#05#
Revisiones-Clínica-Diagnóstico
*** Reviews-Clinical-Diagnostics
AGENTES
INMUNOSUPRESORES *** IMMUNOSUPPRESSIVE COMPOUNDS
(Conceptos
/ Keywords: Immunosuppressive comp; Muromonab-cd3; Sirolimus; Tacrolimus;
Cyclosporine; Mycophenolic acid; Antilymphocyte serum; Immunosuppressive comp.
used in oncology, etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Preliminary guidelines
for diagnosing and treating tuberculosis in patients with rheumatoid arthritis
in immunosuppressive trials or being treated with biological agents.
REVISTA
/ JOURNAL: - Ann Rheum Dis 2002 Nov;61 Suppl 2:ii62-3.
AUTORES
/ AUTHORS: - Furst DE; Cush J; Kaufmann S; Siegel J;
Kurth R
INSTITUCIÓN
/ INSTITUTION: - UCLA Medical School, Los Angeles, USA
Presbyterian Hospital, Dallas, USA.
----------------------------------------------------
[2]
TÍTULO / TITLE: - Overcoming restenosis
with sirolimus: from alphabet soup to clinical reality.
REVISTA
/ JOURNAL: - Lancet 2002 Feb 16;359(9306):619-22.
AUTORES
/ AUTHORS: - Poon M; Badimon JJ; Fuster V
INSTITUCIÓN
/ INSTITUTION: - Mount Sinai School of Medicine, 1 Gustav L
Levy Place, Box 1030, New York, NY 10029, USA.
N. Ref:: 34
----------------------------------------------------
[3]
TÍTULO / TITLE: - Treatment of chronic
granulomatous disease with myeloablative conditioning and an unmodified
hemopoietic allograft: a survey of the European experience, 1985-2000.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2002 Dec 15;100(13):4344-50. Epub 2002 Aug 8.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-02-0583
AUTORES
/ AUTHORS: - Seger RA; Gungor T; Belohradsky BH;
Blanche S; Bordigoni P; Di Bartolomeo P; Flood T; Landais P; Muller S; Ozsahin
H; Passwell JH; Porta F; Slavin S; Wulffraat N; Zintl F; Nagler A; Cant A;
Fischer A
INSTITUCIÓN
/ INSTITUTION: - European Group for Blood and Marrow
Transplantation (EBMT) and the European Society for Immunodeficiencies (ESID),
Division of Immunology/Hematology, University Children’s Hospital, Zurich,
Switzerland. reinhard.seger@kispi.unizh.ch
RESUMEN
/ SUMMARY: - Treatment of chronic granulomatous disease
(CGD) with myeloablative bone marrow transplantation is considered risky. This
study investigated complications and survival according to different risk
factors present at transplantation. The outcomes of 27 transplantations for
CGD, from 1985 to 2000, reported to the European Bone Marrow Transplant
Registry for primary immunodeficiencies were assessed. Most transplant
recipients were children (n = 25), received a myeloablative busulphan-based
regimen (n = 23), and had unmodified marrow allografts (n = 23) from human
leukocyte antigen (HLA)-identical sibling donors (n = 25). After myeloablative
conditioning, all patients fully engrafted with donor cells; after
myelosuppressive regimens, 2 of 4 patients fully engrafted. Severe (grade 3 or
4) graft-versus-host disease (GVHD) disease developed in 4 patients: 3 of 9
with pre-existing overt infection, 1 of 2 with acute inflammatory disease.
Exacerbation of infection during aplasia was observed in 3 patients;
inflammatory flare at the infection site during neutrophil engraftment in 2:
all 5 patients belonged to the subgroup of 9 with pre-existing infection.
Overall survival was 23 of 27, with 22 of 23 cured of CGD (median follow-up, 2
years). Survival was especially good in patients without infection at the
moment of transplantation (18 of 18). Pre-existing infections and inflammatory
lesions have cleared in all survivors (except in one with autologous
reconstitution). Myeloablative conditioning followed by transplantation of
unmodified hemopoietic stem cells, if performed at the first signs of a severe
course of the disease, is a valid therapeutic option for children with CGD
having an HLA-identical donor. N.
Ref:: 30
----------------------------------------------------
[4]
TÍTULO / TITLE: - Drug immunosuppression
therapy for adult heart transplantation. Part 2: clinical applications and
results.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Jan;77(1):363-71.
AUTORES
/ AUTHORS: - Mueller XM
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiovascular Surgery,
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. xavier.mueller@usherbrooke.ca
RESUMEN
/ SUMMARY: - This review describes the clinical
application of classical immunosuppressive drugs as well as that of more recent
drugs. All current immunosuppressive drugs target T-cell activation, and
cytokine production and clonal expansion, or both. Immunosuppressive protocols
can be broadly divided into induction therapy, maintenance immunosuppression,
and treatment of acute rejection episodes.
N. Ref:: 82
----------------------------------------------------
[5]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first four
patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led to
acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[6]
TÍTULO / TITLE: - Drug immunosuppression
therapy for adult heart transplantation. Part 1: immune response to allograft
and mechanism of action of immunosuppressants.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Jan;77(1):354-62.
AUTORES
/ AUTHORS: - Mueller XM
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiovascular Surgery,
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. xavier.mueller@usherbrooke.ca
RESUMEN
/ SUMMARY: - In the early days of transplantation,
immunosuppression therapy was rather broad and nonspecific, mainly using
high-dose corticosteroids and azathioprine. Thereafter we progressively
narrowed the target of immunosuppressive strategy starting with polyclonal
antibodies. The introduction of cyclosporine, OKT3, and tacrolimus further
narrowed the target on the T-cell pathways. More recently mycophenolate mofetil
progressively took the place of azathioprine with its higher lymphocyte specificity
and sirolimus and interleukin-2 receptor antibodies were introduced. In this
field in constant movement the aim is to find a drug or a regimen that provides
optimal immunosuppression therapy with minimal side effects, in other words to
find the right balance between overimmunosuppression and underimmunosuppression
therapy. This review is divided into two parts. The first part will provide a
basic understanding of the immunologic response to allograft and explain how
conventional and recently introduced immunosuppressive agents work. The second
part will describe the clinical application of immunosuppressive drugs to
provide practical information for those in charge of heart transplant
recipients. N. Ref:: 68
----------------------------------------------------
[7]
TÍTULO / TITLE: - Cyclosporin trough
levels: is monitoring necessary during short-term treatment in psoriasis? A
systematic review and clinical data on trough levels.
REVISTA
/ JOURNAL: - Br J Dermatol 2002 Jul;147(1):122-9.
AUTORES
/ AUTHORS: - Heydendael VM; Spuls PI; Ten Berge IJ;
Opmeer BC; Bos JD; de Rie MA
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Academic
Medical Center, University of Amsterdam, PO Box 22660, the Netherlands.
RESUMEN
/ SUMMARY: - BACKGROUND: Cyclosporin is an effective
treatment for severe plaque psoriasis. Unfortunately, its use may be limited by
time- and dose-related nephrotoxicity. Serum trough levels may be useful for
monitoring the risk of nephrotoxicity. OBJECTIVES: To determine whether monitoring
of trough levels is necessary in psoriasis patients undergoing short-term
treatment with cyclosporin. METHODS: A computerized and manual literature
search identified studies on adults with plaque-type psoriasis treated with
cyclosporin < or = 5 mg kg-1 daily, in which trough levels were measured in
whole blood. Number of patients, treatment duration, formulation and dosage,
renal function tests and trough levels were extracted. The association between
renal function and trough levels was investigated. Additionally, in a
randomized controlled trial on cyclosporin vs. methotrexate in moderate to
severe psoriasis, cyclosporin trough levels were measured frequently in 20
patients during 12 weeks of treatment. The Pearson correlation coefficient
between serum creatinine and cyclosporin trough levels was calculated. RESULTS:
Fifty-six articles were found concerning cyclosporin trough level measurements
in psoriasis patients, of which eight were analysed. Many studies were excluded
due to inappropriate cyclosporin dosages used. As data were heterogeneous and
lacked various key parameters, a correlation study and a meta-analysis could
not be performed. Instead, a quantitative description of the literature was
given. No high mean trough levels or elevations of serum creatinine were
described. In our clinical study, all the mean trough levels in 17 patients
treated with cyclosporin 3 mg kg-1 daily were within the therapeutic range
(< 200 ng mL-1). Elevated trough levels were found in two of three patients
treated with cyclosporin 3-5 mg kg-1 daily. No signs of renal dysfunction were
seen. CONCLUSIONS: The literature does not provide a definitive answer on
whether monitoring cyclosporin trough levels in patients with psoriasis should
be standard practice. Our own data show no need for cyclosporin trough level
monitoring during short-term treatment with cyclosporin 3 mg kg-1 daily.
However, when cyclosporin doses are > 3 mg kg-1 daily, monitoring may be
indicated. N. Ref:: 32
----------------------------------------------------
[8]
TÍTULO / TITLE: - Subcutaneous
panniculitic T-cell lymphoma in children: response to combination therapy with
cyclosporine and chemotherapy.
REVISTA
/ JOURNAL: - J Am Acad Dermatol 2004 Feb;50(2
Suppl):S18-22.
●●
Enlace al texto completo (gratuito o de pago) 1016/S0190
AUTORES
/ AUTHORS: - Shani-Adir A; Lucky AW; Prendiville J;
Murphy S; Passo M; Huang FS; Paller AS
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Children’s
Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, USA.
RESUMEN
/ SUMMARY: - We describe 2 adolescent boys with facial
swelling and/or subcutaneous nodules and fever. Extensive evaluation, including
several biopsy specimens, led to a diagnosis of subcutaneous panniculitic
T-cell lymphoma, an entity rarely seen in children. Both patients were treated
with oral cyclosporine in an effort to suppress the cytokine release from
T-cells that has been thought to induce the hemophagocytic syndrome. The
patients responded dramatically to cyclosporine treatment with defervescence of
the fever and reduction in number and size of the subcutaneous nodules.
Subsequent therapy with multidrug chemotherapy achieved complete remission in
the first patient. This report suggests the value of cyclosporine as a
first-line agent coupled with chemotherapy in the treatment of patients with
subcutaneous panniculitic T-cell lymphoma. A clinicopathologic review of 8
described pediatric cases of subcutaneous panniculitic T-cell lymphoma is also
presented. N. Ref:: 15
----------------------------------------------------
[9]
TÍTULO / TITLE: - Patient management by
Neoral C(2) monitoring: an international consensus statement.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9
Suppl):S12-8.
AUTORES
/ AUTHORS: - Levy G; Thervet E; Lake J; Uchida K
INSTITUCIÓN
/ INSTITUTION: - Multiorgan Transplant Program, Toronto
General Hospital, 621 University Avenue, 10NU-116, Toronto, Ontario M5G 2C4,
Canada. N. Ref:: 36
----------------------------------------------------
[10]
TÍTULO / TITLE: - Immunoablation followed
or not by hematopoietic stem cells as an intense therapy for severe autoimmune
diseases. New perspectives, new problems.
REVISTA
/ JOURNAL: - Haematologica. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Haematologica: <> 2001 Apr;86(4):337-45.
AUTORES
/ AUTHORS: - Marmont AM N. Ref:: 127
----------------------------------------------------
[11]
TÍTULO / TITLE: - Inflammatory
myopathies: clinical, diagnostic and therapeutic aspects.
REVISTA
/ JOURNAL: - Muscle Nerve 2003 Apr;27(4):407-25.
●●
Enlace al texto completo (gratuito o de pago) 1002/mus.10313
AUTORES
/ AUTHORS: - Mastaglia FL; Garlepp MJ; Phillips BA;
Zilko PJ
INSTITUCIÓN
/ INSTITUTION: - Centre for Neuromuscular and Neurological
Disorders, University of Western Australia, Queen Elizabeth II Medical Centre,
Nedlands, Australia. flmast@cyllene.uwa.edu.au
RESUMEN
/ SUMMARY: - The three major forms of immune-mediated
inflammatory myopathy are dermatomyositis (DM), polymyositis (PM), and
inclusion-body myositis (IBM). They each have distinctive clinical and
histopathologic features that allow the clinician to reach a specific diagnosis
in most cases. Magnetic resonance imaging is sometimes helpful, particularly if
the diagnosis of IBM is suspected but has not been formally evaluated. Myositis-specific
antibodies are not helpful diagnostically but may be of prognostic value; most
antibodies have low sensitivity. Muscle biopsy is mandatory to confirm the
diagnosis of an inflammatory myopathy and to allow unusual varieties such as
eosinophilic, granulomatous, and parasitic myositis, and macrophagic
myofasciitis, to be recognized. The treatment of the inflammatory myopathies
remains largely empirical and relies upon the use of corticosteroids,
immunosuppressive agents, and intravenous immunoglobulin, all of which have
nonselective effects on the immune system. Further controlled clinical trials
are required to evaluate the relative efficacy of the available therapeutic
modalities particularly in combinations, and of newer immunosuppressive agents (mycophenolate
mofetil and tacrolimus) and cytokine-based therapies for the treatment of
resistant cases of DM, PM, and IBM. Improved understanding of the molecular
mechanisms of muscle injury in the inflammatory myopathies should lead to the
development of more specific forms of immunotherapy for these conditions. N. Ref:: 256
----------------------------------------------------
[12]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[13]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[14]
TÍTULO / TITLE: - Pharmacokinetic,
pharmacodynamic, and outcome investigations as the basis for mycophenolic acid
therapeutic drug monitoring in renal and heart transplant patients.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):17-22.
AUTORES
/ AUTHORS: - Shaw LM; Korecka M; DeNofrio D; Brayman KL
INSTITUCIÓN
/ INSTITUTION: - Departments of Pathology & Laboratory
Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. shawlmj@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Mycophenolate mofetil is widely used in
combination with either cyclosporine or tacrolimus for rejection prophylaxis in
renal and heart transplant patients. Although not monitored routinely nearly to
the degree that other agents such as cyclosporine or tacrolimus, there is an
expanding body of experimental evidence for the utility of monitoring
mycophenolic acid, the primary active metabolite of mycophenolate mofetil,
plasma concentration as an index of risk for the development of acute
rejection. The following are important experimentally-based reasons for
recommending the incorporation of target therapeutic concentration monitoring
of mycophenolic acid: (1) the MPA dose-interval area-under-the-concentration-time
curve, and less precisely, MPA predose concentrations predict the risk for
development of acute rejection; (2) the strong correlation between mycophenolic
acid plasma concentrations and expression of important cell surface activation
antigens, whole blood pharmacodynamic assays of lymphocyte proliferation and
median graft rejection scores in a heart transplant animal model; (3) the
greater than 10-fold interindividual variation of MPA area under the
concentration time curve values in heart and renal transplant patients
receiving a fixed dose of the parent drug; (4) drug-drug interactions involving
other immunosuppressives are such that when switching from one to another (eg,
from cyclosporine to tacrolimus or vice-versa) substantial changes in MPA concentrations
can occur in patients receiving a fixed dose of the parent drug; (5)
significant effects of liver and kidney diseases on the steady-state total and
free mycophenolic acid area under the concentration time curve values; (6) the
need to closely monitor mycophenolic acid when a major change in
immunosuppression is planned such as steroid withdrawal. Current investigations
are focused on determination of the most optimal sampling time and for
mycophenolic acid target therapeutic concentration monitoring. Further
investigations are needed to evaluate the pharmacologic activity of the newly
described acyl glucuronide metabolite of mycophenolic acid which has been shown
to inhibit, in vitro, inosine monophosphate dehydrogenase. N. Ref:: 37
----------------------------------------------------
[15]
TÍTULO / TITLE: - Clinical validation
studies of Neoral C(2) monitoring: a review.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9
Suppl):S3-11.
AUTORES
/ AUTHORS: - Nashan B; Cole E; Levy G; Thervet E
INSTITUCIÓN
/ INSTITUTION: - Klinik fur Viszeral und
Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.
1, D-30625 Hannover, Germany. N.
Ref:: 34
----------------------------------------------------
[16]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[17]
TÍTULO / TITLE: - Treatment responses of
childhood aplastic anaemia with chromosomal aberrations at diagnosis.
REVISTA
/ JOURNAL: - Br J Haematol 2002 Jul;118(1):313-9.
AUTORES
/ AUTHORS: - Ohga S; Ohara A; Hibi S; Kojima S; Bessho
F; Tsuchiya S; Ohshima Y; Yoshida N; Kashii Y; Nishimura S; Kawakami K;
Nishikawa K; Tsukimoto I
INSTITUCIÓN
/ INSTITUTION: - Aplastic Anaemia Committee of the Japanese
Society of Paediatric Haematology, Tokyo, Japan. ohgas@pediatr.med.kyushu-u.ac.jp
RESUMEN
/ SUMMARY: - The clinical outcome of childhood aplastic
anaemia (AA) with aberrant cytogenetic clones at diagnosis was surveyed. Among
198 children with newly diagnosed AA registered with the AA Committee of the
Japanese Society of Paediatric Hematology between 1994 and 1998, cytogenetic
studies of bone marrow (BM) cells were completed in 159 patients. Apart from
one Robertsonian translocation, seven patients (4.4%) showed clonal chromosomal
abnormalities in hypoplastic BM without myelodysplastic features. The patients
included six girls and one boy with a median age of 11 years (range 5-14 years).
Six patients had del(6), del(5), del(13), del(20), or -7, and one showed
add(9). Four patients responded to the first immunosuppressive therapy (IST:
cyclosporin A plus anti-thymocyte globulin) and one obtained a spontaneous
remission. Cytogenetic abnormalities remained in two patients with an IST
response. On the other hand, two patients showed no IST response. One did not
respond to repeat IST and died of acute graft-versus-host disease after an
unrelated-BM transplant. Another obtained a complete response after a
successful BM transplant. No haematological findings at diagnosis predicted the
treatment response. No significant morphological changes developed during the
course of the illness. A literature review revealed that half of 24 AA patients
with chromosomal abnormalities responded to the first IST, and that +6 was the
sole predictable marker for IST unresponsiveness. These results suggest that
IST can be applied as the initial therapy for AA with cytogenetic abnormalities
in the absence of completely matched donors.
N. Ref:: 32
----------------------------------------------------
[18]
TÍTULO / TITLE: - International
Federation of Clinical Chemistry/International Association of Therapeutic Drug
Monitoring and Clinical Toxicology working group on immunosuppressive drug
monitoring.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):59-67.
AUTORES
/ AUTHORS: - Holt DW; Armstrong VW; Griesmacher A;
Morris RG; Napoli KL; Shaw LM
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - Issues surrounding the measurement and
interpretation of immunosuppressive drug concentrations have been summarized in
a number of consensus documents. The Scientific Division of the International
Federation of Clinical Chemistry has formed a working group in collaboration
with the International Association of Therapeutic Drug Monitoring and Clinical
Toxicology. This paper sets out the goals of the working group in light of the
developments that have occurred in the field of immunosuppressive drug
monitoring since the publication of the last consensus documents.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Controlling the
incidence of infection and malignancy by modifying immunosuppression.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S89-93.
AUTORES
/ AUTHORS: - Soulillou JP; Giral M
RESUMEN
/ SUMMARY: - Long-term outcomes in renal transplantation
have improved over the years but are still a matter of concern. Because
patients typically require lifelong immunosuppression, the risks of cancer and
infection associated with immunosuppressive agents continue to demand
attention. Physicians strive endlessly to find the right balance between the
level of immunosuppression required to prevent rejection and the level that
will minimize dose-dependent side effects. Data presented in this paper suggest
that some renal transplant recipients might have more than necessary
immunosuppression during maintenance therapy and that reducing the
immunosuppressant dose can decrease cancer incidence, without worsening
long-term patient or allograft survival. Additionally, data were examined
suggesting that immunosuppressive agents might be associated with different
risks for cancer, specifically, the potential advantage of reduced cancer risk
for sirolimus and sirolimus derivatives in comparison with standard
immunosuppressive agents. Although promising, these preliminary results are
from preclinical studies, and further study is warranted. N. Ref:: 42
----------------------------------------------------
[20]
TÍTULO / TITLE: - Guidelines for the
diagnosis and management of acquired aplastic anaemia.
REVISTA
/ JOURNAL: - Br J Haematol 2003 Dec;123(5):782-801.
AUTORES
/ AUTHORS: - Marsh JC; Ball SE; Darbyshire P;
Gordon-Smith EC; Keidan AJ; Martin A; McCann SR; Mercieca J; Oscier D; Roques
AW; Yin JA
INSTITUCIÓN
/ INSTITUTION: - St. George’s Hospital Medical School, London,
UK. janice@bshhya.demon.co.uk
----------------------------------------------------
[21]
TÍTULO / TITLE: - A retrospective review
of sirolimus (Rapamune) therapy in orthotopic liver transplant recipients
diagnosed with chronic rejection.
REVISTA
/ JOURNAL: - Liver Transpl 2003 May;9(5):477-83.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50119
AUTORES
/ AUTHORS: - Neff GW; Montalbano M; Slapak-Green G;
Berney T; Bejarano PA; Joshi A; Icardi M; Nery J; Seigo N; Levi D; Weppler D;
Pappas P; Ruiz J; Schiff ER; Tzakis AG
INSTITUCIÓN
/ INSTITUTION: - University of Miami, Department of
Medicine, Miami, FL 33136, USA. gneff@med.miami.edu
RESUMEN
/ SUMMARY: - Treatment options are limited for
orthotopic liver transplant (OLT) recipients suffering from chronic rejection
(CR). We performed a retrospective review of OLT recipients diagnosed with CR
and treated with sirolimus. The medical records of all OLT recipients treated
with sirolimus between October, 1998 and October, 2000 were retrospectively
reviewed. The diagnosis of CR was made by both clinical and histologic
criteria: bile duct to hepatic artery ratio less than 0.7, histologic activity
index, hepatic arterial wall thickening, and chronic elevation of liver
chemistries. Two groups were defined in regard to sirolimus response: sirolimus
responders (SR) and sirolimus nonresponders (SNR). Response to treatment was
granted only when patients were found to have resolution of abnormal liver
transaminases and an improvement in hepatic artery to bile duct ratio. Serum
collections for liver chemistries were collected on days 1, 30, 60, and 90.
Liver biopsies were reviewed in blinded fashion from day 1 and at least 180
days on therapy by double-blinded pathologists. Sirolimus-related complications
were recorded and include drug toxicity, anemia with and without treatment,
hospitalizations, infections, immunosuppression complications, lipid profile
disorders, edema, muscle aches, and gastrointestinal complaints. Twenty-one
patients were diagnosed with CR. The SR group included 13 of 21, and 8 of 21
were in the SNR group. Anemia was diagnosed in 12 of 21 patients: SR, 7 of 13;
SNR, 5 of 8; with 5 patients requiring red blood cell transfusions (2 SR, 3
SNR). Recombinant erythropoietin was started in 5 of 21 patients. Sirolimus
serum levels were found to be greater than 20 ng/dL in 12 patients. Sirolimus
was discontinued in 9 patients,
----------------------------------------------------
[22]
TÍTULO / TITLE: - Effective prophylactic
protocol in delayed hypersensitivity to contrast media: report of a case
involving lymphocyte transformation studies with different compounds.
REVISTA
/ JOURNAL: - Radiology. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://radiology.rsnajnls.org/
●●
Cita: Radiology: <> 2002 Nov;225(2):466-70.
AUTORES
/ AUTHORS: - Romano A; Artesani MC; Andriolo M; Viola
M; Pettinato R; Vecchioli-Scaldazza A
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine and
Geriatrics, Universita’ Cattolica del Sacro Cuore, Allergy Unit, Complesso
Integrato Columbus, Via G. Moscati 31, 00168 Rome, Italy. columbus.allerg@linet.it
RESUMEN
/ SUMMARY: - A patient with maculopapular reactions to
iopamidol needed to undergo angiography for a cerebral arteriovenous
malformation. In vivo and in vitro tests were performed with ionic and nonionic
contrast media, including iopamidol and iobitridol. All results were positive,
demonstrating delayed hypersensitivity. The patient received
6-alpha-methylprednisolone and cyclosporine 1 week before and 2 weeks after
four angiograms were obtained with the use of iobitridol, which was well
tolerated.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Persistent remission
after immunosuppressive therapy of hairy cell leukemia mimicking aplastic
anemia: two case reports.
REVISTA
/ JOURNAL: - Int J Hematol 2003 May;77(4):391-4.
AUTORES
/ AUTHORS: - Sugimori C; Kaito K; Nakao S
INSTITUCIÓN
/ INSTITUTION: - Cellular Transplantation Biology, Kanazawa
University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
RESUMEN
/ SUMMARY: - Some patients with hairy cell leukemia
(HCL) manifest pancytopenia and bone marrow hypoplasia without an apparent
increase in atypical cells, so their disease resembles severe aplastic anemia
at onset. We treated 2 HCL patients, who were initially diagnosed with aplastic
anemia, with antithymocyte globulin (ATG) in combination with cyclosporine or
antilymphocyte globulin (ALG). Both patients obtained partial remission in
response to the immunosuppressive therapy and did not need transfusion
treatment for more than 3 years. Sustained improvement of hematopoiesis in such
B-cell malignancies after ATG/ ALG therapy suggests that the mechanisms
underlying successful immunosuppressive therapy for aplastic anemia may involve
B-cell suppression, inhibiting hematopoietic stem cells. N. Ref:: 18
----------------------------------------------------
[24]
TÍTULO / TITLE: - Histopathological study
of intrahepatic islets transplanted in the nonhuman primate model using
edmonton protocol immunosuppression.
REVISTA
/ JOURNAL: - J Clin Endocrinol Metab. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://jcem.endojournals.org/
●●
Cita: J. of Clin Endocrinol & Metab: <> 2002 Dec;87(12):5424-9.
AUTORES
/ AUTHORS: - Hirshberg B; Mog S; Patterson N; Leconte
J; Harlan DM
INSTITUCIÓN
/ INSTITUTION: - Transplantation and Autoimmunity Branch,
National Institute of Diabetes and Digestive and Kidney Diseases, National
Institutes of Health, Bethesda, Maryland 20892, USA.
RESUMEN
/ SUMMARY: - While islet cell transplantation is a promising
way to restore insulin independence to patients with type I diabetes mellitus,
a detailed histological analysis of the transplanted, intraportal islets has
not yet been reported. Rhesus macaques underwent total pancreatectomy, then had
allogeneic isolated islets infused into their portal vein, followed by
daclizumab, tacrolimus, and sirolimus to prevent islet rejection. Islets were
evenly distributed among the liver lobes. Liver sections from a primate given
allogeneic islets 5 d earlier did not display any islet capillary formation,
whereas intrahepatic islets transplanted 30 and 90 d before euthanasia showed
an abundant capillary supply. Localized hepatocellular glycogenosis was
observed surrounding the islets in a primate with functioning islets 7 months
post transplant. Liver sections from a primate that rejected islets
transplanted 2 months prior displayed only islet remnants with prominent local
lymphohistiocytic inflammation and an occasional capillary. We conclude that
islets develop an abundant vascular supply within 30 d following transplant and
because capillaries persist even following rejection, that the vascular cells
are likely from the recipient. While transplanted islets were not vascularized
early post transplant, the primates remained insulin independent. The long-term
consequence of islets in the liver, marked by the glycogenosis, remains unknown
and warrants further study.
----------------------------------------------------
[25]
TÍTULO / TITLE: - Resolution of oral
non-Hodgkin’s lymphoma by reduction of immunosuppressive therapy in a renal
allograft recipient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2002 Dec;94(6):697-701.
●●
Enlace al texto completo (gratuito o de pago) 1067/moe.2002.126889
AUTORES
/ AUTHORS: - Keogh PV; Fisher V; Flint SR
INSTITUCIÓN
/ INSTITUTION: - Department of Oral Surgery, Oral Medicine
and Oral Pathology, Dublin Dental School and Hospital, Trinity College,
Ireland. pakeogh@dental.tcd.ie
RESUMEN
/ SUMMARY: - A case of oral non-Hodgkin’s lymphoma
arising in a patient with insulin-dependent diabetes who had undergone renal
allograft transplantation is described. The resolution of the disease was
achieved by a reduction in her immunosuppressive therapy. The differential
diagnosis is discussed, and the management of posttransplantation lymphoproliferative
disorders is reviewed. N.
Ref:: 40
----------------------------------------------------
[26]
TÍTULO / TITLE: - The cytology of
HIV-induced immunosuppression. Changing pattern of disease in the era of highly
active antiretroviral therapy.
REVISTA
/ JOURNAL: - Cytopathology 2001 Oct;12(5):281-96.
AUTORES
/ AUTHORS: - Kocjan G; Miller R
INSTITUCIÓN
/ INSTITUTION: - Department of Histopathology, Royal Free
and University College Medical School, University College London, UK. N. Ref:: 89
----------------------------------------------------
[27]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressant drugs in clinical practice.
REVISTA
/ JOURNAL: - Clin Ther 2002 Mar;24(3):330-50;
discussion 329.
AUTORES
/ AUTHORS: - Kahan BD; Keown P; Levy GA; Johnston A
INSTITUCIÓN
/ INSTITUTION: - Division of Immunology and Organ
Transplantation, University of Texas Health Science Center at Houston Medical
School, 77030, USA. Barry.D.Kahan@uth.tmc.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Therapeutic drug monitoring
(TDM) is essential to maintain the efficacy of many immunosuppressant drugs
while minimizing their toxicity. TDM has become more refined with the
development of new monitoring techniques and more specific assays. OBJECTIVE:
This article summarizes current data on TDM of the following immunosuppressant
drugs used in organ transplantation: cyclosporine, tacrolimus, sirolimus,
everolimus, and mycophenolate mofetil. METHODS: Published data were identified
by a MEDLINE search of the English-language literature through March 2001 using
the terms therapeutic drug monitoring, cyclosporine, tacrolimus, sirolimus,
everolimus, and mycophenolate mofetil. Relevant conference abstracts were also
included. RESULTS: TDM of cyclosporine has been well studied, and recent
findings indicate that monitoring of drug levels 2 hours after dosing is a more
sensitive predictor of outcome than trough (C0) monitoring. C0 levels are being
used more widely in TDM of tacrolimus; however, the relationship between C0 and
area under the curve has varied widely in clinical trials, with correlations
ranging from 0.11 to 0.92. The use of TDM of sirolimus, everolimus, and
mycophenolate mofetil is evolving rapidly. CONCLUSIONS: TDM of immunosuppressant
drugs that have a narrow therapeutic index is an increasingly useful tool for
minimizing drug toxicity while maximizing prevention of graft loss and organ
rejection. N. Ref:: 85
----------------------------------------------------
[28]
TÍTULO / TITLE: - Autoimmune bullous
dermatoses in the elderly: diagnosis and management.
REVISTA
/ JOURNAL: - Drugs Aging 2003;20(9):663-81.
AUTORES
/ AUTHORS: - Mutasim DF
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
Cincinnati, College of Medicine, Cincinnati, Ohio, USA. diya.mutasim@uc.edu
RESUMEN
/ SUMMARY: - Elderly individuals are susceptible to
autoimmune bullous dermatoses (in particular, pemphigoid, epidermolysis bullosa
acquisita and paraneoplastic pemphigus). Bullous dermatoses are associated with
high morbidity and mortality. Bullous dermatoses result from autoimmune
responses to one or more components of the basement membrane or desmosomes.
Pemphigoid results from autoimmunity to hemidesmosomal proteins present in the
basement membrane of stratified squamous epithelia. Patients present with tense
blisters in flexural areas of the skin. Mild or moderate bullous pemphigoid may
be treated with potent topical corticosteroids while extensive disease usually
requires systemic corticosteroids or systemic immunosuppressive agents such as
azathioprine. Mucosal pemphigoid affects one or more mucous membranes that are
lined by stratified squamous epithelia. The two most commonly involved sites
are the eye and the oral cavity. Lesions frequently result in scar formation,
which may cause blindness. Patients with severe disease or ocular involvement
require aggressive therapy with corticosteroids and cyclophosphamide.
Epidermolysis bullosa acquisita results from autoimmunity to type VII collagen
in the anchoring fibrils of the basement membrane area. Lesions may either
arise on an inflammatory base or be non-inflammatory and result primarily from
trauma. The inflammatory type of the disease is more responsive to therapy than
the non-inflammatory type. Treatment options include corticosteroids, dapsone,
cyclosporin, plasmapheresis and immunoglobulin G. Paraneoplastic pemphigus
results from autoimmunity to multiple antigens within the desmosomes. The
disorder is associated with neoplasms, especially leukaemia and lymphoma.
Patients present with severe stomatitis and polymorphous skin eruption. The
mucosal and cutaneous involvement may respond to successful treatment of the
underlying neoplasm or may require immunosuppressive therapy. N. Ref:: 122
----------------------------------------------------
[29]
TÍTULO / TITLE: - B19 virus infection in
renal transplant recipients.
REVISTA
/ JOURNAL: - J Clin Virol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.elsevier.com/gej-ng/29/46/32/show/Products/VIRUSINT/index.htt
●●
Cita: J Clinical Virology: <> 2003 Apr;26(3):361-8.
AUTORES
/ AUTHORS: - Cavallo R; Merlino C; Re D; Bollero C;
Bergallo M; Lembo D; Musso T; Leonardi G; Segoloni GP; Ponzi AN
INSTITUCIÓN
/ INSTITUTION: - Virology Unit, Department of Public Health
and Microbiology, University of Turin, Via Santena 9, 10126, Turin, Italy. rossana.cavallo@unito.it
RESUMEN
/ SUMMARY: - BACKGROUND: B19 virus infection with
persistent anaemia has been reported in organ transplant recipients. Detection
of B19 virus DNA in serum is the best direct marker of active infection.
OBJECTIVE: The present study evaluated the incidence and clinical role of
active B19 virus infection in renal transplant recipients presenting with
anaemia. STUDY DESIGN: Forty-eight such recipients were investigated by nested
PCR on serum samples. The controls were 21 recipients without anaemia. Active
HCMV infection was also investigated as a marker of high immunosuppression.
RESULTS AND CONCLUSIONS: In 11/48 (23%) patients B19 virus DNA was demonstrated
in serum versus only 1/21 (5%) of the controls. Ten of these 11 patients had
already been seropositive at transplantation and active infection occurred in
eight of them during the first 3 months after transplantation. The remaining
patient experienced a primary infection 9 months after transplantation. Eight
(73%) of these 11 patients displayed a concomitant HCMV infection and four
(36%) showed increasing serum creatinine levels but none developed
glomerulopathy; 3/11 (27%) recovered spontaneously from anaemia whereas 8/11
(73%) needed therapy. In conclusion, the relatively high occurrence (23%) of
B19 virus infection in patients presenting with anaemia, suggests that it
should be considered in the differential diagnosis of persistent anaemia in
renal transplant recipients. Presence of the viral DNA should be assessed early
from transplantation and the viral load should be monitored to follow
persistent infection and better understand the relation between active
infection and occurrence of anaemia, and to assess the efficacy of IVIG therapy
and/or immunosuppression reduction in clearing the virus. N. Ref:: 56
----------------------------------------------------
[30]
- Castellano -
TÍTULO / TITLE:Nuevos tratamientos
inmunodepresores de induccion en el trasplante renal. New induction
immunosuppression treatments in kidney transplantation.
REVISTA
/ JOURNAL: - Med Clin (Barc). Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Medicina Clínica: <> 2001 Jun 30;117(4):147-57.
AUTORES
/ AUTHORS: - Pascual J; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia. Universidad de
Alcala. Hospital Ramon y Cajal. Madrid. jpascual@hrc.insalud.es N. Ref:: 94
----------------------------------------------------
[31]
TÍTULO / TITLE: - Therapeutic monitoring
of mycophenolate mofetil in organ transplant recipients: is it necessary?
REVISTA
/ JOURNAL: - Clin Pharmacokinet 2002;41(5):319-27.
AUTORES
/ AUTHORS: - Mourad M; Wallemacq P; Konig J; de Frahan
EH; Eddour DC; De Meyer M; Malaise J; Squifflet JP
INSTITUCIÓN
/ INSTITUTION: - Department of Kidney and Pancreas
Transplantation, University Hospital Saint Luc, Universite Catholique de
Louvain, Brussels, Belgium. Michel.Mourad@chir.ucl.ac.be
RESUMEN
/ SUMMARY: - Adequate immunosuppression minimising the
risk of organ rejection with acceptable tolerability of the used drugs is a
crucial step in organ transplantation. The primary goal is to maintain a
consistent time-dependent target concentration by tailoring individual dosage leading
to the best efficacy and tolerability combination. The use of therapeutic drug
monitoring (TDM) to optimise immunosuppressive therapy is routinely employed
for maintenance drugs such as cyclosporin and tacrolimus. The question whether
therapeutic monitoring of mycophenolic acid (MPA) in organ transplant
recipients treated with mycophenolate mofetil is necessary is not definitely
answered. The correlation of mycophenolic acid pharmacokinetic parameters with
efficacy and toxicity makes the therapeutic monitoring of this drug promising.
However, further studies are mandatory to draw the best guidelines in order to
achieve higher levels of evidence that MPA-TDM may improve patient
outcome. N. Ref:: 63
----------------------------------------------------
[32]
TÍTULO / TITLE: - Cicatricial pemphigoid
in the upper aerodigestive tract: diagnosis and management in severe laryngeal
stenosis.
REVISTA
/ JOURNAL: - Ann Otol Rhinol Laryngol 2003
Mar;112(3):271-5.
AUTORES
/ AUTHORS: - Boedeker CC; Termeer CC; Staats R; Ridder
GJ
INSTITUCIÓN
/ INSTITUTION: - Department of Otorhinolaryngology-Head and
Neck Surgery, Albert-Ludwigs-University, Freiburg, Germany.
RESUMEN
/ SUMMARY: - Pemphigoid is a group of rare, acquired,
autoimmune subepithelial blistering diseases. The condition has been
subclassified into bullous pemphigoid and cicatricial pemphigoid (CP).
Diagnosis is based on clinical presentation, evidence of subepithelialvesicles
or bullae on routine histologic analysis, and direct and indirect immunofluorescence
studies. Cicatricial pemphigoid is characterized by linear deposition of
immunoreactants, principally IgG and complement factor 3, along epithelial
basement membranes. Cicatricial pemphigoid usually leads to mucosal scarring.
We present a case of severe CP that led to laryngeal and subglottic stenosis
and involvement of both eyes and the oral, nasal, and nasopharyngeal mucosae.
Treatment with dapsone, corticosteroids, azathioprine sodium, cyclosporine A,
cyclophosphamide, methotrexate sodium, and mycophenolate mofetil between 1997
and 2001 only resulted in temporary disease control. The patient has been
treated with leflunomide for the past 8 months, and there have been no
relapses. Treatment of CP with leflunomide has not been described in the literature
until now. N. Ref:: 25
----------------------------------------------------
[33]
TÍTULO / TITLE: - Atopic diseases of
childhood.
REVISTA
/ JOURNAL: - Curr Opin Pediatr 2003 Oct;15(5):495-511.
AUTORES
/ AUTHORS: - Stone KD
INSTITUCIÓN
/ INSTITUTION: - Children’s Hospital Boston, Department of
Pediatrics, Harvard Medical School, Massachusetts, USA. kelly.stone@tch.harvard.edu
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: The incidence of atopic
diseases, including atopic dermatitis, allergic rhinitis, and asthma, has
increased in developed countries over the past several decades. These diseases
comprise a large component of general pediatric practice. This review will
highlight some of the recent advances in understanding the pathogenesis and
natural history of these diseases, as well as the current approaches to the
treatment of children with atopic diseases. RECENT FINDINGS: Recent studies
have identified multiple risk factors for the development and progression of
atopic diseases. As a result, much research is focused on identifying therapies
that can be initiated at a young age to prevent disease progression. New
treatment options have become available in recent years, such as topical
immunomodulators for atopic dermatitis, leukotriene antagonists for seasonal
allergic rhinitis, and alpha-immunoglobulin E therapy for asthma. The
importance of viewing allergic rhinitis and asthma as disorders of a single
airway has been emphasized. Finally, an update on the national asthma
guidelines was recently released in an effort to promote optimal asthma care.
SUMMARY: This review summarizes many of the recent advances in the diagnosis
and treatment of atopic diseases in children. Although not intended to be a comprehensive
review of this broad field, it provides a framework for appreciating the
complexity of these diseases and for effectively managing them. N. Ref:: 180
----------------------------------------------------
[34]
TÍTULO / TITLE: - Molecular diagnosis of
an Enterocytozoon bieneusi human genotype C infection in a moderately
immunosuppressed human immunodeficiency virus seronegative liver-transplant
recipient with severe chronic diarrhea.
REVISTA
/ JOURNAL: - J Clin Microbiol. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://jcm.asm.org/
●●
Cita: J. Clinical Microbiology: <> 2001 Jun;39(6):2371-2.
AUTORES
/ AUTHORS: - Sing A; Tybus K; Heesemann J; Mathis
A N. Ref:: 5
----------------------------------------------------
[35]
TÍTULO / TITLE: - Eradication of
parvovirus B19 infection after renal transplantation requires reduction of
immunosuppression and high-dose immunoglobulin therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Oct;17(10):1840-2.
AUTORES
/ AUTHORS: - Liefeldt L; Buhl M; Schweickert B;
Engelmann E; Sezer O; Laschinski P; Preuschof L; Neumayer HH
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Charite,
Humboldt-University Berlin, Germany. lutz.liefeldt@charite.de N. Ref:: 17
----------------------------------------------------
[36]
TÍTULO / TITLE: - Recent advances in
immunosuppressive therapy for renal transplantation.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):218-22.
AUTORES
/ AUTHORS: - Peddi VR; First MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Hypertension,
Department of Internal Medicine, University of Cincinnati College of Medicine,
Cincinnati, Ohio 45267-0585, USA. ram.peddi@uc.edu
RESUMEN
/ SUMMARY: - Recent advances in immunosuppression have
focused on more effective, safer, and targeted therapies that have resulted in
improved short- and intermediate-term renal allograft survival. During the past
decade there has been a marked decrease in acute rejection rates following
renal transplantation because of the use of newer immunosuppressive agents.
Recent data indicate that the average yearly reduction in the relative hazard
of graft failure beyond 1 year was 4.2% for all recipients (0.4% for those
recipients who had an acute rejection episode and 6.3% for those who did not
have an acute rejection). Despite these improvements the currently available
immunosuppressive agents are associated with significant cardiovascular risk
factors, an increased risk of infection, and the development of malignancies in
the long term. Predictive parameters of donor-specific hyporesponsiveness are
needed so as to allow identification of patients in whom immunosuppressive
therapy can be safely reduced. Immunosuppressive agents that have recently been
approved for use in the United States and those that are in clinical and
preclinical studies are discussed. N.
Ref:: 27
----------------------------------------------------
[37]
TÍTULO / TITLE: - Recommendations for the
implementation of Neoral C(2) monitoring in clinical practice.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9
Suppl):S19-22.
AUTORES
/ AUTHORS: - Cole E; Midtvedt K; Johnston A; Pattison
J; O’Grady C
INSTITUCIÓN
/ INSTITUTION: - University of Toronto, Toronto General Hospital,
621 University Ave., Toronto, Ontario M5G 2C4, Canada.
----------------------------------------------------
[38]
TÍTULO / TITLE: - Role of chiral
chromatography in therapeutic drug monitoring and in clinical and forensic
toxicology.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Apr;24(2):290-6.
AUTORES
/ AUTHORS: - Williams ML; Wainer IW
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, Leicester
University, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - Advances in chiral chromatographic separations
have given pharmacologists and toxicologists the tools to examine unexpected
clinical results involving chiral drugs. The ability to unravel complex
phenomena associated with drug transport and drug metabolism is presented in
this manuscript. The relation between the chirality of the drug mefloquine and
the intracellular concentrations of the drug cyclosporine is illustrated by
examining the effect of the enantiomers of mefloquine on the transport activity
of P-glycoprotein (Pgp). These studies were conducted using a liquid
chromatographic column containing immobilized Pgp. The results demonstrated
that (+)-mefloquine competitively displaced the Pgp substrate cyclosporine
whereas (-)-mefloquine had no effect on cyclosporine-Pgp binding. The data suggest
that cyclosporine cellular and CNS concentrations can be increased through the
concomitant administration of (+)-mefloquine. The use of chirality in clinical
and forensic situations is also illustrated by the metabolism of the
enantiomers of ketamine (KET). The plasma concentrations of (+)-KET and (-)-KET
and the norketamine metabolites (+)-NK and (-)-NK were measured in rat plasma
using enantioselective gas chromatography. The separations were accomplished
using a gas chromatography chiral stationary phase based on beta-cyclodextrin.
The pharmacokinetic profiles of (+)-, (-)-KET and (+)-, (-)-NK were determined
in control and protein-calorie malnourished (PCM) rats to determine the effect
of PCM on ketamine metabolism and clearance. The results indicate that PCM
produced a significant and stereoselective decrease in KET and NK metabolism.
The data suggest that the effects of environmental factors (smoking, alcohol
use, diet) and drug interactions (coadministered agents) can be measured using
the changes in stereochemical metabolic and pharmacokinetic patterns of KET and
similar drugs. N.
Ref:: 33
----------------------------------------------------
[39]
TÍTULO / TITLE: - Diffusion-weighted MR
imaging of posterior reversible leukoencephalopathy syndrome: a pictorial
essay.
REVISTA
/ JOURNAL: - Clin Imaging 2003 Sep-Oct;27(5):307-15.
AUTORES
/ AUTHORS: - Kinoshita T; Moritani T; Shrier DA;
Hiwatashi A; Wang HZ; Numaguchi Y; Westesson PL
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Division of
Radiology, University of Rochester Medical Center, 601 Elmwood Avenue Box 648,
Rochester, NY 14642, USA. kino@grape.med.tottori-u.ac.jp
RESUMEN
/ SUMMARY: - Posterior reversible leukoencephalopathy syndrome
is characterized by reversible white matter lesions. However, ischemic injury
with irreversible damage may occur. This pictorial essay illustrates MR
features associated with posterior reversible leukoencephalopathy syndrome. We
will emphasize the role of diffusion-weighted imaging for the discrimination of
irreversible ischemic injury from reversible vasogenic edema. N. Ref:: 9
----------------------------------------------------
[40]
TÍTULO / TITLE: - Monitoring of cellular
resistance to cancer chemotherapy.
REVISTA
/ JOURNAL: - Hematol Oncol Clin North Am 2002
Apr;16(2):357-72, vi.
AUTORES
/ AUTHORS: - Krishan A; Arya P
INSTITUCIÓN
/ INSTITUTION: - Radiation Oncology Department, University
of Miami Medical School, Division of Experimental Therapeutics (R-71), P.O. Box
01690, Miami, FL 33101, USA. akrishan@med.miami.edu
RESUMEN
/ SUMMARY: - Cellular resistance to a broad spectrum of
natural products used as antitumor drugs is believed to be a major cause for
the failure of chemotherapy. Flow cytometry has been used for monitoring the
expression of drug resistance markers, determining accumulation of fluorescent
drugs, and for screening of drugs that enhance chemosensitivity by blocking
efflux and enhancing drug retention. This article reviews recent developments
in our understanding of the multiple drug resistance phenotype and the use of
flow cytometry for the study of drug efflux and its modulation in human tumor
cells. N. Ref:: 77
----------------------------------------------------
[41]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy based on donor and recipient risk factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2207-11.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati Medical Center,
Cincinnati, Ohio 45267-0585, USA. N.
Ref:: 35
----------------------------------------------------
[42]
TÍTULO / TITLE: - Maintenance
immunosuppression in the renal transplant recipient: an overview.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S25-35.
AUTORES
/ AUTHORS: - Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Alabama at Birmingham, Birmingham, AL 35294, USA. rgaston@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Managing maintenance immunosuppressive
regimens after kidney transplantation is often challenging and confusing,
requiring careful attention to efficacy, dosing, adverse effects, and costs of
multiple medications. Most protocols combine a primary immunosuppressant
(cyclosporine or tacrolimus) with one or two adjunctive agents (azathioprine,
mycophenolate mofetil, sirolimus, corticosteroids). Avoiding drug-drug
interactions is a major part of effective immunosuppressant management, and
special situations (eg, pregnancy, intravenous dosing, caring for minority
patients) can prove especially daunting. This review summarizes available data
regarding current practices in maintenance immunosuppression, emphasizing issues
that arise in day-to-day management of renal transplant recipients. N. Ref:: 69
----------------------------------------------------
[43]
TÍTULO / TITLE: - Advances in the
management of psoriasis: monoclonal antibody therapies.
REVISTA
/ JOURNAL: - Int J Dermatol 2002 Dec;41(12):827-35.
AUTORES
/ AUTHORS: - Mehrabi D; DiCarlo JB; Soon SL; McCall CO
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Emory
University School of Medicine, Atlanta, GA 30322, USA.
RESUMEN
/ SUMMARY: - Psoriasis is a common skin disorder
characterized by erythematous, scaling plaques. Until recently, therapies for
this disease have been aimed at reducing keratinocyte proliferation. We have
learned that psoriasis is not primarily a disorder of keratinocyte hyperproliferation,
but is an inflammatory disease. This knowledge, especially our current
understanding of the role of activated T cells in psoriasis, has led to new
therapeutic options and new areas of research. Immunosuppressive agents such as
cyclosporine have proven very useful in the treatment of psoriasis, but their
use is limited by toxicity. Monoclonal antibodies directed against key
components of the inflammatory process have been studied in an attempt to
produce safer, more selective immunosuppressive agents. This review summarizes
much of the available literature describing the use of monoclonal antibodies in
the treatment of psoriasis. N.
Ref:: 59
----------------------------------------------------
[44]
TÍTULO / TITLE: - Chronic myeloid
leukemia: pathophysiology, diagnostic parameters, and current treatment
concepts.
REVISTA
/ JOURNAL: - Wien Klin Wochenschr 2003 Aug
14;115(13-14):485-504.
AUTORES
/ AUTHORS: - Sillaber C; Mayerhofer M; Agis H; Sagaster
V; Mannhalter C; Sperr WR; Geissler K; Valent P
INSTITUCIÓN
/ INSTITUTION: - Abteilung fur Hamatologie und
Hamostaseologie, Universitatsklinik fur Innere Medizin I, AKH-Wien, Austria. christian.sillaber@univie.ac.at
RESUMEN
/ SUMMARY: - Chronic myeloid leukemia (CML) is a stem
cell disease characterized by excessive accumulation of clonal myeloid
(precursor) cells in hematopoietic tissues. CML cells display the translocation
t(9; 22) that creates the bcr/abl oncogene. The respective oncoprotein (=
BCR/ABL) exhibits constitutive tyrosine kinase activity and promotes growth and
survival in CML cells. Clinically, CML can be divided into three phases: the
chronic phase (CP), the accelerated phase (AP), and the blast phase (BP) that
resembles acute leukemia. Progression to AP and BP is associated with
occurrence of additional genetic defects that cooperate with bcr/abl in
leukemogenesis and lead to resistance against antileukemic drugs. The prognosis
in CML is variable depending on the phase of disease, age, and response to
therapy. The only curative approach available to date is stem cell
transplantation. For those who cannot be transplanted, the BCR/ABL tyrosine
kinase inhibitor STI571 (Glivec, Imatinib), interferon-alpha (with or without
ARAC), or other cytoreductive drugs are prescribed. Currently available data
show that STI571 is a superior compound compared to other drugs in producing
complete cytogenetic and molecular responses. However, despite superior initial
data and high expectations for an effect on survival, long term results are not
available so far, and resistance against STI571 has been reported. Forthcoming
strategies are therefore attempting to prevent or counteract STI571 resistance
by co-administration of other antileukemic drugs. Whether these strategies will
lead to curative drug therapy in CML in the future remains at present
unknown. N. Ref:: 209
----------------------------------------------------
[45]
TÍTULO / TITLE: - Sequential protocol
biopsies from renal transplant recipients show an increasing expression of
active TGF beta.
REVISTA
/ JOURNAL: - Transpl Int 2002 Dec;15(12):630-4. Epub
2002 Oct 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00147-002-0472-3
AUTORES
/ AUTHORS: - Jain S; Mohamed MA; Sandford R; Furness
PN; Nicholson ML; Talbot D
INSTITUCIÓN
/ INSTITUTION: - University Department of Surgery,
Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. sj34@le.ac.uk
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN) is a
major cause of graft loss after renal transplantation. Implicated in the
pathogenesis of this complication is overproduction of the cytokine
transforming growth factor beta (TGF beta). In this study we measured changes
in CAN’s expression in stable patients early after transplantation, and studied
links with established risk factors for CAN, such as delayed graft function,
acute rejection, and cyclosporine exposure. We took biopsies from 40 renal
allografts at time of transplantation (pre-perfusion), and then, using
ultrasound guidance, at 1 week and 6 months after transplantation. An
immunofluorescence technique was used to stain sections for active TGF beta.
These were then assessed by semi-quantitative scanning laser confocal
microscopy. There was very little variation in active TGF-beta expression among
patients in their pre-perfusion biopsies. Expression had increased by 1 week
and then very significantly by 6 months ( P<0.0001). Patients who suffered
delayed graft function had increased TGF-beta expression at both time points.
There was no difference regarding donor type, acute rejection, and
immunosuppressive drug (cyclosporine or tacrolimus). There was no correlation
between the amount of TGF-beta expression at any time-point and isotope
glomerular filtration rate (GFR) at 12 months. This study demonstrated that in
a group of stable renal allograft recipients, TGF-beta expression in the kidney
increased after transplantation. As the study used protocol biopsies, this
increase is unlikely to be due to acute events, and probably represents a
genuine increase.
----------------------------------------------------
[46]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2478-9.
AUTORES
/ AUTHORS: - Vathsala A
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Singapore
General Hospital, Singapore. N.
Ref:: 13
----------------------------------------------------
[47]
TÍTULO / TITLE: - Infectious
complications in SLE after immunosuppressive therapies.
REVISTA
/ JOURNAL: - Curr Opin Rheumatol 2003 Sep;15(5):528-34.
AUTORES
/ AUTHORS: - Kang I; Park SH
INSTITUCIÓN
/ INSTITUTION: - Section of Rheumatology, Yale University
School of Medicine, New Haven, Connecticut 06520, USA. insoo.kang@yale.edu
RESUMEN
/ SUMMARY: - Immunosuppressive drugs have become the
gold standard for the treatment of major organ involvement in systemic lupus
erythematosus. The use of immunosuppressive therapy in systemic lupus
erythematosus carries significant risks for infection. This article reviews
infectious complications in systemic lupus erythematosus, focusing on effects
of immunosuppressive therapy. Patients with systemic lupus erythematosus appear
to carry an intrinsically increased risk for infection. Recent studies support
this notion further by showing increased risk for serious infections in
patients with systemic lupus erythematosus who had mannose-binding lectin
deficiency associated with homozygous mannose-binding lectin variant alleles.
Patients with systemic lupus erythematosus who were homozygous for
mannose-binding lectin variant alleles had a fourfold increase in the incidence
of infections, requiring hospitalization. In terms of extrinsic risk factors
for infection, use of steroids and cyclophosphamide are the strongest risk
factors. The effect of these drugs on infection is also dose dependent. The
incidence of infectious complications in patients treated with mycophenolate
mofetil, a newly used immunosuppressive drug in systemic lupus erythematosus,
appears less frequent compared with cyclophosphamide. Herpes zoster is still
the most common viral infection in patients with systemic lupus erythematosus
treated with cyclophosphamide and mycophenolate mofetil. Overall data indicate
that patients with systemic lupus erythematosus may have intrinsically
increased risks for infection that are augmented by immunosuppressive
therapies. Cyclophosphamide, in particular in combination with high-dose
glucocorticoids, has the strongest effect in suppressing the immune responses
against microorganisms. Careful monitoring of infectious complications is
warranted in patients with systemic lupus erythematosus receiving
immunosuppressive therapies, in particular those on high-dose glucocorticoids
and cytotoxic drugs. N.
Ref:: 87
----------------------------------------------------
[48]
- Castellano -
TÍTULO / TITLE:Sindrome de cogan atipico: a
proposito de dos casos y revision de la literatura. Atypical Cogan’s syndrome:
report of two cases and revision of literature.
REVISTA
/ JOURNAL: - Acta Otorrinolaringol Esp 2002
Feb;53(2):121-5.
AUTORES
/ AUTHORS: - Sanz JJ; Martinez P; Escobar JJ; Menendez
LM
INSTITUCIÓN
/ INSTITUTION: - Servicio de Otorrinolaringologia, Hospital
Clinic, Barcelona.
RESUMEN
/ SUMMARY: - Cogan’s syndrome is a rare autoimmune
disease with systemic involvement. It appears in young people and has two
presentations: the typical form with keratitis, sudden deafness with or without
vestibular syndrome, and the atypical form with different non keratitic ocular
diseases and a great variety of systemic symptoms in relation with the
autoimmune etiology of the process. Cogan’s syndrome has a bad prognosis and
deafness appears in 25% of the cases with the right treatment and in 60% of
patients without treatment. The best treatment is systemic and ocular
corticotherapy. The second treatment of choice is cyclophosphamide or
cyclosporine A. We present two cases of atypical Cogan’s syndrome with
unilateral deafness in both. N.
Ref:: 11
----------------------------------------------------
[49]
TÍTULO / TITLE: - Cyclosporin: revisions
in monitoring guidelines and review of current analytical methods.
REVISTA
/ JOURNAL: - Ann Clin Biochem 2002 Sep;39(Pt 5):424-35.
●●
Enlace al texto completo (gratuito o de pago) 1258/000456302320314430
AUTORES
/ AUTHORS: - Andrews DJ; Cramb R
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Biochemistry,
University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Edgbaston,
Birmingham B15 2TH, UK.
RESUMEN
/ SUMMARY: - This article summarizes the main changes
that have occurred in cyclosporin (ciclosporin) monitoring and measurement
since the previous review in this journal. Cyclosporin has been reformulated to
reduce variability in its absorption, leading to fewer post-transplant
rejection episodes. Monitoring has mostly utilized the measurement of pre-dose
blood levels of the drug, but more recently the potential benefit of using
samples collected during the first few hours post-dose has been evaluated.
Calculating the area under the cyclosporin concentration-time curve may be the
ideal, but is not viable in the routine clinical situation and 2-h post-dose
sampling seems likely to offer a practical clinical solution. Analytical
methods based on high-performance liquid chromatography (HPLC) and immunoassay
are available for the determination of whole blood cyclosporin concentrations.
HPLC is specific but rarely used for routine monitoring, although HPLC-tandem
mass spectrometry is making the technique more viable. New immunoassays have
been introduced, but none are completely specific for the parent drug and all
exhibit cross-reactivity towards cyclosporin metabolites. Immunoassays were
originally designed for the lower cyclosporin concentrations seen in pre-dose
samples, but are being evaluated and modified for determination of the higher
concentrations seen 2 h post-dose. N.
Ref:: 62
----------------------------------------------------
[50]
TÍTULO / TITLE: - Therapeutic monitoring
of sirolimus: its contribution to optimal prescription.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):157S-161S.
AUTORES
/ AUTHORS: - Holt DW; Denny K; Lee TD; Johnston A
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - It is now common practice to measure
immunosuppressive drugs in blood as a guide to therapy. The immunosuppressive
drug sirolimus, recently approved for use following kidney transplantation, was
developed in the context of this clinical approach. Throughout the early
clinical studies, validated analytical techniques based on chromatographic
techniques were used to measure the drug. After a brief period in which an
immunoassay was available, routine measurements are again being performed by
chromatographic assays. In this article the use of blood concentration
measurements in the assessment of the early and pivotal clinical trials of the
drug is documented. Then, the rationale for the routine monitoring of the drug
in clinical practice, a regulatory requirement in some countries, is set out.
It is concluded that the development of this compound has benefited from
experience gained during the pharmacokinetic assessment of other
immunosuppressive drugs. The pharmacokinetic data accumulated on sirolimus have
been a key element in formulating guidelines on dosing with this drug, both
when used in combination with cyclosporine and when used after cyclosporine
withdrawal. N. Ref:: 32
----------------------------------------------------
[51]
TÍTULO / TITLE: - Immunosuppressive
treatment of acquired aplastic anemia and immune-mediated bone marrow failure
syndromes.
REVISTA
/ JOURNAL: - Int J Hematol 2002 Feb;75(2):129-40.
AUTORES
/ AUTHORS: - Young NS
INSTITUCIÓN
/ INSTITUTION: - Hematology Branch, National Heart, Lung,
and Blood Institute, NIH, Bethesda. MD 20892-1652, USA.
RESUMEN
/ SUMMARY: - Modern therapeutic strategies for the
treatment of acquired aplastic anemia are based on the current understanding of
its pathophysiology as well as empiric observations. Most cases of aplastic
anemia appear to be the result of immune-mediated destruction of hematopoietic
cells, which can be approached by stem cell transplantation in younger patients
with appropriate histocompatible donors or by immunosuppression to reduce
T-cell activity. Popular treatment regimens combine antithymocyte globulin with
cyclosporine. Although a majority of patients respond with improved blood
counts and achieve transfusion-independence, late clonal complications of
myelodysplasia and cytogenetic abnormalities occur in a substantial minority of
cases. Additionally, there is no clear algorithm for the treatment of
refractory disease. Newer methods of treatment, including high-dose
cyclophosphamide and the development of potentially tolerizing combinations of
drugs. are under study. Effective therapies for aplastic anemia might also be
applied to other T-cell mediated, organ-specific human diseases. N. Ref:: 129
----------------------------------------------------
[52]
TÍTULO / TITLE: - Evolution of
immunosuppression and continued importance of acute rejection in renal
transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S2-9.
AUTORES
/ AUTHORS: - Chan L; Gaston R; Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, University
of Colorado Health Sciences Center, Denver, CO 80262, USA. Larry.Chan@uchsc.edu
RESUMEN
/ SUMMARY: - As steady improvement in short-term kidney
graft survival and long-term outcomes prolongs the lives of transplant
patients, responsibility for their care is shifting away from transplant
specialists and into the hands of community nephrologists. Therefore, community
nephrologists need to have a deeper understanding of immunosuppressive
therapies than ever before. Pharmacologic immunosuppression has been
continuously evolving over the past two decades. Azathioprine was introduced in
the early 1960s. Introduction of cyclosporine (CsA) in 1983 revolutionized
short-term outcomes after renal transplantation. The first monoclonal antibody
immunosuppressant, OKT3, was introduced in 1986. The 1990s saw the introduction
of a number of important new agents, including mycophenolate mofetil (MMF),
tacrolimus, and a microemulsion CsA, as well as two new monoclonal antibodies.
Combinations of these new agents, along with improving clinical care, have
produced 1-year patient survival approaching 100% and graft survival exceeding
90%. The newest class of agents, the first of which is sirolimus, is called
target of rapamycin (TOR) inhibitors and is used with CsA for maintenance
therapy. Immunosuppressive drug therapy after kidney transplantation continues
to evolve. There is a variety of pharmacologic combinations from which to
choose, based on immunologic risk and side effect profiles. As new regimens are
developed, ongoing communications between the transplant center and community
nephrologists will be required to implement therapeutic changes and optimize
patient care successfully. N.
Ref:: 59
----------------------------------------------------
[53]
TÍTULO / TITLE: - Promising early
outcomes with a novel, complete steroid avoidance immunosuppression protocol in
pediatric renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Jul 15;72(1):13-21.
AUTORES
/ AUTHORS: - Sarwal MM; Yorgin PD; Alexander S; Millan
MT; Belson A; Belanger N; Granucci L; Major C; Costaglio C; Sanchez J; Orlandi
P; Salvatierra O Jr
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Stanford University
Medical Center, 703 Welch Road, Suite H-5, Palo Alto, CA 94304, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Corticosteroids have been a
cornerstone of immunosuppression for four decades despite their adverse side
effects. Past attempts at steroid withdrawal in pediatric renal transplantation
have had little success. This study tests the hypothesis that a complete
steroid-free immunosuppressive protocol avoids steroid dependency for
suppression of the immune response with its accompanying risk of acute
rejection on steroid withdrawal. METHODS: An open labeled prospective study of
complete steroid avoidance immunosuppressive protocol was undertaken in 10
unsensitized pediatric recipients (ages 5-21 years; mean 14.4 years) of first
renal allografts. Steroids were substituted with extended daclizumab use, in
combination with tacrolimus and mycophenolate mofetil. Protocol biopsies were
performed in the steroid-free group at 0, 1, 3, 6, and 12 months
posttransplantation. Clinical outcomes were compared to a steroid-based group
of 37 matched historical controls. RESULTS: Graft and patient survival was 100%
in both groups. Clinical acute rejection was absent in the steroid-free group
at a mean follow-up time of 9 months (range 3-13.7 months). Protocol biopsies
in the steroid-free group (includes 10 patients at 3 months, 7 at 6 months, and
4 at 12 months) revealed only two instances of mild (Banff 1A) subclinical
rejection (reversed by only a nominal increase in immunosuppression) and no
chronic rejection. At 6 months the steroid-free group had no hypertension
requiring treatment (P=0.003), no hypercholesterolemia (P=0.007), and
essentially no body disfigurement (P=0.0001). Serum creatinines, Schwartz GFR,
and mean delta height Z scores trended better in the steroid-free group. In the
steroid-free group, one patient had cytomegalovirus disease at 1 month and
three had easily treated herpes simplex stomatitis, but with no significant
increase in bacterial infections or rehospitalizations over the steroid-based
group. The steroid-free group was more anemic early posttransplantation
(P=0.004), suggesting an early role of steroids in erythrogenesis;
erythropoietin use normalized hematocrits by 6 months. CONCLUSIONS: Complete
steroid-free immunosuppression is efficacious and safe in this selected group
of children with no early clinical acute rejection episodes. This protocol
avoids the morbid side effects of steroids without increasing infection, and
may play a future critical role in avoiding noncompliance, although optimizing
renal function and growth.
----------------------------------------------------
[54]
TÍTULO / TITLE: - Improving tolerability
of immunosuppressive regimens.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S105-12.
AUTORES
/ AUTHORS: - MacDonald A
RESUMEN
/ SUMMARY: - CNIs and corticosteroids are associated
with adverse effects that can diminish quality of life and detrimentally affect
long-term allograft and patient survival. Nephrotoxicity is the major side
effect of CNI therapy. A search has been ongoing for improved immunosuppressive
regimens that will provide adequate protection against acute allograft
rejection, while decreasing the nephrotoxic and other effects associated with
CNIs. This paper reviewed the immunosuppressive agent sirolimus as a potential
new option in transplantation, focusing on its mechanism of action and clinical
efficacy as well as potential antiproliferative and antineoplastic properties.
The findings and lessons learned from key clinical studies in which sirolimus
was used to augment or replace CNIs and/or corticosteroids were highlighted,
and the importance of clinical pharmacokinetics and therapeutic drug monitoring
in these regimens were discussed. Preliminary studies of combination therapy with
sirolimus and tacrolimus in solid organ transplantation indicate that
sirolimus/tacrolimus combination therapy may provide strong protection against
acute rejection and diminish the nephrotoxicity associated with CNI-based
therapy. Other studies suggest that sirolimus can be used as base
immunosuppressive therapy, thereby completely avoiding the nephrotoxicity
associated with CNI-based therapies, while continuing to provide powerful
protection against rejection. With patients surviving longer with functional
allografts, quality of life is becoming an increasing important clinical
endpoint in transplantation. The studies reviewed here suggest that sirolimus
might be used to improve quality of life significantly without increasing the
risk of allograft rejection or shortening patient survival. N. Ref:: 73
----------------------------------------------------
[55]
TÍTULO / TITLE: - New developments in the
immunosuppressive drug monitoring of cyclosporine, tacrolimus, and
azathioprine.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):9-16.
AUTORES
/ AUTHORS: - Armstrong VW; Oellerich M
INSTITUCIÓN
/ INSTITUTION: - Abteilung Klinische Chemie, Zentrum Innere
Medizin, Georg-August-Universitat Gottingen, Robert-Koch-Strasse 40, 37075,
Gottingen, Germany. varmstro@med.uni-goettingen.de
RESUMEN
/ SUMMARY: - The calcineurin inhibitors cyclosporine
and tacrolimus form the cornerstones of most immunosuppression protocols.
Because of their variable pharmacokinetics, and their narrow therapeutic
indices, post-transplant immunosuppressive drug monitoring is an essential part
of patient care to minimize the risks of toxicity or acute rejection.
Furthermore, a reduction in the rate of acute rejection has been shown to
result in a lower rate of graft loss due to chronic rejection. The introduction
of the microemulsion formulation of cyclosporine with its more consistent
bioavailability has renewed interest in the use of alternative sampling
strategies to the trough cyclosporine concentration. Both pharmacokinetic and
pharmacodynamic considerations support the concept that determination of
cyclosporine during the absorption phase (0-4 h) might offer a better
prediction of cyclosporine immunosuppressive efficacy. Initial investigations
suggest that monitoring a 2-h postdose concentration C(2) may provide a more
efficacious alternative to trough monitoring for optimizing therapy with
Neoral. Tacrolimus has a 10- to 100-fold greater in vitro immunosuppressive
activity compared with cyclosporine. Consistent with its greater potency,
therapeutic whole blood trough concentrations for tacrolimus are around 20-fold
lower than the corresponding cyclosporine concentrations. The correlation
between toxicity and tacrolimus trough concentrations appears to be stronger
than that for acute rejection. The results from a concentration-ranging trial
in primary kidney-transplantation and liver-transplantation trials all found a
significant relationship between toxicity and tacrolimus trough levels.
Azathioprine is converted in vivo to 6-mercaptopurine, which is subsequently
metabolized to the pharmacologically active 6-thioguanine nucleotides. The
latter are also responsible for the cytotoxic side effects. Reliance on blood
counts to monitor azathioprine therapy can be misleading, and they do not
provide information on immunosuppresive efficacy. More pertinent information
can be obtained through the measurement of thiopurine S-methyltransferase
activity and the quantification of intracellular 6-thioguanine nucleotides
concentrations in red blood cells. Prospective studies have demonstrated the
clinical utility of determining 6-thioguanine nucleotides to individualise
immunosuppressive therapy with azathioprine not only in the field of transplantation,
but also in inflammatory bowel disease.
N. Ref:: 55
----------------------------------------------------
[56]
TÍTULO / TITLE: - Liver biopsy, viral
kinetics, and the impact of viremia on severity of hepatitis C virus
recurrence.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Nov;9(11):S58-62.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50245
AUTORES
/ AUTHORS: - Charlton M
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, Mayo Clinic and Foundation, Rochester, MN 55905, USA. charlton.michael@mayo.edu
RESUMEN
/ SUMMARY: - 1. Nearly all recipients who are
chronically infected with hepatitis C virus (HCV) at the time of liver
transplantation will have HCV RNA detectable postoperatively. 2. HCV
replication can begin as early as the first postoperative week. 3. HCV levels
fall significantly during the anhepatic phase of liver transplantation and
continue to fall during the first 12-24 hours posttransplantation. 4. Serum HCV
RNA levels typically increase rapidly from the second week posttransplantation
and peak by the fourth postoperative month. HCV RNA levels at one year
posttransplantation are 10-20 fold greater than pretransplant levels. 5.
Corticosteroid treatment for acute cellular rejection is associated with large
increases in HCV RNA levels. 6. HCV RNA levels do not appear to vary with
choice of calcineurin inhibitor. 7. Early HCV RNA levels are predictive of
subsequent histological severity of recurrence. 8. A correlation between early
levels of viremia and subsequent allograft injury suggests that initiation of
antiviral therapy early in the posttransplant course might be desirable. N. Ref:: 31
----------------------------------------------------
[57]
TÍTULO / TITLE: - An alternative
mechanism for the immunosuppressive effect of transfusion.
REVISTA
/ JOURNAL: - Vox Sang 2002 Aug;83 Suppl 1:417-9.
AUTORES
/ AUTHORS: - Dzik WH; Mincheff M; Puppo F
INSTITUCIÓN
/ INSTITUTION: - Blood Transfusion Service, J-224,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. sdzik@partners.org N. Ref:: 15
----------------------------------------------------
[58]
TÍTULO / TITLE: - How to manage patients
with lupus nephritis.
REVISTA
/ JOURNAL: - Best Pract Res Clin Rheumatol 2002
Apr;16(2):195-210.
●●
Enlace al texto completo (gratuito o de pago) 1053/berh.2001.0221
AUTORES
/ AUTHORS: - Esdaile JM
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology, University of
British Columbia, Canada.
RESUMEN
/ SUMMARY: - The clinical and renal biopsy predictors
of assistance in determining therapy are reviewed. While pulse cyclophosphamide
remains the most effective treatment for proliferative nephritis, there is
increasing interest in other agents, such as azathioprine, particularly to
maintain remission. While lupus membranous nephropathy has attracted limited
study, preliminary work suggests a role for cyclophosphamide. Newer therapies,
including cyclosporine A, mycophenolate mofetil, immunoadsorption, intravenous
immune globulin, LJP-394, high-dose immunoablation and nucleoside analogues
require further study but offer hope for those failing conventional
treatments. N. Ref:: 60
----------------------------------------------------
[59]
TÍTULO / TITLE: - Single-agent
immunosuppression after liver transplantation: what is possible?
REVISTA
/ JOURNAL: - Drugs 2002;62(11):1587-97.
AUTORES
/ AUTHORS: - Raimondo ML; Burroughs AK
INSTITUCIÓN
/ INSTITUTION: - Liver Transplantation and Hepato-Biliary
Medicine, Royal Free Hospital, Hampstead, London, UK.
RESUMEN
/ SUMMARY: - Orthotopic liver transplantation is a life
saving and life enhancing procedure. The development of immunosuppressive drugs
has contributed to the high rate of success in terms of both patient and graft
survival. However, the considerable adverse effects of these therapies are
affecting long-term outcomes of transplant recipients. Complications related to
immunosuppression are responsible for the majority of deaths in patients surviving
more than 1 year. Therefore, the search for an optimal immunosuppressive
regimen has become of paramount importance. The liver has proved to be an
‘immunologically privileged’ organ, capable in several animal models to be
accepted as an allograft without any intervention on the immune system of the
recipient. In some human liver allografts acceptance of the new organ is
recognised after withdrawal of immunosuppressants, but prior identification of
such individuals is not yet possible, thus negating this management option.
Graft-recipient interaction is peculiar in liver transplantation: acute
cellular rejection does not always need to be treated, and if it is not severe,
appears to be associated with a better survival of both patient and graft. In
the last decade there has been an evolution of immunosuppressive protocols,
driven by empirical observation and a deeper understanding of immunological
events after transplant. However, most modifications have been made because of
the necessity to reduce long-term drug related morbidity and mortality.
Withdrawal of corticosteroids has proven to be safely achievable in most
patients, with no deleterious effects on patient or graft survival but with a
great benefit in terms of reduction of incidence of metabolic and cardiovascular
complications. Long-term ‘steroid-free’ regimens are therefore now widely used.
Patients with stable graft function can be easily maintained using a single
drug usually after 6 or 12 months and usually with a calcineurin inhibitor. The
more evolved step of using monotherapy ab initio has also proven to be
effective in a few studies and needs to be explored further. In the future new
strategies will be designed to help the development of tolerance of the
allograft, selectively stimulating instead of suppressing the immune reaction
of the recipient. N.
Ref:: 51
----------------------------------------------------
[60]
TÍTULO / TITLE: - Two-hour cyclosporine
concentration determination: an appropriate tool to monitor neoral therapy?
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):40-6.
AUTORES
/ AUTHORS: - Oellerich M; Armstrong VW
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Chemistry,
Georg-August University, Gottingen, Germany. moeller@med.uni-goettingen.de
RESUMEN
/ SUMMARY: - Cyclosporine is a critical dose drug for
which individualisation by therapeutic drug monitoring is indisputable. Current
evidence suggests that a single concentration (C2) taken two hours after cyclosporine
administration with the microemulsion formulation better predicts exposure and
events than the trough concentration (C(0)), which is routinely used for
adjusting the dosage of this drug. Studies have shown that the greatest
calcineurin inhibition and the maximum inhibition of IL-2 production occur in
the first 1 to 2 hours after dosing. These findings support the concept that
the C2 level better reflects immunosuppressive efficacy than the trough
concentration. Preliminary data from an outcome study in liver transplant
recipients have shown that the incidence of biopsy proven moderate to severe
acute rejection was significantly lower in patients managed by C2 monitoring
compared with those monitored by C(0). The critical importance of achieving
adequate cyclosporine exposure during the first 3 to 5 posttransplant days to
prevent acute rejection has been documented in prospective studies with de novo
renal and liver transplant recipients. Conversion of maintenance liver and
heart transplant patients to C2 monitoring resulted in an amelioration of renal
function. Time-dependent target values have been proposed for liver and renal
transplant recipients. These require further prospective validation. For
routine monitoring of C2 levels on-site validated dilution guidelines are
necessary for most of the available immunoassays. C2 monitoring necessitates
further organizational requirements which may be judged differently between
transplant centers. In particular during the early posttransplant period C2
monitoring is a promising new option to make immunosuppressive therapy with the
microemulsion formulation of cyclosporine safer and more efficient. N. Ref:: 38
----------------------------------------------------
[61]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressive drugs in kidney transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):657-63.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040053.33359.26
AUTORES
/ AUTHORS: - Holt DW
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Drug monitoring has
become an accepted adjunct to optimizing therapy with immunosuppressive drugs.
This review assesses publications that relate to the analytical techniques used
to measure cyclosporin, tacrolimus, mycophenolic acid, sirolimus and
everolimus, as well as the clinical data obtained for these drugs. For all of
these drugs there has been a substantial and continuing investment in assessing
the clinical value of drug monitoring. RECENT FINDINGS: Fundamental
controversies still persist regarding which time point to use for monitoring.
The most significant single development has been the move towards using a timed
blood sample 2 h after drug administration (C2) to monitor cyclosporin therapy
with the Neoral formulation. The favourable clinical results obtained with this
approach have had an impact on reevaluating monitoring data for some of the
other drugs. The newest drugs to reach clinical evaluation, sirolimus and
everolimus, have been studied in the context of concentration-controlled dosing
and there is a good rationale for their measurement. There have also been
developments in the analytical techniques used, mostly to improve the
selectivity of the assays or to adapt them to new monitoring strategies.
SUMMARY: Interpretation of drug concentration data is becoming ever more
complex in this field as the number of potential drug combinations expands. The
relatively narrow therapeutic index of these agents and the ever-present risk
of clinically significant pharmacokinetic drug interactions makes drug
monitoring an important aspect of their prescription. N. Ref:: 77
----------------------------------------------------
[62]
TÍTULO / TITLE: - An induction versus
no-induction protocol in anticalcineurin-based immunosuppression using very
low-dose steroids.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Jun;33(4
Suppl):3S-10S.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - University Hospital of Bicetre, Le
Kremlin-Bicetre, France.
----------------------------------------------------
[63]
TÍTULO / TITLE: - Induction versus
non-induction protocols in anti-calcineurin-based immunosuppression.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3334-6.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie, University
Hospital of Bicetre, Bicetre, France.
----------------------------------------------------
[64]
TÍTULO / TITLE: - Immunosuppressant
drugs—the role of therapeutic drug monitoring.
REVISTA
/ JOURNAL: - Br J Clin Pharmacol 2001;52 Suppl
1:61S-73S.
AUTORES
/ AUTHORS: - Johnston A; Holt DW
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pharmacology, St
Bartholomew’s and The Royal London School of Medicine and Dentistry,
Charterhouse Square, London EC1M 6BQ, UK. A.Johnston@mds.qmw.ac.uk N. Ref:: 164
----------------------------------------------------
[65]
TÍTULO / TITLE: - The development of
immunosuppression: the rapamycin milestone.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):15S-17S.
AUTORES
/ AUTHORS: - Calne RY
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Cambridge, Addenbrook Hospital, Cambridge, UK.
N. Ref:: 22
----------------------------------------------------
[66]
TÍTULO / TITLE: - Chromomycosis due to
Exophiala jeanselmei in a renal transplant recipient.
REVISTA
/ JOURNAL: - Eur J Dermatol 2003 May-Jun;13(3):305-7.
AUTORES
/ AUTHORS: - Pena-Penabad C; Duran MT; Yebra MT;
Rodriguez-Lozano J; Vieira V; Fonseca E
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Complejo
Hospitalario Juan Canalejo, Servicio de Dermatologia, Xubias de Arriba, 84,
15006. a Coruna, España.
RESUMEN
/ SUMMARY: - Chromomycosis is a rare mycotic infection
that is more frequent in tropical and subtropical regions. Dematiaceous fungi
are the causal agents of this mycosis. Several cases of chromomycosis in organ
transplant recipients have been reported. We present a case of chromomycosis by
Exophiala jeanselmei in a Spanish male who had received a renal transplant
several months previously, and was receiving treatment with tacrolimus,
prednisone and mycophenolate mofetil. Very few cases of chromomycosis due to
Exophiala have been reported, and this is, to our knowledge, the first European
case. N. Ref:: 16
----------------------------------------------------
[67]
TÍTULO / TITLE: - Intracranial hemorrhage
in neuro-Behcet’s syndrome.
REVISTA
/ JOURNAL: - Intern Med 2002 Sep;41(9):692-5.
AUTORES
/ AUTHORS: - Kikuchi S; Niino M; Shinpo K; Terae S;
Tashiro K
INSTITUCIÓN
/ INSTITUTION: - Department of Neurology, Hokkaido
University Graduate School of Medicine, Sapporo.
RESUMEN
/ SUMMARY: - OBJECTIVE: Most cerebrovascular
disturbances in Behcet’s syndrome are occlusive in nature, while hemorrhage is
rare. In this paper, we report three cases of neuro-Behcet’s syndrome
presenting with intracerebral hemorrhaging, and discuss the possible causes as
they relate to cyclosporine treatment. PATIENTS: Three cases of neuro-Behcet’s
syndrome presented with intracranial hemorrhage. One patient had been taking
cyclosporine, and the other two patients had never taking cyclosporine.
RESULTS: Together with previous reports, these cases suggest that there are two
types of intracranial hemorrhage in neuro-Behcet’s syndrome. One type occurs in
the center of a lesion and during the acute phase of the disease, while the
other occurs in the peripheral lesion and during the subacute phase.
CONCLUSIONS: It appears that the intracranial hemorrhages in neuro-Behcet’s
syndrome can be divided into two groups. It is possible that the vascular
pathologies caused by Behcet’s syndrome and by cyclosporine conspire to induce
CNS hemorrhaging in some cases. N.
Ref:: 19
----------------------------------------------------
[68]
TÍTULO / TITLE: - Acquired anti-FVIII
inhibitors in children.
REVISTA
/ JOURNAL: - Haemophilia 2002 Jan;8(1):28-32.
AUTORES
/ AUTHORS: - Moraca RJ; Ragni MV
INSTITUCIÓN
/ INSTITUTION: - The Department of Medicine, Division of
Hematology/Oncology, University of Pittsburgh Medical Center, PA, USA.
RESUMEN
/ SUMMARY: - Acquired inhibitors to FVIII (anti-FVIII)
are uncommon in children. An acquired anti-FVIII developed in a previously
healthy 4-year-old boy treated with penicillin for streptococcal pharyngitis.
Aspirin prophylaxis begun for suspected rheumatic fever led to compartment
syndromes of all four extremities, which resolved with high-dose FVIII and
surgical decompression. Anti-FVIII in this patient, and the five additional
cases identified in a survey of 160 haemophilia treatment centres, occurred at
a median age of 8 years, with median initial and peak titres of 4.6 and 6.9
Bethesda Units (BU), respectively. All six presented with bleeding, including
haematomas (three intramuscular, one intracranial), and ecchymoses in three.
The median baseline FVIII was 0.05 U mL(-1), and the median baseline activated
partial thromboplastin time (APTT) was 79.8 s. The inhibitor resolved
completely in five patients (83%) within a median 5 months, after treatment
with FVIII concentrate, steroids, cytoxan, methotrexate, and no treatment. The
inhibitor persisted in the patient with Goodpasture’s disease, despite
steroids, cytoxan, cyclosporin, and intravenous gamma globulin. Aspirin
therapy, in two, worsened ongoing bleeding. The association of penicillin-like
drugs in this and three other cases in the literature suggest that to avoid
potential catastrophic bleeding, it is prudent to obtain an APTT prior to
initiating aspirin for suspected rheumatic fever. In conclusion, acquired
anti-FVIII inhibitors in children may cause severe bleeding, and remit in the
majority after FVIII and/or immunosuppressive therapy. N. Ref:: 21
----------------------------------------------------
[69]
TÍTULO / TITLE: - Cutaneous T-cell
lymphoma in a cardiac transplant recipient.
REVISTA
/ JOURNAL: - Tex Heart Inst J. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://texasheartinstitute.org/journal.html
●●
Cita: Texas Heart Institute Journal: <> 2001;28(3):203-7.
AUTORES
/ AUTHORS: - McMullan DM; Radovaneevic B; Jackow CM;
Frazier OH; Duvic M
INSTITUCIÓN
/ INSTITUTION: - Texas Heart Institute and St Luke s
Episcopal Hospital Houston, 77225-0345, USA.
RESUMEN
/ SUMMARY: - Mycosis fungoides, an uncommon form of
cutaneous T-cell lymphoma, arises in the skin and frequently progresses to
generalized lymphadenopathy Although the cause of cutaneous T-cell lymphoma is
unknown, chronic immunosuppression may play a role. A few cases have been
reported in renal transplant recipients; however, ours appears to be the 1st
report of cutaneous T-cell lymphoma in a cardiac transplant recipient. In our
patient, cutaneous manifestations of the disease were noted less than 1 year
after transplantation. Seven years after transplantation, Sezary syndrome, a
variant form of mycosis fungoides, was diagnosed by tissue biopsy and flow
cytometry analysis. Photopheresis improved symptoms but was not well tolerated
because of hemodynamic sequelae. Psoralen and ultraviolet A therapy also
improved the patient’s skin condition, but a generalized lymphadenopathy
developed. The maintenance immunosuppressive regimen was changed from
cyclosporine (3 mg/kg/day) and azathioprine to cyclosporine (1.5 mg/kg/day) and
cyclophosphamide. Although effective in the short-term, the results of this
therapeutic strategy could not be fully evaluated because the patient died of
acute myocardial infarction. N.
Ref:: 25
----------------------------------------------------
[70]
TÍTULO / TITLE: - Cyclosporin monitoring
in Australasia: 2002 update of consensus guidelines.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Dec;24(6):677-88.
AUTORES
/ AUTHORS: - Morris RG; Ilett KF; Tett SE; Ray JE;
Fullinfaw RO; Cooke R; Cook S
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiology and Clinical
Pharmacology, The Queen Elizabeth Hospital, Woodville, South Australia,
Australia.
RESUMEN
/ SUMMARY: - Therapeutic drug monitoring of cyclosporin
(CsA) has been established as part of the routine clinical treatment of
patients following organ transplantation for more than 20 years, and based on
contemporary knowledge, many consensus guidelines have been published to assist
clinics and laboratories attain optimal strategies for patient care. This
article addresses the newer directions in CsA monitoring, with particular
reference to the Australasian situation that has evolved since the 1993
Australasian guideline. These changes have included the introduction of
alternative assay methodologies, changed CsA formulation from Sandimmun to
Neoral throughout Australasia, and alternatives to trough concentration (C0)
monitoring, especially 2-hour concentration (C2) monitoring and associated
validated dilution protocols to accurately quantitate the higher whole blood
CsA concentrations. The revision was prepared following a recent survey of all Australasian
CsA-monitoring laboratories where discordant practices were evident.
----------------------------------------------------
[71]
TÍTULO / TITLE: - Therapeutic drug
monitoring for immunosuppressants.
REVISTA
/ JOURNAL: - Clin Chim Acta 2001 Nov;313(1-2):241-53.
AUTORES
/ AUTHORS: - Wong SH
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Medical College
of Wisconsin, and Dynacare Laboratories, Milwaukee, WI 53206, USA. shwong@mcw.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Immunosuppressants have
significantly increased patient survival, e.g. in renal transplant up to 90%
for the first year. METHODS: Four immunosuppressants are used for clinical
applications in the United States: cyclosporine (CsA) (Sandimmune and Neoral),
FK 506-tacrolimus (ProGraf), mycophenolic mofetil (CellCept)--the prodrug for
the mycophenolic acid (MPA), and rapamycin (RAPA) (Sirolimus). For CsA and FK
506, the rationale for monitoring is due to the variable pharmacokinetics,
acute infection, dosage adjustment, non-compliance check, and for long-term
maintenance therapy. Targeted whole blood concentrations ranges are: for CsA,
100-400 ng/ml depending on the methods, therapy and organs; and for FK 506,
5-20 ng/ml. For MPA, drug bioavailability—the plasma area-under-curve up to 12
h of 32.2-60.6 mg h/l was correlated to the biopsy-proven rejection rate of
<10%. Monitoring is advocated for liver and renal transplants, for
pediatrics, and for checking for non-compliance. RAPA monitoring is useful to
check for variable pharmacokinetics, for non-compliance and others. The
therapeutic range is tentatively targeted for 5-15 ng/ml. Monitoring
methodologies are: for CsA, immunoassays such as fluorescence polarization
immunoassay, and liquid chromatography (LC); for FK 506, microparticle enzyme
immunoassay (MEIA); for MPA, enzyme multiplied immunoassay and LC; and for
RAPA, MEIA, LC and LC-mass spectrometry. Proficiency survey programs for CsA
and FK 506 are available from the US and Europe. CONCLUSIONS: Monitoring of
immunosuppressants has become an essential adjunct to the drug therapy for
organ transplant patients. N.
Ref:: 93
----------------------------------------------------
[72]
TÍTULO / TITLE: - Cyclosporine
therapeutic drug monitoring.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):3003-5.
AUTORES
/ AUTHORS: - Jensen SA; Dalhoff KP
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pharmacology,
Rigshospitalet, Copenhagen, Denmark. sastrup@rh.dk N. Ref:: 36
----------------------------------------------------
[73]
TÍTULO / TITLE: - Homocysteine levels
among transplant recipients: effect of immunosuppressive protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2945-6.
AUTORES
/ AUTHORS: - Mor E; Helfmann L; Lustig S; Bar-Nathan N;
Yussim A; Sela BA
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Petach-Tikva, Israel.
----------------------------------------------------
[74]
TÍTULO / TITLE: - Protocol biopsy program
after renal transplantation: structure and first results.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2238-9.
AUTORES
/ AUTHORS: - Schwarz A; Mengel M; Gwinner W;
Eisenberger U; Hiss M; Radermacher J; Fiebeler A; Abou-Rebyeh F; Haller H
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Hanover Medical
School, Hanover, Germany.
----------------------------------------------------
[75]
TÍTULO / TITLE: - Histopathological
findings of 10-year protocol biopsy in pediatric kidney transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Dec;34(8):3130-1.
AUTORES
/ AUTHORS: - Kamimaki I; Shishido S; Ikeda M; Honda M
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatrics, Clinical Research
Department, National Saitama Hospital, Saitama, Japan.
----------------------------------------------------
[76]
TÍTULO / TITLE: - Diagnosis and
management of refractoriness to platelet transfusion.
REVISTA
/ JOURNAL: - Blood Rev 2001 Dec;15(4):175-80.
●●
Enlace al texto completo (gratuito o de pago) 1054/blre.2001.0164
AUTORES
/ AUTHORS: - Schiffer CA
INSTITUCIÓN
/ INSTITUTION: - Karmanos Cancer Institute, Wayne State
University School of Medicine, Detroit, MI 48201, USA. schiffer@karmanos.org
RESUMEN
/ SUMMARY: - Improvements in the availability and
quality of platelet transfusions have markedly reduced the morbidity and
mortality associated with intensive myelosuppressive therapy. Alloimmunization
and refractoriness to platelet transfusion remains a significant clinical
problem, although the incidence of alloimmunization may be declining due to
more widespread use of leucocyte depleted products. Alloimmunization can be
distinguished from other causes of poor post transfusion increments by the
measurement of lymphocytotoxic or antiplatelet antibodies. In addition to
medical approaches to reduce the risk of bleeding in individual patients,
identification of histocompatible donors can usually be accomplished by HLA
matching of donor and recipient, platelet cross matching or a combination of
both techniques. There are a number of selection strategies which can be
utilized and optimal patient management requires close cooperation and communication
between clinicians and blood centers. N.
Ref:: 48
----------------------------------------------------
[77]
TÍTULO / TITLE: - New concepts in
cyclosporine monitoring.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):619-26.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040047.33359.86
AUTORES
/ AUTHORS: - Keown PA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
British Columbia, Vancouver, Canada. keown@interchange.ubc.ca
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Inadequate cyclosporine
exposure is a key risk factor for acute rejection, and may contribute to the
development of chronic rejection and graft failure. Pre-dose monitoring does
not accurately measure drug exposure because of extensive inter- and
intra-patient variability in cyclosporine absorption and metabolism. Limited
sampling, using individual timed specimens, offers a new, simple and accurate
alternative for clinical monitoring of cyclosporine. RECENT FINDINGS: The area
under the first 4 h of the concentration-time curve (AUC ) and the single-point
concentration at 2 h post-dose (C2) are key measures of cyclosporine exposure.
De novo studies show that achieving an AUC value of more than 4400 microg.h/l
or a C2 level of 1500-2000 microg/l during the first 5 days post-transplant
minimizes the risk of rejection and improves graft function. Maintenance
studies suggest that reducing the C2 level to approximately 800 microg/l after
3-6 months may improve the serum creatinine level, blood pressure, general
well-being and reduce adverse effects. SUMMARY: Single-point C2 monitoring can
be implemented quickly and simply with appropriate site and patient training.
The timing of phlebotomy is more critical, but immunoassay bias is lower with 2
h post-dose than with trough level measures. Single-point C2 monitoring may be
effective in liver and heart replacement, but initial target levels for liver
transplantation are lower because cyclosporine is transported directly to the
liver via the portal system. C2 monitoring is now being widely adopted as an
accurate and practical measure of drug exposure, and can be combined with pharmacodynamic
methods to optimize immunosuppression. N.
Ref:: 76
----------------------------------------------------
[78]
TÍTULO / TITLE: - Impact of
immunosuppressive regimes on posttransplant diabetes mellitus.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5A
Suppl):23S-26S.
AUTORES
/ AUTHORS: - Weir M
INSTITUCIÓN
/ INSTITUTION: - Division of Nephology, University of
Maryland Hospital, Baltimore, Maryland 21201, USA. N. Ref:: 44
----------------------------------------------------
[79]
TÍTULO / TITLE: - Posterior
leukoencephalopathy syndrome.
REVISTA
/ JOURNAL: - Postgrad Med J 2001 Jan;77(903):24-8.
AUTORES
/ AUTHORS: - Garg RK
INSTITUCIÓN
/ INSTITUTION: - Department of Neurology, Institute of
Medical Sciences, Banaras Hindu University, Varanasi, India.
RESUMEN
/ SUMMARY: - Posterior leukoencephalopathy syndrome is
a newly recognised brain disorder that predominantly affects the cerebral white
matter. Oedematous lesions particularly involve the posterior parietal and
occipital lobes, and may spread to basal ganglia, brain stem, and cerebellum.
This rapidly evolving neurological condition is clinically characterised by
headache, nausea and vomiting, seizures, visual disturbances, altered
sensorium, and occasionally focal neurological deficit. Posterior
leukoencephalopathy syndrome is often associated with an abrupt increase in
blood pressure and is usually seen in patients with eclampsia, renal disease,
and hypertensive encephalopathy. It is also seen in the patients treated with
cytotoxic and immunosuppressive drugs such as cyclosporin, tacrolimus, and
interferon alfa. The lesions of posterior leukoencephalopathy are best
visualised with magnetic resonance (MR) imaging. T2 weighted MR images, at the
height of symptoms, characteristically show diffuse hyperintensity selectively
involving the parieto-occipital white matter. Occasionally the lesions also
involve the grey matter. Computed tomography can also be used satisfactorily to
detect hypodense lesions of posterior leukoencephalopathy. Early recognition of
this condition is of paramount importance because prompt control of blood
pressure or withdrawal of immunosuppressive agents will cause reversal of the
syndrome. Delay in the diagnosis and treatment can result in permanent damage
to affected brain tissues. N.
Ref:: 30
----------------------------------------------------
[80]
TÍTULO / TITLE: - C2 monitoring strategy
for optimising cyclosporin immunosuppression from the Neoral formulation.
REVISTA
/ JOURNAL: - BioDrugs 2001;15(5):279-90.
AUTORES
/ AUTHORS: - Levy GA
INSTITUCIÓN
/ INSTITUTION: - Multi-Organ Transplantation, The Toronto
Hospital, Toronto, Ontario, Canada. fg12@email.msn.com
RESUMEN
/ SUMMARY: - Profiling of absorption of cyclosporin
microemulsion (Neoral) is a concept in therapeutic drug monitoring (TDM)
designed to further optimise the clinical benefits of this formulation in
transplant recipients. A single blood concentration measurement 2 hours after
Neoral administration (C2) has been shown in both liver and kidney transplant
recipients to be a significantly more accurate predictor of drug exposure than
trough concentrations (C0), and its use results in a reduction in the incidence
and severity of cellular rejection. In a prospective trial in de novo renal
transplant recipients, patients who achieved target concentrations for area
under the concentration-time curve over the first 4 hours postdose (AUC(0-4h))
of 4500 to 5500 ng. h/ml within 5 days of transplantation had a 7% incidence of
histological acute rejection, compared with 37% rejection in those patients who
did not achieve this target level. Of the single sampling points, C2 correlates
best with AUC(0-4h) (r2 = 0.86); C(0) had the poorest correlation. In an
international study in 21 centres examining the absorption profiling, C2
samples were the most accurate predictors of AUC(0-4h) and freedom from
rejection. In liver transplant recipients receiving Neoral -based maintenance
immunosuppression, adoption of Neoral C2 monitoring identifies patients who are
both over- and under-dosed, which is not distinguished by C0 measurements.
Further adjustment of C2 to recommended targets, even at 5 and 10 years after
transplantation, results in reduction in nephrotoxicity without exposing the
patient to the risk of rejection. In summary, despite a level of simplicity
comparable to C0 measurement, Neoral absorption profiling, and specifically C2
measurement, is a much more sensitive approach to assessing the
pharmacokinetics and predicting the clinical effect of this formulation in the
individual patient, with a consequent marked reduction in the incidence of
acute cellular rejection and improved long term graft function. N. Ref:: 23
----------------------------------------------------
[81]
TÍTULO / TITLE: - Prevention and
treatment of severe hemodynamic compromise in pediatric heart transplant
patients.
REVISTA
/ JOURNAL: - Paediatr Drugs 2002;4(11):705-15.
AUTORES
/ AUTHORS: - Costello JM; Pahl E
INSTITUCIÓN
/ INSTITUTION: - Division of Pulmonary and Critical Care
Medicine, Department of Pediatrics, The Children’s Memorial Hospital, Feinberg
School of Medicine at Northwestern University, Chicago, Illinois 60614, USA.
RESUMEN
/ SUMMARY: - Allograft rejection is a leading cause of
severe hemodynamic compromise in pediatric heart transplant patients. A
triple-drug immunosuppression regimen, which includes a calcineurin inhibitor,
antiproliferative agent, and corticosteroid, suppresses the immune system at
multiple different levels for optimal graft protection while minimizing the
adverse effects of any one particular agent. Some pediatric centers also use
induction therapy with anti-T cell antibodies immediately following
transplantation as additional rejection prophylaxis. These antibodies augment
immunosuppression by either depleting the T cell pool or blocking interleukin-2
receptors on activated T cells. Despite the aggressive preventive measures
outlined above, some pediatric heart transplant patients will develop severe
hemodynamic compromise, most commonly due to fulminant rejection. Such patients
require attention to, and optimization of, the four determinants of cardiac
output (heart rate, preload, contractility and afterload) to stabilize the
circulation until the rejection can be reversed. Careful administration of
volume, diuretics, inotropes, and afterload-reducing agents will meet this
goal. Patients with allograft rejection require augmentation of immune
suppression to facilitate myocardial recovery. Corticosteroids form the cornerstone
of treatment for both cellular and vascular rejection. In patients with
refractory cellular rejection, conversion to mycophenolate mofetil or
tacrolimus may be appropriate if these agents are not already being used for
maintenance immunosuppression. Critically ill patients may additionally benefit
from muromonab-CD3 (OKT3) to augment lympholysis. Treatment employed
specifically for humoral rejection is prescribed with the intention of
suppressing new antibody formation, removing circulating antibody, and
improving coronary blood flow. In addition to corticosteroids, cyclophosphamide
and antithymocyte globulin or muromonab-CD3, along with plasmapheresis, may
improve survival. Systemic heparinization should be considered to minimize
coronary thrombosis in patients with humoral rejection. In the future, novel
immunosuppressive agents may further assist in the prevention as well as
treatment of severe hemodynamic compromise due to rejection in pediatric heart
transplant recipients. N.
Ref:: 99
----------------------------------------------------
[82]
TÍTULO / TITLE: - Polymorphisms in
immunoregulatory genes: towards individualized immunosuppressive therapy?
REVISTA
/ JOURNAL: - Am J Pharmacogenomics 2002;2(1):13-23.
AUTORES
/ AUTHORS: - Daly AK; Day CP; Donaldson PT
INSTITUCIÓN
/ INSTITUTION: - Centre for Liver Research, University of
Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4HH, UK. A.K.Daly@ncl.ac.uk
RESUMEN
/ SUMMARY: - In organ transplantation, successful
immunosuppression requires that both rejection and infection episodes be
minimized. Unfortunately it is currently impossible to predict individual dose
requirement for immunosuppressive drugs, but a number of studies of various
immune response genes are now being performed with a view to identifying
genotypes associated with rejection and/or infection. The key role of cytokines
in the immune response and other processes, including fibrosis, has
concentrated most of this attention on polymorphisms in cytokine genes. Data on
polymorphisms in genes encoding tumor necrosis factor-alpha, transforming
growth factor-beta, interferon-gamma and interleukin (IL)-1, 4, 6 and 10
together with the IL-4 receptor have been analyzed but so far there is
currently no indication of any consistently positive associations between graft
rejection and any of these polymorphisms. Studies of other immunomodulatory
genes including the CTLA4 gene and the chemokine receptor CCR-5 have proved
more positive though the data, so far, are only preliminary. In conclusion,
additional large series studies of these and other cytokine genes, as well as
other immunoregulatory gene polymorphisms of proven functional significance are
needed to achieve major progress in this area.
N. Ref:: 112
----------------------------------------------------
[83]
TÍTULO / TITLE: - Neoral monitoring 2
hours post-dose and the pediatric transplant patient.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Feb;7(1):25-30.
AUTORES
/ AUTHORS: - Dunn SP
INSTITUCIÓN
/ INSTITUTION: - Alfred I. duPont Hospital for Children,
Wilmington, Delaware 19899, USA. Sdunn@nemours.org
RESUMEN
/ SUMMARY: - Cyclosporin A therapy has evolved greatly
over the past 25 years of clinical experience. Sophisticated studies of CsA
pharmacokinetics and pharmacodynamics have led to a better understanding of the
relationship between dose response and biological effect. It has become
apparent that achieving target drug exposure is necessary for optimal clinical
outcomes. Monitoring dose response has become a key aspect of immunosuppressive
management. This review presents the information available supporting
cyclosporin drug concentration drawn two hours post dose (C-2) in children who
have been transplanted as the best single indicator of CsA exposure. Further
studies evaluating the clinical benefit of achieving C-2 targets in children
are indicated. N.
Ref:: 30
----------------------------------------------------
[84]
TÍTULO / TITLE: - Apoptosis, TGF beta and
transfusion-related immunosuppression: Biologic versus clinical effects.
REVISTA
/ JOURNAL: - Transfus Apheresis Sci 2003
Oct;29(2):127-9.
AUTORES
/ AUTHORS: - Dzik WH
INSTITUCIÓN
/ INSTITUTION: - Blood Transfusion Service, J-224,
Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. sdzik@partners.org
RESUMEN
/ SUMMARY: - Whether or not blood transfusion exerts an
immunosuppressive effect on the recipient remains an area of controversy. The
mechanism to clearly explain the effect has been elusive. We have previously
suggested that there may be two categories of immunosuppressive transfusion
effect: one which is HLA-dependent and directed against adaptive immunity and a
second category which is mild, non-specific, and directed against innate
immunity. This non-specific effect might result from the infusion of apoptotic
blood cells. There is solid evidence that blood cells undergo apoptotic changes
during refrigerated storage. The infusion of apoptotic cells has recently been
shown in animal models to be immunosuppressive. Immunosuppression resulting
from the infusion of apoptotic cells may be linked to transforming growth
factor beta (TGF-beta). N.
Ref:: 10
----------------------------------------------------
[85]
TÍTULO / TITLE: - Pyogenic granuloma in a
renal transplant patient: case report.
REVISTA
/ JOURNAL: - Spec Care Dentist 2001
Sep-Oct;21(5):187-90.
AUTORES
/ AUTHORS: - al-Zayer M; da Fonseca M; Ship JA
INSTITUCIÓN
/ INSTITUTION: - Department of Orthodontics and Pediatric
Dentistry, University of Michigan School of Dentistry, 1011 N. University Ave.,
Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - This case report describes a 14-year-old
female referred to Pediatric Dentistry for evaluation and treatment of
cyclosporine-induced gingival hyperplasia. Examination of the anterior
maxillary area showed a red, vascular, exophytic, soft-tissue mass which had
been excised a few months earlier without a histopathologic examination being
done. The mass did not appear consistent with gingival overgrowth induced by
long-term use of medication, and thus an excisional biopsy was performed, which
diagnosed the lesion as a pyogenic granuloma. A review of the literature and
management recommendations are discussed.
N. Ref:: 20
----------------------------------------------------
[86]
TÍTULO / TITLE: - Annual trends and
triple therapy--1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:247-69.
AUTORES
/ AUTHORS: - Nishikawa K; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, CA, USA.
RESUMEN
/ SUMMARY: - 1. Although the number of cadaver donor
transplants did not increase substantially over the past 10 years, unrelated
living donor grafts increased from 153 in 1991 to 1,661 through 2000. Use of
spousal and other unrelated donor organs contributed to this increase. There
was a modest increase in living-related donor transplants from 2,328 in 1991 to
3,451 in 2000. 2. Cadaver donor graft survival at one year improved from 84% in
1991 to 90% in 2000. In contrast, one-year graft survival of living donor
transplants only improved from 93% in 1991 to 95% in 2000. 3. Throughout the
10-year period, approximately 13% of transplants were repeat transplants from
cadaver donors and roughly 8% were regrafts from live donors. 4. Cadaver donor
transplants into White recipients declined from 68% in 1991 to 60% in 2000. For
living donors, the percentage of White patients remained constant at about 70%.
5. Graft survival in patients of all races was about equal at one year but
diverged at 3 years, with Asians having the highest and Blacks having the
lowest 3-year graft survival rates. 6. Average donor age increased from 31.7 in
1991 to 36 in 2000 for cadaveric donor transplants and 37.9 in 1991 to 40.4 in
2000 for living donor transplants. Cadaveric kidneys from donors older than 50
years of age yielded significantly lower 3-year graft survival. 7. Average
recipient age for cadaveric donor transplants increased from 42.1 in 1991 to
46.8 in 2000. The average recipient age for living donor transplants also
increased steadily from 33.7 in 1991 to 42.9 in 2000. There was relatively
little effect on graft survival rates for advanced age recipients. 8. The percentage
of sensitized recipients receiving cadaver donor grafts declined from 27% in
1991 to 21% in 2000. Similarly, sensitized recipients receiving living donor
grafts decreased from 17% in 1991 to 13% in 2000. Graft survival in patients
with more than 50% PRA was lower at 3 years for patients receiving cadaveric
donor grafts. Highly sensitized patients receiving living donor grafts had
graft survival rates similar to those who were not sensitized. 9. Cold ischemia
times decreased from an average of 24.2 hours in 1991 to 18.9 hours in 2000.
Improved graft survival rates over those 10 years were noted in all groups, and
even cold ischemia times more than 36 hours yielded 3-year graft survivals
comparable to those with lower cold ischemia times in 1998. 10. The need for
dialysis has remained constant at about 23% over the last 10 years for patients
receiving kidneys from cadaveric donors. The rate of dialysis for patients
receiving kidneys from living donors was about 5% for each of the 10 years
examined. First day anuria increased from 11% in 1991 to 16% in 2000 for
cadaver donor transplants and 3% in 1999 to 5% in 2000 for living donor grafts.
11. Cadaveric donor patients requiring dialysis had a 3-year graft survival
rate of 63% if there was no first day anuria and 56% if they had first day
anuria. This is in contrast to 80% 3-year graft survival for those with
immediate diuresis and no need for dialysis. The 3-year graft survival rate for
those receiving living donor grafts and needing dialysis was 58% if they had
first day diuresis and 41% if they ware anuric on the first day. Conversely,
those who had first day function and did not require dialysis had 89% 3-year
graft survival. 12. Among the patients receiving cadaveric grafts with first
day diuresis there was a marked reduction in those with rejection, from 21% in
1991 to 5% in 2000. Similarly, for this type of patient receiving living donor
grafts, the reduction was 17% in 1991 to 5% in 2000. However, graft survival
among these patients did not change significantly. The greatest improvement was
noted in those with first day anuria and no rejection. 13. Patients who did not
require dialysis, and had rejection prior to discharge decreased markedly from
17% in 1991 to 3% in 2000 in those receiving cadaveric grafts and 15% in 1991
to 3.9% in 2000 for those receiving living donors. Graft survival of cadaveric
transplants in those needing dialysis, with and without rejection, improved the
most in the 10 year period. 14. Hospitalization days for cadaveric transplant
recipients were reduced from 19 days in 1991 to 10 days in 2000 and 16 days in
1991 to 8 days in 2000 for recipients of living donor grafts. There was an
increase in discharge serum creatinine values from 2.3 mg/dl in 1991 to 3.3
mg/dl in 2000 for cadaver donor grafts. 15. Double therapy was utilized for
about 15% of cadaveric and living donors. There was a sharp increase in
induction therapy, peaking at 51% in 1994 and decreasing to 5% by 2000 for
cadaveric donor transplants. Induction did not improve graft survival for
either cadaver or living donor transplant recipients. 16. Triple therapy
improved graft survival of White and Black patients, but did not affect the
half-lives in either race. 17. The lower graft survival from older donors was
not affected by triple therapy for cadaver donor transplants. Triple therapy
removed the donor age effect for recipients of living donor grafts. 18. Triple
therapy practically eliminated the effect of sensitization for cadaveric donor
grafts. Both double and triple therapy virtually eliminated the sensitization
effect for living donors. 19. Triple therapy significantly improved the
survival of kidneys with more than 36 hours cold ischemia time so that 3-year
graft survival was 76% at 3 years compared with 81% for kidneys stored 1-12
hours. 20. Triple therapy improved the 3-year graft survival of kidneys with
first day anuria from 50% for double therapy to 69% for triple therapy in
cadaver donor transplants. For living donor transplants, there was a similar
improvement from 57% with double therapy to 72% with triple therapy. 21. Triple
therapy improved the 3-year cadaveric graft survival rate of kidneys requiring
dialysis from 51% with double therapy to 67% for triple therapy. There was a
similar improvement for living donors needing dialysis from 37% to 61% at 3
years.
----------------------------------------------------
[87]
TÍTULO / TITLE: - Superficial
leiomyosarcoma of the head and neck: case report and review of the literature.
REVISTA
/ JOURNAL: - Ear Nose Throat J 2001 Jul;80(7):449-53.
AUTORES
/ AUTHORS: - Snowden RT; Osborn FD; Wong FS; Sebelik ME
INSTITUCIÓN
/ INSTITUTION: - Department of Otolaryngology-Head and Neck
Surgery, University of Tennessee, 956 Court Ave., B219, Memphis, TN 38163, USA.
tsnowden@utmem.edu
RESUMEN
/ SUMMARY: - Superficial leiomyosarcomas are rare in
the head and neck region. Because of the infrequent nature of soft tissue
sarcomas in general, superficial leiomyosarcomas are often misdiagnosed on
clinical grounds. Immunohistochemistry is essential for an accurate histologic
diagnosis, and it should include a broad panel of antibody studies. With
respect to differences in clinical appearance and biologic behavior,
superficial leiomyosarcomas can be broadly classified as either cutaneous or
subcutaneous; local control and overall survival are significantly more
favorable in patients with the former. The primary treatment of a
leiomyosarcoma is a wide surgical excision with an emphasis on negative
margins. Treatment failures are usually attributable to a local recurrence.
Systemic metastasis occurs in about one-third of patients with subcutaneous
involvement. Although cutaneous leiomyosarcoma is considered a relatively more
benign process with minimal metastatic potential, systemic metastasis is still
possible. This was demonstrated in our case, as a recurrent cutaneous
leiomyosarcoma metastasized to the lung. Proper management requires inclusion
of this entity in the differential diagnosis, as well as familiarity with its
clinical behavior. In this article, we review the literature on superficial
leiomyosarcoma and discuss its epidemiology, presentation, clinical behavior,
evaluation, tissue diagnosis, staging, and treatment. N. Ref:: 24
----------------------------------------------------
[88]
TÍTULO / TITLE: - Chronic urticaria: a
role for newer immunomodulatory drugs?
REVISTA
/ JOURNAL: - Am J Clin Dermatol 2003;4(5):297-305.
AUTORES
/ AUTHORS: - Tedeschi A; Airaghi L; Lorini M; Asero R
INSTITUCIÓN
/ INSTITUTION: - Allergy and Immunopharmacology Unit, First
Division of Internal Medicine, IRCCS Ospedale Maggiore Policlinico, Milan,
Italy. aval.ted@tin.it
RESUMEN
/ SUMMARY: - Chronic urticaria is now recognized as an
autoreactive disorder in a substantial fraction of patients. A serologic
mediator of whealing has been demonstrated in 50-60% of patients with chronic
urticaria, and autoantibodies against the high affinity IgE receptor or IgE
have been detected in about half of these patients. The demonstration that
chronic urticaria is frequently autoimmune has encouraged a more aggressive
therapeutic approach, with the use of immunomodulatory drugs.A step-by-step
approach to the management of chronic urticaria is proposed, based on our
personal experience and review of current medical literature, identified
through Medline research and hand searching in medical journals.The non- or
low-sedating H(1) receptor antagonists (antihistamines), such as cetirizine,
fexofenadine, loratadine, mizolastine and, more recently, levocetirizine,
desloratadine and ebastine, represent the basic therapy for all chronic
urticaria patients. Older sedating antihistamines, such as hydroxyzine and
diphenhydramine, may be indicated if symptoms are severe, are associated with
angioedema, and if the patient is anxious and disturbed at night.Corticosteroid
therapy with prednisone or methylprednisolone can be administered for a few
days (7-14) if urticarial symptoms are not controlled by antihistamines and a
rapid clinical response is needed. In cases of relapse after corticosteroid
suspension, leukotriene receptor antagonists, such as montelukast and
zafirlukast, should be tried. In our experience, remission of urticarial
symptoms can be achieved in 20-50% of chronic urticaria patients unresponsive
to antihistamines alone. When urticaria is unremitting and is not controlled by
combined therapy with antihistamines and leukotriene receptor antagonists,
prolonged corticosteroid therapy may be needed. Long-term corticosteroid
therapy should be administered at the lowest dose able to control urticarial
symptoms, in order to minimize adverse effects. In a few patients, however,
high-dose corticosteroid therapy may have to be administered for long periods.
In these patients, immunosuppressive treatment with low-dose cyclosporine can
be started. This type of treatment has a corticosteroid-sparing effect and is
also generally effective in patients with severe, unremitting urticaria, but
requires careful monitoring of cyclosporine plasma concentration and possible
adverse effects.Other immunomodulating drugs that have been tried in chronic
urticaria patients include hydroxychloroquine, dapsone, sulfasalazine and
methotrexate, but their efficacy has not been proven in large controlled
studies. Warfarin therapy may also be considered in some patients with chronic
urticaria and angioedema unresponsive to antihistamines. N. Ref:: 91
----------------------------------------------------
[89]
TÍTULO / TITLE: - Diagnosis and
management of aplastic anemia and myelodysplastic syndrome.
REVISTA
/ JOURNAL: - Oncology (Huntingt) 2002 Sep;16(9 Suppl
10):153-61.
AUTORES
/ AUTHORS: - Paquette RL
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology/Oncology, University
of California at Los Angeles, 90095-1678, USA. paquette@ucla.edu
RESUMEN
/ SUMMARY: - The bone marrow failure states, aplastic
anemia and myelodysplastic syndrome, are characterized by reticulocytopenic anemia,
with variable neutropenia and thrombocytopenia. The bone marrow biopsy is very
hypocellular in aplastic anemia, but it is usually hypercellular in
myelodysplastic syndrome. Marrow cytogenetic abnormalities are present in
approximately half of myelodysplastic syndrome patients but are absent in
aplastic anemia. Allogeneic bone marrow transplantation is the treatment of
choice for young patients with severe aplastic anemia. Immunosuppressive
therapy with antithymocyte globulin (ATG) and cyclosporine is used when
transplantation is not the initial therapeutic choice; it induces responses in
65% to 80% of patients. Treatment of myelodysplastic syndrome is dependent upon
risk classification, and patient age and performance status. Allogeneic stem
cell transplantation should be considered for younger myelodysplastic syndrome
patients. An acute myelogenous leukemia (AML) type of induction chemotherapy
may benefit high-risk patients with a good performance status for whom
allogeneic transplantation is not an option. Patients achieving a complete
remission to induction chemotherapy may be considered for autologous stem cell
transplantation. However, aggressive therapy is an option for only a minority
of myelodysplastic syndrome patients; most receive supportive care. Anemia, and
its related symptoms, is the principal problem for most myelodysplastic
syndrome patients. Erythropoietin administration ameliorates anemia in a
minority of myelodysplastic syndrome patients. A wide variety of novel
experimental approaches including immunosuppressive therapy, angiogenesis
inhibitors, platelet growth factors, and demethylating agents are now under
investigation for myelodysplastic syndrome.
N. Ref:: 53
----------------------------------------------------
[90]
TÍTULO / TITLE: - Autoimmune haemolytic
anaemia in a newborn infant.
REVISTA
/ JOURNAL: - Arch Dis Child Fetal Neonatal Ed 2003
Jul;88(4):F341-2.
AUTORES
/ AUTHORS: - Motta M; Cavazza A; Migliori C; Chirico G
INSTITUCIÓN
/ INSTITUTION: - Division of Neonatology and Neonatal
Intensive Care, Spedali Civili, Brescia, Italy.
RESUMEN
/ SUMMARY: - The case is reported of an infant with
autoimmune haemolytic anaemia of perinatal onset. Combined treatment with
steroids and cyclosporin was necessary to improve haemolysis and reduce the
high transfusion requirements. Treatment was discontinued at 13 months of age.
The child was healthy at the follow up at 24 and 36 months of age. N. Ref:: 10
----------------------------------------------------
[91]
TÍTULO / TITLE: - Cutaneous lupus
erythematosus: diagnosis and management.
REVISTA
/ JOURNAL: - Am J Clin Dermatol 2003;4(7):449-65.
AUTORES
/ AUTHORS: - Fabbri P; Cardinali C; Giomi B; Caproni M
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatological Sciences,
University of Florence, Florence, Italy. fabbri@unifi.it
RESUMEN
/ SUMMARY: - Cutaneous lupus erythematosus (CLE)
includes a variety of lupus erythematosus (LE)-specific skin lesions that are
subdivided into three categories - chronic CLE (CCLE), subacute CLE (SCLE) and
acute CLE (ACLE) - based on clinical morphology, average duration of skin
lesions and routine histopathologic examination. This paper describes our
personal experience in the management of CLE over the last 30 years, with
details on preferential therapeutic options related to clinical, histologic and
immunopathologic aspects of each clinical subset of the disease. Effective
sunscreening and sun protection are considered the first rule in the management
of CLE because of the high degree of photosensitivity of the disease.
Antimalarial agents are crucial in the treatment of CLE and are the first-line
systemic agents, particularly in discoid LE (DLE) and SCLE. Dapsone is the drug
of choice for bullous systemic LE (BSLE) as well as for LE in small dermal
vessels (e.g. leukocytoclastic vasculitis). Retinoids, known as second-line
drugs for systemic therapy, are sometimes used to treat chronic forms of CLE
and are particularly successful in treating hypertrophic LE. Systemic
immunosuppressive agents are required to manage the underlying systemic LE
disease activity in patients with ACLE. These drugs, especially azathioprine,
methotrexate, cyclophosphamide and cyclosporine, together with corticosteroids,
constitute third-line systemic therapy of CLE. In our experience, oral
prednisone or parenteral ‘pulsed’ methylprednisolone are useful in
exacerbations of disease activity. Thalidomide provides one of the most useful
therapeutic alternatives for chronic refractory DLE, although its distribution
is limited to a few countries because of the risk of teratogenicity and
polyneuropathy. However, medical treatment with local corticosteroids remains
the mainstay of CLE treatment, especially for DLE. Patient education regarding
the disease is also important in the management of CLE, because it helps
relieve undue anxiety and to recruit the patient as an active participant in
the treatment regimen. N.
Ref:: 113
----------------------------------------------------
[92]
TÍTULO / TITLE: - The role of
immunosuppression in lymphoma.
REVISTA
/ JOURNAL: - Recent Results Cancer Res 2002;159:55-66.
AUTORES
/ AUTHORS: - Trofe J; Buell JF; First MR; Hanaway MJ;
Beebe TM; Woodle ES
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Cincinnati, OH 45267-0558, USA.
RESUMEN
/ SUMMARY: - Post-transplant lymphoproliferative
disorder (PTLD) is a well-recognized yet serious complication in solid organ
transplant recipients and currently represents the second most common de novo
malignancy following solid organ transplantation. PTLD has been noted in all
transplant immunosuppressive eras including the pre-cyclosporine, cyclosporine,
and post-cyclosporine eras. The time from organ transplantation to PTLD
presentation varies widely from less than 1 month to several years. PTLD
presents with a broad spectrum of clinical manifestations depending on the
transplanted organ, immunosuppressive therapy and patient age. Intense
immunosuppressive therapy is a major risk factor for development of PTLD.
Whenever a new agent is introduced, there is a learning curve that leads to
dosing modifications, which in turn result in optimization of its
immunosuppressive efficacy and reduction of toxicities, including PTLD. We
review the major historical and recent immunosuppression trials to assess the
impact of individual immunosuppressive agents and regimens on PTLD risk. N. Ref:: 34
----------------------------------------------------
[93]
TÍTULO / TITLE: - Severe aplastic anemia
and allogeneic hematopoietic stem cell transplantation.
REVISTA
/ JOURNAL: - AACN Clin Issues 2002 May;13(2):169-91.
AUTORES
/ AUTHORS: - Myer SA; Oliva J
INSTITUCIÓN
/ INSTITUTION: - Department of Nursing, State University of
New York at Brockport, NY 14420, USA. smyer@brockport.edu
RESUMEN
/ SUMMARY: - Aplastic anemia is a form of bone marrow
failure that ranges in severity from mild to severe. In all cases, some degree
of pancytopenia is present. The cause usually is unknown, although many drugs
and viruses are associated with the disease. The pathophysiology of aplastic
anemia involves either a stem cell defect or injury or an immunologically
mediated hematopoietic cell destruction, which may operate in concert with
abnormalities in programmed cell death. Excellent clinical care and research
have dramatically improved patient survival, with 70% to 90% of sibling
hematopoietic stem cell transplant recipients surviving long term. Patients
with mild or moderate disease may not require immediate treatment. If and when
these patients require treatment, the mainstay of therapy is immunosuppression.
The initial drug regimen includes antithymocyte globulin, often in combination
with cyclosporine A, followed by moderate-dose steroids and cyclophosphamide.
Nurses assess and monitor patients and their progress, recognizing medication
adverse effects. Nurses educate patients about their disease and its treatment,
and provide necessary emotional support. Severe aplastic anemia is treated with
allogeneic hematopoietic stem cell transplantation. This therapy involves
complex nursing challenges. The patient goes through an extensive
pretransplantation workup. Donor selection and harvesting of hematopoietic stem
cells are preludes to an intensive preparative regimen. This preparative or
conditioning regimen and the need for long-term immunosuppression are the
reasons for many of the acute complications and adverse events that may follow
the hematopoietic stem cell transplantation. Nurses must be vigilant in
assessing and monitoring patients for toxicities and long-term complications
that may affect almost any organ system.
N. Ref:: 86
----------------------------------------------------
[94]
TÍTULO / TITLE: - Maintenance
immunosuppression.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:223-36.
AUTORES
/ AUTHORS: - Takemoto SK
RESUMEN
/ SUMMARY: - An “intent-to-treat” analysis was
developed to examine the administration of primary and adjunctive
immunosuppressive agents by year of transplant for unsensitized, sensitized,
multi-organ and living donor transplant recipients by centers reporting to the
UNOS Registry of Renal Transplant Recipients. Based on these analyses, several
trends were noted: Tacrolimus became the dominant primary agent for multi-organ
transplant recipients in 1998, sensitized recipients in 2000, and unsensitized
and living-donor transplant recipients in 2001. MMF became the dominant
adjunctive agent for all transplants studied in 1996. The combination of
CsA-MMF was most often administered to unsensitized and living donor recipients
while Tac-MMF was most often used for multi-organ transplants. The trend of
decreasing rejection rates from 60% in 1996 to 20% in 2001 was similar for each
type of transplant studied. Rejection rates were highest with the Csa-Aza
combination and lowest with the Tac-MMF combination. Combinations with the
lowest rates of rejection did not necessarily have the highest graft outcome.
HLA matching decreased rejection rates and improved graft outcome for each type
of transplant and immunosuppression combination. Graft outcome in HLA-matched
living donor transplants was highest with the less potent CsA-Aza combination
and lowest with the Tac-MMF combination. Treatment crossover from CsA to Tac or
Aza to MMF was least frequent among HLA-matched recipients. Crossover from MMF
to Aza was highest in HLA-matched living donor transplants.
----------------------------------------------------
[95]
TÍTULO / TITLE: - Psoriasis in children:
a guide to its diagnosis and management.
REVISTA
/ JOURNAL: - Paediatr Drugs 2001;3(9):673-80.
AUTORES
/ AUTHORS: - Leman J; Burden D
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Western
Infirmary, Glasgow, Scotland.
RESUMEN
/ SUMMARY: - Psoriasis often presents in childhood. The
diagnosis may be challenging if the disease is mild or the presentation is
atypical. All of the forms recognised in adults are encountered in childhood
(plaque, guttate, erythrodermic and pustular). Guttate and flexural forms are
particularly common in children. Successful management requires education of
the child and parents regarding the course of the disease and treatment
options. Environmental triggers should be sought out and eliminated where
possible. Most patients respond to topical treatment with emollients, coal tar,
anthralin (dithranol) or calcipotriol. Treatment is tailored according to
patient age, extent and distibution of psoriasis. For those who fail to
respond, daycare or inpatient care is appropriate. Phototherapy with UVB may be
combined with topical agents. Systemic therapy is required in a minority,
usually those with resistant or erythrodermic disease, pustular psoriasis and
arthropathic psoriasis. Retinoids are probably the systemic agent of choice.
There are few data regarding the use of methotrexate or cyclosporin in
childhood psoriais. N.
Ref:: 55
----------------------------------------------------
[96]
TÍTULO / TITLE: - New monoclonal
antibodies in renal transplantation.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):57-66.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - Kidney Transplant Service, University of
California, San Francisco, CA 94143-0780, USA. vincentif@surgery.ucsf.edu
RESUMEN
/ SUMMARY: - A decade of spectacular innovation in
maintenance immunosuppression drugs has resulted in dramatic reductions in
acute rejection and improvement in short and long term outcome after renal
transplantation. However the new drugs continue to lack specificity, many
require frequent therapeutic drug monitoring and all are associated with acute
and chronic toxicities. The new biologic agents, monoclonal antibodies
(chimeric, humanized, and fully human) and receptor-fusion proteins, lack
immunogenicity, have long half-life and prolonged biologic effects, require
intermittent administration and have minimal toxicity. The specificity and
selectively of the targets of the new biologic agents render them less toxic
than the oral maintenance drugs and thus could possibly replace the maintenance
drugs most associated with long-term toxicity such as the corticosteroids and
the calcineurin inhibitors. The recently introduced anti-interleukin 2 receptor
(IL-2R) monoclonal antibodies (mAbs) are the prototype of future biologic agents;
selective, safe, and inducing prolonged biologic effects. The IL-2R mAbs have
been used with a variety of maintenance immunosuppression regimens double
therapy with cyclosporine and prednisone, triple therapy with cyclosporine,
azathioprine and prednisone and with newer regimens such as cyclosporine or
tacrolimus, mycophenolate mofetil (MMF) and prednisone, and most recently with
sirolimus, MMF and prednisone. The major thrust of the new biologics in
clinical development is to block the co-stimulatory pathway. The first attempt
at blockade of the CD40-CD154 with anti-CD154 mAbs was disappointing. Anti-CD
154 therapy was associated with thromboembolic events and acute rejection.
Attempts at blocking the CD28-B7s (CD80-CD86) pathway are currently underway
with the receptor fusion protein, LEA29Y a second generation CTL4Aig, and
humanized mAbs to CD 80 and CD86. LFA1, an adhesion molecule that also
participates in the co-stimulatory pathway, has also been targeted with a mAb
that binds to the CD11a chain of LFA1. Efalizumab, a humanized anti-CD11a mAb,
was shown in a phase I trial to be potentially effective in renal
transplantation. A humanized anti-CD45 RB mAb is currently in pre-clinical
studies and will likely be tested in a phase I trial of renal transplantation
within 1 year. While excellent results with anti-CD45 RB mAbs have been
published in experimental transplantation, the mechanism of action of anti-CD45
RB mAbs remains to be determined. Several antibodies that are currently
approved for non-transplant indications are currently used in single center
clinical trials in renal transplantation including Campath 1 H, a humanized
anti-CD52 mAb, Rituxamab, an anti-CD20 chimeric mAb, and Infliximab an
anti-TNFa chimeric mAb. In addition, several humanized mutagenized anti-CD3
mAbs, huOKT3g1, aglycosyl CD3 and HuM291 have been used in limited trials in
renal transplantation but have yet to have a formal clinical development.
Humanized mAbs and receptor fusion proteins offer the potential of providing renal
transplant recipients with a novel algorithm for immunosuppression that relies
on chronic intermittent intravenous administration of safe, non-toxic agents
replacing oral drug therapy maintenance.
N. Ref:: 50
----------------------------------------------------
[97]
TÍTULO / TITLE: - An update in transplant
immunosuppressive therapy.
REVISTA
/ JOURNAL: - Med Health R I 2002 Apr;85(4):131-3.
AUTORES
/ AUTHORS: - Thursby MA; Yango AF; Gohh RY
INSTITUCIÓN
/ INSTITUTION: - Rhode Island Hospital, Division of Renal
Diseases, 593 Eddy Street, Providence, RI 02903, USA. Mthursby@lifespan.org N. Ref:: 10
----------------------------------------------------
[98]
TÍTULO / TITLE: - Protocol biopsy and
subclinical rejection in patients after kidney transplantation treated by
tacrolimus (Prograf).
REVISTA
/ JOURNAL: - Biomed Pap Med Fac Univ Palacky Olomouc
Czech Repub 2003 Dec;147(2):193-6.
AUTORES
/ AUTHORS: - Zadrazil J; Krejci K; Al-Jabry S; Horcicka
V Jr; Tichy T; Hrabalova M; Bachleda P
INSTITUCIÓN
/ INSTITUTION: - 3rd Clinic of Internal
Medicine, Teaching Hospital, I. P. Pavlova 22, Olomouc, 775 00, Czech Republic.
RESUMEN
/ SUMMARY: - The article deals with the contribution of
tacrolimus (Prograf) to improvement in kidney transplant results. Tacro-limus,
in comparison with cyclosporine significantly reduces the incidence of acute
rejection and improves survival of grafts as well as patients. Based on the
literature, the primary immunological differences between tacrolimus and
cyclosporine effects are pointed out. These differences explain the better
immunosuppressive effectiveness of tacrolimus. Based on analysis of the
results, subclinical rejection problems and significance of protocol biopsy for
present-day transplantology are discussed. There is also a critical analysis of
the questions, which priority, in relationship to the expanding availability of
immunosuppressive substances currently has high interest for nephrologists
researching subclinical rejection.
----------------------------------------------------
[99]
TÍTULO / TITLE: - Immunosuppression in
liver transplantation.
REVISTA
/ JOURNAL: - Minerva Chir 2003 Oct;58(5):725-40.
AUTORES
/ AUTHORS: - Everson GT; Trotter JF; Kugelmas M; Forman
L
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology and Department of Medicine, University of Colorado School of
Medicine, Denver, CO 80262, USA. greg.overson@uchsc.edu
RESUMEN
/ SUMMARY: - This article highlights the currently
available immunosuppressive medications that are used to prevent or treat
hepatic allograft rejection. Currently-available immunosuppressive medications
are highly effective in prevention of allograft rejection, graft loss, and
patient death. However, side effects of medications are common, usually
dose-related, and specific to the administered drug. Maintenance
immunosuppression which has been primarily based upon calcineurin inhibitors
(Cyclosporine, CsA, or tacrolimus, Tac) is commonly modified to reduce
metabolic complications of therapy. Toxic consequences of steroids may be
ameliorated by steroid withdrawal without risk of acute rejection or
immunologic graft loss. Calcineurin-sparing regimens may include use of mycophenolate
mofetil (MMF) or sirolimus, and allow reduction in doses and plasma levels of
CsA and Tac. Recurrence of hepatitis C is universal after liver transplantation
and progresses rapidly, compared to its natural history in
non-immunocompromised patients. Unfortunately, no single immunosuppressive
agent or strategy has yet been shown to convincingly modify the course of
post-transplant recurrence. Most centers manage recurrenc hepatitis C by either
steroid avoidance, reduction in immunosuppression, or institution of antiviral
therapy. Ongoing advances in immunosuppressive and antiviral medications will
allow tailoring of the immunosuppressive prescription, which undoubtedly will
benefit current and future liver recipients.
N. Ref:: 88
----------------------------------------------------
[100]
TÍTULO / TITLE: - The management of
immunosuppression: the art and the science.
REVISTA
/ JOURNAL: - Crit Care Nurs Q 2004 Jan-Mar;27(1):61-4.
AUTORES
/ AUTHORS: - Mancini MC; Cush EM; Launius BK; Brown PA
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Louisiana State
University Health Sciences Center, Shreveport, La, USA.
RESUMEN
/ SUMMARY: - The optimal use of immunosuppressant drugs
requires an understanding of their mechanism of action as well as a basic
understanding of the biology of transplant rejection and tolerance. The ability
to tailor a drug regimen that strikes a fine balance between allograft
maintenance and patient well-being demands a sensitivity to the patient’s needs
and expectations as well. The object of this article is to cover the basic
biological principles involved in selecting an immunosuppressant protocol while
sharing our experiences with these various regimen. N. Ref:: 19
----------------------------------------------------
[101]
TÍTULO / TITLE: - Kidney transplantation
from living donors: comparison of results between related and unrelated donor
transplants under new immunosuppressive protocols.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2003 Sep;5(9):622-5.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai EL; Yussim
A; Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Center of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - BACKGROUND: Recent advances in
immunosuppressive therapy have led to a substantial improvement in the outcome
of kidney transplantation. Living unrelated donors may become a source of
additional organs for patients on the kidney waiting list. OBJECTIVES: To study
the impact of the combination of calcineurin inhibitors and mycophenolate-mofetile,
together with steroids, on outcomes of living related and unrelated
transplants. METHODS: Between September 1997 and January 2000, 129 patients
underwent living related (n = 80) or unrelated (n = 49) kidney transplant. The
mean follow-up was 28.2 months. Immunosuppressive protocols consisted of MMF
with cyclosporine (41%) or tacrolimus (59%), plus steroids. Patient and graft
survival data, rejection rate, and graft functional parameters were compared
between the groups. RESULTS: LUD recipients were older (47.8 vs. 33.6 years)
with a higher number of re-transplants (24.5% vs. 11.2% in LRD recipients, P
< 0.05). Human leukocyte antigen matching was higher in LRD recipients (P
< 0.001). Acute rejection developed in 28.6% of LUD and 27.5% of LRD
transplants (P = NS). Creatinine levels at 1, 2 and 3 years post-transplant
were 1.6, 1.7 and 1.7 mg/dl for LRD patients and 1.5, 1.5 and 1.3 mg/dl for LUD
recipients (P = NS). There was no difference in patient survival rates between
the groups. One, 2 and 3 years graft survival rates were similar in LRD (91.3%,
90% and 87.5%) and LUD (89.8%, 87.8% and 87.8%) recipients. CONCLUSIONS:
Despite HLA disparity, rejection and survival rates of living unrelated
transplants under current immunosuppressive protocols are comparable to those
of living related transplants.
----------------------------------------------------
[102]
TÍTULO / TITLE: - Evolution of biologic
therapies for the treatment of psoriasis.
REVISTA
/ JOURNAL: - Skinmed 2003 Sep-Oct;2(5):286-94.
AUTORES
/ AUTHORS: - Gordon KB; McCormick TS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Dermatology, Loyola University, Stritch School of Medicine, Maywood, IL 60153,
USA. kgordon@lumc.edu
RESUMEN
/ SUMMARY: - Over the past three decades, laboratory
and clinical research findings have shown that T cells are the primary
mediators of psoriasis pathogenesis and that psoriasis can be treated by
eliminating these T cells or interfering with their activation or activity.
Based on these observations, many new biologic therapies to treat psoriasis are
now in development. These agents, developed primarily through recombinant DNA
techniques, are designed to target T cells and the immunologic cascade
associated with their activation. Four basic strategic approaches that focus on
the steps involved in the immunopathology of psoriasis are: 1) elimination of
the pathogenic T cells; 2) inhibition of T-cell activation, proliferation, and
migration; 3) immune deviation to down-regulate the type 1 (TH1) response
predominant in psoriasis; and 4) blockade of cytokine production. The goal of
these new therapies is to improve the treatment of psoriasis, particularly
moderate to severe disease, with agents that are well tolerated and safe for
long-term use. N.
Ref:: 52
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