ÿWPC -³-f|‘GPÇ‹Z¡[SK(ÞðWªÊHÍA•”CN[RW"‰ U–!'¦+ʬÃ`¾óÄ%¦á‡,~//I¡¹*û¨ˆî³NÖã›<°„}+Vc×zO¿ lèáJŒ‘•9r³¡#½öe—ªkÜ¡]2 zØ*V«NýÜU/r¹û÷!².´15^jÆa^©i*>ú#ÛƒÐ{˜ZiŸÍThQ#µTÒÔÒNØ3Ö­ìvv;qÆêöóôê+D/*C®w[²‹¡ÞÔìj"ͪeËF•¨b…@»`]ÙØÚg´uñÁhª ¼XœaجCa›ƒ„Œ,þ5ÊÅÔ£?Í hC‘p¯À ß‚QQÍ\±£i©· UÙTÈ–&qªÃ=…rBM‚I%‚…›Ì›ßß‚Àcþƒî´H¿vÄ…¶«Ü+~e÷Z6œ€/è|.b:“RÚ!QåÝóãw ¶i¸ß©ZÆrgI <ò"퓟­I²Â·O^è±Ö ­} X×&4)YmòSì§a6ˆ62;à=w m¦áh·ì+ÛIê;7;¯vHIq:X÷‘W 6¿•Ú™·ªÉ2œôü\åßò¾[k”9¤+±§£ÿŒüD ÎrKß„Æ(U60 %f€lìn­üN© 0L«UN÷wE4I„] 0há EI UBK # 0h° UB U:Z  Æ” 0eZ ¿ mÁ Á Á Á Á #ÉØ U@¡¡^ áááá Bííííí  <ô\  `(Roman 10cpiX' É XIV. HLA and TransplantationLecture  0 .   #|x«<ô\  `(Roman 10cpiXÂxô\  @Ž”×õ X@($. $¡¡Ó  ÓÔ  ÔÑ  Ñ(ÖÃ9 Z ‹6Times New Roman Regulara‡1(# zÝ ƒ z÷)ÝÓ  ÓÔ  ÔÝ  ÝÔ_ÔßA€" ) °°xdtE°WxAßÐ X ÐÔ€XxXXXÔÔ€ôMÅòXXxÔÔ‡ôºòòôMÅÔXIV.€€HLA€and€Transplantation€Medicineà€HH<(#àMLAB€2431€ðð€Ú  Ú155Ú  ÚÔ#†ôMÅòòôº×#Ô(@3z÷$©©Ý ƒ. !ÝÓ  ÓÔ  ÔÑ  ÑÝ  Ý,§ÖhAZ*Helvetica Regular Ý ƒz÷*ÝÓ  ÓÔ  ÔÝ  ÝÔ_ÔßA€" ) °°xdE°WxAßÐ X ÐÔ€ôsCXXXÔÔ€ôW òXôsCÔÔ‡ôºò òôWÔÔ#†ôW òòôº×#Ô(@3z÷$ªªÝ ƒ. !ÝÓ  ÓÔ  ÔÑ  ÑÝ  Ý+½FSAZ*Helvetica Regularƒ{è”AZ‹"Arial RegularA, B,Level 1Level 2Level 3Level 4Level 54#+Ö2Quick A.ÚƒÚÚ  Ú.à0 àÛ€Û£ÿU‹ÿÀÀÀ˜hp LaserJet 1300 PCL 5eÈÈ,,,,ÈÈ0(ÈÇG Z‹(Times New Roman 7wH2é  dHÝ ƒ. !ÝÓ  ÓÔ  ÔÑ  ÑÝ  ÝÔ_ÔØ›ØÔ€XxXXXÔÔ‡XsCXXXxÔÑX°ÑÑX°ÑÒH°ÒÒH°Òò òÖ€ ÿÿÖÓ  ÓÔ‡¼GG»XXsCÔXIV.€€HLA€AND€TRANSPLANTATION€MEDICINEÔ#†XsCX»¼GGú#ÔÐ X ÐÓîÓÌó óÓ*X X°‚,` —X°œX*ÓÔ€&8%XXsCÔA.à0   àIntroductionÐX $ $ ÐÌÓ<X X°Üʸ –XX X°‚,` —X<Óà0   à1.à0Ì $ $àThe€HLA€system€includes€a€complex€array€of€genes€and€their€molecular€products€that€are€involved€inÐ ° Ðimmune€regulation€and€cellular€differentiation.ÐàˆÌ$Ì$ ÐÌà0   à2.à0Ì $ $àAntigens€of€the€HLA€system€have€been€variously€designated€òòhistocompatibility€locus€antigensóó,€òòhumanÐ 8 Ðleukocyte€antigensóó,€transplantation€antigens€and€tissue€antigens.Ðh Ì$Ì$ ÐÌà0   à3.à0Ì $ $àThe€HLA€gene€products€are€glycoprotein€antigens€found€on€the€surface€membranes€of€all€òònucleated€cellsÐ  À  Ðóóof€the€body,€including€those€of€solid€tissues€and€most€of€the€circulating€blood€cells;€namely€lymphocytes,Ð ð ˜  Ðgranulocytes,€monocytes€and€platelets.ÐÈ p Ì$Ì$ ÐÌà0   à4.à0Ì $ $àMature€òòÔ_ÔnonnucleatedÔ_Ô€red€cells€usually€lack€HLA€antigens€óódemonstrable€by€conventional€methods,€butÐ x  Ðimmature,€nucleated€Ô_ÔrbcsÔ_Ô€exhibit€HLA€reactivity.ÐPø Ì$Ì$ ÐÌà0   à5.à0Ì $ $àThe€antigens€of€the€HLA€system€are€second€in€importance€only€to€the€ABO€antigens€in€influencing€theÐ ¨ Ðsurvival€of€transplanted€solid€organs.ÐØ€Ì$Ì$ ÐÌà0   à6.à0Ì $ $àImmunologic€recognition€of€differences€in€HLA€antigens€is€probably€the€first€step€in€the€rejection€ofÐ ˆ0 Ðtransplanted€tissue.Ð`Ì$Ì$ ÐÌà0   à7.à0Ì $ $àThe€antigens€of€the€HLA€system€are€determined€by€genes€present€in€the€major€histocompatibility€complexÐ ¸ Ð(MHC)€on€the€short€arm€of€chromosome€6.ÐèÌ$Ì$ ÐÌà0   à8.à0Ì $ $àGenes€of€the€MHC€contribute€to€recognition€of€non„self,€to€coordination€of€cellular€and€humoral€immunity,Ð ˜@ Ðto€synthesis€of€several€circulating€proteins€and,€quite€possibly,€to€genetic€susceptibility€to€various€diseases.ÐpÌ$Ì$ ÐÌà0   à9.à0Ì $ $àHLA€antigens€are€important€in€tissue€and€organ€transplantation,€platelet€transfusions,€disease€associationsÐ  È Ðand€very€useful€in€parentage€testing.Ðø Ì$Ì$ ÐÌB.à0   àDiscoveryШP  $ $ ÐÌà   à1.à0 Ì àThe€MHC€that€encodes€cell€surface€antigens€was€first€òòdiscovered€in€skin€graft€rejection€óóexperiments€withÐ X" Ðmice.€€When€the€antigens€were€matched€between€donor€and€recipient,€the€ability€of€a€graft€to€survive€wasÐ 0 Ø# Ðremarkably€improved.Ð!°$Ì$Ì$ Ðà0   àà0Ì $ $àÐ Ì$Ì$ Ðà   à2.à0 Ì àBy€the€early€1960's,€an€association€between€human€Ô_ÔleukoagglutinatingÔ_Ô€antibodies€and€tissue€transplantationÐ ¸"` & Ðwas€inferred€from€observations€of€òòaccelerated€skin€graft€rejection€óóin€recipients€who€were€Ô_ÔpreimmunizedÔ_ÔÐ #8!' Ðwith€peripheral€blood€leukocytes€from€the€prospective€donor.Ðh$"(Ì$Ì$ ÐÌà   à3.à0 Ì àThe€presence€of€HLA€in€humans€was€first€recognized€when€multiply€transfused€patients€experiencedÐ &À#* Ðtransfusion€reactions€despite€proper€crossmatching.Ðð&˜$+Ì$Ì$ ÐÌà   à4.à0 Ì àIt€was€discovered€that€these€reactions€resulted€from€òòleukocyte€antibodies€óórather€than€antibodies€directedÐ  (H&- Ðagainst€RBC€antigens.Ðx) '.Ì$Ì$ ÐÌÔ% €' ÔÖ€ÿÿÖC.à0   àGeneral€ConsiderationsÐ(+Ð(0 $ $ ÐÌà   à1.à0 Ì àThe€MHC€is€the€òòmost€complex€Ô_ÔimmunogeneticÔ_Ô€system€óópresently€known€in€humans.ÐØ,€*2Ì$Ì$ Ðâ âÐ °-X+3 Ðà   à2.à0 Ì àThe€Ô_ÔMHCÔ_Ô€includes€several€loci€closely€linked.€€Each€of€these€loci€involves€numerous€alleles,€having€atÐ X Ðâ âleast€10€to€40€alleles€per€locus€that€control€the€production€of€their€corresponding€antigens.Ð0ØÌ$Ì$ ÐÌà0   à3.à0Ì $ $àSome€groups€of€these€antigens€exhibit€cross„reacting€characteristics€that€further€increase€the€complexityÐ àˆ Ðof€the€system.и`Ì$Ì$ ÐÌà0   à4.à0Ì $ $àAlthough€Ô_ÔHLAÔ_Ô€was€originally€identified€by€its€role€in€transplant€rejection,€it€is€now€recognized€thatÐ h Ðproteins€encoded€in€this€region€are€involved€in€many€aspects€of€immunologic€recognition,€includingÐ @è Ðinteraction€between€different€lymphoid€cells€and€between€lymphocytes€and€antigen„presenting€cells.Ð ÀÌ$Ì$ ÐÌà0   à5.à0Ì $ $àThe€products€of€Ô_ÔHLAÔ_Ô€genes€play€a€crucial€role€in€our€immune€system.€€The€Ô_ÔHLAÔ_Ô€genes€encode€for€threeÐ È p  Ðclasses€of€molecules€(ò òMEMORIZEó ó):Р H Ì$Ì$ ÐÌÓEX X°ÜÊŒ •XX X°Üʸ –XEÓà0   àà Ì àa.à0ø $ $àò òClass€Ió ó€major€transplantation€antigens€are€serologically€defined.€€This€class€includes€the€main€Ô_ÔHLAÔ_Ô„A,Ð T ü  ÐB,€and€C€antigens.€€Ð0Ø ø$ø$ ÐÌà0   àà0Ì $ $àb.à0øÌ$Ì$àò òClass€IIó ó€immune€response€gene€region€antigens€are€encoded€in€the€Ô_ÔHLAÔ_Ô„D€region€and€can€beÐ àˆ  Ðsubdivided€into€three€families,€called€Ô_ÔHLAÔ_Ô„DR,€DC€(Ô_ÔDQÔ_Ô),€and€„SB€(DP).мdø$ø$ ÐÌà0   àà0Ì $ $àc.à0øÌ$Ì$àò òClass€IIIó ó€molecules€bear€no€clear€relation€to€class€I€and€II€molecules€aside€from€their€genetic€linkage.€Ð l ÐClass€III€molecules€are€involved€in€immunologic€phenomena€because€they€represent€components€ofÐ Hð Ðthe€complement€pathways.Ð Èø$ø$ ÐÌà0   à6.à0Ì $ $àBoth€class€I€and€Class€II€gene€products€are€biochemically€distinct,€although€they€appear€to€be€distantlyÐ Ðx Ðrelated€through€evolution.ШPÌ$Ì$ ÐÌà0   à7.à0Ì $ $àBoth€class€I€and€class€II€antigens€function€as€targets€of€T€lymphocytes€that€regulate€the€immune€response.ÐXÌ$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àIn€an€infection,€the€invading€microorganism€infects€cells€or€is€engulfed€by€immune€cells€such€asÐ ° Ðmonocytes.Ðàˆø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àClass€I€or€class€II€molecules€act€as€receptors€for€fragments€of€these€microorganisms.€€€à À! àÐ8ø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àOnce€antigenic€fragments€have€bound€to€the€cell€surface€,€receptors€on€T€lymphocytes€interact€withÐ @è! Ðthe€antigen„Ô_ÔMHCÔ_Ô€complex€triggering€both€humoral€and€cellular€immune€responses.ÐÀ"ø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àT€cell„specific€cell€surface€molecules,€CD8€and€CD4,€act€to€strengthen€this€cellular€interaction€and€toÐ È p$ Ðtransmit€activation€signals.Р!H%ø$ø$ ÐÌà0   àà Ì àe.à0ø $ $àOther€cell€adhesion€molecules€(CD2,€Ô_ÔLFAÔ_Ô„3€or€Ô_ÔLFAÔ_Ô„1)€also€act€to€increase€the€affinity€of€cellularÐ P#ø ' Ðinteractions.Ð($Ð!(ø$ø$ ÐÌà0   àà Ì àf.à0ø $ $àThe€same€pattern€of€interactions€between€a€cell€bearing€an€antigen„Ô_ÔMHCÔ_Ô€complex€and€a€T€lymphocyteÐ Ø%€#* Ðoccur€not€only€in€the€recognition€of€infecting€microorganisms€but€also€in€the€recognition€of€foreignÐ °&X$+ ÐÔ_ÔhistocompatibilityÔ_Ô€molecules€(Ô_ÔalloantigensÔ_Ô)€found€on€an€Ô_ÔallograftÔ_Ô€and€in€the€recognition€of€selfÐ ˆ'0%, Ðantigens€(Ô_ÔautoantigensÔ_Ô)€during€autoimmune€disease.Ð`(&-ø$ø$ ÐÌà   à7.à0 Ì àThe€impact€of€studies€of€the€human€Ô_ÔMHCÔ_Ô€on€clinical€medicine€was€first€felt€in€tissue€transplantation,€theÐ *¸'/ Ðarea€that€gave€the€Ô_ÔMHCÔ_Ô€its€name.Ðè*(0Ì$Ì$ ÐÌà   à8.à0 Ì àBecause€foreign€Ô_ÔMHCÔ_Ô€molecules€are€recognized€as€antigens€by€the€graft€recipient,€it€is€beneficial€to€ensureÐ ˜,@*2 Ðthat€donor€and€recipient€share€Ô_ÔHLAÔ_Ô€alleles.Ðp-+3Ì$Ì$ ÐÐ H.ð+4 Ðà   à9.à0 Ì àSince€the€Ô_ÔMHCÔ_Ô€is€extremely€polymorphic,€this€is€often€a€difficult€task€and€requires€close€collaborationÐ X Ðamong€the€surgeon,€the€clinical€Ô_ÔHLAÔ_Ô€typing€laboratory,€and€large€organ„sharing€networks.Ð0ØÌ$Ì$ Ðà0   àÐ  $ $ ÐØ€ØÝ‚+ÖÿÝÝ  ÝÝ‚+ÖV'ÝÚƒÚDÚ  Ú.à0   àÝ  ÝÔ_ÔHLAÔ_Ô€and€Disease݃+ÖV'q'ÝÛ€ÛŒÐàˆ $ $ ÐŒÝ  ÝÌà0   à1.€à0Ì $ $àMore€recently,€studies€of€the€Ô_ÔMHCÔ_Ô€have€been€important€in€understanding€many€autoimmune€diseases€thatÐ 8 Ðhave€immunologic€imbalance€or€disturbances€of€immune€regulation€with€an€Ô_ÔMHCÔ_Ô€associated€geneticÐ h Ðcomponent.Ð@èÌ$Ì$ ÐÌà0   à2.à0Ì $ $àFor€some€conditions,€an€association€exists€between€Ô_ÔHLAÔ_Ô€phenotype€and€occurrence€of€clinical€disease.Ðð ˜ Ì$Ì$ ÐÌà0   à3.à0Ì $ $àStatistically€significant€associations€have€been€noted€between€Ô_ÔHLAÔ_Ô€antigens€and€a€number€of€diseases.Р H Ì$Ì$ ÐÌà0   à4.à0Ì $ $àThe€use€of€Ô_ÔHLAÔ_Ô€profiles€to€identify€individuals€at€risk€is€useful€for€some€diseases€in€which€an€absoluteÐ P ø  Ðassociation€in€individual€families€between€transmission€of€these€diseases€and€inheritance€of€certain€Ô_ÔHLAÔ_ÔÐ (Ð  ÐÔ_ÔhaplotypesÔ_Ô€has€been€proven.Ш Ì$Ì$ ÐÌE.à0   àTechniques€for€Detection€of€Ô_ÔHLAÔ_Ô€AntigensаX $ $ ÐÌà   à1.à0 Ì àò òÔ_ÔLymphocytoxicityÔ_Ôó ó€(Ô_ÔAKAÔ_Ô€Ô_ÔmicrolymphcytoxicityÔ_Ô€test)Ð`Ì$Ì$ ÐÌà0   àà0Ì $ $àa.à0øÌ$Ì$àThe€standard€technique€used€to€detect€Ô_ÔHLAÔ_Ô„A,€„B,€„C,€„DR€and€„Ô_ÔDQÔ_Ô€antigens€is€theÐ ¼ ÐÔ_ÔmicrolymphocytotoxicityÔ_Ô€test.Ðì”ø$ø$ ÐÌà0   àà0Ì $ $àb.à0øÌ$Ì$àA€living€lymphocyte€suspension€from€peripheral€blood€or€lymphatic€tissue€is€mixed€with€antisera€andÐ œD Ðcomplement.Ðtø$ø$ ÐÌà0   àà0Ì $ $àc.à0øÌ$Ì$àIn€the€presence€of€the€corresponding€antigen,€complement€is€fixed€and€the€cells€are€killed.Ð$Ìø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àCell€death€is€determined€by€staining.€€A€stain€such€as€Ô_ÔtrypanÔ_Ô€blue€penetrates€dead€cells€but€not€livingÐ Ô| Ðones.ЬTø$ø$ ÐÌà0   àà Ì àe.à0ø $ $àUnaffected€cells€remain€brilliantly€Ô_ÔrefractileÔ_Ô€when€observed€microscopically.Ð\ ø$ø$ ÐÌà0   à2.à0Ì $ $àò òMixed€Leukocyte€Culture€(Ô_ÔMLCÔ_Ô)€Testsó óÐ ´"Ì$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àThe€Ô_ÔHLAÔ_Ô„D€system€is€determined€by€cellular€events€in€Ô_ÔMLCÔ_Ô.ÐÀ h$ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àIn€the€Ô_ÔMLCÔ_Ô,€lymphocytes€from€two€individuals€are€cultured€together,€allowing€mutual€exposure€to€cellÐ p" & Ðsurface€antigens.ÐH#ð 'ø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àIf€the€Ô_ÔHLAÔ_Ô„DR€and€„Ô_ÔDQÔ_Ô€antigens€are€not€completely€identical,€stimulation€with€lymphocyteÐ ø$ ") Ðenlargement€and€proliferation€occurs€within€5€days.ÐÐ%x#*ø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àThis€blast€transformation€and€DNA€synthesis€is€measured€by€adding€a€Ô_ÔradiolabeledÔ_Ô€material€after€theÐ €'(%, Ð5„7€days€incubation.ÐX(&-ø$ø$ ÐÌà0   àà Ì àe.à0ø $ $àUptake€of€the€radiolabeled€material€is€proportional€to€DNA€synthesis€in€the€dividing€cells€and€isÐ *°'/ Ðindicative€of€an€immune€response.Ðà*ˆ(0ø$ø$ ÐÌÌÌÐ @.è+4 Ðà   à3.à0 Ì àDonor„Recipient€TestingÐXÌ$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àÔ_ÔMLCÔ_Ô€is€used€to€determine€class€II€compatibility€between€a€recipient€and€prospective€organ€donor,€theÐ ° Ðdonor€cell€line€is€Ô_ÔpretreatedÔ_Ô€with€a€substance€to€prevent€proliferation€in€response€to€the€recipient'sÐ àˆ Ðantigens.и`ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àA€unilateral€reaction€thus€occurs€in€which€the€treated€donor€cells€act€only€as€Ô_ÔstimulatorÔ_Ô€cells€and€theÐ h ÐÔ_ÔnoninhibitedÔ_Ô€lymphocytes€of€the€recipient€respond€to€foreign€antigens€present€on€the€stimulating€cells.Ð@èø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àKidney€transplants€from€recipient/donor€pairs€with€low€reactivity€in€the€Ô_ÔMLCÔ_Ô€have€better€survival€thanÐ ð ˜  Ðthose€showing€high€reactivity.ÐÈ p ø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àThe€Ô_ÔMLCÔ_Ô€takes€several€days€to€perform€and€is€used€to€select€living„related,€prospective€kidney€donors,Ð x  Ðbut€it€is€not€practical€for€selecting€cadaveric€transplant€donors.ÐP ø ø$ø$ ÐÌà0   àà Ì àe.à0ø $ $àThe€Ô_ÔMLCÔ_Ô€is€also€used€to€select€donors€for€bone€marrow€transplantation.Ш ø$ø$ ÐÌà   à4.à0 Ì àò òPrimed€Lymphocyte€Typing€(PLT)ó óаXÌ$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àPLT€is€a€faster€method€for€cellular€compatibility€testing,€but€is€more€expensive€and€more€complex€thanÐ d  Ðthe€routine€Ô_ÔMLCÔ_Ô€test.Ð<äø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àIf€cells€in€an€Ô_ÔMLCÔ_Ô€are€continued€in€culture€for€9„14€days,€the€Ô_ÔstimulatorÔ_Ô€cells€die€and€the€responderÐ ì” Ðcells,€although€still€viable,€cease€to€proliferate€actively.ÐÄlø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àThese€"primed"€responder€cells€undergo€very€rapid€proliferation€if€again€exposed€to€the€DR,€Ô_ÔDQÔ_Ô€andÐ t Ðalso,€in€this€case,€the€DP€antigens€present€on€the€original€stimulating€cell.ÐLôø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àThis€technique€gives€results€within€24€hours€rather€than€4„7€days,€but€the€results,€although€closelyÐ ü¤ Ðassociated€with€Ô_ÔMLCÔ_Ô€results,€are€not€identical.ÐÔ|ø$ø$ ÐÌà0   àà Ì àe.à0ø $ $àThe€PLT€system€defines€the€system€of€antigens,€designated€DP,€which€do€not€cause€sufficientÐ „, Ðproliferation€to€be€detected€in€primary€Ô_ÔMLCÔ_Ô€tests.Ð\ ø$ø$ ÐÌF.à0   àÔ_ÔHLAÔ_Ô€Testing€and€TransplantationÐ ´" $ $ ÐÌà0   à1.€à Ì àIntroductionм d$ $ $ ÐÌà0   àà Ì àa.à0ø $ $àTransplantation€of€foreign€tissue€induces€both€humoral€and€cellular€immune€responses€in€the€recipient,Ð l" & Ðwhich€leads€to€graft€rejection€or,€for€bone€marrow€transplantation,€graft€vs€host€disease€(Ô_ÔGVHDÔ_Ô).ÐD#ì 'ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àThe€severity€of€rejection€or€Ô_ÔGVHDÔ_Ô€may€be€reduced€by:Ðô$œ")ø$ø$ ÐÓK"X X°ÜÊŒ  h”XX X°ÜÊŒ •XKÓà0   àà0Ì $ $àà0øÌ$Ì$à1)à0º ø$ø$àÔ_ÔHLAÔ_Ô„matching€between€donor€graft€and€the€host,ÐÌ%t#*º $º $ Ðà0   àà0Ì $ $àà0øÌ$Ì$à2)à0º ø$ø$àgiving€steroids€to€decrease€the€humoral€antibody€response€and,Ф&L$+º $º $ Ðà0   àà0Ì $ $àà0øÌ$Ì$à3)à0º ø$ø$àinhibiting€the€cellular€immune€response€with€Ô_ÔcyclosporinÔ_Ô€A,€Ô_ÔantithymocyteÔ_Ô€or€Ô_ÔantilymphocyteÔ_ÔÐ |'$%, Ðglobulin,€Ô_ÔazathioprineÔ_Ô€or€monoclonal€antibody€to€the€T3€cell€receptor.ÐT(ü%-º $º $ ÐÌÌà0   àà0Ì $ $à2.à0øÌ$Ì$àAntigen€TestingÐÜ*„(0ø$ø$ ÐÌà0   àà0Ì $ $àà0øÌ$Ì$àa.à0º ø$ø$àBoth€recipient€and€donor€are€ordinarily€tested€in€most€solid€organ€transplants€for€ABO,€Ô_ÔHLAÔ_Ô„Ð Œ,4*2 ÐDR,€Ô_ÔHLAÔ_Ô„B€and€Ô_ÔHLAÔ_Ô„A€antigens;€listed€in€decreasing€order€of€importance.Ðd- +3º $º $ ÐÐ <.ä+4 Ðà0   àà0Ì $ $àà0øÌ$Ì$àb.à0º ø$ø$àAnti„Ô_ÔHLAÔ_Ô„C€testing€is€sometimes€performed.ÐXº $º $ ÐÌà0   àà0Ì $ $àà0øÌ$Ì$àc.à0º ø$ø$àThe€Ô_ÔDQÔ_Ô€and€DP€systems€are€under€evaluation€for€their€usefulness€in€predicting€transplantÐ ° Ðsurvival€for€solid€organs€but€are€known€to€be€important€in€bone€marrow€transplantation.Ðàˆº $º $ ÐÌà0   àà0Ì $ $àà0øÌ$Ì$àd.à0º ø$ø$àA€positive€T„cell€Ô_ÔcrossmatchÔ_Ô€by€Ô_ÔmicrolymphocytotoxicityÔ_Ô€testing€indicates€preexistingÐ 8 Ðantibodies€and€contraindicates€performing€a€kidney€transplant€since€patients€can€continue€to€beÐ h Ðmaintained€on€dialysis.Ð@èº $º $ ÐÌà0   àà0Ì $ $àà0øÌ$Ì$àe.à0º ø$ø$àIncompatibility€between€donor€and€recipient€in€the€ABO€system€and€preexisting€antibodies€inÐ ð ˜  Ðthe€Ô_ÔHLAÔ_Ô„A€and€„B€systems€pose€the€possibility€of€Ô_ÔhyperacuteÔ_Ô€rejection.ÐÈ p º $º $ ÐÌà0   àà0Ì $ $àà0øÌ$Ì$àf.à0º ø$ø$àÔ_ÔHLAÔ_Ô„A€and„B€typing€is€important€in€matching€donors€for€recipients€with€preexisting€Ô_ÔHLAÔ_ÔÐ x  Ðantibodies,€and€also€contributes€to€the€likelihood€for€long„term€kidney€graft€survival.ÐP ø º $º $ ÐÌG.à0   àBlood€Transfusion€in€Kidney€TransplantationШ  $ $ ÐÌà   à1.à0 Ì àIn€the€early€1970's,€many€potential€kidney€recipients€were€not€transfused,€or€were€transfused€with€D„Ô_ÔRBCsÔ_ÔÐ °X Ðin€order€to€minimize€Ô_ÔHLAÔ_Ô€immunization€from€exposure€to€white€cells€and€platelets.Ј0Ì$Ì$ ÐÌà   à2.à0 Ì àInterestingly,€however,€kidney€graft€survival€was€poorer€in€these€patients€than€in€patients€repeatedlyÐ 8à Ðtransfused€with€WB€or€Ô_ÔRBCsÔ_Ô.€€Ð¸Ì$Ì$ ÐÌà   à3.à0 Ì àAs€a€results,€some€investigators€deliberately€transfused€potential€kidney€transplant€patients€with€Ô_ÔnonfrozenÔ_ÔÐ Àh Ðcomponents€that€contained€abundant€Ô_ÔHLAÔ_Ô„reactive€material,€and€observed€increased€kidney€graft€survival.И@Ì$Ì$ ÐÌà   à4.à0 Ì àSome€current€protocols€to€select€living,€related€kidney€donors€include€transfusing€Ô_ÔRBCsÔ_Ô€from€the€potentialÐ Hð Ðdonor€in€an€attempt€to€improve€graft€survival.Ð ÈÌ$Ì$ ÐÌà   à5.à0 Ì àThese€donor€specific€transfusions€(Ô_ÔDSTsÔ_Ô)€are€examples€of€using€a€designated€donor.€€If€the€recipientÐ Ðx Ðproduces€Ô_ÔHLAÔ_Ô€antibodies€against€the€donor€cells,€transplantation€does€not€occur.€€This€spares€both€donorÐ ¨P Ðand€recipient€major€surgery.Ѐ(Ì$Ì$ ÐÌà   à6.à0 Ì àIf€the€donor€does€not€produce€antibodies€following€the€Ô_ÔDSTsÔ_Ô,€the€likelihood€of€success€in€the€subsequentÐ 0Ø! Ðrenal€transplantation€is€high.а"Ì$Ì$ ÐÌà   à7.à0 Ì àThe€mechanism€by€which€blood€transfusions€enhance€kidney€graft€survival€remains€an€enigma.и `$Ì$Ì$ ÐÌH.à0   àRed€Blood€Cell€Antigens€and€Kidney€Transplantation.Ðh" & $ $ ÐÌà   à1.à0 Ì àABO€compatibility€is€probably€the€most€important€factor€determining€the€immediate€survival€of€organ€andÐ $À!( Ðtissue€transplants€other€than€bone€marrow.Ðð$˜")Ì$Ì$ ÐÌà   à2.à0 Ì àAn€interesting€exception€to€the€requirement€for€ABO€compatibility€is€the€observation€that€A2€donorÐ  &H$+ Ðkidneys€survive€as€well€as€O€donor€kidneys€in€group€O€recipients.Ðx' %,Ì$Ì$ ÐÌà   à3.à0 Ì àSince€ABO€antigens€are€expressed€in€varying€amounts€on€all€cells€of€the€body,€transplanted€ABO„Ð ()Ð&. Ðincompatible€tissue€comes€into€continuous€contact€with€the€recipient's€ABO€antibodies.Ð*¨'/Ì$Ì$ ÐÌà   à4.à0 Ì àFor€bone€marrow€transplants,€unlike€other€organ€transplants,€Ô_ÔHLAÔ_Ô€identity€between€donor€and€recipientÐ °+X)1 Ðis€more€important€than€ABO.Ј,0*2Ì$Ì$ ÐÌÐ 8.à+4 ЇI.à0   àLiver€TransplantsÐX $ $ ÐÌà   à1.à0 Ì àA€clinical€liver€transplant€program€presents€one€of€the€greatest€challenges€to€the€donor€center€and€hospitalÐ ° Ðtransfusion€service.ÐàˆÌ$Ì$ ÐÌà   à2.à0 Ì àThe€demands€of€a€liver€transplant€program€require€that€the€support€be€maximal€in€terms€of€preparedness,Ð 8 Ðsupply€and€responsiveness.ÐhÌ$Ì$ ÐÌà   à3.à0 Ì àInstitutes€that€begin€a€liver€transplant€program€must€make€a€major€commitment€to€this€support.Ð ÀÌ$Ì$ ÐÌà   à4.à0 Ì àCooperation€and€communication€are€required€between€the€hospital€administration,€staff€of€the€operatingÐ È p  Ðroom,€intensive€care€unit,€respiratory€therapy,€radiology,€Ô_ÔgastroenterologyÔ_Ô,€anesthesiology,€coagulationÐ   H  Ðlaboratory,€transfusion€service€and€donor€center.Ðx Ì$Ì$ ÐÌà   à5.à0 Ì àThe€institutional€commitment€must€extend€24€hours€a€day€and€on€weekends€and€holidays€since€advanceÐ (Ð  Ðnotice€of€a€liver€transplant€may€be€minimal€and€may€extend€only€for€a€few€hours.Ш Ì$Ì$ ÐÌà   à6.à0 Ì àThe€surgical€procedure€frequently€takes€place€at€night€or€on€weekends€because€of€the€availability€of€theÐ °X Ðdonor€organ€and€in€order€not€to€disrupt€the€set€operating€room€schedule.€€The€transplant€procedure€mayÐ ˆ0 Ðtake€6„24€hours€and€involve€several€surgical€teams.Ð`Ì$Ì$ ÐÌà   à7.à0 Ì àWhen€the€organ€arrives€the€institution€may€have€more€than€one€patient€waiting€for€a€liver€transplant,Ð ¸ Ðtherefore,€the€blood€bank€may€have€to€Ô_ÔcrossmatchÔ_Ô€more€than€one€patient.ÐèÌ$Ì$ ÐÌà   à8.à0 Ì àThis€could€involve€patients€with€different€ABO€and€D€types€(liver€must€be€ABO€compatible):И@Ì$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àOne€protocol€involves€Type€and€Screen€and€Ô_ÔcrossmatchingÔ_Ô€the€patient€with€20€units€of€Ô_ÔRBCsÔ_Ô€usingÐ Hð Ðthe€Ô_ÔcoombsÔ_Ô€Ô_ÔcrossmatchÔ_Ô€procedure.Ð Èø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àAll€additional€units€are€released€after€an€IS€Ô_ÔcrossmatchÔ_Ô€only,€if€the€antibody€detection€test€is€negative.ÐÐxø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àThe€protocol€also€involves€the€provision€of€the€first€10€units€of€Ô_ÔRBCsÔ_Ô€as€D=€for€D=€patients.€Ð €( ÐSubsequent€units€issued€may€be€D+€until€near€the€end€of€the€procedure.ÐX ø$ø$ ÐÌà0   àà0Ì $ $àd.à0øÌ$Ì$àThe€last€10€to€15€units€are€provided€as€D=.а"ø$ø$ ÐÌà0   àà0Ì $ $àe.à0øÌ$Ì$àAn€attempt€to€provide€all€D=€blood€for€younger€female€adults€and€children.и `$ø$ø$ ÐÌà0   àà0Ì $ $àf.à0øÌ$Ì$àThe€same€policy€has€been€used€for€patients€with€specific€clinically€significant€Ô_ÔalloantibodiesÔ_Ô;€the€firstÐ h" & Ð10€are€antigen€negative„next,€additional€units€are€antigen€untested€and€the€last€10„15€units€are€antigenÐ @#è ' Ðnegative.Ð$À!(ø$ø$ ÐÌà0   àà0Ì $ $àg.à0øÌ$Ì$àAdditionally,€10„20€units€of€Ô_ÔFFPÔ_Ô€are€thawed€for€initial€transplant€availability.ÐÈ%p#*ø$ø$ ÐÌà0   à9.à0Ì $ $àAdults€use€approximately€20€units€of€Ô_ÔRBCsÔ_Ô,€24€units€of€Ô_ÔFFPÔ_Ô,€25€units€of€PCs€and€8€units€of€Ô_ÔCRYOÔ_Ô.€Ð x' %, ÐChildren€may€use€up€to€one„half€of€these€amounts.ÐP(ø%-Ì$Ì$ ÐÌÌÌÌÌÌÐ 8.à+4 ÐJ.à0   àHeart€TransplantsÐX $ $ ÐÌà0   à1.à0Ì $ $àBlood€bank€support€for€cardiac€transplantation€is€very€similar€to€that€routinely€sued€for€other€types€ofÐ ° Ðopen„heart€surgery€in€which€cardiopulmonary€bypass€is€employed.€ÐàˆÌ$Ì$ ÐÌà0   à2.à0Ì $ $àThe€heart€must€be€ABO€compatible€with€the€recipient.Ð8Ì$Ì$ ÐÌà0   à3.à0Ì $ $àIf€two€patients€are€waiting€for€a€heart,€the€heart€is€given€to€the€patient€with€the€better€Ô_ÔHLAÔ_Ô€Ô_ÔcrossmatchÔ_Ô.Ð@èÌ$Ì$ ÐÌK.à0   àPancreas€TransplantsÐð ˜  $ $ ÐÌà   à1.à0 Ì àPancreatic€transplants€have€lesser€transfusion€requirements.€€Ð  H Ì$Ì$ ÐÌà   à2.à0 Ì àEither€a€Type€and€Screen€or€the€complete€Ô_ÔcrossmatchingÔ_Ô€of€a€few€RBC€units€should€be€established€as€aÐ P ø  Ðroutine.Ð(Ð Ì$Ì$ ÐÌà   à3.à0 Ì àPancreas€must€be€ABO€compatible.ÐØ€ Ì$Ì$ ÐÌL.à0   àAutologous€Bone€Marrow€TransplantationЈ0 $ $ ÐÌà   à1.à0 Ì àAutologous€bone€marrow€transplantation€(Ô_ÔBMTÔ_Ô)€is€used€in€patients€with€malignancies€of€the€Ô_ÔtheÔ_Ô€marrowÐ 8à Ðitself€or€of€solid€tumors€elsewhere€in€the€body.иÌ$Ì$ ÐÌà   à2.à0 Ì àPreservation€of€the€patient's€harvested€marrow€allows€the€use€of€an€otherwise€lethal€dose€of€radiationÐ Àh Ðand/or€chemotherapy€followed€by€Ô_ÔreinfusionÔ_Ô€of€the€stored€marrow€to€"rescue"€the€patient.И@Ì$Ì$ ÐÌà   à3.à0 Ì àIn€patients€with€leukemia,€the€marrow€may€be€collected€during€remission€for€storage€or€it€can€be€treatedÐ Hð Ðto€remove€the€leukemic€cells€after€harvesting€and€before€storage.Ð ÈÌ$Ì$ ÐÌà   à4.à0 Ì àExperimental€methods€to€eradicate€the€leukemic€cells€in€vitro€have€included€methods€that€depend€uponÐ Ðx Ðphysical,€chemical€and€immunological€differences€between€the€leukemic€cells€and€normal€Ô_ÔhematopoieticÔ_Ô.ШPÌ$Ì$ ÐÌà   à5.à0 Ì àThe€marrow€is€harvested€by€aspiration€from€multiple€sites€in€the€iliac€crest€under€general€anesthesia.ÐX Ì$Ì$ ÐÌà   à6.à0 Ì àThe€marrow€is€processed€and€may€be€stored€at€4C€for€up€to€3€days€or€frozen€at€„196C€for€long€term€storage.а"Ì$Ì$ ÐÌM.à0   àHomologous€Bone€Marrow€Transplantationи `$ $ $ ÐÌà   à1.à0 Ì àIntroductionÐh" &Ì$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àTransfusions€prior€to€homologous€Ô_ÔBMTÔ_Ô€are€known€to€be€detrimental€since€they€compromise€theÐ $À!( Ðsuccess€of€Ô_ÔengraftmentÔ_Ô,€particularly€in€patients€with€aplastic€anemia.Ðð$˜")ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àUnfortunately,€since€most€Ô_ÔBMTÔ_Ô€candidates€have€aplastic€anemia€or€leukemia,€transfusions€areÐ  &H$+ Ðoftentimes€necessary.Ðx' %,ø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àFamily€members€in€particular,€should€be€avoided€as€blood€donors€prior€to€transplant€since€one€of€themÐ ()Ð&. Ðmay€be€used€as€the€bone€marrow€donor.Ð*¨'/ø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àFollowing€Ô_ÔBMTÔ_Ô,€the€recipient€must€receive€transfusion€support€until€Ô_ÔengraftmentÔ_Ô€occurs€and€bloodÐ °+X)1 Ðcell€production€is€adequate.Ј,0*2ø$ø$ Ðâ âÐ `-+3 Ðà0   àà Ì àe.à0ø $ $àÔ_ÔRBCsÔ_Ô€are€usually€given€to€maintain€the€hemoglobin€at€9„10€mg/Ô_ÔdLÔ_Ô.€€This€usually€requires€6„20€unitsÐ X Ðâ âin€the€10€week€Ô_ÔposttransplantÔ_Ô€patient.Ð0Øø$ø$ ÐÌà0   àà Ì àf.à0ø $ $àAll€blood€components€(except€Ô_ÔbuffyÔ_Ô€coats€from€the€donor)€must€be€irradiated€to€prevent€Ô_ÔGVHDÔ_Ô€andÐ àˆ Ðbe€anti„Ô_ÔCMVÔ_Ô€negative€(Ô_ÔCMVÔ_Ô„)€if€the€recipient€and€donor€are€Ô_ÔCMVÔ_Ô„.и`ø$ø$ ÐÌà0   àà Ì àg.à0ø $ $àPlatelet€support€may€also€be€needed€for€Ô_ÔBMTÔ_Ô€recipients€and€should€be€Ô_ÔHLAÔ_Ô€identical,€although€thisÐ h Ðis€not€always€possible€and€random€donor€platelets€are€often€used.Ð@èø$ø$ ÐÌà0   àà Ì àh.à0ø $ $àSince€an€Ô_ÔHLAÔ_Ô„identical€donor€is€usually€required€for€bone€marrow€transplantation,€the€donor€(usuallyÐ ð ˜  Ða€sibling)€may€not€have€the€same€ABO€and€D€identity€as€the€patient.€€ABO€and€D€identity€orÐ È p  Ðcompatibility€between€the€donor€and€the€recipient€are€not€required€for€success€of€the€Ô_ÔBMTÔ_Ô,€butÐ   H  Ðincompatibilities€may€pose€special€problems€for€the€blood€bank.Ðx ø$ø$ ÐÌà   à2.à0 Ì àMajor€ABO€incompatibilityÐ(Ð Ì$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àIf€the€donor€and€recipient€have€a€major€ABO€incompatibility€(Ô_ÔieÔ_Ô,€donor€is€group€A,€recipient€is€groupР؀  ÐO),€then€the€group€A€red€cells€in€the€aspirated€bone€marrow€would€be€rapidly€Ô_ÔhemolyzedÔ_Ô€when€theÐ °X Ðmarrow€is€transfused€into€the€recipient€and€could€cause€significant€problems.Ј0ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àThe€problem€is€resolved€by€processing€the€aspirated€marrow€to€deplete€it€of€contaminating€red€cells.Ð8àø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àStem€cells€do€not€express€A€or€B€antigens.Ðèø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àThe€group€O€recipient€transplanted€with€group€A€marrow€may€continue€to€produce€anti„A€and€anti„BÐ ˜@ Ðfor€3„4€months.Ðpø$ø$ ÐÌà0   àà Ì àe.à0ø $ $àThe€grafted€marrow€will€begin€to€produce€a€new€population€of€blood€cells.€€Group€A€red€cells€willÐ  È Ðappear€in€the€circulation€when€the€recipient's€anti„A€disappears.Ðø ø$ø$ ÐÌà0   àà Ì àf.à0ø $ $àIf€transfusion€is€necessary,€washed€group€O€Ô_ÔRBCSÔ_Ô,€Ô_ÔCMVÔ_Ô„,€can€be€given.€€All€blood€componentsÐ ¨P Ðtransfused€to€Ô_ÔBMTÔ_Ô€recipients€should€be€irradiated€to€prevent€Ô_ÔGVHDÔ_Ô.Ѐ(ø$ø$ ÐÌà   à3.à0 Ì àMinor€Side€ABO€IncompatibilityÐ0Ø!Ì$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àWhen€marrow€from€a€group€O€donor€is€to€be€transfused€into€a€non„O€recipient,€the€plasma€should€beÐ àˆ# Ðremoved€to€reduce€the€amount€of€incompatible€Ô_ÔalloantibodyÔ_Ô€given€to€the€recipient.и `$ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àThe€marrow€transfusion€then€is€analogous€to€a€unit€of€group€O€Ô_ÔRBCsÔ_Ô€used€as€a€universal€donor€unit.Ðh" &ø$ø$ ÐÌà   à4.à0 Ì àÔ_ÔChimerismÔ_ÔÐ$À!(Ì$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àIn€spite€of€the€intensive€Ô_ÔpretransplantÔ_Ô€chemotherapy€and€irradiation,€some€of€the€host's€Ô_ÔhematopoieticÔ_ÔÐ È%p#* Ðcells€may€survive€and€subsequently€co„exist€with€the€transplanted€donor's€cells.Р&H$+ø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àThis€results€in€what€has€been€termed€mixed€Ô_ÔhematopoieticÔ_Ô€Ô_ÔchimerismÔ_Ô€and€thus€the€recipient€may€haveÐ P(ø%- Ða€dual€cell€population.Ð()Ð&.ø$ø$ Ðà0   àà Ì àc.à0ø $ $àThis€phenomenon€does€not€mean€that€the€recipient€will€necessarily€have€a€recurrence€of€theÐ *¨'/ Ðhematologic€malignancy.ÐØ*€(0ø$ø$ ÐÌÌÌÐ 8.à+4 Ðà   à5.à0 Ì àNational€Bone€Marrow€Donor€RegistryÐXÌ$Ì$ ÐÌà0   àà Ì àa.à0ø $ $àThis€registry€was€established€for€those€patients€in€need€of€a€bone€marrow€transplant€who€do€not€haveÐ ° Ða€suitably€matched€family€member€to€serve€as€a€donor.Ðàˆø$ø$ ÐÌà0   àà Ì àb.à0ø $ $àÔ_ÔHLAÔ_Ô„A,€„B€(and/or€„DR)€typed€volunteers€are€included€in€the€central€registry€of€potential€bone€marrowÐ 8 Ðdonors€for€unrelated€patients.Ðhø$ø$ ÐÌà0   àà Ì àc.à0ø $ $àAfter€preliminary€Ô_ÔHLAÔ_Ô„A,€B€matching,€„DR€typing€and€Ô_ÔMLCÔ_Ô€tests€are€performed€as€indicated.Ð Àø$ø$ ÐÌà0   àà Ì àd.à0ø $ $àWhen€a€match€is€found,€and€the€volunteer€wishes€to€proceed,€the€donor€may€have€his/her€bone€marrowÐ È p  Ðaspirated€locally.Р H ø$ø$ Ðà0   àà Ì àe.à0ø $ $àThe€aspirated€marrow€is€then€sent€by€airplane€to€the€transplant€center€of€the€recipient.Ðx ø$ø$ ÐÌà0   àà Ì àf.à0ø $ $àAccess€to€the€registry€is€through€participating€transplant€centers.Ð(Ð ø$ø$ ÐÌØ€ØÝ‚+ÖÿÝÝ  ÝÝ‚+ÖK—ÝÚƒÚNÚ  Ú.à0   àÝ  ÝÔ_ÔHematopoieticÔ_Ô€Stem€and€Progenitor€Cells݃+ÖK—f—ÝÛ€ÛŒÐØ€  $ $ ÐŒÝ  ÝÌà0   à1.à0Ì $ $àReplacing€bone€marrow€transplants.Ј0Ì$Ì$ ÐÌà0   à2.à0Ì $ $àÔ_ÔHematopoieticÔ_Ô€stem€cells€are€capable€of€self€renewal€and€of€differentiation€into€any€blood€cell€lineage.Ð8àÌ$Ì$ ÐÌà0   à3.à0Ì $ $àProgenitor€cells€are€committed€to€a€lineage€pathway€and€do€not€have€the€capacity€for€infinite€self€renewal.ÐèÌ$Ì$ ÐÌà0   à4.à0Ì $ $àÔ_ÔHematopoieticÔ_Ô€stem€and€progenitor€cells€can€be€collected€from€bone€marrow,€circulating€peripheral€bloodÐ ˜@ Ðand€umbilical€cord€blood.€€Collection€is€performed€by€cell€separator€instruments€and€involves€severalÐ p Ðcollections€to€ensure€adequate€numbers€of€cells€are€obtained.ÐHðÌ$Ì$ ÐÌà0   à5.à0Ì $ $àThree€types€of€transplant€options:Ðø Ì$Ì$ ÐÌà0   àà0Ì $ $àa.à0øÌ$Ì$àÔ_ÔAllogeneicÔ_Ô,€infusion€of€Ô_ÔhematopoieticÔ_Ô€stem€cells€from€an€individual€with€genetic€constitution€differentÐ ¨P Ðfrom€the€recipientððs.Ѐ(ø$ø$ Ðà0   àà0Ì $ $àb.à0øÌ$Ì$àÔ_ÔSyngeneicÔ_Ô,€transplant€from€an€identical€twin.ÐX ø$ø$ Ðà0   àà0Ì $ $àc.à0øÌ$Ì$àAutologous,€patient€donates€their€own,€then€is€subjected€to€intensive€chemotherapy€and/or€radiationÐ 0Ø! Ðtherapy€to€cure€malignancy,€then€the€autologous€donation€is€infused€to€rescue€the€patient.а"ø$ø$ ÐÌà0   à6.à0Ì $ $àUmbilical€cord€blood€is€an€alternative€to€bone€marrow€or€peripheral€blood€as€a€source€of€Ô_ÔhematopoieticÔ_ÔÐ ¸ `$ Ðcells.Ð!8%Ì$Ì$ ÐÌà0   àà0Ì $ $àa.à0øÌ$Ì$àOne€study€estimated€that€a€single€cord€blood€collection€can€provide€enough€stem€cells€forÐ @#è ' Ðtransplantation€and€Ô_ÔhematopoieticÔ_Ô€reconstitution€of€an€adult.Ð$À!(ø$ø$ ÐÌà0   àà0Ì $ $àb.à0øÌ$Ì$àThe€cord€blood€progenitor€cells€grow€well€in€culture€suggesting€the€possibility€of€using€in„vitroÐ È%p#* Ðtechniques€to€provide€more€stem€and€progenitor€cells.Ô#†&4] %%&8#Ô