Correspondence: Joseph P Uberti Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer institute, wayne State University School of Medicine, Detroit, Mi 48201, USA Tel +1 313 576 8760 Fax +1 313 576 8766 email ubertij@karmanos.org Abstract: Acute graft-versus-host disease (aGVHD) is an immunologically mediated inflammatory reaction, which continues to be a major cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplant. Although the occurrence and severity of this disease may be devastating, there is a proven immunologically mediated antitumor activity that accompanies the disease process, which has a beneficial effect on outcome. Animal models of graft-versus-host disease (GVHD) have given us a conceptual model that has allowed a better understanding of the pathophysiology and offers a framework for understanding the complex interactions between antigen-presenting cells, donor T-cells, and cytokines in the development of aGVHD. It has also given us a model that allows testing of various strategies for prevention and treatment. New, innovative approaches for treatment and prevention of aGVHD including better donor selection with the use of sophisticated human leukocyte antigen typing, use of T-cell depletion, reduced-intensity transplant regimens, and improved pharmacologic immunosuppression have improved outcomes by decreasing the incidence and severity of aGVHD. However, the limitation of these strategies is that effective treatment and prevention of aGVHD is often accompanied by a concomitant rise in relapses, graft failure and infections, and ultimately no improvement in overall survival. Investigators are working on understanding the difference between GVHD and graft versus tumor effect, as this would be the key in improving outcomes for our patients. In this review, we will discuss the pathophysiology of aGVHD along with the preventative and treatment strategies.
通讯:Joseph P Uberti肿瘤学系，血液和骨髓干细胞移植项目，Barbara Ann Karmanos癌症研究所，韦恩州立大学医学院，底特律，Mi 48201，美国电话+1 313 576 8760传真+1 313 576 8766邮箱ubertij@karmanos.org急性移植物抗宿主病(aGVHD)是一种免疫介导的炎症反应，它仍然是异体造血干细胞移植患者发病和死亡的主要原因。尽管这种疾病的发生和严重程度可能是毁灭性的，但已证实免疫介导的抗肿瘤活性伴随疾病过程，这对结果有有益的影响。移植物抗宿主病(GVHD)的动物模型为我们提供了一个概念模型，使我们能够更好地理解病理生理学，并为理解抗原呈递细胞、供体t细胞和细胞因子在aGVHD发展中的复杂相互作用提供了一个框架。它还为我们提供了一个模型，可以测试各种预防和治疗策略。新的、创新的治疗和预防aGVHD的方法包括更好的供体选择，使用复杂的人类白细胞抗原分型，使用t细胞耗损，降低强度的移植方案，以及改进的药理学免疫抑制，通过降低aGVHD的发病率和严重程度，改善了结果。然而，这些策略的局限性在于，aGVHD的有效治疗和预防往往伴随着复发、移植物衰竭和感染的增加，最终没有改善总生存期。研究人员正在努力了解GVHD和移植物抗肿瘤效应之间的差异，因为这将是改善患者预后的关键。在这篇综述中，我们将讨论aGVHD的病理生理以及预防和治疗策略。
{"title":"Pathophysiology, prevention, and treatment of acute graft-versus-host disease","authors":"A. Deol, V. Ratanatharathorn, J. Uberti","doi":"10.2147/TRRM.S11989","DOIUrl":"https://doi.org/10.2147/TRRM.S11989","url":null,"abstract":"Correspondence: Joseph P Uberti Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer institute, wayne State University School of Medicine, Detroit, Mi 48201, USA Tel +1 313 576 8760 Fax +1 313 576 8766 email ubertij@karmanos.org Abstract: Acute graft-versus-host disease (aGVHD) is an immunologically mediated inflammatory reaction, which continues to be a major cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplant. Although the occurrence and severity of this disease may be devastating, there is a proven immunologically mediated antitumor activity that accompanies the disease process, which has a beneficial effect on outcome. Animal models of graft-versus-host disease (GVHD) have given us a conceptual model that has allowed a better understanding of the pathophysiology and offers a framework for understanding the complex interactions between antigen-presenting cells, donor T-cells, and cytokines in the development of aGVHD. It has also given us a model that allows testing of various strategies for prevention and treatment. New, innovative approaches for treatment and prevention of aGVHD including better donor selection with the use of sophisticated human leukocyte antigen typing, use of T-cell depletion, reduced-intensity transplant regimens, and improved pharmacologic immunosuppression have improved outcomes by decreasing the incidence and severity of aGVHD. However, the limitation of these strategies is that effective treatment and prevention of aGVHD is often accompanied by a concomitant rise in relapses, graft failure and infections, and ultimately no improvement in overall survival. Investigators are working on understanding the difference between GVHD and graft versus tumor effect, as this would be the key in improving outcomes for our patients. In this review, we will discuss the pathophysiology of aGVHD along with the preventative and treatment strategies.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"3 1","pages":"31-44"},"PeriodicalIF":0.9,"publicationDate":"2011-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S11989","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Tedesco-Silva, C. Felipe, T. S. Freitas, Marina Pontello Cristeli, C. Rodrigues, J. M. Pestana
Everolimus is an immunosuppressive agent used for the prophylaxis of acute rejection after kidney transplantation. Everolimus inhibits the activity of the serine/threonine kinase mammalian target of rapamycin (mTOR), a key enzyme that controls cell growth and metabolism, producing cell cycle arrest from the G1 to S phase. As a consequence, everolimus has antiproliferative and antineoplastic effects. Everolimus is a drug with a narrow therapeutic index. The pharmacokinetics of everolimus indicates a need for twice-daily dosing. Intra- and interindividual variability and drug-drug interactions suggest the need for therapeutic drug monitoring to maximize the efficacy/toxicity ratio. The good correlation between exposure (area under the concentration-time curve) and trough concentration indicates that monitoring of everolimus trough concentrations is an adequate strategy after kidney transplantation. Everoli- mus is indicated for low- to moderate-risk de novo kidney transplant candidates. There are no conclusive studies thus far indicating that everolimus can be used in high-risk patients, such as sensitized patients, retransplants, and African Americans. In de novo kidney transplant recipi- ents, the recommended initial dose of everolimus is 0.75 mg twice daily, adjusted to maintain blood trough concentrations of 3-8 ng/mL, in combination with progressive reduction in blood trough cyclosporine concentrations to 25-50 ng/mL. In combination with reduced trough blood tacrolimus concentrations of 4-7 ng/mL the recommended initial dose of everolimus is 1.5 mg twice daily, adjusted to maintain trough blood concentrations of 3-8 ng/mL. Everolimus can also be used as a conversion strategy, mainly to preserve renal function and to manage patients with malignancy. There is no definition of the ideal strategy for conversion, ie, abrupt or sequential, initial dose of everolimus, or target therapeutic trough blood concentrations. Intensive monitor- ing is recommended after conversion, especially for acute rejection and proteinuria. Because mTOR is ubiquitous and central to many intracellular processes, an array of adverse reactions may occur, including delayed tissue regeneration, proteinuria, dyslipidemia, diabetes, myelosup- pression, infertility, ovarian cysts, and mouth ulcers. Because long-term benefits are the goal of any immunosuppressive strategy, further investigations aiming to understand, prevent, and manage everolimus-related adverse reactions are necessary to mitigate the risks and improve tolerability, allowing maximization of all the benefits of this drug.
{"title":"Impact of everolimus: update on immunosuppressive therapy strategies and patient outcomes after renal transplantation","authors":"H. Tedesco-Silva, C. Felipe, T. S. Freitas, Marina Pontello Cristeli, C. Rodrigues, J. M. Pestana","doi":"10.2147/TRRM.S12217","DOIUrl":"https://doi.org/10.2147/TRRM.S12217","url":null,"abstract":"Everolimus is an immunosuppressive agent used for the prophylaxis of acute rejection after kidney transplantation. Everolimus inhibits the activity of the serine/threonine kinase mammalian target of rapamycin (mTOR), a key enzyme that controls cell growth and metabolism, producing cell cycle arrest from the G1 to S phase. As a consequence, everolimus has antiproliferative and antineoplastic effects. Everolimus is a drug with a narrow therapeutic index. The pharmacokinetics of everolimus indicates a need for twice-daily dosing. Intra- and interindividual variability and drug-drug interactions suggest the need for therapeutic drug monitoring to maximize the efficacy/toxicity ratio. The good correlation between exposure (area under the concentration-time curve) and trough concentration indicates that monitoring of everolimus trough concentrations is an adequate strategy after kidney transplantation. Everoli- mus is indicated for low- to moderate-risk de novo kidney transplant candidates. There are no conclusive studies thus far indicating that everolimus can be used in high-risk patients, such as sensitized patients, retransplants, and African Americans. In de novo kidney transplant recipi- ents, the recommended initial dose of everolimus is 0.75 mg twice daily, adjusted to maintain blood trough concentrations of 3-8 ng/mL, in combination with progressive reduction in blood trough cyclosporine concentrations to 25-50 ng/mL. In combination with reduced trough blood tacrolimus concentrations of 4-7 ng/mL the recommended initial dose of everolimus is 1.5 mg twice daily, adjusted to maintain trough blood concentrations of 3-8 ng/mL. Everolimus can also be used as a conversion strategy, mainly to preserve renal function and to manage patients with malignancy. There is no definition of the ideal strategy for conversion, ie, abrupt or sequential, initial dose of everolimus, or target therapeutic trough blood concentrations. Intensive monitor- ing is recommended after conversion, especially for acute rejection and proteinuria. Because mTOR is ubiquitous and central to many intracellular processes, an array of adverse reactions may occur, including delayed tissue regeneration, proteinuria, dyslipidemia, diabetes, myelosup- pression, infertility, ovarian cysts, and mouth ulcers. Because long-term benefits are the goal of any immunosuppressive strategy, further investigations aiming to understand, prevent, and manage everolimus-related adverse reactions are necessary to mitigate the risks and improve tolerability, allowing maximization of all the benefits of this drug.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"3 1","pages":"9-29"},"PeriodicalIF":0.9,"publicationDate":"2011-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S12217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Samandari, S. Adibi, A. Khoshzaban, Sara Aghazadeh, Parviz Dihimi, S. S. Torbaghan, Saeed Hidari Keshel, Zohreh Shahabi
1Department of Oral and Maxillofacial Surgery, Dentistry Faculty, 2Dental Research of Torabinejad Research centre, 3iranian Tissue Bank Research and Preparation centre, imam Khomeini hospital complex, 4Department of Oral and Maxillofacial Pathology, Dentistry Faculty, isfahan University of Medical Sciences, isfahan, iran; 5Stem cells Preparation Unit, eye Research center, Farabi hospital, 6Department of Pathology, imam Khomeini Medical centre, 7BMT center, Shariati hospital, Tehran University of Medical Sciences, Tehran, iran
{"title":"Human amniotic membrane, best healing accelerator, and the choice of bone induction for vestibuloplasty technique (an animal study)","authors":"M. Samandari, S. Adibi, A. Khoshzaban, Sara Aghazadeh, Parviz Dihimi, S. S. Torbaghan, Saeed Hidari Keshel, Zohreh Shahabi","doi":"10.2147/TRRM.S11741","DOIUrl":"https://doi.org/10.2147/TRRM.S11741","url":null,"abstract":"1Department of Oral and Maxillofacial Surgery, Dentistry Faculty, 2Dental Research of Torabinejad Research centre, 3iranian Tissue Bank Research and Preparation centre, imam Khomeini hospital complex, 4Department of Oral and Maxillofacial Pathology, Dentistry Faculty, isfahan University of Medical Sciences, isfahan, iran; 5Stem cells Preparation Unit, eye Research center, Farabi hospital, 6Department of Pathology, imam Khomeini Medical centre, 7BMT center, Shariati hospital, Tehran University of Medical Sciences, Tehran, iran","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"3 1","pages":"1-8"},"PeriodicalIF":0.9,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S11741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Correspondence: Joseph O Fadare Department of internal Medicine, Kogi State Specialist Hospital, Lokoja, Nigeria Tel +234 813 804 8127 email jofadare@gmail.com Abstract: Organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Kidney transplantation, now the treatment of choice for end-stage renal disease, is the commonest solid organ transplantation carried out in the world at the moment and it is the only solid organ transplantation done in Nigeria. This procedure, in addition to prolonging lives, also provides better quality of life and is evaluated as cost-effective, because it makes more resources available to other sectors of the economy. Organ transplantation in general and kidney transplantation in particular are fraught with ethical issues and dilemmas worldwide. Some of the ethical issues arising in the setting of developing countries like Nigeria may differ from those in countries where this procedure is established. Informed consent of the donor and the recipient is a major requirement for both organ donation and transplantation. Regarding donation, the ethical issues may differ depending on the type of organ donation, ie, whether it is living-related, living-unrelated, cadaveric, or from brain-dead individuals. Commodification of organs is identified as an ethical dilemma, and arguments for and against this practice are put forward here. Confidentiality of donor information, fairness and equity in donor selection, and access to kidney transplantation when needed are also discussed. Finally, the issue of safety of organ harvesting for the donor and of the transplantation process itself, and the possible long-term consequences for both parties are investigated.
通讯:Joseph O Fadare内科，Kogi州立专科医院，Lokoja，尼日利亚电话+234 813 804 8127电子邮件jofadare@gmail.com摘要:器官移植已经成为许多迄今为止被认为无法治愈的疾病的救命手段。肾移植是目前世界上进行的最常见的实体器官移植，也是尼日利亚唯一进行的实体器官移植，是终末期肾病的治疗选择。这一程序除了延长生命之外，还提供了更好的生活质量，并被评价为具有成本效益，因为它为其他经济部门提供了更多的资源。器官移植，特别是肾脏移植，在世界范围内充满了伦理问题和困境。在尼日利亚等发展中国家的环境中出现的一些伦理问题可能与建立这一程序的国家不同。器官捐献和移植的主要要求是捐赠者和接受者的知情同意。关于器官捐赠，伦理问题可能会因器官捐赠的类型而有所不同，即是否与活着的人有关，是否与活着的人无关，尸体还是脑死亡的人。器官商品化被认为是一个伦理困境，并提出了支持和反对这种做法的论点。还讨论了供体信息的保密性，供体选择的公平性和公平性，以及在需要时获得肾移植的机会。最后，对供体器官采集和移植过程本身的安全性问题，以及对双方可能产生的长期后果进行了调查。
{"title":"Ethical issues in kidney transplantation – reflections from Nigeria","authors":"J. Fadare, B. Salako","doi":"10.2147/TRRM.S14371","DOIUrl":"https://doi.org/10.2147/TRRM.S14371","url":null,"abstract":"Correspondence: Joseph O Fadare Department of internal Medicine, Kogi State Specialist Hospital, Lokoja, Nigeria Tel +234 813 804 8127 email jofadare@gmail.com Abstract: Organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Kidney transplantation, now the treatment of choice for end-stage renal disease, is the commonest solid organ transplantation carried out in the world at the moment and it is the only solid organ transplantation done in Nigeria. This procedure, in addition to prolonging lives, also provides better quality of life and is evaluated as cost-effective, because it makes more resources available to other sectors of the economy. Organ transplantation in general and kidney transplantation in particular are fraught with ethical issues and dilemmas worldwide. Some of the ethical issues arising in the setting of developing countries like Nigeria may differ from those in countries where this procedure is established. Informed consent of the donor and the recipient is a major requirement for both organ donation and transplantation. Regarding donation, the ethical issues may differ depending on the type of organ donation, ie, whether it is living-related, living-unrelated, cadaveric, or from brain-dead individuals. Commodification of organs is identified as an ethical dilemma, and arguments for and against this practice are put forward here. Confidentiality of donor information, fairness and equity in donor selection, and access to kidney transplantation when needed are also discussed. Finally, the issue of safety of organ harvesting for the donor and of the transplantation process itself, and the possible long-term consequences for both parties are investigated.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"87-91"},"PeriodicalIF":0.9,"publicationDate":"2010-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S14371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Lipshutz, E. Reed, P. Pham, Jeffrey M. Miller, J. Singer, G. Danovitch, A. Wilkinson, Dean W. Wallace, Suzanne McGuire, P. Pham, P. Pham
Over the past decade ABO incompatible transplantation has emerged as an important potential source for increasing living kidney transplantation in selected transplant centers. Early reports suggest that patients who have elevated serum anti-blood group antibody titers (anti-A/B) before transplantation and a rebound antibody production after antibody removal may be at high immunological risk. With currently available immune modulation protocols and immunosuppressive therapy, excellent short- and long-term patient and graft survival rates have been achieved even in those with high anti-A/B antibody titers before plasmapheresis or immunoadsorption. Nonetheless, acute infection with an organism possessing surface markers analogous to blood group antigens such as carbohydrate structures on the surface of bacterial cell wall occurring before the firm establishment of accommodation can trigger the onset of acute antibody-mediated rejection. We herein report a case of delayed hyperacute rejection in an A1 to O, ABO incompatible transplant recipient following an episode of Clostridium difficile infection.
{"title":"Delayed hyperacute rejection in a patient who developed clostridium difficile infection after ABO-incompatible kidney transplantation","authors":"G. Lipshutz, E. Reed, P. Pham, Jeffrey M. Miller, J. Singer, G. Danovitch, A. Wilkinson, Dean W. Wallace, Suzanne McGuire, P. Pham, P. Pham","doi":"10.2147/TRRM.S11720","DOIUrl":"https://doi.org/10.2147/TRRM.S11720","url":null,"abstract":"Over the past decade ABO incompatible transplantation has emerged as an important potential source for increasing living kidney transplantation in selected transplant centers. Early reports suggest that patients who have elevated serum anti-blood group antibody titers (anti-A/B) before transplantation and a rebound antibody production after antibody removal may be at high immunological risk. With currently available immune modulation protocols and immunosuppressive therapy, excellent short- and long-term patient and graft survival rates have been achieved even in those with high anti-A/B antibody titers before plasmapheresis or immunoadsorption. Nonetheless, acute infection with an organism possessing surface markers analogous to blood group antigens such as carbohydrate structures on the surface of bacterial cell wall occurring before the firm establishment of accommodation can trigger the onset of acute antibody-mediated rejection. We herein report a case of delayed hyperacute rejection in an A1 to O, ABO incompatible transplant recipient following an episode of Clostridium difficile infection.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"81-85"},"PeriodicalIF":0.9,"publicationDate":"2010-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S11720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Wu, Bindhu Musunuru, C. Arunachalam, A. Sett, Paul Musker
Correspondence: Paul Musker Lakes District health Board, emergency Department, Rotorua hospital, Private Bag 3023, Rotorua Mail Centre, Rotorua 3046, New Zealand Tel +64 7 348 1199 Fax +64 7 349 7952 email sabrebadger@hotmail.com Abstract: The aim of this pilot study was to compare renal transplant biopsies carried out by ward-based nephrology trainees and departmental based radiologists, primarily reviewing major complications and glomerular yield. There was only one patient who developed a single episode of major complication out of the 145 procedures recorded. We concluded there is no significant difference in complication rate and glomerular yield for renal allograft biopsies between nephrology trainees and radiologists, regardless of location.
{"title":"Assessing the safety and quality of ward-based renal transplant biopsies","authors":"K. Wu, Bindhu Musunuru, C. Arunachalam, A. Sett, Paul Musker","doi":"10.2147/TRRM.S10677","DOIUrl":"https://doi.org/10.2147/TRRM.S10677","url":null,"abstract":"Correspondence: Paul Musker Lakes District health Board, emergency Department, Rotorua hospital, Private Bag 3023, Rotorua Mail Centre, Rotorua 3046, New Zealand Tel +64 7 348 1199 Fax +64 7 349 7952 email sabrebadger@hotmail.com Abstract: The aim of this pilot study was to compare renal transplant biopsies carried out by ward-based nephrology trainees and departmental based radiologists, primarily reviewing major complications and glomerular yield. There was only one patient who developed a single episode of major complication out of the 145 procedures recorded. We concluded there is no significant difference in complication rate and glomerular yield for renal allograft biopsies between nephrology trainees and radiologists, regardless of location.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"77-79"},"PeriodicalIF":0.9,"publicationDate":"2010-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S10677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Spagnuolo, M. Cicalese, E. Bruzzese, M. Caiazzo, S. Caro, V. Squeglia, A. Guarino
Correspondence: Maria Immacolata Spagnuolo Department of Paediatrics, University Federico II, Naples, Via S. Pansini, 580131 Naples, Italy Tel + 39 081 746 4337 Fax + 39 081 746 4337 email mispagnu@unina.it Background: Children with intestinal failure need parenteral nutrition to survive, and the only alternative is intestinal transplantation which still entails high mortality. The aim of this study was to compare the outcomes in candidates and noncandidates for intestinal transplantation, and to compare the outcomes with and without transplant surgery. Patients and methods: The clinical records of children admitted to hospital from 1997 to 2008 because of intestinal failure were reviewed for etiology of intestinal failure, age at start of parenteral nutrition, duration of parenteral nutrition, indications for intestinal transplantation, and outcome. Results: Thirty-four children were enrolled. Median age at start of parenteral nutrition was 13.1 (median 20.7) months. There was no difference in survival rate between candidates and noncandidates for intestinal transplantation. Survival was significantly higher in candidates who did not undergo intestinal transplantation than in children who underwent intestinal transplantation (P , 0.001). Conclusion: Candidates for intestinal transplantation who did not undergo transplant surgery had a better outcome than children who underwent transplant surgery.
{"title":"Eleven years of management of children with intestinal failure and not candidates for intestinal transplantation","authors":"M. Spagnuolo, M. Cicalese, E. Bruzzese, M. Caiazzo, S. Caro, V. Squeglia, A. Guarino","doi":"10.2147/TRRM.S11930","DOIUrl":"https://doi.org/10.2147/TRRM.S11930","url":null,"abstract":"Correspondence: Maria Immacolata Spagnuolo Department of Paediatrics, University Federico II, Naples, Via S. Pansini, 580131 Naples, Italy Tel + 39 081 746 4337 Fax + 39 081 746 4337 email mispagnu@unina.it Background: Children with intestinal failure need parenteral nutrition to survive, and the only alternative is intestinal transplantation which still entails high mortality. The aim of this study was to compare the outcomes in candidates and noncandidates for intestinal transplantation, and to compare the outcomes with and without transplant surgery. Patients and methods: The clinical records of children admitted to hospital from 1997 to 2008 because of intestinal failure were reviewed for etiology of intestinal failure, age at start of parenteral nutrition, duration of parenteral nutrition, indications for intestinal transplantation, and outcome. Results: Thirty-four children were enrolled. Median age at start of parenteral nutrition was 13.1 (median 20.7) months. There was no difference in survival rate between candidates and noncandidates for intestinal transplantation. Survival was significantly higher in candidates who did not undergo intestinal transplantation than in children who underwent intestinal transplantation (P , 0.001). Conclusion: Candidates for intestinal transplantation who did not undergo transplant surgery had a better outcome than children who underwent transplant surgery.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"71-75"},"PeriodicalIF":0.9,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S11930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Successful management of the solid-organ transplant recipient begins with prevention of rejection and achieving a balance between insufficient and excessive immunosuppression. Standard tacrolimus therapy for prevention of solid-organ transplant rejection consists of 2 divided doses per day. In an effort to simplify tacrolimus dosing to once daily, a new formulation (tacroli- mus prolonged release (PR)) was chosen for its combination of a similar extent of bioavailability and a substantially reduced rate of clearance. Several clinical conversion studies have now been completed using PR to clarify its pharmacokinetics, efficacy at prevention of allograft rejection, and safety profiles in solid-organ transplant patients. A cohort of 67 stable kidney transplant recipients was converted from standard tacrolimus to PR in an open-label, multicenter study in the United States and Canada. A second open-label, multicenter study was performed in liver transplant recipients with stable graft function on standard tacrolimus therapy converted to PR. A third conversion study was performed as an open-label study at 5 centers in the United States in stable pediatric liver transplant recipients. As medication noncompliance can significantly contribute to the incidence of graft rejection and graft loss in transplant recipients, a potentially significant advance in the transplant community's ongoing mission to optimize prevention of rejection occurred with the development of a once-daily tacrolimus PR. The results of these preliminary studies suggest that select solid-organ transplant recipients converted to PR can be safely maintained using the same monitoring and patient care techniques historically used for
{"title":"Role of tacrolimus prolonged release in the prevention of allograft rejection","authors":"Peter L. Abrams, A. Humar, H. Tan","doi":"10.2147/TRRM.S12276","DOIUrl":"https://doi.org/10.2147/TRRM.S12276","url":null,"abstract":"Successful management of the solid-organ transplant recipient begins with prevention of rejection and achieving a balance between insufficient and excessive immunosuppression. Standard tacrolimus therapy for prevention of solid-organ transplant rejection consists of 2 divided doses per day. In an effort to simplify tacrolimus dosing to once daily, a new formulation (tacroli- mus prolonged release (PR)) was chosen for its combination of a similar extent of bioavailability and a substantially reduced rate of clearance. Several clinical conversion studies have now been completed using PR to clarify its pharmacokinetics, efficacy at prevention of allograft rejection, and safety profiles in solid-organ transplant patients. A cohort of 67 stable kidney transplant recipients was converted from standard tacrolimus to PR in an open-label, multicenter study in the United States and Canada. A second open-label, multicenter study was performed in liver transplant recipients with stable graft function on standard tacrolimus therapy converted to PR. A third conversion study was performed as an open-label study at 5 centers in the United States in stable pediatric liver transplant recipients. As medication noncompliance can significantly contribute to the incidence of graft rejection and graft loss in transplant recipients, a potentially significant advance in the transplant community's ongoing mission to optimize prevention of rejection occurred with the development of a once-daily tacrolimus PR. The results of these preliminary studies suggest that select solid-organ transplant recipients converted to PR can be safely maintained using the same monitoring and patient care techniques historically used for","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"65-70"},"PeriodicalIF":0.9,"publicationDate":"2010-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S12276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
correspondence: AO Takure Division of Urology, Department of surgery, University college hospital, PMB 5116, ibadan, nigeria email aotakure@yahoo.com Background: Although renal transplantation has been available since 2000 in Nigeria at St Nicholas Hospital, Lagos, only 134 procedures have been performed as of March 2010. This may be related to the level of knowledge of medical practitioners in the Nigerian communities. Our medical students come from different communities, and assessing their level of awareness may contribute to better utilization of the available resources for renal transplantation in our country. The aim of this study was to determine the knowledge and level of awareness of renal transplantation among medical students in a potential university transplant center. Methods: A 10-item questionnaire was administered to fourth-, fifth-, and sixth-year medical students at Irrua Specialist Teaching Hospital, Irrua, Nigeria. The data obtained were analyzed using standard simple statistical tools in Microsoft Excel Office 2007. Results: The level of participation of respondents was 69.6%; mean age was 26.2 (range 21–45) years. Seventy percent of the respondents were males. The majority of the respondents had obtained information on renal transplantation from school lectures, electronic media, and the Internet. Many were also aware of the indications, pretransplant evaluation, and renal transplant complications. Only five (3.2%) knew of the four existing renal transplant centers in Nigeria. In total, 79.1% knew of living donors, while 11.4% knew of cadaveric donors. One hundred and three respondents (65.2%) were aware of open surgery for recipient transplantation, while 125 (79.1%) knew of open or laparoscopic procedures for donor nephrectomy. Conclusion: The medical students in this sample lacked knowledge about the number of hospitals that offered renal transplantation, as well as about issues relating to cadaveric organ donation in Nigeria.
{"title":"Knowledge and level of awareness of renal transplantation among medical students in Nigeria","authors":"A. Takure, Sylvester O Alikah, V. Onuora","doi":"10.2147/TRRM.S11734","DOIUrl":"https://doi.org/10.2147/TRRM.S11734","url":null,"abstract":"correspondence: AO Takure Division of Urology, Department of surgery, University college hospital, PMB 5116, ibadan, nigeria email aotakure@yahoo.com Background: Although renal transplantation has been available since 2000 in Nigeria at St Nicholas Hospital, Lagos, only 134 procedures have been performed as of March 2010. This may be related to the level of knowledge of medical practitioners in the Nigerian communities. Our medical students come from different communities, and assessing their level of awareness may contribute to better utilization of the available resources for renal transplantation in our country. The aim of this study was to determine the knowledge and level of awareness of renal transplantation among medical students in a potential university transplant center. Methods: A 10-item questionnaire was administered to fourth-, fifth-, and sixth-year medical students at Irrua Specialist Teaching Hospital, Irrua, Nigeria. The data obtained were analyzed using standard simple statistical tools in Microsoft Excel Office 2007. Results: The level of participation of respondents was 69.6%; mean age was 26.2 (range 21–45) years. Seventy percent of the respondents were males. The majority of the respondents had obtained information on renal transplantation from school lectures, electronic media, and the Internet. Many were also aware of the indications, pretransplant evaluation, and renal transplant complications. Only five (3.2%) knew of the four existing renal transplant centers in Nigeria. In total, 79.1% knew of living donors, while 11.4% knew of cadaveric donors. One hundred and three respondents (65.2%) were aware of open surgery for recipient transplantation, while 125 (79.1%) knew of open or laparoscopic procedures for donor nephrectomy. Conclusion: The medical students in this sample lacked knowledge about the number of hospitals that offered renal transplantation, as well as about issues relating to cadaveric organ donation in Nigeria.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"15 1","pages":"59-64"},"PeriodicalIF":0.9,"publicationDate":"2010-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S11734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Correspondence: Richard T Maziarz Medical Director, Adult Blood and Marrow Stem Cell Transplant Program, Oregon Health and Science University, 3181 SW. Sam Jackson Park Road, Portland, OR 97239, USA Tel +1503-494-4606 Fax +1 503-418-4054 Email maziarzr@ohsu.edu Abstract: Plerixafor is a CXC4:CXCL12 antagonist that has an expanding role in the stem cell mobilization phase of the hematopoietic stem cell transplant procedure. The drug is currently licensed by the FDA to be used in combination with granulocyte colony stimulating factor (G-CSF) to mobilize hematopoietic stem cells into the peripheral blood for collection and subsequent autologous transplantations in patients with non-Hodgkin’s lymphoma and multiple myeloma. Plerixafor is particularly useful in patients who have been heavily pretreated or as effective therapy for frontline salvage of poor peripheral blood stem cells mobilizers. In conjunction with G-CSF, plerixafor can be successful in decreasing the number of apheresis days and therefore the associated additional risks and cost of more apheresis procedures. Patients taking plerixafor, when compared to the side effect profile of G-CSF alone, do not report significantly more side effects.
通信:Richard T Maziarz医学主任，成人血液和骨髓干细胞移植项目，俄勒冈健康与科学大学，3181 SW。摘要:Plerixafor是一种CXC4:CXCL12拮抗剂，在造血干细胞移植过程中的干细胞动员阶段发挥着越来越大的作用。该药物目前已获得FDA许可，可与粒细胞集落刺激因子(G-CSF)联合使用，动员造血干细胞进入外周血，用于非霍奇金淋巴瘤和多发性骨髓瘤患者的采集和随后的自体移植。Plerixafor特别适用于接受过大量预处理的患者，或作为一线挽救外周血干细胞动员不良者的有效疗法。与G-CSF联合使用，plerixafor可以成功地减少采血天数，从而减少采血操作的额外风险和成本。与单独使用G-CSF的副作用相比，服用plerixafor的患者并没有报告更多的副作用。
{"title":"Clinical use of plerixafor in combination with granulocyte-colony stimulating factor in hematopoietic stem cell transplantation","authors":"Cedar Fowler, R. Maziarz","doi":"10.2147/TRRM.S6122","DOIUrl":"https://doi.org/10.2147/TRRM.S6122","url":null,"abstract":"Correspondence: Richard T Maziarz Medical Director, Adult Blood and Marrow Stem Cell Transplant Program, Oregon Health and Science University, 3181 SW. Sam Jackson Park Road, Portland, OR 97239, USA Tel +1503-494-4606 Fax +1 503-418-4054 Email maziarzr@ohsu.edu Abstract: Plerixafor is a CXC4:CXCL12 antagonist that has an expanding role in the stem cell mobilization phase of the hematopoietic stem cell transplant procedure. The drug is currently licensed by the FDA to be used in combination with granulocyte colony stimulating factor (G-CSF) to mobilize hematopoietic stem cells into the peripheral blood for collection and subsequent autologous transplantations in patients with non-Hodgkin’s lymphoma and multiple myeloma. Plerixafor is particularly useful in patients who have been heavily pretreated or as effective therapy for frontline salvage of poor peripheral blood stem cells mobilizers. In conjunction with G-CSF, plerixafor can be successful in decreasing the number of apheresis days and therefore the associated additional risks and cost of more apheresis procedures. Patients taking plerixafor, when compared to the side effect profile of G-CSF alone, do not report significantly more side effects.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"47-58"},"PeriodicalIF":0.9,"publicationDate":"2010-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S6122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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