sensitized to HLA. This exploratory, open-label, phase 1â2, single-center study examined whether intravenous immune globulin plus rituximab could reduce anti-HLA...

IMAGES IN CLINICAL MEDICINE: Digital Verrucae

Nektarios I. Lountzis, M.D. and Omar Rahman, M.D. — Thu, 10Â JulÂ 2008 00:00:00 -05:00

A 34-year-old woman underwent renal transplantation for chronic idiopathic glomerulonephritis, and 4 years later small verrucae developed on her distal fingertips. Over the course of 11 years after transplantation, during...

SOUNDING BOARD: Informing Candidates for Solid-Organ Transplantation about Donor Risk Factors

Thu, 26Â JunÂ 2008 00:00:00 -05:00

For the first time in 15 years, there has been documented transmission of the human immunodeficiency virus (HIV) through solid-organ transplantation.1 Although transmission of infectious agents through transplantation is rare,2...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2008 â A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation

Thu, 12Â JunÂ 2008 00:00:00 -05:00

A 68-year-old man was admitted to the hospital because of headache and loss of vision in the right eye. Orthotopic allogeneic liver transplantation had been performed 3 1/2 months earlier...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2008 â A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation

Thu, 10Â AprÂ 2008 00:00:00 -05:00

A 45-year-old man was admitted to this hospital for orthotopic liver transplantation. The patient had been well until the age of 18 years, when a diagnosis of non-A, non-B hepatitis...

PERSPECTIVE: Consent for Organ Donation â Balancing Conflicting Ethical Obligations

Thu, 20Â MarÂ 2008 00:00:00 -05:00

Organ transplantation is truly one of the miracles of modern medicine, saving the lives of many patients and improving the quality of life for many more. Given the ever-increasing gap...

IMAGES IN CLINICAL MEDICINE: Green Urine

Piero Stratta, M.D. and Maria Cristina Barbe, M.D. — Thu, 13Â MarÂ 2008 00:00:00 -05:00

A 76-year-old man with renal failure from nephroangiosclerosis received a kidney transplant from a deceased donor. The transplant was functioning well when the patient underwent a radical laryngopharyngoesophagectomy, with colopharyngeal...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Chemical Immunosuppression in Islet Transplantation â Friend or Foe?

Lucienne Chatenoud, M.D., Ph.D. — Thu, 13Â MarÂ 2008 00:00:00 -05:00

Insulin-dependent (type 1) diabetes mellitus is an autoimmune disease caused by the selective destruction of pancreatic beta cells by CD4+ and CD8+ autoreactive T lymphocytes. The induction of effective and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Dr. Robert B. Den (Medicine): A 33-year-old man was admitted to this hospital because of fever, abdominal pain, and pancytopenia.

The patient had received a cadaveric renal allograft 15 years earlier...

ORIGINAL ARTICLE: A New Arenavirus in a Cluster of Fatal Transplant-Associated Diseases

Thu, 06Â MarÂ 2008 00:00:00 -05:00

Background: Three patients who received visceral-organ transplants from a single donor on the same day died of a febrile illness 4 to 6 weeks after transplantation. Culture, polymerase-chain-reaction (PCR) and...

PERSPECTIVE: The New Age of Molecular Diagnostics for Microbial Agents

Thu, 06Â MarÂ 2008 00:00:00 -05:00

How, in this era of molecular diagnostic tests, can we best determine whether there is a causal relationship between the presence of a genetic signature of an infectious agent and...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A New Dawn for Stem-Cell Therapy

Douglas R. Higgs, M.D., D.Sc. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

Recently, the potential use of stem cells for regenerative medicine and for the treatment of genetic disease has rarely been out of the news. Discussion has focused mainly on the...

ORIGINAL ARTICLE: Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Hepatitis E virus (HEV) is considered an agent responsible for acute hepatitis that does not progress to chronic hepatitis. We identified 14 cases of acute HEV infection in three patients...

IMAGES IN CLINICAL MEDICINE: Renal Failure from Vitamin C after Transplantation

Brian J. Nankivell, M.D., Ph.D. and Karumathil M. Murali, M.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

A 31-year-old woman with bilateral nephrectomy due to bleeding angiomyolipomas from tuberous sclerosis received a kidney transplant with good early graft function. Irreversible, oliguric renal allograft failure soon developed from...

EDITORIAL: Immunosuppressive Therapy and Tolerance of Organ Allografts

Thomas E. Starzl, M.D., Ph.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

In this issue of the Journal, three articles describe several organ-transplant recipients in whom allografts have maintained good function for up to 5 years without immunosuppressive treatment.123 In two articles...

ORIGINAL ARTICLE: Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

Thu, 24Â JanÂ 2008 00:00:00 -05:00

Complete hematopoietic chimerism and tolerance of a liver allograft from a deceased male donor developed in a 9-year-old girl, with no evidence of graft-versus-host disease 17 months after transplantation. The...

ORIGINAL ARTICLE: Tolerance and Chimerism after Renal and Hematopoietic-Cell Transplantation

Thu, 24Â JanÂ 2008 00:00:00 -05:00

We describe a recipient of combined kidney and hematopoietic-cell transplants from an HLA-matched donor. A post-transplantation conditioning regimen of total lymphoid irradiation and antithymocyte globulin allowed engraftment of the donor's...

ORIGINAL ARTICLE: HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression

Thu, 24Â JanÂ 2008 00:00:00 -05:00

08012430.xml 08012430.xml 08012430.xml 08012430.xml Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a...

EDITORIAL: Balancing Efficacy and Toxicity in Kidney-Transplant Immunosuppression

Alan B. Leichtman, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

Although protocols differ among transplantation centers, most immunosuppressive strategies for kidney-transplant recipients are built on two core practices: delivery of immunosuppression in two phases, usually termed induction and maintenance, and...

REVIEW ARTICLE: Infection in Solid-Organ Transplant Recipients

Jay A. Fishman, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

Increasingly potent immunosuppressive agents have dramatically reduced the incidence of rejection of transplanted organs while increasing patients' susceptibility to opportunistic infections and cancer.12 At the same time, patterns of opportunistic...

ORIGINAL ARTICLE: Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation

Thu, 20Â DecÂ 2007 00:00:00 -05:00

Background: Immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients. This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens.

Methods: We randomly assigned...

ORIGINAL ARTICLE: Outcomes 18 Months after the First Human Partial Face Transplantation

Thu, 13Â DecÂ 2007 00:00:00 -05:00

Background: We performed the first human partial face allograft on November 27, 2005. Here we report outcomes up to 18 months after transplantation.

Methods: The postsurgical induction immunosuppression protocol included thymoglobulins...

EDITORIAL: Lung Transplantation in Cystic Fibrosis â Primum Non Nocere?

Julian Allen, M.D., and Gary Visner, D.O. — Thu, 22Â NovÂ 2007 00:00:00 -05:00

Cystic fibrosis is one of the most common autosomal recessive diseases. It causes intestinal, pancreatic, and progressive lung dysfunction, which is ultimately lethal. In 1989, the first specific cystic fibrosis...

ORIGINAL ARTICLE: Lung Transplantation and Survival in Children with Cystic Fibrosis

Thu, 22Â NovÂ 2007 00:00:00 -05:00

Background: The effects of lung transplantation on the survival and quality of life in children with cystic fibrosis are uncertain.

Methods: We used data from the U.S. Cystic Fibrosis Foundation Patient...

PERSPECTIVE: Hematopoietic-Cell Transplantation at 50

Thu, 11Â OctÂ 2007 00:00:00 -05:00

September 12, 2007, marked the 50th anniversary of E. Donnall (Don) Thomas's initial report of a radical new approach to cancer treatment: radiation and chemotherapy followed by the intravenous infusion...

PERSPECTIVE: Pluripotency Redux â Advances in Stem-Cell Research

Thu, 11Â OctÂ 2007 00:00:00 -05:00

Acell's ability to give to rise to all the cell types of the embryo and the adult organism is called pluripotency. Pluripotent cells are found within mammalian blastocysts and persist...

EDITORIAL: Will MICA Glitter for Recipients of Kidney Transplants?

Willy Albert Flegel, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

Renal transplantation as the treatment of choice for end-stage renal failure is associated with excellent short-term results. The 1-year patient-survival rate is 96%, and the 1-year allograft-survival rate is more...

ORIGINAL ARTICLE: Antibodies against MICA Antigens and Kidney-Transplant Rejection

Thu, 27Â SepÂ 2007 00:00:00 -05:00

Background: Good HLA-A, HLA-B, and HLA-DR matches do not guarantee rejection-free renal transplantation. Some kidney transplants fail despite such matches, suggesting that other antigens might be targets for rejection. Major-histocompatibility-complex...

ORIGINAL ARTICLE: High-Dose Melphalan versus Melphalan plus Dexamethasone for AL Amyloidosis

Thu, 13Â SepÂ 2007 00:00:00 -05:00

Background: High-dose chemotherapy followed by autologous hematopoietic stem-cell transplantation has been reported to provide higher response rates and better overall survival than standard chemotherapy in immunoglobulin-light-chain (AL) amyloidosis, but these...

ORIGINAL ARTICLE: Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

Thu, 30Â AugÂ 2007 00:00:00 -05:00

Background: The use of left ventricular assist devices is an accepted therapy for patients with refractory heart failure, but current pulsatile volume-displacement devices have limitations (including large pump size and...

ORIGINAL ARTICLE: High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors

Thu, 26Â JulÂ 2007 00:00:00 -05:00

Background: Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.

Methods: We conducted a retrospective review of 184 consecutive patients...

PERSPECTIVE: Organ Donation after Cardiac Death

Thu, 19Â JulÂ 2007 00:00:00 -05:00

Although the numbers of organ donors and transplantations in the United States have more than doubled over the past 20 years (see line graph), the demand for organs continues to...

ORIGINAL ARTICLE: Allogeneic Bone Marrow Transplantation in Mevalonic Aciduria

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Mevalonic aciduria is a rare, inborn error of isoprene biosynthesis characterized by severe, periodic attacks of fever and inflammation, developmental delay, ataxia, and dysmorphic features. This autosomal recessive disease is...

PERSPECTIVE: The Stem-Cell Market â Patents and the Pursuit of Scientific Progress

Thu, 07Â JunÂ 2007 00:00:00 -05:00

University of Wisconsin researcher James Thomson and his colleagues wowed the scientific community when they reported in November 1998 that they had isolated and cultured human embryonic stem cells.1 They...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2007 â A 56-Year-Old Woman with Renal Failure after HeartâLung Transplantation

Nelson B. Goes, M.D., and Robert B. Colvin, M.D. — Thu, 19Â AprÂ 2007 00:00:00 -05:00

A 56-year-old woman with a history of primary pulmonary hypertension and heart and lung transplantation was admitted to the hospital because of renal failure.

When the patient was approximately 43 years...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Retinal Progenitor Cells â Timing Is Everything

Jean Bennett, M.D., Ph.D. — Thu, 12Â AprÂ 2007 00:00:00 -05:00

More than 10 million people in the United States are blind or visually impaired, and 50,000 more will become blind each year. The results of a survey conducted by the...

IMAGES IN CLINICAL MEDICINE: Liver Transplantation for Polycystic Liver Disease

William J. Wall, M.D. — Thu, 12Â AprÂ 2007 00:00:00 -05:00

A 51-year-old woman with polycystic liver and kidney disease had undergone renal transplantation 21 years before presentation. She had no evidence of cerebrovascular malformations. Both her father and aunt also...

REVIEW ARTICLE: Strategies for Safer Liver Surgery and Partial Liver Transplantation

Thu, 12Â AprÂ 2007 00:00:00 -05:00

The liver possesses the unique ability to regenerate within a short period.123 This feature has led to the development of innovative strategies in liver surgery and transplantation. The anatomy of...

ORIGINAL ARTICLE: A Comparison of Allografting with Autografting for Newly Diagnosed Myeloma

Thu, 15Â MarÂ 2007 00:00:00 -05:00

Background: In this trial of the treatment of newly diagnosed multiple myeloma, we compared a protocol that entailed a hematopoietic stem-cell autograft followed by an allograft from an HLA-identical sibling...

SOUNDING BOARD: Ethical Challenges Posed by the Solicitation of Deceased and Living Organ Donors

Douglas W. Hanto, M.D., Ph.D. — Thu, 08Â MarÂ 2007 00:00:00 -05:00

Given the shortage of transplantable organs, some potential recipients are going to great lengths to find organ donors on their own. For example, a patient with advanced liver cancer advertised...

IMAGES IN CLINICAL MEDICINE: Two Hearts

Reyan A. Ghany, M.D. and Eduardo de Marchena, M.D. — Thu, 15Â FebÂ 2007 00:00:00 -05:00

A 64-year-old man presented with progressive shortness of breath and exercise intolerance due to end-stage ischemic cardiomyopathy. Since he remained severely symptomatic despite maximal medical therapy, he underwent a heterotopic...

IMAGES IN CLINICAL MEDICINE: Hepatosplenic Candidiasis

Nermin Halkic, M.D. and Riadh Ksontini, M.D. — Thu, 25Â JanÂ 2007 00:00:00 -05:00

A 19-year-old woman underwent five cycles of chemotherapy for acute myelomonocytic leukemia that had been diagnosed 7 months earlier. During the last cycle of chemotherapy, neutropenia developed, lasting 22 days,...

EDITORIAL: Prophylaxis and Aspergillosis â Has the Principle Been Proven?

Ben E. De Pauw, M.D., and J. Peter Donnelly, Ph.D. — Thu, 25Â JanÂ 2007 00:00:00 -05:00

Invasive fungal diseases contribute substantially to death and illness associated with the prolonged, profound neutropenia resulting from intensive chemotherapy for hematologic cancers and from myeloablation for allogeneic hematopoietic stem-cell transplantation....

ORIGINAL ARTICLE: Posaconazole or Fluconazole for Prophylaxis in Severe Graft-versus-Host Disease

Thu, 25Â JanÂ 2007 00:00:00 -05:00

Background: Invasive fungal infections are an important cause of morbidity and mortality after allogeneic hematopoietic stem-cell transplantation.

Methods: In an international, randomized, double-blind trial, we compared oral posaconazole with oral fluconazole...

PERSPECTIVE: Concurrent Sentences â Dialysis in the State Penitentiary

Thu, 11Â JanÂ 2007 00:00:00 -05:00

I was driving the last desolate stretch of road to the state penitentiary, headed to visit patients undergoing dialysis. I was well outside my comfort zone of the university transplantation...

EDITORIAL: Rabbit Antithymocyte Globulin or Basiliximab for Induction Therapy?

Michelle A. Josephson, M.D. — Thu, 09Â NovÂ 2006 00:00:00 -05:00

In this issue of the Journal, Brennan et al.1 compare the safety and efficacy of two induction therapies commonly used in kidney transplantation: rabbit antithymocyte globulin and basiliximab. Induction refers...

ORIGINAL ARTICLE: Rabbit Antithymocyte Globulin versus Basiliximab in Renal Transplantation

Thu, 09Â NovÂ 2006 00:00:00 -05:00

Background: Induction therapy reduces the frequency of acute rejection and delayed graft function after transplantation. A rabbit antithymocyte polyclonal antibody or basiliximab, an interleukin-2 receptor monoclonal antibody, is most commonly...

PERSPECTIVE: Single-Cell Storm

Thu, 19Â OctÂ 2006 00:00:00 -05:00

Scientists at Advanced Cell Technology, a California company, reported in August that a single cell taken from an eight-cell human embryo can sometimes be coaxed to produce embryonic stem cells,...

PERSPECTIVE: Stem-Cell Politics

Thu, 19Â OctÂ 2006 00:00:00 -05:00

In Missouri this election season, former Republican Senator John Danforth, an Episcopal priest and abortion opponent, is citing the New Testament in support of a state constitutional amendment protecting the...

EDITORIAL: Diabetes Cure â Is the Glass Half Full?

Jonathan S. Bromberg, M.D., Ph.D., and Derek LeRoith, M.D., Ph.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

Nearly 80 years after the first clinical use of insulin, many important advances in the treatment of type 1 diabetes mellitus continue to be made. In this issue of the...

ORIGINAL ARTICLE: International Trial of the Edmonton Protocol for Islet Transplantation

Thu, 28Â SepÂ 2006 00:00:00 -05:00

Background: Islet transplantation offers the potential to improve glycemic control in a subgroup of patients with type 1 diabetes mellitus who are disabled by refractory hypoglycemia. We conducted an international,...

PERSPECTIVE: Thoughts from the Transition Zone

Thu, 20Â JulÂ 2006 00:00:00 -05:00

I got the call earlier today. A teenager has been on life support at our hospital while awaiting a heart transplant. She was running out of time when we got...

PERSPECTIVE: Taking Heart â Cardiac Transplantation Past, Present, and Future

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Heart transplantation hit the international news with a splash in December 1967, when the first human-to-human transplantation was performed in South Africa by Christiaan Barnard, and the first transplantation in...

CLINICAL PROBLEM-SOLVING: Heading Down the Wrong Path

Thu, 06Â JulÂ 2006 00:00:00 -05:00

A 52-year-old woman who had undergone renal transplantation 13 years earlier was brought by her family to the emergency department of a community hospital. Five days earlier, she had suddenly...

ORIGINAL ARTICLE: Transmission of Lymphocytic Choriomeningitis Virus by Organ Transplantation

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Background: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were...

PERSPECTIVE: Lymphocytic Choriomeningitis Virus â An Old Enemy up to New Tricks

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Lymphocytic choriomeningitis virus (LCMV) was among the first human pathogenic viruses to be isolated. In the mid-1930s, Armstrong and Lillie obtained a filterable agent thought to be from the brain...

EDITORIAL: Influence of Graft Characteristics on the Outcome of Kidney Transplantation

Jean-Paul Soulillou, M.D., and Magali Giral, M.D. — Thu, 11Â MayÂ 2006 00:00:00 -05:00

The characteristics of renal allografts before transplantation present a multifaceted puzzle that in large part predetermines the outcome of kidney transplantation. Compatibility at the major-histocompatibility-complex (MHC) loci, the age of...

ORIGINAL ARTICLE: Influence of Donor C3 Allotype on Late Renal-Transplantation Outcome

Thu, 11Â MayÂ 2006 00:00:00 -05:00

Background: The complement system has a critical role in both the innate and the adaptive immune responses. In humans, C3 exists as two main allotypes, F (fast) and S (slow),...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Disciplining the Stem Cell into Myogenesis

Terry Partridge, Ph.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

NaivetÃ© is a much lauded but equivocal virtue of the stem cell that implies both versatility and â if this quality is to be exploited to clinical advantage â the...

REVIEW ARTICLE: Hematopoietic Stem-Cell Transplantation

Edward A. Copelan, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

Although hematopoietic stem-cell transplantation was originally conceived more than 50 years ago as a treatment for injury from irradiation and, later, for cancer, associated problems needed to be solved before...

SOUNDING BOARD: Ethical Considerations Related to Pregnancy in Transplant Recipients

Lainie Friedman Ross, M.D., Ph.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

By 1998, 40 years after the first child had been born to a transplant recipient,1 more than 7000 women with renal transplants in the United States had had successful pregnancies,2...

REVIEW ARTICLE: Pregnancy in Recipients of Solid Organs â Effects on Mother and Child

Dianne B. McKay, M.D., and Michelle A. Josephson, M.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

The first child born to a transplant recipient turned 48 years old on March 10, 2006.1 When the field of transplantation was first developing, physicians worried about the teratogenicity of...

EDITORIAL: The Changing Landscape of Myeloma Therapy

Michele Cavo, M.D., and Michele Baccarani, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

The introduction of melphalan and prednisone for the treatment of multiple myeloma was followed by only minor advances in the management of the disease for almost 20 years.1 The failure...

PERSPECTIVE: Brave New Face

Thu, 02Â MarÂ 2006 00:00:00 -05:00

In her office at the Cleveland Clinic, plastic surgeon Maria Siemionow has been studying the photographs and perusing the medical records of severely disfigured people, looking for the ideal candidate...

EDITORIAL: Maximizing the Success of Transplantation with Kidneys from Older Donors

Francis L. Delmonico and James F. Burdick — Thu, 26Â JanÂ 2006 00:00:00 -05:00

In this issue of the Journal, Remuzzi et al.1 report on the important challenge of maximizing success when transplanting kidneys from older donors while minimizing poor outcomes due to the...

ORIGINAL ARTICLE: Long-Term Outcome of Renal Transplantation from Older Donors

Thu, 26Â JanÂ 2006 00:00:00 -05:00

Background: Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic...

EDITORIAL: Inhaled Cyclosporine â A Breath of Fresh Air?

Malcolm M. DeCamp, Jr., M.D. — Thu, 12Â JanÂ 2006 00:00:00 -05:00

During the past two decades, lung transplantation has evolved from a new investigational intervention performed in fewer than 20 patients per year at one institution to an accepted, albeit complex,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2006 â A 64-Year-Old Male Lung-Transplant Recipient with Fever, Cough, Hemoptysis, and Abdominal Pain

Robert H. Rubin, M.D., Matthew D. Gilman, M.D., and Richard L. Kradin, M.D. — Thu, 12Â JanÂ 2006 00:00:00 -05:00

A 64-year-old man with emphysema who had received a double-lung allograft six months previously was admitted to the hospital because of cough, hemoptysis, and abdominal pain.

Three days before admission, abdominal...

ORIGINAL ARTICLE: A Randomized Trial of Inhaled Cyclosporine in Lung-Transplant Recipients

Thu, 12Â JanÂ 2006 00:00:00 -05:00

Background: Conventional regimens of immunosuppressive drugs often do not prevent chronic rejection after lung transplantation. Topical delivery of cyclosporine in addition to conventional systemic immunosuppression might help prevent acute and...

EDITORIAL: Rejection â More Than the Eye Can See

Terry B. Strom, M.D. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

In comparing current clinical outcomes in renal transplantation with those of 30 years ago,1 graft failure from immunologic factors and death from opportunistic infection in the first year after transplantation...

ORIGINAL ARTICLE: Messenger RNA for in the Urine of Renal-Allograft Recipients

Thu, 01Â DecÂ 2005 00:00:00 -05:00

Background: The outcome of renal transplantation after an episode of acute rejection is difficult to predict, even with an allograft biopsy.

Methods: We studied urine specimens from 36 subjects with acute...

EDITORIAL: Graft-versus-Host Disease â From the Bench to the Bedside?

GÃ©rard SociÃ©, M.D., Ph.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

Myeloablative conditioning with high doses of chemotherapy before transplantation of allogeneic hematopoietic stem cells is a procedure that can cure hematologic malignant diseases, but its wide applicability is limited by...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2005 â A 56-Year-Old Man with Fever and Axillary Lymphadenopathy

Jane E. Koehler, M.D., and Lyn M. Duncan, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

A 56-year-old man was referred to the transplantation infectious-disease clinic because of a low-grade fever and left axillary lymphadenopathy.

The patient had received a cadaveric kidney transplant five years earlier for...

ORIGINAL ARTICLE: Protective Conditioning for Acute Graft-versus-Host Disease

Thu, 29Â SepÂ 2005 00:00:00 -05:00

Background: Conditioning with total lymphoid irradiation plus antithymocyte serum protects mice against acute graft-versus-host disease (GVHD) after hematopoietic-cell transplantation. We tested this strategy in humans.

Methods: Thirty-seven patients with lymphoid malignant...

IMAGES IN CLINICAL MEDICINE: Coagulase-Negative Staphylococcus within Neutrophils in Acute Leukemia

Francisco J. OrtuÃ±o, M.D., Ph.D. and Inmaculada Heras, M.D. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

A 43-year-old man was admitted with a relapse of acute myelomonocytic leukemia eight months after having undergone autologous hematopoietic stem-cell transplantation. Fever (temperature, >39Â°C) developed within one day of the...

EDITORIAL: Immunosuppression â The Promise of Specificity

Julie R. Ingelfinger, M.D., and Robert S. Schwartz, M.D. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

The success of organ transplantation owes much to improvements in the immunosuppressive regimens that prevent or suppress allograft rejection. Nevertheless, the potent immunosuppressive drugs that are now in general use...

ORIGINAL ARTICLE: Costimulation Blockade with Belatacept in Renal Transplantation

Thu, 25Â AugÂ 2005 00:00:00 -05:00

Background: Renal transplantation is the standard of care for patients with end-stage renal disease. Although maintenance immunosuppression with calcineurin inhibitors yields excellent one-year survival, it is associated over the long...

PERSPECTIVE: Risks and Benefits to the Living Donor

Julie R. Ingelfinger, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

In the five decades since the first renal transplantation from a living donor took place, in 1954, donating a kidney has become common; according to the Organ Procurement and Transplantation...

PERSPECTIVE: The Ethics of Organ Donation by Living Donors

Robert D. Truog, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

Most organs for transplantation come from cadavers, but as these have failed to meet the growing need for organs, attention has turned to organs from living donors. Organ donation by...

PERSPECTIVE: Public Solicitation of Organ Donors

Robert Steinbrook, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

During the past half-century, organ donation has been fertile territory for both extraordinary compassion and complex ethical questions. As transplantation has become safer and outcomes have improved, the rules for...

ORIGINAL ARTICLE: Ovarian Transplantation between Monozygotic Twins Discordant for Premature Ovarian Failure

Thu, 07Â JulÂ 2005 00:00:00 -05:00

Monozygotic 24-year-old twins presented with discordant ovarian function. One had had premature ovarian failure at the age of 14 years, whereas her sister had normal ovaries and three naturally conceived...

IMAGES IN CLINICAL MEDICINE: Calcific Arteriopathy

France Joyal, M.D. and Pascal Margaroli, M.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

A 38-year-old man who had undergone renal and pancreatic transplantation five years earlier was referred because of acral gangrene of both hands. The patient also had type 1 diabetes and...

EDITORIAL: Immunosuppression in Cardiac Transplantation

Jeffrey D. Hosenpud, M.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

In this issue of the Journal, Hershberger and colleagues present data from a multicenter trial of immunosuppression in cardiac-transplant recipients showing that daclizumab, a monoclonal antibody against the interleukin-2 receptor,...

ORIGINAL ARTICLE: Daclizumab to Prevent Rejection after Cardiac Transplantation

Thu, 30Â JunÂ 2005 00:00:00 -05:00

Background: Daclizumab, a humanized monoclonal antibody against the interleukin-2 receptor, reduced the risk of rejection without increasing the risk of infection among renal-transplant recipients and, in a single-center trial, among...

EDITORIAL: Early Use of Drastic Therapy

Kenneth I. Weinberg, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Krabbe's disease, or globoid-cell leukodystrophy, is an inborn error of lipid metabolism first described in 1916 in two children with spasticity who died in infancy and were found to have...

ORIGINAL ARTICLE: Transplantation of Umbilical-Cord Blood in Babies with Infantile Krabbe's Disease

Thu, 19Â MayÂ 2005 00:00:00 -05:00

Background: Infantile Krabbe's disease produces progressive neurologic deterioration and death in early childhood. We hypothesized that transplantation of umbilical-cord blood from unrelated donors before the development of symptoms would favorably...

EDITORIAL: Immunosuppressive Drugs and the Risk of Cancer after Organ Transplantation

Jacques Dantal, M.D., Ph.D., and Jean-Paul Soulillou, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Improvements in immunosuppressive therapy during the past decade have brought us closer to the day when long-term acceptance of organ allografts will be routine. These achievements, however, have run up...

ORIGINAL ARTICLE: Sirolimus for Kaposi's Sarcoma in Renal-Transplant Recipients

Thu, 31Â MarÂ 2005 00:00:00 -05:00

Background: Recipients of organ transplants are susceptible to Kaposi's sarcoma as a result of treatment with immunosuppressive drugs. Sirolimus (rapamycin), an immunosuppressive drug, may also have antitumor effects.

Methods: We stopped...

ORIGINAL ARTICLE: Transmission of Rabies Virus from an Organ Donor to Four Transplant Recipients

Thu, 17Â MarÂ 2005 00:00:00 -05:00

Background: In 2004, four recipients of kidneys, a liver, and an arterial segment from a common organ donor died of encephalitis of an unknown cause.

Methods: We reviewed the medical records...

EDITORIAL: Agonistic Autoantibodies and Rejection of Renal Allografts

Julie R. Ingelfinger, M.D. — Thu, 10Â FebÂ 2005 00:00:00 -05:00

Allograft rejection remains a major problem in renal transplantation, despite the substantial improvements in post-transplantation management that now result in fewer acute rejection episodes and better overall survival.1 Rejection can...

ORIGINAL ARTICLE: Angiotensin II Type 1âReceptor Activating Antibodies in Renal-Allograft Rejection

Thu, 10Â FebÂ 2005 00:00:00 -05:00

Background: Antibodies against HLA antigens cause refractory allograft rejection with vasculopathy in some, but not all, patients.

Methods: We studied 33 kidney-transplant recipients who had refractory vascular rejection. Thirteen had donor-specific...

OCCASIONAL NOTES: Transplantation 50 Years Later â Progress, Challenges, and Promises

Mohamed H. Sayegh, M.D., and Charles B. Carpenter, M.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

On December 23, 1954, a surgical team at the Peter Bent Brigham Hospital in Boston, under the direction of Joseph Murray, removed a kidney from a healthy donor and transplanted...

REVIEW ARTICLE: Care of the Potential Organ Donor

Thu, 23Â DecÂ 2004 00:00:00 -05:00

Even in the face of the urgent need for transplantable organs, there continues to be a disparity between the number of potential organ donors and that of actual donors.1 Reducing...

REVIEW ARTICLE: Immunosuppressive Drugs for Kidney Transplantation

Philip F. Halloran, M.D., Ph.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

The central issue in organ transplantation remains suppression of allograft rejection. Thus, development of immunosuppressive drugs is the key to successful allograft function. Immunosuppressive agents are used for induction (intense...

PERSPECTIVE: Transplantation â A Medical Miracle of the 20th Century

Peter J. Morris, F.R.S. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

Fifty years ago, on December 23, 1954, a kidney was transplanted from one healthy identical twin to his twin who was dying of renal disease. The surgery was performed at...

EDITORIAL: Cord-Blood Transplantation in Patients with Leukemia â A Real Alternative for Adults

Miguel A. Sanz, M.D., Ph.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

A steady stream of advances in allogeneic hematopoietic stem-cell transplantation has not only improved the clinical outcome in a variety of malignant and nonmalignant diseases but also widened the indications...

ORIGINAL ARTICLE: Transplants of Umbilical-Cord Blood or Bone Marrow from Unrelated Donors in Adults with Acute Leukemia

Thu, 25Â NovÂ 2004 00:00:00 -05:00

Background: Promising results of cord-blood transplants from unrelated donors have been reported in adults.

Methods: We compared outcomes in 682 adults with acute leukemia who received a hematopoietic stem-cell transplant from...

ORIGINAL ARTICLE: Outcomes after Transplantation of Cord Blood or Bone Marrow from Unrelated Donors in Adults with Leukemia

Thu, 25Â NovÂ 2004 00:00:00 -05:00

Background: Data regarding the outcome of cord-blood transplantation in adults are scant, despite the fact that these grafts are increasingly used in adults.

Methods: We compared the outcomes of the transplantation...

PERSPECTIVE: The Cord-Blood-Bank Controversies

Robert Steinbrook, M.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

Umbilical-cord blood is increasingly used as a source of stem cells to repopulate the bone marrow in the treatment of life-threatening diseases in children and adults (as discussed in this...

REVIEW ARTICLE: Multiple Myeloma

Robert A. Kyle, M.D., and S. Vincent Rajkumar, M.D. — Thu, 28Â OctÂ 2004 00:00:00 -05:00

Multiple myeloma is a plasma-cell neoplasm that is characterized by skeletal destruction, renal failure, anemia, and hypercalcemia.1 Although myeloma remains incurable, recent advances in its treatment, including the use of...

ORIGINAL ARTICLE: Corneal Reconstruction with Tissue-Engineered Cell Sheets Composed of Autologous Oral Mucosal Epithelium

Thu, 16Â SepÂ 2004 00:00:00 -05:00

Background: Ocular trauma or disease may lead to severe corneal opacification and, consequently, severe loss of vision as a result of complete loss of corneal epithelial stem cells. Transplantation of...

PERSPECTIVE: Changing the Cell Source in Cell Therapy?

Graziella Pellegrini, Ph.D. — Thu, 16Â SepÂ 2004 00:00:00 -05:00

One dream of scientists is to be able to rebuild, in vitro, âspare partsâ to replace injured or diseased tissues â a notion that was once relegated to the realm...

ORIGINAL ARTICLE: Cardiac Replacement with a Total Artificial Heart as a Bridge to Transplantation

Thu, 26Â AugÂ 2004 00:00:00 -05:00

Background: The CardioWest Total Artificial Heart orthotopically replaces both native cardiac ventricles and all cardiac valves, thus eliminating problems commonly seen in the bridge to transplantation with left ventricular and...

PERSPECTIVE: Building a Bridge to Heart Transplantation

Dale G. Renlund, M.D. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

End-stage heart failure, characterized by marked symptoms at rest or with minimal activity despite optimal therapy, is designated as stage D heart failure. Frequent, recurring exacerbations may often be treated...

EDITORIAL: The Safety and Availability of Blood and Tissues â Progress and Challenges

Jesse L. Goodman, M.D., M.P.H. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

The availability of a safe blood supply is critical for both medical progress and national security. Safety has been increased by nucleic acidâamplification testing, as documented by Stramer et al....

ORIGINAL ARTICLE: Probability of Viremia with HBV, HCV, HIV, and HTLV among Tissue Donors in the United States

Thu, 19Â AugÂ 2004 00:00:00 -05:00

Background: Tissue-banking organizations in the United States have introduced various review and testing procedures to reduce the risk of the transmission of viral infections from tissue grafts. We estimated the...

PERSPECTIVE: Pediatric Renal-Replacement Therapy â Coming of Age

Dawn S. Milliner, M.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

Before the middle of the 20th century, the prospect that a child with end-stage renal disease (ESRD) would reach adulthood was essentially nil. Once dialysis and transplantation became available, that...

ORIGINAL ARTICLE: Clostridium Infections Associated with Musculoskeletal-Tissue Allografts

Thu, 17Â JunÂ 2004 00:00:00 -05:00

Background: Allografts are commonly used in orthopedic reconstructive surgery. In 2001, approximately 875,000 musculoskeletal allografts were distributed by U.S. tissue banks. After the death from Clostridium sordellii sepsis of a...

PERSPECTIVE: Infections Transmitted through Musculoskeletal-Tissue Allografts

Robin Patel, M.D, and Andrej Trampuz, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

The 2003 Institute of Medicine report Microbial Threats to Health: Emergence, Detection, and Response lists âadvances in medical technologies, such as blood transfusions and organ transplants,â as one reason for...

ORIGINAL ARTICLE: Cord-Blood Transplants from Unrelated Donors in Patients with Hurler's Syndrome

Thu, 06Â MayÂ 2004 00:00:00 -05:00

Background: Hurler's syndrome (the most severe form of mucopolysaccharidosis type I) causes progressive deterioration of the central nervous system and death in childhood. Allogeneic bone marrow transplantation before the age...

PERSPECTIVE: Advances in the Treatment of Mucopolysaccharidosis Type I

Joseph Muenzer, M.D., Ph.D., and Amy Fisher, M.S. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

The mucopolysaccharidoses are a group of lysosomal storage diseases caused by a deficiency of enzymes that degrade glycosaminoglycans.1 Mucopolysaccharidosis type I, an autosomal recessive disorder caused by a deficiency of...

PERSPECTIVE: Exchanging Kidneys â Advances in Living-Donor Transplantation

Francis L. Delmonico, M.D. — Thu, 29Â AprÂ 2004 00:00:00 -05:00

This year marks the 50th anniversary of the first successful kidney transplantation from a living donor to his identical twin. Over the ensuing five decades, kidney transplantation has progressed from...

ORIGINAL ARTICLE: Initial Treatment of Aggressive Lymphoma with High-Dose Chemotherapy and Autologous Stem-Cell Support

Thu, 25Â MarÂ 2004 00:00:00 -05:00

Background: The efficacy of first-line intensive chemotherapy plus transplantation of autologous hematopoietic stem cells in adults with disseminated aggressive lymphoma is unknown.

Methods: We compared high-dose therapy plus autologous stem-cell support...

ORIGINAL ARTICLE: Alendronate versus Calcitriol for the Prevention of Bone Loss after Cardiac Transplantation

Thu, 19Â FebÂ 2004 00:00:00 -05:00

Background: Osteoporosis is a well-known complication of cardiac transplantation. We conducted a randomized trial comparing alendronate with calcitriol for the prevention of bone loss during the first year after cardiac...

PERSPECTIVE: Bone Loss after Cardiac Transplantation

Robert Lindsay, M.D. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

Although clinicians generally consider osteoporosis to be a disease primarily affecting postmenopausal women, other populations are also at high risk. One such group is recipients of organ transplants, who, as...

REVIEW ARTICLE: Islet Transplantation as a Treatment for Diabetes â A Work in Progress

R. Paul Robertson, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

In 1993 the Diabetes Control and Complications Trial (DCCT) established the modern standard of care for the medical management of type 1 diabetes mellitus.1 The DCCT randomly assigned 1441 patients...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Getting a Handle on Graft-versus-Host Disease

Robertson Parkman, M.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

A central dichotomy of allogeneic hematopoietic stem-cell transplantation for neoplastic diseases is that the immune responses initiated by donor-derived cells provide both the chief benefit and the major limitation of...

ORIGINAL ARTICLE: Effect of Changing the Priority for HLA Matching on the Rates and Outcomes of Kidney Transplantation in Minority Groups

Thu, 05Â FebÂ 2004 00:00:00 -05:00

Background: HLA typing and the time a patient has spent on the waiting list are the primary criteria used to allocate cadaveric kidneys for transplantation in the United States. Candidates...

PERSPECTIVE: The Artificial Heart

Sandeep Jauhar, M.D., Ph.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

At 10:30 p.m. on December 1, 1982, a retired dentist named Barney Clark was wheeled into an operating room at the University of Utah Medical Center in Salt Lake City....

PERSPECTIVE: Weighing Optimal Graft Survival through HLA Matching against the Equitable Distribution of Kidney Allografts

Jon J. van Rood, M.D., Ph.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

At almost exactly the same time that Dr. David Willard, whose letter to the editor appears in this issue of the Journal (page 624), received three skin grafts in order...

EDITORIAL: Multiple Myeloma, 2004 â One or Two Transplants?

Edward A. Stadtmauer, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

Contrary to a widely held belief, multiple myeloma is not a rare, rapidly fatal disorder that affects only elderly patients. Instead, it is the second most common hematologic cancer after...

ORIGINAL ARTICLE: Single versus Double Autologous Stem-Cell Transplantation for Multiple Myeloma

Thu, 25Â DecÂ 2003 00:00:00 -05:00

Background: We conducted a randomized trial of the treatment of multiple myeloma with high-dose chemotherapy followed by either one or two successive autologous stem-cell transplantations.

Methods: At the time of diagnosis,...

ORIGINAL ARTICLE: The Natural History of Chronic Allograft Nephropathy

Thu, 11Â DecÂ 2003 00:00:00 -05:00

Background: With improved immunosuppression and early allograft survival, chronic allograft nephropathy has become the dominant cause of kidney-transplant failure.

Methods: We evaluated the natural history of chronic allograft nephropathy in a...

PERSPECTIVE: Chronic Allograft Nephropathy

Robert B. Colvin, M.D. — Thu, 11Â DecÂ 2003 00:00:00 -05:00

Long-term survival of kidney transplants (renal allografts) has changed little during the past decade, despite dramatic improvements in short-term survival. Most late renal allograft loss, other than that associated with...

IMAGES IN CLINICAL MEDICINE: Oral Lichen Planus as a Clinical Sign of Graft-versus-Host Disease

Mordechai Findler,, M.D., D.M.D. and Adi A. Garfunkel, D.M.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

A 19-year-old woman had acute lymphocytic leukemia. While she was in her first remission, she underwent bone marrow transplantation. Three months later, she had an oral eruption consistent with lichen...

ORIGINAL ARTICLE: Relation of an Interleukin-10 Promoter Polymorphism to Graft-versus-Host Disease and Survival after Hematopoietic-Cell Transplantation

Thu, 04Â DecÂ 2003 00:00:00 -05:00

Background: Polymorphisms in cytokine genes can influence immune responses, inflammation, and tissue injury and may affect the outcome of hematopoietic stem-cell transplantation.

Methods: We analyzed single-nucleotide polymorphisms in the genes for...

PERSPECTIVE: A Protective Gene for Graft-versus-Host Disease

Kenneth R. Cooke, M.D., and James L.M. Ferrara, M.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

Hematopoietic stem-cell transplantation is an effective but toxic therapy for a number of life-threatening diseases, especially hematologic cancers. The principal complication of allogeneic stem-cell transplantation (the transplantation of grafts from...

OCCASIONAL NOTES: The 50th Anniversary of the Discovery of Immunologic Tolerance

Leslie Brent, Ph.D. — Thu, 02Â OctÂ 2003 00:00:00 -05:00

On October 3, 1953 â almost exactly half a century ago â Rupert E. Billingham, Peter B. Medawar, and I published a paper in Nature titled ââActively Acquired Toleranceâ of...

EDITORIAL: The Growing Problem of Chronic Renal Failure after Transplantation of a Nonrenal Organ

Colm Magee, M.D., M.P.H., and Manuel Pascual, M.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

The clinical introduction of the immunosuppressive drug cyclosporine in the early 1980s revolutionized the field of organ transplantation. The adoption of cyclosporine-based immunosuppressive regimens dramatically improved survival among patients who...

ORIGINAL ARTICLE: Chronic Renal Failure after Transplantation of a Nonrenal Organ

Thu, 04Â SepÂ 2003 00:00:00 -05:00

Background: Transplantation of nonrenal organs is often complicated by chronic renal disease with multifactorial causes. We conducted a population-based cohort analysis to evaluate the incidence of chronic renal failure, risk...

ORIGINAL ARTICLE: Everolimus for the Prevention of Allograft Rejection and Vasculopathy in Cardiac-Transplant Recipients

Thu, 28Â AugÂ 2003 00:00:00 -05:00

Background: Everolimus, a novel proliferation inhibitor and immunosuppressive agent, may suppress cardiac-allograft vasculopathy. We conducted a randomized, double-blind, clinical trial comparing everolimus with azathioprine in recipients of a first heart...

PERSPECTIVE: Cardiac-Allograft Vasculopathy

Robin K. Avery, M.D. — Thu, 28Â AugÂ 2003 00:00:00 -05:00

Vasculopathy of cardiac allografts is a major therapeutic challenge, occurring in 50 percent or more of heart-transplant recipients in the first several years after surgery. Improving survival for these patients...

EDITORIAL: Disparity between Solid-Organ Supply and Demand

Anthony J. Langone, M.D., and J. Harold Helderman, M.D. — Thu, 14Â AugÂ 2003 00:00:00 -05:00

More patients die awaiting solid-organ transplantation than currently receive viable organs. Perhaps a victim of its own success, transplantation is the treatment of choice for failed organ function. Despite the...

SPECIAL ARTICLE: Estimating the Number of Potential Organ Donors in the United States

Thu, 14Â AugÂ 2003 00:00:00 -05:00

Background: As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a...

REVIEW ARTICLE: Adult Stem Cells for Tissue Repair â A New Therapeutic Concept?

Martin KÃ¶rbling, M.D., and Zeev Estrov, M.D. — Thu, 07Â AugÂ 2003 00:00:00 -05:00

Adult human stem cells that are intrinsic to various tissues have been described and characterized, some of them only recently. These cells are capable of maintaining, generating, and replacing terminally...

EDITORIAL: Legislative Myopia on Stem Cells

Jeffrey M. Drazen, M.D. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

The U.S. House of Representatives has voted to ban research on, and the use of, medical treatments derived from embryonic stem cells. This bill is shortsighted and has the potential...

REVIEW ARTICLE: Nuclear Transplantation, Embryonic Stem Cells, and the Potential for Cell Therapy

Konrad Hochedlinger, Ph.D., and Rudolf Jaenisch, M.D. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

Nuclear cloning, also referred to as nuclear transfer or nuclear transplantation, denotes the introduction of a nucleus from an adult donor cell into an enucleated oocyte to generate a cloned...

REVIEW ARTICLE: Prometheus's Vulture and the Stem-Cell Promise

Nadia Rosenthal, Ph.D. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

When Prometheus transgressed the law of the ancient gods and stole fire for humankind, to teach them civilization and the arts, his punishment was typically brutal. Jupiter had the great...

PERSPECTIVE: Cloning and Stem Cells â Handicapping the Political and Scientific Debates

George Q. Daley, M.D., Ph.D. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

On August 9, 2001, President George W. Bush delivered an extraordinary prime-time television address to the nation that was devoted exclusively to an arcane topic of basic biomedical research: human...

EDITORIAL: Predicting Outcomes after Renal Transplantation â New Tools and Old Tools

Philip A. Marsden, M.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

More than 90 percent of renal allografts transplanted today will still be functioning one year from now. This rate represents a remarkable improvement over one-year graft-survival rates of 70 percent...

ORIGINAL ARTICLE: Molecular Heterogeneity in Acute Renal Allograft Rejection Identified by DNA Microarray Profiling

Thu, 10Â JulÂ 2003 00:00:00 -05:00

Background: The causes and clinical course of acute rejection vary, and it is not possible to predict graft outcome reliably on the basis of available clinical, pathological, and genetic markers....

ORIGINAL ARTICLE: The Renal Arterial Resistance Index and Renal Allograft Survival

Thu, 10Â JulÂ 2003 00:00:00 -05:00

Background: Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal...

EDITORIAL: Stem-Cell Transplantation for High-Risk Breast Cancer

Gerald J. Elfenbein, M.D. — Thu, 03Â JulÂ 2003 00:00:00 -05:00

The controversy over the question of whether to use high-dose chemotherapy and autologous hematopoietic stem-cell transplantation in women with high-risk breast cancer has persisted for more than a decade.1 It...

ORIGINAL ARTICLE: High-Dose Chemotherapy with Hematopoietic Stem-Cell Rescue for High-Risk Breast Cancer

Thu, 03Â JulÂ 2003 00:00:00 -05:00

Background: The use of high-dose adjuvant chemotherapy for high-risk primary breast cancer is controversial. We studied its efficacy in patients with 4 to 9 or 10 or more tumor-positive axillary...

ORIGINAL ARTICLE: Conventional Adjuvant Chemotherapy with or without High-Dose Chemotherapy and Autologous Stem-Cell Transplantation in High-Risk Breast Cancer

Thu, 03Â JulÂ 2003 00:00:00 -05:00

Background: The prognosis for women with primary breast cancer and 10 or more involved axillary lymph nodes is poor. High-dose chemotherapy with autologous hematopoietic stem-cell transplantation has been reported to...

ORIGINAL ARTICLE: Successful Cardiac Transplantation in an HIV-1âInfected Patient with Advanced Disease

Thu, 05Â JunÂ 2003 00:00:00 -05:00

Advances in the management of human immunodeficiency virus (HIV) infection â specifically, the introduction of highly active antiretroviral therapy â have dramatically delayed the progression of disease, enhanced immunologic function,...

PERSPECTIVE: Responding to Organ Failure in HIV-Infected Patients

Michelle E. Roland, M.D., and Diane V. Havlir, M.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

Until recently, patients infected with the human immunodeficiency virus (HIV) who had organ failure were not routinely evaluated for transplantation. The poor prognosis for persons with the acquired immunodeficiency syndrome...

ORIGINAL ARTICLE: Transmission of West Nile Virus from an Organ Donor to Four Transplant Recipients

Thu, 29Â MayÂ 2003 00:00:00 -05:00

Background: In August 2002, fever and mental-status changes developed in recipients of organs from a common donor. Transmission of West Nile virus through organ transplantation was suspected.

Methods: We reviewed medical...

PERSPECTIVE: West Nile Virus â Not a Passing Phenomenon

Dale L. Morse, M.D. — Thu, 29Â MayÂ 2003 00:00:00 -05:00

As private citizens and as public health professionals, we are enthralled by the new, the unknown, and the catastrophic. This is especially true for epidemics that appear suddenly, spread rapidly,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Platelet Storage â Time to Come in from the Cold?

Edward L. Snyder, M.D., and Henry M. Rinder, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

Refrigerated platelets have better in vitro function than those stored at room temperature,1 but once transfused, they are rapidly cleared from the circulation. Thus, platelets are currently stored at room...

ORIGINAL ARTICLE: High-Dose Chemotherapy with Hematopoietic Stem-Cell Rescue for Multiple Myeloma

Thu, 08Â MayÂ 2003 00:00:00 -05:00

Background: High-dose therapy with supporting autologous stem-cell transplantation remains a controversial treatment for cancer. In multiple myeloma, first-line regimens incorporating high-dose therapy yield higher remission rates than do conventional-dose treatments,...

REVIEW ARTICLE: Skin Cancers after Organ Transplantation

Sylvie Euvrard, M.D., Jean Kanitakis, M.D., and Alain Claudy, M.D. — Thu, 24Â AprÂ 2003 00:00:00 -05:00

Long-term survival after organ transplantation is increasing. As a result, many physicians may encounter patients who have long-term complications of transplantation. Adequate graft function requires lifelong immunosuppressive treatment, and the...

PERSPECTIVE: A Death at Duke

Edward W. Campion, M.D. — Thu, 20Â MarÂ 2003 00:00:00 -05:00

Last month, a 17-year-old girl died at Duke University Medical Center after receiving a heartâlung transplant from an incompatible donor. Her blood type was O, the donor's was A, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2003 â A 35-Year-Old Man with Early Dysfunction of a Second Renal Transplant

Mohamed H. Sayegh, M.D., and Robert B. Colvin, M.D. — Thu, 13Â MarÂ 2003 00:00:00 -05:00

A 35-year-old man with end-stage renal disease and a history of failed renal transplantation was admitted to the hospital for another transplantation.

When the patient was 10 years old, diabetes mellitus...

SPECIAL ARTICLE: Diversity of the Immune Repertoire and Immunoregulation

Robert S. Schwartz, M.D. — Thu, 13Â MarÂ 2003 00:00:00 -05:00

Since the midpoint of the 20th century, medical advances in economically developed countries have exceeded all expectations. In 1950, the year I entered medical school, the average life expectancy in...

SPECIAL ARTICLE: A Survey of Liver Transplantation from Living Adult Donors in the United States

Thu, 27Â FebÂ 2003 00:00:00 -05:00

Background: The transplantation of the right lobe of a liver from a living adult donor into an adult recipient has been performed increasingly frequently in the United States. Although the...

EDITORIAL: Nephrogenic Adenomas as Renal Tubular Outposts

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Nephrogenic adenomas, which are rare intraurothelial lesions that occur in the bladder, ureter, or urethra, most often present with hematuria or discomfort on voiding. Some patients have no symptoms at...

ORIGINAL ARTICLE: Derivation of Nephrogenic Adenomas from Renal Tubular Cells in Kidney-Transplant Recipients

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Background: Nephrogenic adenomas are benign, tumor-like lesions within the urothelial mucosa of the urinary tract that are not uncommon in renal-transplant recipients. We investigated the origin of nephrogenic adenomas in...

EDITORIAL: BK Virus Nephropathy â Polyomavirus Adding Insult to Injury

Thu, 15Â AugÂ 2002 00:00:00 -05:00

Viruses are particularly troublesome pathogens in transplant recipients. Viral infections enhance susceptibility to opportunistic infection both by causing tissue injury and by contributing to systemic immunosuppression.1 Such infections increase the...

IMAGES IN CLINICAL MEDICINE: Pulmonary Cryptococcal Granulomas

Rick M. Fairhurst, M.D. and David A. Pegues, M.D. — Thu, 15Â AugÂ 2002 00:00:00 -05:00

Figure 1. A 48-year-old man with diabetes mellitus underwent pancreasâkidney transplantation for end-stage renal disease. One month later, he was treated for rejection, and computed tomography of the chest showed...

ORIGINAL ARTICLE: Prospective Study of Polyomavirus Type BK Replication and Nephropathy in Renal-Transplant Recipients

Thu, 15Â AugÂ 2002 00:00:00 -05:00

Background: Nephropathy associated with the polyomavirus type BK (BKV) nephropathy has emerged as a cause of allograft failure linked to immunosuppressive regimens containing tacrolimus or mycophenolate mofetil. The presence of...

SOUNDING BOARD: Solid-Organ Transplantation in HIV-Infected Patients

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Before the introduction of highly active antiretroviral therapy in the mid-1990s, transplantation centers were understandably reluctant to provide scarce solid organs for patients infected with the human immunodeficiency virus (HIV)....

EDITORIAL: Donors without a Heartbeat

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Kidney transplantation offers patients with end-stage renal disease a significant survival advantage as compared with dialysis.12 Despite the success of kidney transplantation, however, fewer than 9000 cadaveric kidneys are transplanted...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Leslie A. Kory, M.D. — Thu, 25Â JulÂ 2002 00:00:00 -05:00

Figure 1. A 34-year-old woman who was receiving dialysis and who had had multiple admissions for uremic pericarditis in the previous few years was evaluated for abdominal pain. What does...

ORIGINAL ARTICLE: Kidney Transplantation from Donors without a Heartbeat

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Background: The dramatic shortage of kidney donors has triggered interest in other sources of organs, such as donors without a heartbeat. Accumulating evidence suggests that the short-term survival of cadaveric...

ORIGINAL ARTICLE: Risk of Renal Allograft Loss from Recurrent Glomerulonephritis

Thu, 11Â JulÂ 2002 00:00:00 -05:00

Background: Recurrent glomerulonephritis is a known cause of renal allograft loss; however, the incidence of this complication is poorly defined. We determined the incidence, timing, and relative importance of allograft...

CLINICAL PRACTICE: Long-Term Care after Hematopoietic-Cell Transplantation in Adults

Joseph H. Antin, M.D. — Thu, 04Â JulÂ 2002 00:00:00 -05:00

A 35-year-old man who had undergone allogeneic hematopoietic-cell transplantation two years earlier for acute myeloid leukemia recently moved to a new town. He comes in for a general checkup because...

ORIGINAL ARTICLE: Use of an Inactivated Varicella Vaccine in Recipients of Hematopoietic-Cell Transplants

Thu, 04Â JulÂ 2002 00:00:00 -05:00

Background: The reactivation of varicellaâzoster virus from latency causes zoster and is common among recipients of hematopoietic-cell transplants.

Methods: We randomly assigned patients who were scheduled to undergo autologous hematopoietic-cell transplantation...

SOUNDING BOARD: Ethical Incentives â Not Payment â For Organ Donation

Thu, 20Â JunÂ 2002 00:00:00 -05:00

The therapeutic promise of transplanting organs from cadaveric donors, as envisioned by the pioneers of transplantation,1 has never been realized because the demand for cadaveric organs has far exceeded the...

ORIGINAL ARTICLE: Fumagillin Treatment of Intestinal Microsporidiosis

Thu, 20Â JunÂ 2002 00:00:00 -05:00

Background: Intestinal microsporidiosis due to Enterocytozoon bieneusi is a cause of chronic diarrhea, malabsorption, and wasting in immunocompromised patients. Currently, there is no effective treatment.

Methods: We conducted a randomized, double-blind,...

SOUNDING BOARD: Stem Cells â Scientific, Medical, and Political Issues

Thu, 16Â MayÂ 2002 00:00:00 -05:00

It is rare that a scientific subject causes controversy not only among scientists but also among politicians and the public. Stem-cell biology is such a subject. The media reports new...

ORIGINAL ARTICLE: Sustained Correction of X-Linked Severe Combined Immunodeficiency by ex Vivo Gene Therapy

Thu, 18Â AprÂ 2002 00:00:00 -05:00

Background: X-linked severe combined immunodeficiency due to a mutation in the gene encoding the common Î³ (Î³c) chain is a lethal condition that can be cured by allogeneic stem-cell transplantation....

REVIEW ARTICLE: Adult-to-Adult Transplantation of the Right Hepatic Lobe from a Living Donor

Thu, 04Â AprÂ 2002 00:00:00 -05:00

Transplantation of the right hepatic lobe from an adult living donor to an adult recipient is rapidly emerging as an effective treatment for selected patients with end-stage liver disease.1234 The...

REVIEW ARTICLE: Strategies to Improve Long-Term Outcomes after Renal Transplantation

Thu, 21Â FebÂ 2002 00:00:00 -05:00

After cyclosporine and muromonab-CD3 (OKT3 monoclonal antibody) were introduced into clinical practice in the early 1980s, one-year survival rates for renal allografts improved from approximately 60 percent to between 80...

ORIGINAL ARTICLE: Voriconazole Compared with Liposomal Amphotericin B for Empirical Antifungal Therapy in Patients with Neutropenia and Persistent Fever

Thu, 24Â JanÂ 2002 00:00:00 -05:00

Background: Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and...

PERSPECTIVE: Persistent Fever in Patients with Neutropenia

Thu, 24Â JanÂ 2002 00:00:00 -05:00

Organ transplantation and major cancer chemotherapy are often associated with prolonged neutropenia (defined as less than 500 polymorphonuclear neutrophils per cubic millimeter), alterations in phagocyte function and lymphopenia due to...

EDITORIAL: Regeneration of the Human Heart â No Chimera?

Thu, 03Â JanÂ 2002 00:00:00 -05:00

In ancient Greece, chimeras were mythical monsters â part lion, part goat, and part snake. In addition to these interspecies animal chimeras, humanâanimal hybrids were common in Greek mythology; the...

ORIGINAL ARTICLE: Chimerism of the Transplanted Heart

Thu, 03Â JanÂ 2002 00:00:00 -05:00

Background: Cases in which a male patient receives a heart from a female donor provide an unusual opportunity to test whether primitive cells translocate from the recipient to the graft...

PERSPECTIVE: Can the Heart Repair Itself?

Thu, 03Â JanÂ 2002 00:00:00 -05:00

Bone marrow, the liver, and intestinal epithelium can regenerate, but the conventional teaching is that the heart cannot, because cardiac myocytes cannot divide. Consequently, it is generally accepted that the...

EDITORIAL: HLA Matching for Bone Marrow Transplantation â How Much Is Enough?

Thu, 20Â DecÂ 2001 00:00:00 -05:00

Despite the very large number of volunteers willing to donate bone marrow for unrelated recipients (currently numbering over 7 million worldwide), many candidate recipients still cannot obtain marrow because no...

ORIGINAL ARTICLE: Major-Histocompatibility-Complex Class I Alleles and Antigens in Hematopoietic-Cell Transplantation

Thu, 20Â DecÂ 2001 00:00:00 -05:00

Background: Successful engraftment of hematopoietic stem cells from unrelated donors is influenced by disparities between the donor and recipient for HLA-A, B, and C alleles. Disparities between HLA sequence polymorphisms...

ORIGINAL ARTICLE: Transmission of a T-Cell Lymphoma by Allogeneic Bone Marrow Transplantation

Thu, 15Â NovÂ 2001 00:00:00 -05:00

Secondary cancer is a well-established long-term complication of bone marrow transplantation.123 These post-transplantation cancers are usually associated with exposure to radiation, other genotoxic agents, or EpsteinâBarr virus; in rare cases,...

ORIGINAL ARTICLE: BK-Related Polyomavirus Vasculopathy in a Renal-Transplant Recipient

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Polyomaviruses typically infect a single species and limited types of tissue. Examples include the human BK and JC viruses and simian virus 40 (SV40). These three viruses are approximately 70...

ORIGINAL ARTICLE: A Comparison of the Survival of Shipped and Locally Transplanted Cadaveric Renal Allografts

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Background: The effect on allograft survival of the shipment of cadaveric renal allografts from one organ-procurement organization to another is uncertain.

Methods: Using data from the Organ Procurement and Transplantation Network...

EDITORIAL: Reinnervation of the Transplanted Heart â Why Is It Important?

Thu, 06Â SepÂ 2001 00:00:00 -05:00

The ability of the heart to respond to the demands of exercise through an increase in output is a complex physiologic process that involves intrinsic properties of heart muscle as...

ORIGINAL ARTICLE: Effect of Sympathetic Reinnervation on Cardiac Performance after Heart Transplantation

Thu, 06Â SepÂ 2001 00:00:00 -05:00

Background: Late after cardiac transplantation, limited reinnervation of the transplanted heart may occur, but little is known about the effect of reinnervation on cardiac function and exercise performance.

Methods: We quantified...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2001 â A 71-Year-Old Man with Gastric Ulcers and Ileocecal Thickening Eight Years after Renal Transplantation

Nezam H. Afdhal, M.D., and Rhonda K. Yantiss, M.D. — Thu, 16Â AugÂ 2001 00:00:00 -05:00

A 71-year-old man was admitted to the hospital because of diarrhea and abdominal pain.

The patient had a history of polycystic renal disease with hypertension and end-stage renal failure, for which...

ORIGINAL ARTICLE: Neointimal and Tubulointerstitial Infiltration by Recipient Mesenchymal Cells in Chronic Renal-Allograft Rejection

Thu, 12Â JulÂ 2001 00:00:00 -05:00

Background: Tissue remodeling depends on mesenchymal cells (fibroblasts and myofibroblasts) and is a prominent feature of chronic renal-transplant rejection. It is not known whether the mesenchymal cells that participate in...

EDITORIAL: Hematopoietic Stem-Cell Transplants Using Umbilical-Cord Blood

Thu, 14Â JunÂ 2001 00:00:00 -05:00

Transplantation of umbilical-cord blood was successfully performed for the first time in 1988 to treat a boy with Fanconi's anemia; the donor, the boy's newborn sister, was a perfect HLA...

ORIGINAL ARTICLE: Hematopoietic Engraftment and Survival in Adult Recipients of Umbilical-Cord Blood from Unrelated Donors

Thu, 14Â JunÂ 2001 00:00:00 -05:00

Background: Umbilical-cord blood from unrelated donors who are not HLA-identical with the recipients can restore hematopoiesis after myeloablative therapy in children. We studied the use of transplantation of umbilical-cord blood...

ORIGINAL ARTICLE: Treatment of the Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-Linked Syndrome (IPEX) by Allogeneic Bone Marrow Transplantation

Thu, 07Â JunÂ 2001 00:00:00 -05:00

The immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) is a recessive disorder of early childhood.1 Symptoms of the disease generally appear in infancy and include protracted diarrhea, ichthyosiform dermatitis, insulin-dependent...

EDITORIAL: Transplantation of the Larynx â A Case Report That Speaks for Itself

Thu, 31Â MayÂ 2001 00:00:00 -05:00

In this issue of the Journal, Strome and colleagues1 describe the extraordinary case of the first successful transplantation of the larynx in a human. The recipient was a 40-year-old man...

ORIGINAL ARTICLE: Laryngeal Transplantation and 40-Month Follow-up

Thu, 31Â MayÂ 2001 00:00:00 -05:00

Total laryngectomy and total occlusion of the larynx with tracheostomy are associated with an impaired sense of taste and smell, an increased incidence of tracheobronchial infections, stomal encrustations, loss of...

SOUNDING BOARD: Transplantation of Liver Grafts from Living Donors into Adults â Too Much, Too Soon

Thu, 24Â MayÂ 2001 00:00:00 -05:00

Since 1995, many liver-transplantation programs in the United States,12 Europe,3 and Asia45 have performed adult-to-adult transplantation of liver grafts from living donors. Since 1997, more than 30 U.S. transplantation programs...

ORIGINAL ARTICLE: Noninvasive Diagnosis of Renal-Allograft Rejection by Measurement of Messenger RNA for Perforin and Granzyme B in Urine

Thu, 29Â MarÂ 2001 00:00:00 -05:00

Background: Acute rejection is a serious and frequent complication of renal transplantation, and its diagnosis is contingent on the invasive procedure of allograft biopsy. A noninvasive diagnostic test for rejection...

EDITORIAL: Immune Monitoring for Rejection of Kidney Transplants

Thu, 29Â MarÂ 2001 00:00:00 -05:00

Kidney transplantation is the best treatment for patients with end-stage renal disease. The first six months after a technically successful transplantation is, however, often complicated by episodes of renal dysfunction...

EDITORIAL: What is the Best Way to Treat Inherited Disorders?

Thu, 22Â MarÂ 2001 00:00:00 -05:00

In his Croonian Lectures in 1908, Garrod discussed what he called the âinborn factors of disease.â In his pioneering studies of alkaptonuria, he recognized that the disorder occurred in families...

ORIGINAL ARTICLE: Treatment of Chronic Granulomatous Disease with Nonmyeloablative Conditioning and a T-CellâDepleted Hematopoietic Allograft

Thu, 22Â MarÂ 2001 00:00:00 -05:00

Background: The treatment of chronic granulomatous disease with conventional allogeneic hematopoietic stem-cell transplantation carries a high risk of serious complications and death. We investigated the feasibility of stem-cell transplantation without...

EDITORIAL: Providing Antiretroviral Therapy for HIV Infection

Thu, 15Â MarÂ 2001 00:00:00 -05:00

Dramatic declines in the incidence of AIDS and the number of deaths from this disease began in the United States in 1996, in association with the widespread use of potent...

ORIGINAL ARTICLE: ABO-Incompatible Heart Transplantation in Infants

Thu, 15Â MarÂ 2001 00:00:00 -05:00

Background: Transplantation of hearts from ABO-incompatible donors is contraindicated because of the risk of hyperacute rejection mediated by preformed antibodies in the recipient to blood-group antigens of the donor. This...

ORIGINAL ARTICLE: Effect of the Use or Nonuse of Long-Term Dialysis on the Subsequent Survival of Renal Transplants from Living Donors

Thu, 08Â MarÂ 2001 00:00:00 -05:00

Background: The effect on allograft survival of the transplantation of kidneys from living donors without the previous initiation of long-term dialysis is controversial.

Methods: Using data from the U.S. Renal Data...

ORIGINAL ARTICLE: Transplantation of Embryonic Dopamine Neurons for Severe Parkinson's Disease

Thu, 08Â MarÂ 2001 00:00:00 -05:00

Background: Transplantation of human embryonic dopamine neurons into the brains of patients with Parkinson's disease has proved beneficial in open clinical trials. However, whether this intervention would be more effective...

ORIGINAL ARTICLE: Transplantation of Bone Marrow as Compared with Peripheral-Blood Cells from HLA-Identical Relatives in Patients with Hematologic Cancers

Thu, 18Â JanÂ 2001 00:00:00 -05:00

Background: In recipients of allogeneic hematopoietic-cell transplants, peripheral-blood cells mobilized with the use of filgrastim (recombinant granulocyte colony-stimulating factor) engraft more rapidly than bone marrow. However, the relative effects of...

REVIEW ARTICLE: Renal Transplantation in Black Americans

Carlton J. Young, M.D., and Robert S. Gaston, M.D. — Thu, 23Â NovÂ 2000 00:00:00 -05:00

Despite remarkable social changes in the United States during the past century, issues related to race and ethnic background continue to permeate public discourse regarding health care.12 The influence of...

SPECIAL ARTICLE: Racial Disparities in Access to Renal Transplantation â Clinically Appropriate or Due to Underuse or Overuse?

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or underuse of...

ORIGINAL ARTICLE: Bone Marrow Failure Associated with Human Herpesvirus 8 Infection after Transplantation

Thu, 09Â NovÂ 2000 00:00:00 -05:00

Background: Human herpesvirus 8 (HHV-8) infection has been linked to the development of Kaposi's sarcoma and to rare lymphoproliferative disorders.

Methods: We used molecular methods, serologic methods, in situ hybridization, and...

ORIGINAL ARTICLE: Transmission of by Organ Transplantation

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Histoplasmosis may occur either after primary infection or after reactivation of latent infection, and its incidence among immunocompromised persons, including recipients of organ transplants, is increasing.123 A variety of infectious...

ORIGINAL ARTICLE: Twelve Years' Experience with National Sharing of HLA-Matched Cadaveric Kidneys for Transplantation

Thu, 12Â OctÂ 2000 00:00:00 -05:00

Background: In October 1987, the United Network for Organ Sharing (UNOS) established a national kidney-sharing program to increase the number of HLA-matched transplantations. Since then, over 7500 cadaveric kidneys have...

EDITORIAL: Cancer Immunotherapy with Alloreactive Lymphocytes

Thu, 14Â SepÂ 2000 00:00:00 -05:00

In this issue of the Journal, Childs and colleagues present preliminary evidence that in patients with metastatic renal-cell cancer, infusions of allogeneic hematopoietic stem cells after a preparative regimen that...

ORIGINAL ARTICLE: Regression of Metastatic Renal-Cell Carcinoma after Nonmyeloablative Allogeneic Peripheral-Blood Stem-Cell Transplantation

Thu, 14Â SepÂ 2000 00:00:00 -05:00

Background: Since allogeneic stem-cell transplantation can induce curative graft-versus-leukemia reactions in patients with hematologic cancers, we sought to induce analogous graft-versus-tumor effects in patients with metastatic renal-cell carcinoma by means...

EDITORIAL: Composite-Tissue Transplantation â A New Frontier

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Limb transplantation has long been of interest to surgeons. The legend of the pysician twins Saint Cosmos and Saint Damian, who transplanted a whole leg in a.d. 348, has come...

ORIGINAL ARTICLE: Successful Hand Transplantation â One-Year Follow-up

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Background: On the basis of positive results in studies of the transplantation of pig extremities and the information exchanged at an international symposium on composite-tissue transplantation, we developed a protocol...

SOUNDING BOARD: Nondirected Donation of Kidneys from Living Donors

Thu, 10Â AugÂ 2000 00:00:00 -05:00

The transplantation of organs from living donors has always involved a balancing of the physical risks and psychological benefits to the donor against the benefits to the recipient. Early in...

EDITORIAL: Organ Donation by Unrelated Donors

Thu, 10Â AugÂ 2000 00:00:00 -05:00

The transplantation of organs is a triumph of modern medicine. Life expectancy and the quality of life are greater with kidney transplantation than with maintenance dialysis. Successful liver and heart...

REVIEW ARTICLE: Strategies for Making More Organs Available for Transplantation

Bruno Gridelli, M.D., and Giuseppe Remuzzi, M.D. — Thu, 10Â AugÂ 2000 00:00:00 -05:00

Organ transplantation has evolved rapidly from the first early successes1 to the current widespread use of donated organs for the treatment of end-stage kidney, heart, and liver failure. With limited...

EDITORIAL: Successful Islet Transplantation for Patients with Diabetes â Fact or Fantasy?

Thu, 27Â JulÂ 2000 00:00:00 -05:00

Medical history is replete with sagas of scientists who doggedly pursue dreams of better ways to treat disease. In these tales, somewhere on the road between the first success and...

ORIGINAL ARTICLE: Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen

Thu, 27Â JulÂ 2000 00:00:00 -05:00

Background: Registry data on patients with type 1 diabetes mellitus who undergo pancreatic islet transplantation indicate that only 8 percent are free of the need for insulin therapy at one...

ORIGINAL ARTICLE: Reconstruction of Damaged Corneas by Transplantation of Autologous Limbal Epithelial Cells

Ray Jui-Fang Tsai, M.D., Lien-Min Li, B.S., and Jan-Kan Chen, Ph.D. — Thu, 13Â JulÂ 2000 00:00:00 -05:00

Background: The StevensâJohnson syndrome, ocular pemphigoid, and thermal or chemical burns can cause scarring and opacification of the cornea and loss of vision. Transplantation of epithelial cells from the limbus...

EDITORIAL: Bioengineered Corneas â The Promise and the Challenge

Thu, 13Â JulÂ 2000 00:00:00 -05:00

The promise of bioengineered replacements for diseased or damaged tissues has become a reality, notably for skin and cartilage. The article by Tsai et al. in this issue of the...

ORIGINAL ARTICLE: Graft-Versus-Host Disease in Children Who Have Received a Cord-Blood or Bone Marrow Transplant from an HLA-Identical Sibling

Thu, 22Â JunÂ 2000 00:00:00 -05:00

Background: Umbilical-cord blood as an alternative to bone marrow for hematopoietic stem-cell transplantation may lower the risk of graft-versus-host disease (GVHD).

Methods: We studied the records of 113 recipients of cord...

EDITORIAL: Nephropathy Due to Polyomavirus Type BK

Thu, 04Â MayÂ 2000 00:00:00 -05:00

Polyomavirus type BK (BK virus) is a nonenveloped virus with circular, double-stranded DNA that has 70 percent homology with simian virus 40. It was first recognized as a member of...

ORIGINAL ARTICLE: Thymic Function after Hematopoietic Stem-Cell Transplantation for the Treatment of Severe Combined Immunodeficiency

Thu, 04Â MayÂ 2000 00:00:00 -05:00

Background: Immune function can be restored in infants with severe combined immunodeficiency by transplantation of unfractionated bone marrow from HLA-identical donors or T-cellâdepleted marrow stem cells from haploidentical donors, with...

ORIGINAL ARTICLE: Testing for Polyomavirus Type BK DNA in Plasma to Identify Renal-Allograft Recipients with Viral Nephropathy

Thu, 04Â MayÂ 2000 00:00:00 -05:00

Background: Reactivation of polyomavirus type BK (BK virus) is increasingly recognized as a cause of severe renal-allograft dysfunction. Currently, patients at risk for nephropathy due to infection with the BK...

REVIEW ARTICLE: Myelofibrosis with Myeloid Metaplasia

Ayalew Tefferi, M.D. — Thu, 27Â AprÂ 2000 00:00:00 -05:00

Myelofibrosis with myeloid metaplasia is classified broadly as a chronic myeloid disorder and, more specifically, as a chronic myeloproliferative disease1 (Figure 1). The primary pathogenetic mechanism is a clonal stem-cell...

EDITORIAL: High-Dose Chemotherapy plus Autologous Bone Marrow Transplantation for Metastatic Breast Cancer

Thu, 13Â AprÂ 2000 00:00:00 -05:00

In this issue of the Journal, Stadtmauer et al. present the results of a clinical trial in which conventional-dose chemotherapy was compared with high-dose chemotherapy plus autologous bone marrow transplantation...

ORIGINAL ARTICLE: Conventional-Dose Chemotherapy Compared with High-Dose Chemotherapy plus Autologous Hematopoietic Stem-Cell Transplantation for Metastatic Breast Cancer

Thu, 13Â AprÂ 2000 00:00:00 -05:00

Background: We conducted a randomized trial in which we compared high-dose chemotherapy plus hematopoietic stem-cell rescue with a prolonged course of monthly conventional-dose chemotherapy in women with metastatic breast cancer.

Methods:...

EDITORIAL: Improving the Success of Organ Transplantation

Thu, 02Â MarÂ 2000 00:00:00 -05:00

The concept of drug-induced immunosuppression arose in the late 1950s with the observation by Schwartz and Dameshek that 6-mercaptopurine, developed as an antileukemic drug, was effective in blocking primary, but...

ORIGINAL ARTICLE: Prevention of Rejection in Cardiac Transplantation by Blockade of the Interleukin-2 Receptor with a Monoclonal Antibody

Thu, 02Â MarÂ 2000 00:00:00 -05:00

Background: Alloantigen-activated T cells express the high-affinity interleukin-2 receptor. Specific blockade of this receptor with the human IgG1 monoclonal antibody daclizumab may prevent rejection of allografts after cardiac transplantation without...

ORIGINAL ARTICLE: Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996

Thu, 02Â MarÂ 2000 00:00:00 -05:00

Background: The introduction of cyclosporine has resulted in improvement in the short-term outcome of renal transplantation, but its effect on the long-term survival of kidney transplants is not known.

Methods: We...

ORIGINAL ARTICLE: Correction of the Hyper-IgM Syndrome after Liver and Bone Marrow Transplantation

Thu, 03Â FebÂ 2000 00:00:00 -05:00

The hyper-IgM syndrome, a rare form of combined primary immunodeficiency, is characterized by neutropenia and defective B-cell isotype switching, which results in elevated or normal levels of serum IgM and...

ORIGINAL ARTICLE: The Effect of the Volume of Procedures at Transplantation Centers on Mortality after Liver Transplantation

Thu, 30Â DecÂ 1999 00:00:00 -05:00

Background: For many complex surgical procedures there is an association between a low volume of procedures and an increased risk of death for the patients who undergo the procedures.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Cutaneous Zygomycosis (Mucormycosis)

Christopher F. Carpenter, M.D. and Aruna K. Subramanian, M.D. — Thu, 16Â DecÂ 1999 00:00:00 -05:00

Figure 1. A 60-year-old man with diabetes mellitus and advanced cirrhosis underwent orthotopic liver transplantation that was complicated by an intraoperative myocardial infarction. His immunosuppressive regimen included tacrolimus and methylprednisolone,...

EDITORIAL: A Survival Advantage for Renal Transplantation

Thu, 02Â DecÂ 1999 00:00:00 -05:00

There is virtual unanimity that the optimal treatment for most patients with end-stage renal disease is renal transplantation. However, unlike the case for liver, heart, and lung transplantation, for which...

ORIGINAL ARTICLE: Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant

Thu, 02Â DecÂ 1999 00:00:00 -05:00

Background: The extent to which renal allotransplantation â as compared with long-term dialysis â improves survival among patients with end-stage renal disease is controversial, because those selected for transplantation may...

EDITORIAL: Quality and Equity in Dialysis and Renal Transplantation

Thu, 25Â NovÂ 1999 00:00:00 -05:00

The Medicare End Stage Renal Disease (ESRD) Program began in 1973. Over the past 26 years, it has illustrated both the benefits of modern, high-technology medicine and the problems associated...

SPECIAL ARTICLE: The Effect of Patients' Preferences on Racial Differences in Access to Renal Transplantation

Thu, 25Â NovÂ 1999 00:00:00 -05:00

Background: In the United States, black patients undergo renal transplantation less often than white patients, but few studies have directly assessed the association between race and patients' preferences with respect...

SPECIAL ARTICLE: Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation

Thu, 25Â NovÂ 1999 00:00:00 -05:00

Background: More than 200,000 patients with end-stage renal disease undergo dialysis in the United States each year, about two thirds in for-profit centers. Economic pressures, such as the decline in...

ORIGINAL ARTICLE: Alloimmune Thrombocytopenia after Organ Transplantation

Thu, 11Â NovÂ 1999 00:00:00 -05:00

Transplanted organs, particularly livers and kidneys, carry passenger lymphocytes that can transmit autoimmune diseases1 or initiate alloimmune disorders2 in the recipient. We recently treated three unrelated patients who each received...

EDITORIAL: The Allocation of Cadaveric Kidneys

Thu, 04Â NovÂ 1999 00:00:00 -05:00

With the discovery of cyclosporine and antiâT-cell antibodies and the successful application of HLA matching, short-term and long-term graft-survival rates for cadaveric kidney transplants have improved dramatically. Nonetheless, there are...

SPECIAL ARTICLE: The Economic Implications of HLA Matching in Cadaveric Renal Transplantation

Thu, 04Â NovÂ 1999 00:00:00 -05:00

Background: The potential economic effects of the allocation of cadaveric kidneys on the basis of tissue-matching criteria are controversial. We analyzed the economic costs associated with the transplantation of cadaveric...

EDITORIAL: Immune Reconstitution

Thu, 14Â OctÂ 1999 00:00:00 -05:00

In this issue of the Journal, Markert et al.1 teach us that transplanting pieces of human thymus can rescue children with the DiGeorge syndrome. Complete DiGeorge syndrome is a rare...

ORIGINAL ARTICLE: Transplantation of Thymus Tissue in Complete DiGeorge Syndrome

Thu, 14Â OctÂ 1999 00:00:00 -05:00

Background: The DiGeorge syndrome is a congenital disorder that affects the heart, parathyroid glands, and thymus. In complete DiGeorge syndrome, patients have severely reduced T-cell function.

Methods: We treated five infants...

ORIGINAL ARTICLE: Treatment of High-Risk Neuroblastoma with Intensive Chemotherapy, Radiotherapy, Autologous Bone Marrow Transplantation, and 13--Retinoic Acid

Thu, 14Â OctÂ 1999 00:00:00 -05:00

Background: Children with high-risk neuroblastoma have a poor outcome. In this study, we assessed whether myeloablative therapy in conjunction with transplantation of autologous bone marrow improved event-free survival as compared...

ORIGINAL ARTICLE: Prevalence and Clinical Outcome of Hepatitis C Infection in Children Who Underwent Cardiac Surgery before the Implementation of Blood-Donor Screening

Thu, 16Â SepÂ 1999 00:00:00 -05:00

Background: and Methods: There are few data on the prevalence and clinical outcome of hepatitis C infection in children. We studied 458 children who underwent cardiac surgery in Munich, Germany,...

ORIGINAL ARTICLE: Donor-Derived Acute Promyelocytic Leukemia in a Liver-Transplant Recipient

Thu, 09Â SepÂ 1999 00:00:00 -05:00

The long-term survival of donor lymphoid cells in recipients of solid-organ transplants or of fetal lymphocytes that cross the placenta and enter the maternal circulation has been established,123 but the...

REVIEW ARTICLE: The Î²-Thalassemias

Nancy F. Olivieri, M.D. — Thu, 08Â JulÂ 1999 00:00:00 -05:00

In 1925, Thomas Cooley and Pearl Lee described a form of severe anemia, occurring in children of Italian origin and associated with splenomegaly and characteristic bone changes.1 Over the next...

IMAGES IN CLINICAL MEDICINE: Successful Treatment of Severe Thalassemia

Pietro Muretto, M.D. and Emanuele Angelucci, M.D. — Thu, 08Â JulÂ 1999 00:00:00 -05:00

Figure 1. A six-year-old girl underwent successful allogeneic bone marrow transplantation for severe Î²-thalassemia in 1985. Before transplantation, the serum ferritin concentration was 4044 Î¼g per liter and the serum...

EDITORIAL: Does Bone Marrow Transplantation Confer a Normal Life Span?

Thu, 01Â JulÂ 1999 00:00:00 -05:00

In the 1950s and 1960s, many bone marrow transplantations were attempted in terminally ill patients with leukemia or aplastic anemia without success, except in a few patients who had identical-twin...

ORIGINAL ARTICLE: Long-Term Survival and Late Deaths after Allogeneic Bone Marrow Transplantation

Thu, 01Â JulÂ 1999 00:00:00 -05:00

Background: and Methods: It is uncertain whether mortality rates among patients who have undergone bone marrow transplantation return to the level of the mortality rates of the general population. We...

EDITORIAL: Epithelial Stem-Cell Transplantation for Severe Ocular-Surface Disease

Thu, 03Â JunÂ 1999 00:00:00 -05:00

The treatment of patients with severe ocular-surface disease has been largely unsuccessful. Superficial keratectomy (the excision of abnormal cells on the corneal surface) can lead to invasion of the corneal...

ORIGINAL ARTICLE: Transplantation of Anergic Histoincompatible Bone Marrow Allografts

Thu, 03Â JunÂ 1999 00:00:00 -05:00

Background: Successful allogeneic bone marrow transplantation relies on global immunosuppression or elimination of T cells. In contrast, the induction of anergy can inactivate specific sets of alloreactive T cells in...

ORIGINAL ARTICLE: Treatment of Severe Ocular-Surface Disorders with Corneal Epithelial Stem-Cell Transplantation

Thu, 03Â JunÂ 1999 00:00:00 -05:00

Background: Conditions that destroy the limbal area of the peripheral cornea, such as the StevensâJohnson syndrome, ocular pemphigoid, and chemical and thermal injuries, can deplete stem cells of the corneal...

ORIGINAL ARTICLE: Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

Thu, 13Â MayÂ 1999 00:00:00 -05:00

Background: Cytomegalovirus (CMV) disease is a major complication of organ transplantation. We hypothesized that prophylactic treatment with valacyclovir would reduce the risk of CMV disease.

Methods: A total of 208 CMV-negative...

REVIEW ARTICLE: Chronic Myeloid Leukemia

Charles L. Sawyers, M.D. — Thu, 29Â AprÂ 1999 00:00:00 -05:00

In the past decade clinical and laboratory studies have led to important new insights into the biology of chronic myeloid leukemia (CML). Basic science has defined the molecular pathogenesis of...

REVIEW ARTICLE: Lung Transplantation

Selim M. Arcasoy, M.D., and Robert M. Kotloff, M.D. — Thu, 08Â AprÂ 1999 00:00:00 -05:00

Since the performance of the first successful lung transplantation nearly two decades ago, the procedure has gained widespread acceptance as a therapeutic option for a diverse array of lung diseases....

ORIGINAL ARTICLE: Recurrence of Bronchioloalveolar Carcinoma in Transplanted Lungs

Thu, 08Â AprÂ 1999 00:00:00 -05:00

Background: Bronchioloalveolar carcinoma is a distinctive subtype of typical adenocarcinoma of the lung that tends to metastasize widely throughout the lungs but less commonly elsewhere. Because conventional therapies for intrapulmonary...

REVIEW ARTICLE: Management of Sickle Cell Disease

Martin H. Steinberg, M.D. — Thu, 01Â AprÂ 1999 00:00:00 -05:00

One of every 600 black people in the United States has sickle cell anemia. In addition, sickle cellâhemoglobin C disease and sickle cellâÎ²-thalassemia, which are other common genotypes of sickle...

EDITORIAL: Thirty Years of Bone Marrow Transplantation for Severe Combined Immunodeficiency

Thu, 18Â FebÂ 1999 00:00:00 -05:00

It has been 30 years since the first patient with combined T-cell and B-cell immunodeficiency was successfully treated with transplantation of bone marrow from an HLA-identical sibling.1 Since then, hundreds...

ORIGINAL ARTICLE: Hematopoietic Stem-Cell Transplantation for the Treatment of Severe Combined Immunodeficiency

Thu, 18Â FebÂ 1999 00:00:00 -05:00

Background: Since 1968 it has been known that bone marrow transplantation can ameliorate severe combined immunodeficiency, but data on the long-term efficacy of this treatment are limited. We prospectively studied...

ORIGINAL ARTICLE: A Controlled Trial of Exercise Rehabilitation after Heart Transplantation

Thu, 28Â JanÂ 1999 00:00:00 -05:00

Background: In patients who have received a cardiac transplant, the denervated donor heart responds abnormally to exercise and exercise tolerance is reduced. The role of physical exercise in the treatment...

REVIEW ARTICLE: Antigen Localization and Migration in Immunity and Tolerance

Thomas E. Starzl, M.D., Ph.D., and Rolf M. Zinkernagel, M.D. — Thu, 24Â DecÂ 1998 00:00:00 -05:00

Survival in a hostile environment requires the ability to mount a protective immune response while avoiding a reaction of the immune system against the self. We propose that the migration...

ORIGINAL ARTICLE: Photopheresis for the Prevention of Rejection in Cardiac Transplantation

Thu, 10Â DecÂ 1998 00:00:00 -05:00

Background: Photopheresis is an immunoregulatory technique in which lymphocytes are reinfused after exposure to a photoactive compound (methoxsalen) and ultraviolet A light. We performed a preliminary study to assess the...

EDITORIAL: Transplantation Toleranceâ The Search Continues

Thu, 03Â DecÂ 1998 00:00:00 -05:00

The induction in a host of immunologic tolerance to the major histocompatibility complex (MHC) antigens of a donor (in humans, the HLA antigens) is the unquestioned goal of clinical transplantation....

EDITORIAL: Transplantation in First Remission of Acute Myeloid Leukemia

Thu, 03Â DecÂ 1998 00:00:00 -05:00

In patients under the age of 60 who have acute myeloid leukemia, chemotherapy now routinely produces a complete remission in 70 to 80 percent of cases.12 Since it is generally...

ORIGINAL ARTICLE: The Effect of Tolerance to Noninherited Maternal HLA Antigens on the Survival of Renal Transplants from Sibling Donors

Thu, 03Â DecÂ 1998 00:00:00 -05:00

Background: During pregnancy and nursing, a baby's developing immune system is intimately exposed to the mother's antigens. To determine whether this exposure is of clinical benefit to patients who later...

ORIGINAL ARTICLE: Chemotherapy Compared with Autologous or Allogeneic Bone Marrow Transplantation in the Management of Acute Myeloid Leukemia in First Remission

Thu, 03Â DecÂ 1998 00:00:00 -05:00

Background: In young adults with acute myeloid leukemia, intensive chemotherapy during the initial remission improves the long-term outcome, but the role of bone marrow transplantation is uncertain. We compared high-dose...

EDITORIAL: The Future of Placental-Blood Transplantation

Thu, 26Â NovÂ 1998 00:00:00 -05:00

During the past decade the use of placental blood as a source of transplantable hematopoietic stem cells has been accelerating. Initially, the placental blood was obtained from siblings, but now...

ORIGINAL ARTICLE: Outcomes among 562 Recipients of Placental-Blood Transplants from Unrelated Donors

Thu, 26Â NovÂ 1998 00:00:00 -05:00

Background: A program for banking, characterizing, and distributing placental blood, also called umbilical-cord blood, for transplantation provided grafts for 562 patients between August 24, 1992, and January 30, 1998. We...

EDITORIAL: Human Herpesvirus 8 â Let the Transplantation Physician Beware

Thu, 05Â NovÂ 1998 00:00:00 -05:00

In this issue of the Journal, Regamey et al.1 provide evidence that human herpesvirus 8 (HHV-8) can be transmitted through a kidney transplant. Physicians must be ever aware of new...

ORIGINAL ARTICLE: Transmission of Human Herpesvirus 8 Infection from Renal-Transplant Donors to Recipients

Thu, 05Â NovÂ 1998 00:00:00 -05:00

Background: Human herpesvirus 8 (HHV-8) has been detected in all forms of Kaposi's sarcoma, including transplantation-associated Kaposi's sarcoma. To investigate the possibility of transmission of HHV-8 through allografts, we measured...

SOUNDING BOARD: Geographic Favoritism in Liver Transplantation â Unfortunate or Unfair?

Thu, 29Â OctÂ 1998 00:00:00 -05:00

Donna Shalala, secretary of the Department of Health and Human Services, recently proposed regulations that would fundamentally change the way in which cadaveric livers for transplantation are allocated in the...

EDITORIAL: The Quest for a Bone Marrow Donor â Optimal or Maximal HLA Matching?

Thu, 22Â OctÂ 1998 00:00:00 -05:00

Bone marrow transplantation was first used successfully exactly 30 years ago, in children with congenital immune deficiencies.1 The demonstration that bone marrow transplantation was also effective in treating aplastic anemia...

ORIGINAL ARTICLE: Treatment of High-Risk Acute Leukemia with T-CellâDepleted Stem Cells from Related Donors with One Fully Mismatched HLA Haplotype

Thu, 22Â OctÂ 1998 00:00:00 -05:00

Background: In this study we tried to achieve successful transplantation in patients with acute leukemia with the use of hematopoietic stem cells from donors who shared only one HLA haplotype...

ORIGINAL ARTICLE: Effect of Matching of Class I HLA Alleles on Clinical Outcome after Transplantation of Hematopoietic Stem Cells from an Unrelated Donor

Thu, 22Â OctÂ 1998 00:00:00 -05:00

Background: The requirements with respect to HLA compatibility and the relative importance of matching for individual class I and class II HLA alleles in the transplantation of hematopoietic stem cells...

REVIEW ARTICLE: Acute Lymphoblastic Leukemia

Ching-Hon Pui, M.D., and William E. Evans, Pharm.D. — Thu, 27Â AugÂ 1998 00:00:00 -05:00

Acute lymphoblastic leukemia (ALL) is diagnosed in 3000 to 4000 persons in the United States each year; two thirds of them are children.12 The current rate of cure of nearly...

ORIGINAL ARTICLE: Primary-Effusion Lymphoma and Kaposi's Sarcoma in a Cardiac-Transplant Recipient

Thu, 13Â AugÂ 1998 00:00:00 -05:00

Human herpesvirus 8 (HHV-8) is a recently discovered virus that appears to have a pathogenic role in Kaposi's sarcoma, multicentric Castleman's disease, and primary-effusion lymphoma, a distinctive lymphoma that arises...

ORIGINAL ARTICLE: Reversal of Lesions of Diabetic Nephropathy after Pancreas Transplantation

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Background: In patients with type 1 diabetes mellitus who do not have uremia and have not received a kidney transplant, pancreas transplantation does not ameliorate established lesions of diabetic nephropathy...

EDITORIAL: Pancreas Transplantation and Diabetic Complications

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Hyperglycemia is an important factor in the development and progression of the complications of diabetes mellitus. In this issue of the Journal, Fioretto et al. report that pancreas transplantation reverses...

REVIEW ARTICLE: The Role of T-Cell Costimulatory Activation Pathways in Transplant Rejection

Mohamed H. Sayegh, M.D., and Laurence A. Turka, M.D. — Thu, 18Â JunÂ 1998 00:00:00 -05:00

Organ transplantation is now common. For patients with end-stage cardiac, hepatic, or pulmonary failure, it can be lifesaving.1 For patients with diabetes mellitus, pancreatic transplantation offers the chance of a...

REVIEW ARTICLE: Infection in Organ-Transplant Recipients

Jay A. Fishman, M.D., and Robert H. Rubin, M.D. — Thu, 11Â JunÂ 1998 00:00:00 -05:00

A primary goal in organ transplantation is the prevention or effective treatment of infection, the most common life-threatening complication of long-term immunosuppressive therapy. The challenges involved in achieving this goal...

EDITORIAL: Hepatocyte Transplantation

Thu, 14Â MayÂ 1998 00:00:00 -05:00

Attempts to treat a variety of conditions, including type I diabetes mellitus and fulminant liver failure, with epithelial-cell transplantation have been disappointing. In this issue of the Journal, Fox and...

ORIGINAL ARTICLE: Treatment of the CriglerâNajjar Syndrome Type I with Hepatocyte Transplantation

Thu, 14Â MayÂ 1998 00:00:00 -05:00

CriglerâNajjar syndrome type I is a recessively inherited disorder characterized by severe unconjugated hyperbilirubinemia beginning at birth. The syndrome results from an absence of hepatic uridine diphosphoglucuronate (UDP) glucuronosyltransferase activity,...

ORIGINAL ARTICLE: Identification of Fetal DNA and Cells in Skin Lesions from Women with Systemic Sclerosis

Carol M. Artlett, Ph.D., J. Bruce Smith, M.D., and Sergio A. Jimenez, M.D. — Thu, 23Â AprÂ 1998 00:00:00 -05:00

Background: Systemic sclerosis is a disease of unknown origin which often occurs in women after their childbearing years. It has many clinical and histopathological similarities to chronic graft-versus-host disease. Recent...

ORIGINAL ARTICLE: Hematopoietic Stem-Cell Transplantation in Globoid-Cell Leukodystrophy

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Background: Globoid-cell leukodystrophy is caused by a deficiency of galactocerebrosidase, which results in progressive central nervous system deterioration. We investigated whether allogeneic hematopoietic stem-cell transplantation can provide a source of...

ORIGINAL ARTICLE: Bone Marrow Transplants from Unrelated Donors for Patients with Chronic Myeloid Leukemia

Thu, 02Â AprÂ 1998 00:00:00 -05:00

Background: Chronic myeloid leukemia can be cured by marrow transplantation from an HLA-identical sibling donor. The use of transplants from unrelated donors is an option for the 70 percent of...

ORIGINAL ARTICLE: Transplantation of Kidneys from Donors Whose Hearts Have Stopped Beating

Thu, 22Â JanÂ 1998 00:00:00 -05:00

Background: Attempts have recently been made to expand the number of cadaveric kidneys available for transplantation by using kidneys from donors without heartbeats in addition to those from brain-dead donors...

ORIGINAL ARTICLE: Interleukin-2âReceptor Blockade with Daclizumab to Prevent Acute Rejection in Renal Transplantation

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Background: Monoclonal antibodies that block the high-affinity interleukin-2 receptor expressed on alloantigen-reactive T lymphocytes may cause selective immunosuppression. Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically...

ORIGINAL ARTICLE: Transfer of Symptomatic Peanut Allergy to the Recipient of a Combined Liver-And-Kidney Transplant

Thu, 18Â SepÂ 1997 00:00:00 -05:00

Peanuts are one of the commonest causes of food allergy in the United States and Europe.123 They are also a leading cause of food-induced anaphylaxis and death, which usually follow...

ORIGINAL ARTICLE: Outcome of Cord-Blood Transplantation from Related and Unrelated Donors

Thu, 07Â AugÂ 1997 00:00:00 -05:00

Background: Cord-blood banks have increased the use of cord-blood transplantation in patients with hematologic disorders. We have established a registry containing information on the outcome of cord-blood transplantation.

Methods: We sent...

SOUNDING BOARD: Ethics of a Paired-Kidney-Exchange Program

Thu, 12Â JunÂ 1997 00:00:00 -05:00

Although transplantation is the best treatment for many people with end-stage renal disease, the gap between the number of organ donors and the number of potential recipients continues to widen.1...

ORIGINAL ARTICLE: High-Dose Chemotherapy and Autologous Bone Marrow Transplantation Compared with MACOP-B in Aggressive B-Cell Lymphoma

Thu, 01Â MayÂ 1997 00:00:00 -05:00

Background: We compared a regimen of six chemotherapeutic agents administered sequentially at high doses, followed by myeloablative treatment and bone marrow transplantation, with a regimen of methotrexate, doxorubicin, cyclophosphamide, vincristine,...

EDITORIAL: Neoplasms and Transplantation â Trading Swords for Plowshares

Thu, 27Â MarÂ 1997 00:00:00 -05:00

The recent death of former U.S. Senator Paul Tsongas at the age of 55 from complications of bone marrow transplantation was a reminder that we have not cleared this treatment...

ORIGINAL ARTICLE: Solid Cancers after Bone Marrow Transplantation

Thu, 27Â MarÂ 1997 00:00:00 -05:00

Background: The late effects of bone marrow transplantation, including cancer, need to be determined in a large population at risk.

Methods: We studied 19,229 patients who received allogeneic transplants (97.2 percent)...

EDITORIAL: Allocating Livers â Devising a Fair System

Thu, 06Â FebÂ 1997 00:00:00 -05:00

Because there is a wide gap in the United States between the number of patients on waiting lists for organ transplants and the number of organs available for transplantation, any...

REVIEW ARTICLE: Procurement and Allocation of Solid Organs for Transplantation

Paul J. Hauptman, M.D., and Kevin J. O'Connor, B.S. — Thu, 06Â FebÂ 1997 00:00:00 -05:00

The success of solid-organ transplantation has increased the need for an expanded supply of organ donors.12 In response to this need, the age limit for cadaveric donors has been increased,...

EDITORIAL: The Therapeutic Potential of Fetal and Neonatal Hematopoietic Stem Cells

Thu, 12Â DecÂ 1996 00:00:00 -05:00

The transplantation of allogeneic hematopoietic stem cells is being used to treat thousands of adults and children with life-threatening hematologic diseases. In the absence of a suitable HLA-identical sibling donor,...

ORIGINAL ARTICLE: Bone Marrow Transplantation in Severe Combined Immunodeficiency from a Sibling Who Had Received a Paternal Bone Marrow Transplant

Thu, 12Â DecÂ 1996 00:00:00 -05:00

Bone marrow transplantation to treat autosomal recessive severe combined immunodeficiency was undertaken in a one-month-old girl. The donor was the patient's HLA-mismatched six-year-old sister, who had previously received a marrow...

ORIGINAL ARTICLE: Treatment of X-Linked Severe Combined Immunodeficiency by in Utero Transplantation of Paternal Bone Marrow

Thu, 12Â DecÂ 1996 00:00:00 -05:00

Severe combined immunodeficiency is a congenital syndrome due to various genetic abnormalities that cause susceptibility to infection, failure to thrive, lymphoid hypoplasia, very low levels of T lymphocytes, and hypogammaglobulinemia.12...

ORIGINAL ARTICLE: Genetic Analysis of a Sarcoma Accidentally Transplanted from a Patient to a Surgeon

Thu, 14Â NovÂ 1996 00:00:00 -05:00

Modern concepts of cancer immunology originated from the classic observations by Jensen, Loeb, Tyzzer, and Little in the early years of the 20th century of the rejection of transplanted allogeneic...

ORIGINAL ARTICLE: Lung Transplantation for Lymphangioleiomyomatosis

Thu, 24Â OctÂ 1996 00:00:00 -05:00

Background: Lymphangioleiomyomatosis is a rare disease of unknown origin that usually leads to progressive deterioration of lung function and eventual death from respiratory failure. It occurs in women of reproductive...

EDITORIAL: Islet and Pancreatic Transplantation â Autoimmunity and Alloimmunity

Thu, 19Â SepÂ 1996 00:00:00 -05:00

Given the autoimmune cause of insulin-dependent diabetes mellitus,1 the theoretical barriers to successful pancreatic and islet transplantation are autoimmunity (destruction of beta cells due to recurrent autoimmunity) and alloimmunity (rejection...

ORIGINAL ARTICLE: Recurrence of Autoimmune Diabetes Mellitus in Recipients of Cadaveric Pancreatic Grafts

Thu, 19Â SepÂ 1996 00:00:00 -05:00

Insulin-dependent diabetes mellitus is an autoimmune disease in which the beta cells of the islets of Langerhans are selectively destroyed.1 In a patient with this disease, a transplanted pancreas should...

EDITORIAL: Bone Marrow Transplantation in Sickle Cell Anemia â The Dilemma of Choice

Thu, 08Â AugÂ 1996 00:00:00 -05:00

The clinical complications of sickle cell anemia reflect the vascular damage caused by the abnormal red cells. Filled with hemoglobin S, sickle red cells obstruct and injure vessels when the...

ORIGINAL ARTICLE: Bone Marrow Transplantation for Sickle Cell Disease

Thu, 08Â AugÂ 1996 00:00:00 -05:00

Background: We investigated the risks and benefits of allogeneic bone marrow transplantation in children with complications of sickle cell disease.

Methods: Twenty-two children less than 16 years of age who had...

MOLECULAR MEDICINE: Gene Transfer to Hematopoietic Cells

Malcolm K. Brenner, M.D., Ph.D. — Thu, 01Â AugÂ 1996 00:00:00 -05:00

Although diseases of blood cells constitute a relatively small proportion of clinical disorders, many valuable studies of gene transfer have relied on hematopoietic stem cells or their progeny. What features...

MOLECULAR MEDICINE: Gene Transfer to Hematopoietic Cells

Malcolm K. Brenner, M.D., Ph.D. — Thu, 01Â AugÂ 1996 00:00:00 -05:00

EDITORIAL: Placental-Blood Banking â A New Frontier in Transfusion Medicine

Thu, 18Â JulÂ 1996 00:00:00 -05:00

Bone marrow has for years been the principal source of transplantable hematopoietic stem cells and progenitor cells. For bone marrow transplantation to succeed, it is crucial to find a donor...

ORIGINAL ARTICLE: Cord-Blood Transplantation from an Unrelated Donor in an Adult with Chronic Myelogenous Leukemia

Thu, 18Â JulÂ 1996 00:00:00 -05:00

To circumvent the problems inherent in allogeneic bone marrow transplantation, allogeneic cord blood has been studied as an alternative source of hematopoietic stem cells. Preliminary results with cord blood from...

ORIGINAL ARTICLE: Placental Blood as a Source of Hematopoietic Stem Cells for Transplantation into Unrelated Recipients

Thu, 18Â JulÂ 1996 00:00:00 -05:00

Background: Transplantation of bone marrow from unrelated donors is limited by a lack of HLA-matched donors and the risk of graft-versus-host disease (GVHD). Placental blood from sibling donors can reconstitute...

ORIGINAL ARTICLE: A Prospective, Randomized Trial of Autologous Bone Marrow Transplantation and Chemotherapy in Multiple Myeloma

Thu, 11Â JulÂ 1996 00:00:00 -05:00

Background: The median survival of patients with myeloma after conventional chemotherapy is three years or less. Promising results have been reported with high-dose therapy supported by autologous bone marrow transplantation....

ORIGINAL ARTICLE: Autologous Bone Marrow Transplantation versus Intensive Consolidation Chemotherapy for Acute Myeloid Leukemia in Childhood

Thu, 30Â MayÂ 1996 00:00:00 -05:00

Background: The value of autologous bone marrow transplantation in the treatment of children with acute myeloid leukemia (AML) is unknown. We compared autologous bone marrow transplantation with intensive consolidation chemotherapy...

EDITORIAL: Idiopathic Focal Segmental Glomerulosclerosis â New Lessons from Kidney Transplantation

Thu, 04Â AprÂ 1996 00:00:00 -05:00

The study of renal allografts has provided insight into the pathogenesis of renal diseases.1 In patients with some disorders, such as Liddle's syndrome (in which long-standing hypertension may severely impair...

ORIGINAL ARTICLE: Circulating Factor Associated with Increased Glomerular Permeability to Albumin in Recurrent Focal Segmental Glomerulosclerosis

Thu, 04Â AprÂ 1996 00:00:00 -05:00

Background: Heavy proteinuria and progressive renal injury recur after transplantation in up to 40 percent of patients with renal failure caused by idiopathic focal segmental glomerulosclerosis. A circulating factor may...

ORIGINAL ARTICLE: Long-Term Outcome of Hepatitis C Infection after Liver Transplantation

Thu, 28Â MarÂ 1996 00:00:00 -05:00

Background: End-stage cirrhosis related to hepatitis C virus (HCV) is a common reason for liver transplantation, although viremia is known to persist in most cases. We investigated the impact of...

ORIGINAL ARTICLE: Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis

Thu, 14Â MarÂ 1996 00:00:00 -05:00

Background: The role of orthotopic liver transplantation in the treatment of patients with cirrhosis and hepatocellular carcinoma is controversial, and determining which patients are likely to have a good outcome...

EDITORIAL: Minor Histocompatibility Antigens and Marrow Transplantation

Thu, 01Â FebÂ 1996 00:00:00 -05:00

Acute graft-versus-host disease (GVHD) and graft rejection are the principal obstacles to successful allogeneic bone marrow transplantation. Even among recipients of transplants from HLA-identical siblings, the incidence of severe acute...

ORIGINAL ARTICLE: Polymorphism of Adhesion Molecule CD31 and Its Role in Acute Graft-Versus-Host Disease

Thu, 01Â FebÂ 1996 00:00:00 -05:00

Background: Graft-versus-host disease (GVHD) caused by poorly defined minor (i.e., other than HLA) histocompatibility antigens remains a serious problem in recipients of bone marrow transplants. We sought to determine whether...

ORIGINAL ARTICLE: Mismatches of Minor Histocompatibility Antigens between HLA-Identical Donors and Recipients and the Development of Graft-Versus-Host Disease after Bone Marrow Transplantation

Thu, 01Â FebÂ 1996 00:00:00 -05:00

Background: Graft-versus-host disease (GVHD) can be a major complication of allogeneic bone marrow transplantation even when the donor and recipient are siblings and share identical major histocompatibility antigens. The explanation...

NEJM â Collection Updates for Transplantation

CLINICAL PROBLEM-SOLVING: Under Pressure

EDITORIAL: Immune Evasion by Chimeric Trachea

ORIGINAL ARTICLE: Tracheal Allotransplantation after Withdrawal of Immunosuppressive Therapy

ORIGINAL ARTICLE: Allogeneic Hematopoietic Stem-Cell Transplantation for Sickle Cell Disease

EDITORIAL: Interleukin-10 in Inflammatory Bowel Disease

ORIGINAL ARTICLE: Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

CORRESPONDENCE: Indigenous Australians and Living Kidney Donation

ORIGINAL ARTICLE: Recurrence of Bile Salt Export Pump Deficiency after Liver Transplantation

REVIEW ARTICLE: Renal Failure in Cirrhosis

REVIEW ARTICLE: Intestinal Transplantation

EDITORIAL: Genetic Trickery â Escape of Leukemia from Immune Attack

ORIGINAL ARTICLE: Loss of Mismatched HLA in Leukemia after Stem-Cell Transplantation

BOOK REVIEW:

BOOK REVIEW:

CORRESPONDENCE: B-CellâDepleting Induction Therapy and Acute Cellular Rejection

CLINICAL THERAPEUTICS: Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2009 â A 25-Year-Old Man with Coma after Cardiac Arrest

CORRESPONDENCE: Outcome of Renal Transplantation from Very Old Donors

ORIGINAL ARTICLE: A Nonsimultaneous, Extended, Altruistic-Donor Chain

ORIGINAL ARTICLE: C3 Polymorphisms and Allograft Outcome in Renal Transplantation

EDITORIAL: Not an HIV Cure, but Encouraging New Directions

ORIGINAL ARTICLE: Long-Term Control of HIV by Delta32/Delta32 Stem-Cell Transplantation

CORRESPONDENCE: Eculizumab for Atypical HemolyticâUremic Syndrome

EDITORIAL: Cautious Optimism Concerning Long-Term Safety of Kidney Donation

ORIGINAL ARTICLE: Long-Term Consequences of Kidney Donation

BOOK REVIEW:

EDITORIAL: Organ Procurement and Perfusion before Transplantation

ORIGINAL ARTICLE: Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Boosting Beta-Cell Numbers

CORRESPONDENCE: Successful Pregnancy after Microsurgical Transplantation of an Intact Ovary

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

CORRESPONDENCE: Osteosarcoma Derived from Donor Stem Cells Carrying the Norrie's Disease Gene

CORRESPONDENCE: Triglyceride Deposit Cardiomyovasculopathy

BOOK REVIEW:

EDITORIAL: Polymorphisms and the Risk of Invasive Fungal Infections

ORIGINAL ARTICLE: Toll-like Receptor 4 Polymorphisms and Aspergillosis in Stem-Cell Transplantation

CORRESPONDENCE: Long-Term Results of Rabbit Antithymocyte Globulin and Basiliximab Induction

BOOK REVIEW:

EDITORIAL: Predicting Mortality in Cirrhosis â Serum Sodium Helps

ORIGINAL ARTICLE: Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

CORRESPONDENCE: Widespread Amyloid Deposition in Transplanted Human Pancreatic Islets

EDITORIAL: Cardiac Transplantation in Infants

ORIGINAL ARTICLE: Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death

PERSPECTIVE: The Dead Donor Rule and Organ Transplantation

PERSPECTIVE: Donating Hearts after Cardiac Death â Reversing the Irreversible

PERSPECTIVE: The Boundaries of Organ Donation after Circulatory Death

BOOK REVIEW:

EDITORIAL: Reducing Antibody Levels in Patients Undergoing Transplantation

ORIGINAL ARTICLE: Rituximab and Intravenous Immune Globulin for Desensitization during Renal Transplantation

IMAGES IN CLINICAL MEDICINE: Digital Verrucae

SOUNDING BOARD: Informing Candidates for Solid-Organ Transplantation about Donor Risk Factors

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2008 â A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2008 â A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation

PERSPECTIVE: Consent for Organ Donation â Balancing Conflicting Ethical Obligations

IMAGES IN CLINICAL MEDICINE: Green Urine

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Chemical Immunosuppression in Islet Transplantation â Friend or Foe?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

ORIGINAL ARTICLE: A New Arenavirus in a Cluster of Fatal Transplant-Associated Diseases

PERSPECTIVE: The New Age of Molecular Diagnostics for Microbial Agents

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A New Dawn for Stem-Cell Therapy

ORIGINAL ARTICLE: Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients

IMAGES IN CLINICAL MEDICINE: Renal Failure from Vitamin C after Transplantation

EDITORIAL: Immunosuppressive Therapy and Tolerance of Organ Allografts

ORIGINAL ARTICLE: Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

ORIGINAL ARTICLE: Tolerance and Chimerism after Renal and Hematopoietic-Cell Transplantation

ORIGINAL ARTICLE: HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression

EDITORIAL: Balancing Efficacy and Toxicity in Kidney-Transplant Immunosuppression

REVIEW ARTICLE: Infection in Solid-Organ Transplant Recipients

ORIGINAL ARTICLE: Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation

ORIGINAL ARTICLE: Outcomes 18 Months after the First Human Partial Face Transplantation

EDITORIAL: Lung Transplantation in Cystic Fibrosis â Primum Non Nocere?

ORIGINAL ARTICLE: Lung Transplantation and Survival in Children with Cystic Fibrosis

PERSPECTIVE: Hematopoietic-Cell Transplantation at 50

PERSPECTIVE: Pluripotency Redux â Advances in Stem-Cell Research

EDITORIAL: Will MICA Glitter for Recipients of Kidney Transplants?

ORIGINAL ARTICLE: Antibodies against MICA Antigens and Kidney-Transplant Rejection

ORIGINAL ARTICLE: High-Dose Melphalan versus Melphalan plus Dexamethasone for AL Amyloidosis

ORIGINAL ARTICLE: Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

NEJM â Collection Updates for Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

EDITORIAL: Genetic Trickery â Escape of Leukemia from Immune Attack

CORRESPONDENCE: B-CellâDepleting Induction Therapy and Acute Cellular Rejection

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2009 â A 25-Year-Old Man with Coma after Cardiac Arrest

CORRESPONDENCE: Eculizumab for Atypical HemolyticâUremic Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

EDITORIAL: Predicting Mortality in Cirrhosis â Serum Sodium Helps

PERSPECTIVE: Donating Hearts after Cardiac Death â Reversing the Irreversible

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2008 â A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2008 â A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation

PERSPECTIVE: Consent for Organ Donation â Balancing Conflicting Ethical Obligations

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Chemical Immunosuppression in Islet Transplantation â Friend or Foe?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

EDITORIAL: Lung Transplantation in Cystic Fibrosis â Primum Non Nocere?

PERSPECTIVE: Pluripotency Redux â Advances in Stem-Cell Research

PERSPECTIVE: The Stem-Cell Market â Patents and the Pursuit of Scientific Progress

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2007 â A 56-Year-Old Woman with Renal Failure after HeartâLung Transplantation

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Retinal Progenitor Cells â Timing Is Everything

EDITORIAL: Prophylaxis and Aspergillosis â Has the Principle Been Proven?

PERSPECTIVE: Concurrent Sentences â Dialysis in the State Penitentiary

EDITORIAL: Diabetes Cure â Is the Glass Half Full?

PERSPECTIVE: Taking Heart â Cardiac Transplantation Past, Present, and Future

PERSPECTIVE: Lymphocytic Choriomeningitis Virus â An Old Enemy up to New Tricks

REVIEW ARTICLE: Pregnancy in Recipients of Solid Organs â Effects on Mother and Child

EDITORIAL: Inhaled Cyclosporine â A Breath of Fresh Air?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2006 â A 64-Year-Old Male Lung-Transplant Recipient with Fever, Cough, Hemoptysis, and Abdominal Pain

EDITORIAL: Rejection â More Than the Eye Can See

EDITORIAL: Graft-versus-Host Disease â From the Bench to the Bedside?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2005 â A 56-Year-Old Man with Fever and Axillary Lymphadenopathy

EDITORIAL: Immunosuppression â The Promise of Specificity

ORIGINAL ARTICLE: Angiotensin II Type 1âReceptor Activating Antibodies in Renal-Allograft Rejection

OCCASIONAL NOTES: Transplantation 50 Years Later â Progress, Challenges, and Promises

PERSPECTIVE: Transplantation â A Medical Miracle of the 20th Century

EDITORIAL: Cord-Blood Transplantation in Patients with Leukemia â A Real Alternative for Adults