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DESCRIBING THE EFFECTIVENESS OF IMMUNOSUPPRESSION DRUGS AND APHERESIS IN THE TREATMENT OF TRANSPLANT PATIENTS
HATTERSLEY JG, CHAPPELL MJ, ZEHNDER D, HIGGINS RM, EVANS ND.
HENRY ADELEYE, MARCI SEARLES
DAVID SAVAGE 2006
1990
Heart transplant 1990
Terminally-ill journalist Adrian Sudbury is campaigning to educate young adults about what it means to be a bone marrow donor
PURPOSE OF OUR CHOICE IN CHOOSING THIS PAPER
• Henry is interested in working with orthopedics, which includes limb reattachment.
• Marci wanted to understand why educated adults are not more interested in being organ donors.
FACTORS DETERMINING ORGAN COMPATIBILITY
Blood type Genetic markers What kind of organ/tissue Immunoglobulins IgG,IgM,IgA Age and sex of the giver and receiver of
certain organs.
Immunosuppressant drugs can change everything!
IMMUNOSUPPRESSANT DRUGS
5 classes of immunosuppressant drugs 1)glucocorticoids 2)cytostatics 3)antibodies 4)drugs acting on immunophilins5)other drugs.
IMMUNOSUPPRESSANT DRUGS
Used to prevent rejection of transplanted organs
Auto immune disease
Chronic anti-inflammatory
APHERESIS
Apheresis: the process by which plasma or cellular components are separated from the whole blood
PLASMAPHERESIS DFPP
Plasmapheresis DFPP: apheresis used to remove blood plasma.
In DFPP, plasma is separated with a plasma separator and passesthrough the plasma component separator with a small pore size.
Large molecular-weight proteins are discarded andsmall molecular-weight substances includingvaluable albumin are returned to the patient.
Small amount of substitution fluid such as albumin may be added.
PLASMA EXCHANGE (PE)
Plasma exchange: Plasma exchange involves replacing the plasma (the liquid part of a person’s blood) with plasma from a donor.
PLASMA ABSORPTION
In PA, plasma is separated with a plasma separator and flows into a plasma adsorption column.
Pathogenic substances are adsorbed and removed due to affinity between ligands
and pathogenic substances.
Note: Fluids are not replaced
RESULTS
Patient 1 After three
successive apheresis treatments
Vertical line after transplant occurs
Antibody production suppressed
CONT.
Patient 3 Received extended
apheresis treatment
IgM shows typical response
IgG and IgA show increased immune response
CONT.
PA more consistent with each antibody type IgM moves consistently with each apheresis
method IgG and IgA differ amongst apheresis types PE clears IgG fastest, PA clears it slowest DFPP clears IgA fastest, PA clears it slowest Can customize apheresis method depending on
patient’s condition
CONCLUSION
Examines the effectiveness of certain immunosuppressive procedures
Enables clinicians to better categorize the patient’s response to implants
Enables clinicians to estimate antibody production during transplant procedures using algorithm
SHORTCOMINGS?
No data post-operatively for the patient in figure 3.
Plasmapheresis used in unequal proportion compared to the two other methods of apheresis.
Limited sample size Quantity and type of
immunosuppressive drugs used was not recorded