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By Max A. Chernesky, David Gretch, Isa K. Mushahwar, Paul D. Swenson, Patrice O. Yarbough, Stephen Young
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Diagnosis is usually made by examination of bronchoalveolar lavage (BAL) fluid or transbronchial biopsy. Treatment is with co-trimoxazole. Most transplant centres also offer prophylaxis in the first 6 months post transplant. 3 Aspergillus fumigatus is the most commonly observed aspergillus species in transplant recipients. It is acquired from the environment by inhalation of spores. It frequently causes lung disease (often cavitating lesions on CXR), forming nodules, which can be invasive and erode into blood vessels.
Calcineurin dephosphorylates the transcription factor NF-AT, allowing its translocation to the nucleus, where it enhances the transcription of a number of cytokines, including IL-2. Calcineurin inhibitors (CNIs) such as ciclosporin and tacrolimus form complexes with intracellular immunophilins (cyclophilin and FK506binding protein respectively). These CNI–immunophilin complexes inhibit calcineurin and thus prevent the translocation of NF-AT to the nucleus and inhibit its subsequent actions there.
Allele names are prefixed with a ‘*’; for example, the alleles encoding the HLA-A3 antigen are named A*03. g. A*0301, A*0302, etc. In clinical practice in solid organ transplantation, HLA type is now determined by DNA sequencing. e. two A mismatches, two B mismatches, etc. However, in renal transplantation only A, B and DR mismatches are considered, so the maximum number of mismatches possible is six. Such a mismatch would be described as a 2-2-2 mismatch (2 A, 2 B and 2 DR mismatches). The best mismatch would be a 0-0-0 mismatch.
Cumitech 18A: Laboratory Diagnosis of Hepatitis Viruses by Max A. Chernesky, David Gretch, Isa K. Mushahwar, Paul D. Swenson, Patrice O. Yarbough, Stephen Young