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(Circulation Research. 2002;91:1085.)
© 2002 American Heart Association, Inc.

Editorials

Alive and Kicking

Endothelium at the Geographic Nexus of Vascular Rejection

Sean P. Mazer, David J. Pinsky

From Columbia University, College of Physicians and Surgeons, New York, NY.

Correspondence to David J. Pinsky, MD, Division of Cardiology and Circulatory Physiology, Dept of Medicine, Columbia University, College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032. E-mail djp5@columbia.edu

Key Words: xenotransplantation • vascular biology • rejection

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Transplantation of vascularized cardiac grafts across an alloimmune barrier has revolutionized the treatment of organ failure, including heart failure. With current immunosuppressive therapy, acute vascular rejection is an uncommon complication of allograft transplantation. However, the shortage of donor organs continues to limit the benefit of organ replacement therapy. The United Network of Organ Sharing (UNOS) registry data indicate that although 2202 heart transplants were performed in 2001, approximately 4000 patients remained on the waiting list and 622 patients died before receiving an organ. Many times this number died without even being listed for transplant at all.

Xenotransplantation, transplantation of organs between different species, could theoretically provide an unlimited source of organs. However, a number of barriers remain to the clinical implementation of xenotransplantation. One of the most important of these barriers, acute vascular rejection, develops in the continuum of delayed xenograft rejection (DXR). DXR occurs shortly after implantation of a vascularized xenograft and remains a major impediment to clinical application of xenotransplantation of vascularized organs. Acute vascular rejection occurs within a time frame of one to several days after transplantation, as a consequence of immune activation. Histologically, it is characterized by platelet aggregation, fibrin deposition, and cellular infiltration by host natural killer cells and monocytes.¹ Small vessels are typically involved in DXR, and eventually, focal infarcts and interstitial hemorrhage develop in the transplanted organ.

As a tissue, the endothelium sits at the geographic nexus of blood and tissue. It regulates homeostasis (nutrient delivery and waste removal) and modulates pathophysiology (inflammation, . . . [Full Text of this Article]

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