Current And Future Immunosuppressive Therapies Following Transplantation

This title provides a comprehensive and state-of-the-art summary of current and future immunosuppressive strategies in transplantation, with emphasis on the basic science mechanisms and clinical applicability of these strategies. The uniqueness of this book is the inclusion of up-to-date information on the basic mechanisms of actions of the immunosuppressive drugs as well as a summary of the clinical trials data and the potential use of these drugs in clinical organ transplantation. In addition to describing the various immunosuppressive strategies, the book has three special features, including immunosuppression in xenotransplantation, gene therapy approaches, and transplantation tolerance. A group of outstanding investigators have been assembled to write the chapters. The book is intended for the transplant professional and the specialist who wants to stay abreast of the current status of immunosuppression in organ transplantation. The book is also useful for basic scientists who work in the field of transplantation immunology.

This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop. As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicareâ€"or to society generallyâ€"is not evaluated for the services examined. The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004. In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions.

Therapeutic immunosuppression has very broad applications in clinical medicine, ranging from prevention and treatment of organ and bone marrow transplant rejection, management of various autoimmune disorders (e.g., rheumatoid arthritis), skin disease, and asthma. Whereas traditionally only a small repertoire of immunosuppressive agents was available for clinical use, recent discoveries have significantly increased the number of approved agents, resulting in numerous trials to further evaluate their potential. In addition, products of the biotechnology industry - monoclonal antibodies, cytokines, cytokine antagonists, and other products of genetic engineering that target key molecular pathways in disease pathogenesis - have either already made, or are on the verge of making an important impact on treatment. There is also considerable interest in the potential of cell-based therapies (particularly hematopoietic stem and dendritic cell therapy) of allo- and autoimmunity. Important recent advances in the immunotherapy of allergic diseases are also covered in this book. Gene therapy offers considerable promise for suppressing pathogenic processes in either transplantation or autoimmune disorders. The possibility of combining these important new advances to maximize benefit to the patient, and to minimize possible untoward effects (which are also given extensive coverage in this book), is one of the most exciting challenges of contemporary medicine. This volume is intended both for practising physicians and surgeons and for biomedical scientists at the graduate/postdoctoral levels, and is designed to provide the theory behind these various approaches to immunosuppression, and to provide state-of-the-art reviews of current developments in each area. Each chapter is contributed by one or more experts in the field. There was a need to bring this information together in a single volume, as much of the key recent developments have been dispersed throughout the biomedical literature, largely in specialized journals. Since, as in the past, important developments in immunosuppressive therapy in one branch of medicine (i.e. transplantation) are likely to benefit another (e.g., dermatology, rheumatology, gastroenterology), cross-disciplinary coverage of the mechanistic basis of the various therapeutic strategies in a single volume is likely to convey the potential of advances in therapy in the most coherent manner possible.

The here presented book covers different areas of clinical and scientific interest, reaching from donor evaluation to newest methods in immunological diagnostics. But also aspects of daily care of transplant recipients can be found in the carefully selected chapters. Everything driven by the aim to improve the care for all of our transplanted patients.

This book discusses all aspects of the uterus transplantation procedure in women who are childless because of a dysfunctional or missing uterus, from initial pre-operative investigations to follow-up after the uterine graft has been removed. All the international experts who are engaged in clinical activities and/or research in this field have contributed one or more of the book’s chapters. Since the first live birth following uterus transplantation was reported in Sweden in September 2014, the field has been rapidly evolving around the globe: the first cases in USA, Germany, China, Brazil, and Czech Republic were performed in 2016 and several other centres are preparing for clinical trials of uterus transplantation. Uterus transplantation is a subject that attracts the attention of many bioethicists, and like all other major procedures in transplantation surgery and assisted reproduction techniques, it is a complex process that requires a multidisciplinary team if it is to be successful. As such the book is a valuable resource not only for clinicians from many disciplines, but also for nurses, ethicists, psychologists and researchers.

One of the most interesting and at the same time most challenging fields of medicine and surgery has been that of organ donation and transplantation. It is a field that has made tremendous strides during the last few decades through the combined input and efforts of scientists from various specialties. What started as a dream of pioneers has become a reality for the thousands of our patients whose lives can now be saved and improved. However, at the same time, the challenges remain significant and so do the expectations. This book will be a collection of chapters describing these same challenges involved including the ethical, legal, and medical issues in organ donation and the technical and immunological problems the experts are facing involved in the care of these patients.The authors of this book represent a team of true global experts on the topic. In addition to the knowledge shared, the authors provide their personal clinical experience on a variety of different aspects of organ donation and transplantation.

The inadequate supply of organs in the United States and other countries continues to drive the reliance on living donor transplantation. In 2000, representatives of the transplant community convened for a meeting on living donation in an effort to provide guidelines to promote the welfare of living donors. The consensus statement that resulted from this meeting recommended that transplant centers retain an Independent Living Donor Advocate (ILDA) to focus on the best interest of the donor. A decade later, nearly every transplant center in the United States, performing living donor surgeries, has incorporated an ILDA into their living donor screening and/or evaluation process Living Donor Advocate provides an overview of living donation and its risks, ethical challenges and future developments​, as well as details about the role a Living Donor Advocate plays in the transplantation process. This book will interest health professionals across various disciplines and patients undergoing transplantation or living donor surgery.

Molecules and Medicine provides, for the first time ever, a completely integrated look at chemistry, biology, drug discovery, and medicine. It delves into the discovery, application, and mode of action of more than one hundred of the most significant molecules in use in modern medicine. Opening sections of the book provide a unique, clear, and concise introduction, which enables readers to understand chemical formulas.