Author/Editor		Jeras, Matjaž
Title		Aloreaktivnost in alosenzibilizacija pri bolnikih s presajenimi tkivi in organi
Translated title		Alloreactivity and allosensibilization in patients with transplanted tissues and organs
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 38, št. Suppl 7
Publication year		1999
Volume		str. 31-6
Language		slo
Abstract		Transplantation of organs and tissues from related as well as unrelated, living and cadaveric donors used for the replacement of diseased or a damaged ones in patients is an important segment of today's clinical therapies. One of the key factors influencing the success of transplantation is the intensivity of the alloimune response to transplanted tissue. It is shaped by the degree of histocompatibility between the donor and recipient of the transplant as well as the episodes of prior allosensibilisations of the patient, due to multiple blood transfusions, rejected transplants or pregnancies. Whenever a transplanted tissue contains nucleated cells, a substantial alloimmune response of donor's (bone marrow) or recipient's lymphocytes T is to be expected, recognising foreign MHC molecules, which are extremely polymorphic. A complete identity considering tissue antigens as well as other polymorphic genetic markers which can also influence the success of the transplantation is limited to closerly related persons. Several tools are used to assess the degree of histocompatibility between the donors and recipients of transplants: the typing of HLA molecules and/or alleles accompanied by several in vitro functional tests, like one-way mixed lymphocyte reactions and the estimations of frequencies of cytotoxic and helper T cell presursors. Additional extensive screening tests are performed for the patients included in waiting lists for organ transplantation reviling the potential existence and specificity of anti-HLA antibodies.
Summary		Presajanje tkiv in organov sorodnih in nesorodnih, živih in umrlih dajalcev za nadomestilo obolelih oziroma okvarjenih v bolniku predstavlja pomembne del današnje klinične terapije. Eden od ključnih dejavnikov, ki odločajo o uspešnosti, je intenzivnost in obsežnost imunskega odziva prejemnika na presajeno tkivo. Le-ta je odvisen od stopnje tkivne skladnosti med sprejemalcem in dajalcem presadka ter predhodnih alosenzibilizacij bolnika, denimo zaradi prejetih transfuzij, predhodno zavrnjenih presadkov ali nosečnosti. Vedno, kadar presajeno tkivo ali organ vsebuje celice z jedrom, moramo računati na buren aloimunski odziv limfocitov T na dajalcu (kostni mozeg) oziroma prejemniku tuje, izjemno polimorfne molekule MHC. Popolno ali skoraj popolno ujemanje v tkivnih antigenih ter drugih polimorfnih dednih znamenjih, ki tudi lahko vplivajo na uspešnost transplantacije, lahko najdemo le pri sorodnih osebah. Za ugotavljanje tkivne skladnosti med dajalci in prejemniki presadkov uporabljamo tipizacijo molekul in/ali alelov (genskih zapisov) HLA ter nekatere funkcijske teste in vitro, na primer enosmerno reakcijo v kulturi pomešanih limfocitov ter določevanje frekvenc predhodnikov citotoksičnih limfocitov T in celic T pomagalk. Bolnikom, ki so vključeni v čakalne spiske za transplantacijo organov, pa s pomočjo obsežnih presejalnih testov določamo tudi prisotnost in specifičnost protiteles zoper posamezne molekule HLA.
Descriptors		TRANSPLANTATION IMMUNOLOGY TRANSPLANTATION, HOMOLOGOUS ISOANTIGENS GRAFT REJECTION MAJOR HISTOCOMPATIBILITY COMPLEX HISTOCOMPATIBILITY ANTIGENS HISTOCOMPATIBILITY TESTING