It has recently been reported that HLA-DP antigens may play an important role in the development of graft-versus-host disease (GVHD) following transplantations of haploidentical bone marrow as a treatment for haematological malignancies. Mixed lymphocyte culture (MLC) is routinely performed prior to bone marrow transplantation to assess the suitability of the donor, and we have therefore examined the role of HLA-DP in this test. One-way MLC chequerboard experiments were performed between 17 HLA-Dw3 homozygous typing cells (HTC) with a range of HLA-DP antigens represented, including HLA-DPw1, w2, w3, w4 and CP63. The experiments were performed on multiple occasions and each time a highly significant difference (P = less than 0.001) was observed between the Relative Responses (RR) in the HLA-DP matched responder/stimulator pairs and the HLA-DP mismatched pairs. There was, however, considerable overlap in these results with ranges in the HLA-DP-matched group RRs of 0-17%, and 0-62% in the mismatched group. Only 3.1% of the HLA-DP-matched grou had a RR greater than 5%, while 48% of the HLA-DP mismatched group had a RR greater than 5%. From these results it was calculated that a positive response (greater than 5%) has a 96% chance of being due to an HLA-DP disparity of one or two antigens. Conversely, with a negative MLC the chance of their being no HLA-DP antigen disparity was only 65%.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Marrow Transplantation↗

PubMedDate not supplied

Implantable venous access device.

Procedures for long-term angio access have for many years made up a major component of vascular surgical practice. A totally implantable vascular device for chronic venous access developed in the early '80s compares favorably with other methods of angio access. We implanted 76 of these devices in 73 patients on the oncology service of Fairview General Hospital between May 1984 and May 1986. The infusion ports were in place for a total of 14,509 patient days with a 3.9% rate of catheter related sepsis and 6.5% rate of catheter occlusion. Three occlusions resolved with streptokinase. Pocket infection occurred as a late complication in 3 patients. Emphasis is placed on a modified technique for device implantation. Strict adherence to a simplified percutaneous technique for the silastic catheter placement via the subclavian vein, with creation of the reservoir pocket after adequate vascular access is secure, has led to no serious complications during placement. Routine use of fluoroscopy during this procedure helped avoid potential technical complications. The advantages and disadvantages of the implantable systems compared to the dacron cuffed silastic catheters are discussed. Patient acceptance is excellent and improved cost/benefit ratio has been observed when compared to other forms of chronic venous access. Implantable vascular devices can be safely inserted with little morbidity or risk to the patient. They provide a convenient route for drawing blood, administering chemotherapy, hyperalimentation, and intravenous therapy in oncology patients and may represent an advantage over Hickman-Broviac catheters and the attendant catheter related sepsis associated with their use.

Adolescent↗