Correspondence: Galal El-Gazzaz Department of Colorectal Surgery A30, Cleveland Clinic Foundation, Cleveland, Ohio-44195, USA Tel +1 216 444 3103 Email elgazzg@ccf.org Background: Egyptian patients with end-stage liver disease need to seek whole cadaveric liver transplantation (CLT) abroad. We studied the outcome of Egyptian patients who underwent CLT in China. Methods: Between 2004–2006, 22 patients who underwent CLT in China and attended two liver surgery outpatient clinics in Egypt for follow-up were included in the study. Demographic, preoperative, postoperative, and follow-up data after coming back from China were reviewed. Results: For 22 patients of median age 48 years (30–62) and with BMI 27.5 ± 6.2, the median follow-up was 23.5 months (range 1–48); 18 patients were males. Hepatitis C (HCV)-cirrhosis alone or with schistosomiasis was the main indication for CLT (n = 12); Hepatitis B (HBV)cirrhosis was the indication for transplantation in two patients, HCV-cirrhosis with hepatocellular carcinoma (HCC) in six, HBV-cirrhosis with HCC in one, and both HBVand HCV-related cirrhosis with HCC in another. There were eight deaths, one as a result of primary nonfunction, one because of postoperative bleeding, two because of recurrent HCV, and four because of recurrent HCC. Overall survival at one and three years was 68.5% and 64%, respectively, and 50% and 37.5% for HCC patients, respectively, while three-year survival was 80% for hepatitis patients. Twelve patients (54%) developed complications. Biliary complications occurred in 45% of cases. Conclusion: CLT tourism to China raises serious concerns regarding selection criteria and ethical issues. Furthermore, the negative impact of this practice on the successful setting up of LT programs in Egypt must be addressed carefully. In Egypt efforts should be directed to get legalization for CLT.
通讯:Galal El-Gazzaz结直肠外科A30, Cleveland Clinic Foundation, Cleveland, Ohio-44195, USA Tel +1 216 444 3103 Email elgazzg@ccf.org背景:埃及终末期肝病患者需要寻求国外全尸体肝移植(CLT)。我们研究了在中国接受CLT的埃及患者的结果。方法:2004-2006年间，22例在中国接受CLT治疗并在埃及两家肝脏外科门诊接受随访的患者被纳入研究。我们回顾了从中国回来后的人口学、术前、术后和随访数据。结果:22例患者中位年龄48岁(30-62岁)，BMI为27.5±6.2，中位随访时间为23.5个月(范围1-48);男性18例。丙型肝炎(HCV)-肝硬化单独或合并血吸虫病是CLT的主要适应症(n = 12);2例患者以乙肝肝硬化为移植指征，6例患者以乙肝肝硬化合并肝细胞癌(HCC)为移植指征，1例患者以乙肝肝硬化合并肝细胞癌(HCC)为移植指征，1例患者以乙肝和乙肝相关肝硬化合并肝细胞癌为移植指征。有8例死亡，1例因原发性功能丧失，1例因术后出血，2例因复发性丙型肝炎，4例因复发性肝细胞癌。1年和3年的总生存率分别为68.5%和64%，HCC患者分别为50%和37.5%，而肝炎患者的3年生存率为80%。12例(54%)出现并发症。45%的病例发生胆道并发症。结论:中国的CLT旅游在选择标准和伦理问题上引起了严重的关注。此外，这种做法对在埃及成功建立LT项目的负面影响必须谨慎处理。在埃及，应该努力使CLT合法化。
{"title":"Liver transplantation in Egypt from West to East","authors":"G. El-Gazzaz, A. El-elemi","doi":"10.2147/TRRM.S8490","DOIUrl":"https://doi.org/10.2147/TRRM.S8490","url":null,"abstract":"Correspondence: Galal El-Gazzaz Department of Colorectal Surgery A30, Cleveland Clinic Foundation, Cleveland, Ohio-44195, USA Tel +1 216 444 3103 Email elgazzg@ccf.org Background: Egyptian patients with end-stage liver disease need to seek whole cadaveric liver transplantation (CLT) abroad. We studied the outcome of Egyptian patients who underwent CLT in China. Methods: Between 2004–2006, 22 patients who underwent CLT in China and attended two liver surgery outpatient clinics in Egypt for follow-up were included in the study. Demographic, preoperative, postoperative, and follow-up data after coming back from China were reviewed. Results: For 22 patients of median age 48 years (30–62) and with BMI 27.5 ± 6.2, the median follow-up was 23.5 months (range 1–48); 18 patients were males. Hepatitis C (HCV)-cirrhosis alone or with schistosomiasis was the main indication for CLT (n = 12); Hepatitis B (HBV)cirrhosis was the indication for transplantation in two patients, HCV-cirrhosis with hepatocellular carcinoma (HCC) in six, HBV-cirrhosis with HCC in one, and both HBVand HCV-related cirrhosis with HCC in another. There were eight deaths, one as a result of primary nonfunction, one because of postoperative bleeding, two because of recurrent HCV, and four because of recurrent HCC. Overall survival at one and three years was 68.5% and 64%, respectively, and 50% and 37.5% for HCC patients, respectively, while three-year survival was 80% for hepatitis patients. Twelve patients (54%) developed complications. Biliary complications occurred in 45% of cases. Conclusion: CLT tourism to China raises serious concerns regarding selection criteria and ethical issues. Furthermore, the negative impact of this practice on the successful setting up of LT programs in Egypt must be addressed carefully. In Egypt efforts should be directed to get legalization for CLT.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"41-46"},"PeriodicalIF":0.9,"publicationDate":"2010-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S8490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497703","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}
E. Ticehurst, J. Trofe‐Clark, E. Blumberg, R. Bloom
Cytomegalovirus (CMV) can be a problematic virus for solid organ transplant recipients affecting both morbidity and mortality. Valganciclovir (VGC) is a commonly utilized antiviral agent for the prevention of this virus post-transplantation and recently it has been evaluated for the treatment of CMV. It is a pro-drug of ganciclovir (GCV) and has increased bioavailability compared to GCV. It is unclear whether VGC is superior to intravenous or oral GCV in terms of efficacy and safety in the prevention of CMV particularly in the liver transplant population as there have been studies reporting inferiority while other studies have not. Despite this, VGC has been reported to be the most commonly utilized agent for CMV prophylaxis in the liver transplant population in the United States and Canada. This article reviews CMV and VGC in the context of solid organ transplant, describes and assesses selected studies that have been conducted using this agent in this patient population, and summarizes VGC's advantages and disadvantages. Additional studies are needed to further define VGC's role in the treatment of CMV in the solid organ transplantation population as there are an insufficient number of studies pertaining to CMV treatment and no studies have been performed to assess its role in the treatment of life-threatening CMV disease. VGC is non-inferior to GCV for CMV prevention in the solid organ transplant population with the exception of liver transplant recipients.
{"title":"Valganciclovir for the prophylaxis and treatment of cytomegalovirus infection in solid organ transplantation","authors":"E. Ticehurst, J. Trofe‐Clark, E. Blumberg, R. Bloom","doi":"10.2147/TRRM.S5979","DOIUrl":"https://doi.org/10.2147/TRRM.S5979","url":null,"abstract":"Cytomegalovirus (CMV) can be a problematic virus for solid organ transplant recipients affecting both morbidity and mortality. Valganciclovir (VGC) is a commonly utilized antiviral agent for the prevention of this virus post-transplantation and recently it has been evaluated for the treatment of CMV. It is a pro-drug of ganciclovir (GCV) and has increased bioavailability compared to GCV. It is unclear whether VGC is superior to intravenous or oral GCV in terms of efficacy and safety in the prevention of CMV particularly in the liver transplant population as there have been studies reporting inferiority while other studies have not. Despite this, VGC has been reported to be the most commonly utilized agent for CMV prophylaxis in the liver transplant population in the United States and Canada. This article reviews CMV and VGC in the context of solid organ transplant, describes and assesses selected studies that have been conducted using this agent in this patient population, and summarizes VGC's advantages and disadvantages. Additional studies are needed to further define VGC's role in the treatment of CMV in the solid organ transplantation population as there are an insufficient number of studies pertaining to CMV treatment and no studies have been performed to assess its role in the treatment of life-threatening CMV disease. VGC is non-inferior to GCV for CMV prevention in the solid organ transplant population with the exception of liver transplant recipients.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"29-39"},"PeriodicalIF":0.9,"publicationDate":"2010-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S5979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497400","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: AH El-Elemi Forensic Medicine and Clinical Toxicology Department, Suez Canal University, 58-60 Tarek Ebn Zeyad, ismailia, Egypt Tel +2 012 3705451 Fax +2 064 3209448 Email azza.el.elemi@utoronto.ca Abstract: The high prevalence of chronic liver disease in Egypt has led to increasing numbers of patients with end-stage liver disease in need of liver transplantation. To date, cadaveric liver transplantation is not legal in Egypt. However, introducing living-donor liver transplantation seems appropriate for patients who need transplantation. There are no clinical bioethicists in the Egyptian healthcare system. The idea of implementing an ethics consultation program has evolved as a response to complicated legal, ethical, and social dilemmas that accompany the transplantation process, especially in Egypt where organs are obtained by advertising without consideration of an acceptable level of risk to donors or recipients. Recommendations need to be made to start to implement bioethics consultation in liver transplantation units. To achieve this goal there is a need to develop training standards, credentials, and certification before embarking on clinical consultation to ensure good ethics practice in Egypt.
{"title":"Moving towards implementation of a clinical ethics consultation program in Egyptian liver transplant units","authors":"A. El-elemi, G. El-Gazzaz","doi":"10.2147/TRRM.S8439","DOIUrl":"https://doi.org/10.2147/TRRM.S8439","url":null,"abstract":"Correspondence: AH El-Elemi Forensic Medicine and Clinical Toxicology Department, Suez Canal University, 58-60 Tarek Ebn Zeyad, ismailia, Egypt Tel +2 012 3705451 Fax +2 064 3209448 Email azza.el.elemi@utoronto.ca Abstract: The high prevalence of chronic liver disease in Egypt has led to increasing numbers of patients with end-stage liver disease in need of liver transplantation. To date, cadaveric liver transplantation is not legal in Egypt. However, introducing living-donor liver transplantation seems appropriate for patients who need transplantation. There are no clinical bioethicists in the Egyptian healthcare system. The idea of implementing an ethics consultation program has evolved as a response to complicated legal, ethical, and social dilemmas that accompany the transplantation process, especially in Egypt where organs are obtained by advertising without consideration of an acceptable level of risk to donors or recipients. Recommendations need to be made to start to implement bioethics consultation in liver transplantation units. To achieve this goal there is a need to develop training standards, credentials, and certification before embarking on clinical consultation to ensure good ethics practice in Egypt.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"23-27"},"PeriodicalIF":0.9,"publicationDate":"2010-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S8439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497673","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: nicholas Zavazava University of iowa hospitals and clinics, Department of internal Medicine, 200 hawkins Drive, c51-F, iowa city, iowa 52242, UsA Tel +1 319 384 6577 Fax +1 319 356 8280 email nicholas-zavazava@uiowa.edu Abstract: Human embryonic stem (hES) cells are essential for improved understanding of diseases and our ability to probe new therapies for use in humans. Currently, bone marrow cells and cord blood cells are used for transplantation into patients with hematopoietic malignancies, immunodeficiencies and in some cases for the treatment of autoimmune diseases. However, due to the high immunogenicity of these hematopoietic cells, toxic regimens of drugs are required for preconditioning and prevention of rejection. Here, we investigated the efficiency of deriving hematopoietic progenitor cells (HPCs) from the hES cell line H13, after co-culturing with the murine stromal cell line OP9. We show that HPCs derived from the H13 ES cells poorly express major histocompatibility complex (MHC) class I and no detectable class II antigens (HLA-DR). These characteristics make hES cell-derived hematopoietic cells (HPCs) ideal candidates for transplantation across MHC barriers under minimal immunosuppression.
{"title":"Low antigenicity of hematopoietic progenitor cells derived from human ES cells","authors":"Eun-Mi Kim, N. Zavazava","doi":"10.2147/TRRM.S8272","DOIUrl":"https://doi.org/10.2147/TRRM.S8272","url":null,"abstract":"correspondence: nicholas Zavazava University of iowa hospitals and clinics, Department of internal Medicine, 200 hawkins Drive, c51-F, iowa city, iowa 52242, UsA Tel +1 319 384 6577 Fax +1 319 356 8280 email nicholas-zavazava@uiowa.edu Abstract: Human embryonic stem (hES) cells are essential for improved understanding of diseases and our ability to probe new therapies for use in humans. Currently, bone marrow cells and cord blood cells are used for transplantation into patients with hematopoietic malignancies, immunodeficiencies and in some cases for the treatment of autoimmune diseases. However, due to the high immunogenicity of these hematopoietic cells, toxic regimens of drugs are required for preconditioning and prevention of rejection. Here, we investigated the efficiency of deriving hematopoietic progenitor cells (HPCs) from the hES cell line H13, after co-culturing with the murine stromal cell line OP9. We show that HPCs derived from the H13 ES cells poorly express major histocompatibility complex (MHC) class I and no detectable class II antigens (HLA-DR). These characteristics make hES cell-derived hematopoietic cells (HPCs) ideal candidates for transplantation across MHC barriers under minimal immunosuppression.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"15-22"},"PeriodicalIF":0.9,"publicationDate":"2010-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S8272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497583","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: Fernando Giron Scientific Director, Colombiana de Trasplantes, Calle 61 N 13-23 Oficina 402 Bogota, Colombia Tel +57 1 8051165 Fax +57 1 8051164 email fgiron@colombianadetrasplantes. com Abstract: Everolimus is a proliferation inhibitor designed to target chronic allograft nephropathy including prevention of acute rejection. Acute renal allograft rejection incidence varies with the therapy used for immunosuppression. Registry data show that 15% to 35% of kidney recipients will undergo treatment for at least one episode of acute rejection within the first post-transplant year. Everolimus has been used as therapy with fullor reduced-dose cyclosporine A without evidence of increasing the acute rejection incidence. This review will summarize the available clinical trial data on the use of everolimus and its role in preventing acute rejection incidence in renal transplantation.
通讯:Fernando Giron科学主任，columbiana de Trasplantes, Calle 61 N 13-23 office 402波哥大，哥伦比亚电话+57 1 8051165传真+57 1 8051164电子邮件fgiron@colombianadetrasplantes。摘要:依维莫司是一种针对慢性同种异体移植肾病的增殖抑制剂，可预防急性排斥反应。急性同种异体肾移植排斥反应的发生率随免疫抑制疗法的不同而不同。注册数据显示，15%至35%的肾移植受者在移植后的第一年内至少会出现一次急性排斥反应。依维莫司与全剂量环孢素A一起使用，没有证据表明会增加急性排斥反应的发生率。本文将对依维莫司在肾移植中预防急性排斥反应的临床试验数据进行综述。
{"title":"Critical appraisal on the use of everolimus in renal transplantation as an immunosuppressant to prevent organ transplant rejection","authors":"F. Girón, Y. Baez","doi":"10.2147/TRRM.S5135","DOIUrl":"https://doi.org/10.2147/TRRM.S5135","url":null,"abstract":"Correspondence: Fernando Giron Scientific Director, Colombiana de Trasplantes, Calle 61 N 13-23 Oficina 402 Bogota, Colombia Tel +57 1 8051165 Fax +57 1 8051164 email fgiron@colombianadetrasplantes. com Abstract: Everolimus is a proliferation inhibitor designed to target chronic allograft nephropathy including prevention of acute rejection. Acute renal allograft rejection incidence varies with the therapy used for immunosuppression. Registry data show that 15% to 35% of kidney recipients will undergo treatment for at least one episode of acute rejection within the first post-transplant year. Everolimus has been used as therapy with fullor reduced-dose cyclosporine A without evidence of increasing the acute rejection incidence. This review will summarize the available clinical trial data on the use of everolimus and its role in preventing acute rejection incidence in renal transplantation.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"11-14"},"PeriodicalIF":0.9,"publicationDate":"2010-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S5135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497276","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}
C. Ramirez, Adam Bozdin, A. Frank, W. Maley, C. Doria
Antibody induction therapy has not been part of standard immunosuppressive regimens in liver transplantation. However, in recent years there has been an upward trend in the use of antibody induction therapy in orthotopic liver transplantation (OLT), attributed mainly to the growing number of OLT recipients with renal dysfunction after the Model for End Stage Liver Disease (MELD) scoring system was adopted in 2002. Basiliximab, a chimeric monoclonal antibody, is the most frequently used induction antibody in OLT. Basiliximab targets the alpha chain of interleukin-2 receptors in activated T-lymphocytes, inhibiting T-lymphocyte proliferation responsible for acute cellular rejection. Basiliximab (given in two 20 mg doses intravenously on post OLT day 0 and 4) has an excellent efficacy and safety profile. Basiliximab induction also allows early steroid withdrawal or avoidance, as well as delayed introduction and minimization of calcineurin inhibitors (CNI) in the setting of renal insufficiency. Although its long-term effect on hepatitis C virus (HCV) recurrence post OLT is currently unknown, studies using basiliximab induction in steroid-free protocols suggest no harmful effect on histologic HCV recurrence and survival rates. Basiliximab is a well tolerated, effective and safe anti-rejection drug in pediatric and adult OLT recipients when given in conjunction with a CNI-based immunotherapy.
{"title":"Optimizing use of basiliximab in liver transplantation","authors":"C. Ramirez, Adam Bozdin, A. Frank, W. Maley, C. Doria","doi":"10.2147/TRRM.S4829","DOIUrl":"https://doi.org/10.2147/TRRM.S4829","url":null,"abstract":"Antibody induction therapy has not been part of standard immunosuppressive regimens in liver transplantation. However, in recent years there has been an upward trend in the use of antibody induction therapy in orthotopic liver transplantation (OLT), attributed mainly to the growing number of OLT recipients with renal dysfunction after the Model for End Stage Liver Disease (MELD) scoring system was adopted in 2002. Basiliximab, a chimeric monoclonal antibody, is the most frequently used induction antibody in OLT. Basiliximab targets the alpha chain of interleukin-2 receptors in activated T-lymphocytes, inhibiting T-lymphocyte proliferation responsible for acute cellular rejection. Basiliximab (given in two 20 mg doses intravenously on post OLT day 0 and 4) has an excellent efficacy and safety profile. Basiliximab induction also allows early steroid withdrawal or avoidance, as well as delayed introduction and minimization of calcineurin inhibitors (CNI) in the setting of renal insufficiency. Although its long-term effect on hepatitis C virus (HCV) recurrence post OLT is currently unknown, studies using basiliximab induction in steroid-free protocols suggest no harmful effect on histologic HCV recurrence and survival rates. Basiliximab is a well tolerated, effective and safe anti-rejection drug in pediatric and adult OLT recipients when given in conjunction with a CNI-based immunotherapy.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"1-10"},"PeriodicalIF":0.9,"publicationDate":"2010-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S4829","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495930","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}
Rituximab (anti-CD20, anti-B-cell) is now emerging as an important drug for modification of B-cell and antibody responses in solid-organ transplant recipients. Its uses are varied and range from facilitating desensitization and ABO blood group-incompatible transplantation to the treatment of antibody-mediated rejection (AMR), post-transplant lymphoproliferative disorder (PTLD), and recurrent glomerular diseases in the renal allograft. Despite these uses, prospective randomized trials are lacking. Only case reports exist in regards to its use in de novo and recurrent diseases in the renal allograft. Recent reports suggests that the addition of rituximab to intravenous immunoglobulin (IVIG) may have significant benefits for desensitization and treatment of AMR and chronic rejection. Current dosing recommendations are based on data from United States Food and Drug Administration-approved indications for treatment of B-cell lymphomas and rheumatoid arthritis. From the initial reported experience in solid organ transplant recipients, the drug is well tolerated and not associated with increased infectious risks. However, close monitoring for viral infections is recommended with rituximab use. The occurrence of progressive multifocal leukoencephalopathy (PML) has been reported with rituximab use. However, this is rare and not reported in the renal transplant population. Here we will review current information regarding the effectiveness of rituximab as an agent for desensitization of highly human leukocyte antigen-sensitized and ABO-incompatible transplant recipients and its use in treatment of AMR. In addition, the post-transplant use of rituximab for treatment of PTLD and for recurrent and de novo glomerulonephritis in the allograft will be discussed. In summary, we will make recommendations based on existing literature and our extensive experience at Cedars-Sinai Medical Center for using rituximab in renal transplantation.
{"title":"Rituximab: An emerging therapeutic agent for kidney transplantation","authors":"J. Kahwaji, C. Tong, S. Jordan, A. Vo","doi":"10.2147/TRRM.S6359","DOIUrl":"https://doi.org/10.2147/TRRM.S6359","url":null,"abstract":"Rituximab (anti-CD20, anti-B-cell) is now emerging as an important drug for modification of B-cell and antibody responses in solid-organ transplant recipients. Its uses are varied and range from facilitating desensitization and ABO blood group-incompatible transplantation to the treatment of antibody-mediated rejection (AMR), post-transplant lymphoproliferative disorder (PTLD), and recurrent glomerular diseases in the renal allograft. Despite these uses, prospective randomized trials are lacking. Only case reports exist in regards to its use in de novo and recurrent diseases in the renal allograft. Recent reports suggests that the addition of rituximab to intravenous immunoglobulin (IVIG) may have significant benefits for desensitization and treatment of AMR and chronic rejection. Current dosing recommendations are based on data from United States Food and Drug Administration-approved indications for treatment of B-cell lymphomas and rheumatoid arthritis. From the initial reported experience in solid organ transplant recipients, the drug is well tolerated and not associated with increased infectious risks. However, close monitoring for viral infections is recommended with rituximab use. The occurrence of progressive multifocal leukoencephalopathy (PML) has been reported with rituximab use. However, this is rare and not reported in the renal transplant population. Here we will review current information regarding the effectiveness of rituximab as an agent for desensitization of highly human leukocyte antigen-sensitized and ABO-incompatible transplant recipients and its use in treatment of AMR. In addition, the post-transplant use of rituximab for treatment of PTLD and for recurrent and de novo glomerulonephritis in the allograft will be discussed. In summary, we will make recommendations based on existing literature and our extensive experience at Cedars-Sinai Medical Center for using rituximab in renal transplantation.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":"15-29"},"PeriodicalIF":0.9,"publicationDate":"2009-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S6359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497164","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}
Hepatitis C virus (HCV) reinfection after liver transplantation (LT) and recurrent hepatitis C often lead to recurrent cirrhosis (RC). RC is one of the most frequent complications resulting in organ failure and early death after LT in HCV-positive patients with reported 5-year rates from 20% to 40%. As HCV-cirrhosis is one of the leading indications for LT, the therapeutic management is a central issue. To date, the best available therapy is a combination of pegylated interferon + ribavirin in patients with established recurrent hepatitis C proven by liver biopsy. Although increasing experience in using interferon therapy after LT has suggested better response rates, treatment is limited by a poor tolerability and high rates of severe side effects, necessitating lower doses or withdrawal of therapy. The extent to which dose reductions and the concomitant administration of growth factors affect virological response or prevent complications is still to be determined. Prospective clinical trials are mandatory to identify the best time point and schedule of antiviral treatment in transplant patients. Currently, therapeutic options need to be discussed for each individual patient. Therefore therapy should be carried out only in transplant centers with experience in managing hepatitis C after LT.
{"title":"Managing hepatitis C in liver transplant patients with recurrent infection","authors":"T. Zimmermann, G. Otto, M. Schuchmann","doi":"10.2147/TRRM.S4615","DOIUrl":"https://doi.org/10.2147/TRRM.S4615","url":null,"abstract":"Hepatitis C virus (HCV) reinfection after liver transplantation (LT) and recurrent hepatitis C often lead to recurrent cirrhosis (RC). RC is one of the most frequent complications resulting in organ failure and early death after LT in HCV-positive patients with reported 5-year rates from 20% to 40%. As HCV-cirrhosis is one of the leading indications for LT, the therapeutic management is a central issue. To date, the best available therapy is a combination of pegylated interferon + ribavirin in patients with established recurrent hepatitis C proven by liver biopsy. Although increasing experience in using interferon therapy after LT has suggested better response rates, treatment is limited by a poor tolerability and high rates of severe side effects, necessitating lower doses or withdrawal of therapy. The extent to which dose reductions and the concomitant administration of growth factors affect virological response or prevent complications is still to be determined. Prospective clinical trials are mandatory to identify the best time point and schedule of antiviral treatment in transplant patients. Currently, therapeutic options need to be discussed for each individual patient. Therefore therapy should be carried out only in transplant centers with experience in managing hepatitis C after LT.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":"1-14"},"PeriodicalIF":0.9,"publicationDate":"2009-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S4615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495757","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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