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Opening the Silos

Amir A. Qamar, MD; Robert H. Rubin, MD

JAMA. 2006;296:1900-1901.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Over the past 30 years, organ transplantation has evolved from an interesting experiment in human immunobiology to the most practical means of rehabilitating patients with end-stage dysfunction.¹ At the same time, the requirement for chronic antirejection therapy, the presence of chronic or relapsing viral infection, and environmental exposures to a variety of opportunistic pathogens, have created a pathophysiological state and set of vulnerabilities rarely seen before.^2-3 It has been estimated that 75% or more of organ transplant patients will have evidence of microbial replication and invasion in the first year posttransplant.^4-6 Several principles have emerged from this experience.

First, allograft rejection and invasive infection are closely linked, creating the need for a "therapeutic prescription" that has 2 components: an immunosuppressive program to prevent and treat rejection, and an antimicrobial strategy to make this safe. Changes in the immunosuppressive regimen should result in . . . [Full Text of this Article]

Author Affiliations: Department of Medicine, Harvard Medical School (Drs Qamar and Rubin), and Division of Gastroenterology, Hepatology, and Endoscopy (Dr Qamar) and Division of Infectious Diseases (Dr Rubin), Brigham and Women’s Hospital, Boston, Mass.

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