Cardiopulmonary transplantation--growing pains

Reduced antibody responses after immunization in rat lung transplants

Pulmonary infections occur so frequently in recipients of lung transplants as well as of combined heart and lung transplants that it has been suggested that the function of the defense system in lung transplants is impaired. Therefore, we investigated in rats whether antibody responses against intrapulmonary antigens were impaired at various time points after transplantation. Antibody responses were induced in lungs of four experimental groups. Group 1: normal lungs (LEW); Group 2: hilar-stripped (sham-operated) lungs (LEW); Group 3: syngeneic lung transplants (LEW-to-LEW); Group 4: allogeneic lung transplants (BN-to-LEW). The operations were performed on the left lungs. All rats (including those with normal lungs) were treated with cyclosporine on Days 2 and 3 after operation, which treatment is adequate to induce permanent graft acceptance of the allografts. Rats were immunized 7, 10, 14, 21, and 28 days and at 6 months after operation with sheep red blood cells, injected selectively into the bronchus of the left lung. The resulting serum antibody titers were detected with a hemolysis assay. After immunization on Day 7, no antibody responses could be detected in all hilar-stripped and transplanted rats, whereas responses were normal in two allografted rats immunized in the nontransplanted right lung. After immunization on Day 14, responses had returned to normal in hilar-stripped rats, whereas they were still impaired in the transplanted rats. After immunization on Day 28, responses were almost normal in all rats and remained so until 6 months after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic analysis of solid organ transplantation: a review for policy makers

Solid organ transplantation has advanced over the past decade to the point at which it is now a realistic form of treatment for irreversible failure of many vital organs. While organ transplantation is becoming increasingly successful, the cost of the procedures is still very high. As with all high cost medical procedures, decisions need to be made about the cost-effectiveness of solid organ transplantation. A review of the available literature with respect to the quality of life of the patient and the economic evaluation of transplantation, subdivided in regard to specific organs, is presented. A number of issues which need to be taken into account and reinforced when contemplating policy decisions based on the economic evaluation of solid organ transplantation are then discussed.