Download Handbook of Kidney Transplantation by Gabriel M. Danovitch MD PDF

By Gabriel M. Danovitch MD

This renowned instruction manual is a realistic consultant for physicians, surgeons, nurses, and different pros who deal with kidney transplant sufferers. it really is concise, readable, and well-illustrated. Chapters define the key matters surrounding renal transplantation and the main winning methods to difficulties bobbing up in temporary and long term sufferer care.

Chapter issues comprise immunobiology and immunosuppression, in addition to chapters on surgical procedure, histocompatibility, and the 1st 3 months post-transplant surgical procedure. This completely up-to-date 5th variation contains new info on techniques for sufferers with end-stage renal illness, immunosuppressive medicines and protocols for kidney transplantation, and the 1st months following transplant.

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T-cell activation requires one signal through the TCR and a second, or costimulatory, signal through accessory molecules. These accessory molecules play two important roles. The first role is to provide adhesive strength to keep the T cells and APCs in contact with each other, thus providing time for the TCR to sample antigens on the APC. Integrins, particularly LFA-1 on T cells binding to ICAMs on APCs, are among the most important adhesion molecules for T-cell activation. The second role of accessory molecules is to cooperate with TCR-initiated signals in the process of T-cell activation.

Although the histologic findings in these cases are variable, the presence of C4d appears to correlate with the presence of donor-specific antibodies (see Chapter 14). Antibodies may also play an important role in chronic rejection. Both acute and chronic antibody-mediated rejection can potentially be treated with biologic agents that target the B-cell–specific marker, CD20 (see Chapter 5). 32 Chapter 2 Transplantation Immunobiology EFFECTOR MECHANISMS OF GRAFT DESTRUCTION Once CD4 T cells recognize foreign class II MHC molecules, they play a critical role in regulating various arms of the effector response.

The antigen-specific activation of CD4 T cells leads to expression of cell surface molecules and production of cytokines, which, in turn, further stimulates monocytes. This cooperation between CD4 T cells and monocytes, or DTH response, plays an important role in the destruction of a graft. The activation of CD4 T cells and production of cytokines also stimulates the activation and proliferation of cytolytic CD8 T cells and natural killer (NK) cells. On recognition of class I MHC molecules on graft cells, the CD8 T cells cause cell death by two main mechanisms.

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