#04#
Revisiones-Clínica-Epidemiología,
Higiene & Prevención *** Reviews-Clinical-Epidemiology, Hygiene &
Prevention
INMUNOSUPRESIÓN
*** IMMUNOSUPPRESSION
(Conceptos
/ Keywords: Immunosuppression; Immunosuppressive ag.; Transpl. immunol.; GVH;
Antirejection therapy; Lymphocyte depletion; Transpl. conditioning; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Nystatin prophylaxis
and treatment in severely immunodepressed patients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2002;(4):CD002033.
AUTORES
/ AUTHORS: - Gotzsche PC; Johansen HK
INSTITUCIÓN
/ INSTITUTION: - The Nordic Cochrane Centre,
Rigshospitalet, Dept. 7112, Blegdamsvej 9, Copenhagen O, Denmark, 2100. p.c.gotzsche@cochrane.dk
RESUMEN
/ SUMMARY: - BACKGROUND: Nystatin is sometimes used
prophylactically in patients with severe immunodeficiency or in the treatment
of fungal infection in such patients, although the effect seems to be
equivocal. OBJECTIVES: To study whether nystatin decreases morbidity and
mortality when given prophylactically or therapeutically to patients with
severe immunodeficiency. SEARCH STRATEGY: MEDLINE and The Cochrane Library
using a comprehensive search strategy, date of last search November 2001.
Contacted industry and scanned reference lists. SELECTION CRITERIA: Randomised
trials comparing nystatin with placebo, an untreated control group, fluconazole
or amphotericin B. DATA COLLECTION AND ANALYSIS: Data on mortality, invasive
fungal infection and colonisation were extracted by both authors independently.
A random effects model was used unless p>0.10 for the test of heterogeneity.
MAIN RESULTS: We included 12 trials (1,464 patients). The drugs were given
prophylactically in ten trials and as treatment in two. Seven trials were in
acute leukaemia, two in cancer, one in liver transplant patients, one in
critically ill surgical and trauma patients, and one in AIDS patients. Nystatin
had been compared with placebo in three trials and with fluconazole in nine;
the dose varied from 1.5 MIE to 72 MIE daily. The effect of nystatin was
similar to that of placebo on fungal colonisation (relative risk 0.85, 95%
confidence interval 0.65 to 1.13). There was no statistically significant
difference between fluconazole and nystatin on mortality (relative risk 0.76,
0.49 to 1.18) whereas fluconazole was more effective in preventing invasive
fungal infection (relative risk 0.37, 0.15 to 0.91) and colonisation (relative
risk 0.49, 0.34 to 0.70). The results were very similar if the three studies
which were not performed in cancer patients were excluded. REVIEWER’S
CONCLUSIONS: Nystatin cannot be recommended for prophylaxis or treatment of
Candida infections in immunodepressed patients. N. Ref:: 22
----------------------------------------------------
[2]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Novel therapeutic
molecular targets for prostate cancer: the mTOR signaling pathway and epidermal
growth factor receptor.
REVISTA
/ JOURNAL: - J Urol 2004 Feb;171(2 Pt 2):S41-3;
discussion S44.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000108100.53239.b7
AUTORES
/ AUTHORS: - Tolcher AW
INSTITUCIÓN
/ INSTITUTION: - Director Clinical Research, Institute for
Drug Development Cancer Therapy and Research Center, San Antonio, Texas, USA.
RESUMEN
/ SUMMARY: - PURPOSE: The scientific rationale and
existing evidence for the use of novel molecular targets in the chemoprevention
of cancer are reviewed, with special attention to prostate cancer. MATERIALS
AND METHODS: A search for relevant literature on basic science and clinical
trials was conducted using PubMed/MEDLINE. RESULTS: The emergence of
molecularly targeted therapies for advanced malignancies creates an important
opportunity to examine these agents for the chemoprevention of prostate cancer.
Two critical targets in the proliferation and malignant transformation of
normal cells, the PI3/Akt signal transduction pathway and the epidermal growth
factor receptor, are currently the focus of several novel investigational
therapies that are in late stage phase II and phase III studies. CONCLUSIONS:
Research to date supports consideration of these novel molecular targets as
future agents in the chemoprevention of prostate cancer. N. Ref:: 28
----------------------------------------------------
[4]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[5]
TÍTULO / TITLE: - Depletion of host
reactive T cells by photodynamic cell purging and prevention of graft versus
host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Nov;44(11):1871-9.
AUTORES
/ AUTHORS: - Goggins TF; Chao N
INSTITUCIÓN
/ INSTITUTION: - Hematology-Oncology, Duke University
Medical Center, 2400 Pratt Street, Ste. 1100, Durham, NC 27710, USA. goggi002@mc.duke.edu
RESUMEN
/ SUMMARY: - Graft versus Host Disease (GVHD) is the
principal cause of morbidity and mortality in patients undergoing allogeneic
stem cell transplant. T cell depletion has been recognized as a method of
reducing the incidence of GVHD in allogeneic transplants. Until recently, most
T cell depletion methods were non-selective in reducing lymphocytes. Rhodamine
purging is one method, which selectively reduces alloreactive T cells
preventing GVHD. We review here the methods of non-selective and selective T
cell depletion, particularly the newer method of photodynamic purging utilizing
rhodamine. N. Ref:: 129
----------------------------------------------------
[6]
TÍTULO / TITLE: - Patient and graft
survival following liver transplantation for hepatitis C: much ado about
something.
REVISTA
/ JOURNAL: - Gastroenterology 2002 Apr;122(4):1162-5.
AUTORES
/ AUTHORS: - Charlton M N. Ref:: 20
----------------------------------------------------
[7]
TÍTULO / TITLE: - Fulminant hepatic
failure secondary to acetaminophen poisoning: a systematic review and
meta-analysis of prognostic criteria determining the need for liver
transplantation.
REVISTA
/ JOURNAL: - Crit Care Med 2003 Jan;31(1):299-305.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.CCM.0000034674.51554.4C
AUTORES
/ AUTHORS: - Bailey B; Amre DK; Gaudreault P
INSTITUCIÓN
/ INSTITUTION: - Division of Emergency Medicine, Department
of Pediatrics, Hopital Ste-Justine, Universite de Montreal, Quebec, Canada. baileyb@med.umontreal.ca
RESUMEN
/ SUMMARY: - OBJECTIVES: To summarize and compare
different prognostic criteria used to determine need for liver transplantation
in patients with fulminant hepatic failure secondary to acetaminophen
poisoning. DATA SOURCES: Studies published in the literature that investigated
criteria for hepatic transplantation secondary to acetaminophen-induced liver
failure as identified by a preestablished MEDLINE strategy (1966 through
October 2001). STUDY SELECTION: Studies were included if 2 x 2 tables could be
reconstructed and if they did not assume that patients undergoing transplantation
would have eventually died had they not received the transplant. DATA
EXTRACTION: Relevant articles were reviewed by two authors independently.
Discrepancies or disagreements, if any, on the inclusion or exclusion of
studies were resolved by consulting the third author. DATA SYNTHESIS: King’s
criteria (pH < 7.30 or prothrombin time of >100 secs plus creatinine of
>300 micromol/L plus encephalopathy grade of > or =3) were evaluated in
nine studies, pH < 7.30 in four, prothrombin time of >100 secs in three,
prothrombin time of >100 secs plus creatinine of >300 micromol/L plus
encephalopathy grade of > or =3 in three, creatinine of >300 micromol/L
in two, and one each for increase in prothrombin time day 4, factor V of
<10%, Acute Physiology and Chronic Health Evaluation (APACHE) II score of
>15, and Gc-globulin of <100 mg/L. King’s criteria were more sensitive
than pH: 69% (95% confidence interval, 63-75) vs. 57% (95% confidence interval,
44-68). Their specificities were, however, comparable: 92% (95% confidence
interval, 81-97) vs. 89% (95% confidence interval, 62-97). APACHE II score of
>15 had the highest positive likelihood ratio (16.4) and the lowest negative
likelihood ratio (0.19) but was evaluated in only one study. The accuracy
measures of all other criteria were lower than that of King’s criteria or pH
< 7.30. CONCLUSIONS: Presently, available criteria are not very sensitive
and may miss patients requiring transplantation. Future studies should further
evaluate the efficacy of the APACHE II criteria. N. Ref:: 33
----------------------------------------------------
[8]
TÍTULO / TITLE: - Suppression of
graft-versus-host disease by naturally occurring regulatory T cells.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S9-S11.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106475.38978.11
AUTORES
/ AUTHORS: - Zeng D; Lan F; Hoffmann P; Strober S
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology and Immunology,
Department of Medicine, Stanford University School of Medicine, Stanford, CA
94305, USA.
RESUMEN
/ SUMMARY: - Studies of graft-versus-host disease after
allogeneic bone marrow transplantation have shown that there are subsets of freshly
isolated donor T cells that induce the disease and subsets that suppress the
disease. The balance of subsets in the graft determines disease severity. The
authors’ work on the nature of the regulatory-suppressor T cells and their
mechanisms of action is summarized in this article. N. Ref:: 24
----------------------------------------------------
[9]
TÍTULO / TITLE: - Diagnosis and therapy
of coronary artery disease in renal failure, end-stage renal disease, and renal
transplant populations.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):214-27.
AUTORES
/ AUTHORS: - Logar CM; Herzog CA; Beddhu S
INSTITUCIÓN
/ INSTITUTION: - Renal Section, Salt Lake VA Healthcare
System, Department of Medicine, University of Utah School of Medicine, Salt
Lake City, USA.
RESUMEN
/ SUMMARY: - Even though cardiovascular disease is the
leading cause of death in patients with CRF and end-stage renal disease (ESRD),
ill-conceived notions have led to therapeutic nihilism as the predominant
strategy in the management of cardiovascular disease in these populations. The
recent data clearly support the application of proven interventions in the
general population, such as angiotensin-converting enzyme inhibitors and
statins to patients with CRF and ESRD. The advances in coronary stents and
intracoronary irradiation have decreased the restenosis rates in renal failure
patients. Coronary artery bypass with internal mammary graft might be the
procedure of choice for coronary revascularization in these patients. The role
of screening for asymptomatic coronary disease is established as a
pretransplant procedure, but it is unclear whether this will be applicable to
all patients with ESRD. Future studies need to focus on unraveling the
mechanisms by which uremia leads to increased cardiovascular events to design
optimal therapies targeted toward these mechanisms and improve cardiovascular
outcomes. N. Ref:: 125
----------------------------------------------------
[10]
TÍTULO / TITLE: - Drug-eluting stents in
vascular intervention.
REVISTA
/ JOURNAL: - Lancet 2003 Jan 18;361(9353):247-9.
AUTORES
/ AUTHORS: - Fattori R; Piva T
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Cardiovascular
Unit, University Hospital S Orsola, 40138, Bologna, Italy. ross@med.unibo.it
RESUMEN
/ SUMMARY: - CONTEXT: Restenosis is the most important
long-term limitation of stent implantation for coronary artery disease,
occurring in 15-60% of patients. In-stent restenosis, a refractory coronary
lesion resulting from neointimal hyperplasia, challenges both vascular
biologist and interventional cardiologist. Various drugs and devices have been
used tried to overcome restenosis but are not particularly successful. Over
1500000 percutaneous coronary interventions are done annually. Restenosis is
not only important clinically but also for its impact on health-care costs.
STARTING POINT: Growth and migration of vascular smooth-muscle cells result in
neointimal proliferation after vascular injury and are the key mechanism of
in-stent restenosis. The rationale of the most recent approaches to restenosis
(eg, brachytherapy and immunosuppressive agents) arises from the similarity
between tumour-cell growth and the benign tissue proliferation which
characterises intimal hyperplasia. Several immunosuppressants have been tested
for their potential to inhibit restenosis, with the novel strategy of
administering the drug via a coated stent platform. Local drug delivery
achieves higher tissue concentrations of drug without systemic effects, at a
precise site and time. The first multicentre trial with stents coated with
sirolimus was by Marie-Claude Morice and colleagues (N Engl J Med 2002; 346:
1773-80). In a trial of 238 patients, restenosis of 50% or more at 6 months was
0% and 27% with sirolimus or normal stents (p<0.001), respectively, after
percutaneous revascularisation. Muzaffer Degertekin and colleagues (Circulation
2002; 106: 1610-13) present data on 2-year follow-up of 15 patients who had
been implanted with the sirolimus stent in another study, and confirm
persistent inhibition of restenosis and an absence of unexpected adverse
events. WHERE NEXT? Local application of antiproliferative agents is a
promising technique and research is developing. Other agents with potential
benefits (eg, statins, local gene-therapy, adenovirus-mediated arterial
gene-transfer, L-arginine, abciximab, angiopeptin, recombinant pegylated
hirudin, and hiloprost) as well as improvements in polymer technology
(biodegradable smart polymers, coatings for multiple-drug release) are under
evaluation. The clinical impact of the elimination of restenosis may influence
the approach to coronary artery disease, the future of cardiac surgery, and
health-care economics in cardiology. N.
Ref:: 22
----------------------------------------------------
[11]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
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 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma,
antiviral treatment with acyclovir, valacyclovir or ganciclovir may be initiated
for at least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[12]
TÍTULO / TITLE: - Regulatory (suppressor)
T cells in peripheral allograft tolerance and graft-versus-host reaction.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107184.18562.FC
AUTORES
/ AUTHORS: - Rifle G; Herve P
INSTITUCIÓN
/ INSTITUTION: - UPRES EA563, Faculte de Medecine, Universite
de Bourgogne and Department of Nephrology-Intensive Care-Transplantation,
Hopital du Bocage, Dijon, France. gerard.rifle@chu-dijon.fr.
RESUMEN
/ SUMMARY: - Among the mechanisms capable of inducing peripheral
tolerance, regulatory (suppressor) T cells (Treg) probably play a key role in
the control of both reactivity to self-antigens and alloimmune response.
Augmentation or manipulation of Treg could improve organ allograft survival or
control graft-versus-host disease, thus resulting in operational tolerance. The
role of this immunomanipulation as one method of inducing tolerance has yet to
be clearly defined. N.
Ref:: 14
----------------------------------------------------
[13]
TÍTULO / TITLE: - Nystatin prophylaxis
and treatment in severely immunodepressed patients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2002;(2):CD002033.
AUTORES
/ AUTHORS: - Gotzsche PC; Johansen HK
INSTITUCIÓN
/ INSTITUTION: - The Nordic Cochrane Centre, Rigshospitalet,
Dept. 7112, Blegdamsvej 9, Copenhagen O, Denmark, 2100. p.c.gotzsche@cochrane.dk
RESUMEN
/ SUMMARY: - BACKGROUND: Nystatin is sometimes used
prophylactically in patients with severe immunodeficiency or in the treatment
of fungal infection in such patients, although the effect seems to be
equivocal. OBJECTIVES: To study whether nystatin decreases morbidity and
mortality when given prophylactically or therapeutically to patients with
severe immunodeficiency. SEARCH STRATEGY: MEDLINE and The Cochrane Library
using a comprehensive search strategy, date of last search November 2001.
Contacted industry and scanned reference lists. SELECTION CRITERIA: Randomised
trials comparing nystatin with placebo, an untreated control group, fluconazole
or amphotericin B. DATA COLLECTION AND ANALYSIS: Data on mortality, invasive
fungal infection and colonisation were extracted by both authors independently.
The outcomes were weighted by the inverse variance. A random effects model was
used unless p>0.10 for the test of heterogeneity. MAIN RESULTS: We included
12 trials (1,464 patients). The drugs were given prophylactically in ten trials
and as treatment in two. Seven trials were in acute leukaemia, two in cancer,
one in liver transplant patients, one in critically ill surgical and trauma
patients, and one in AIDS patients. Nystatin had been compared with placebo in
three trials and with fluconazole in nine; the dose varied from 1.5 MIE to 72
MIE daily. The effect of nystatin was similar to that of placebo on fungal
colonisation (relative risk 0.85, 95% confidence interval 0.65 to 1.13). There
was no statistically significant difference between fluconazole and nystatin on
mortality (relative risk 0.76, 0.49 to 1.18) whereas fluconazole was more
effective in preventing invasive fungal infection (relative risk 0.37, 0.15 to
0.91) and colonisation (relative risk 0.49, 0.34 to 0.70). The results were
very similar if the three studies which were not performed in cancer patients
were excluded. REVIEWER’S CONCLUSIONS: Nystatin cannot be recommended for
prophylaxis or treatment of Candida infections in immunodepressed
patients. N. Ref:: 21
----------------------------------------------------
[14]
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
----------------------------------------------------
[15]
TÍTULO / TITLE: - Valacyclovir provides
optimum acyclovir exposure for prevention of cytomegalovirus and related
outcomes after organ transplantation.
REVISTA
/ JOURNAL: - J Infect Dis. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://www.journals.uchicago.edu/
●●
Cita: J. of Infectious Diseases: <> 2002 Oct 15;186 Suppl 1:S110-5.
AUTORES
/ AUTHORS: - Fiddian P; Sabin CA; Griffiths PD
INSTITUCIÓN
/ INSTITUTION: - Royal Free and University College Medical
School (Royal Free Campus), London NW3 2PF, United Kingdom. paul.fiddian@which.net
RESUMEN
/ SUMMARY: - A meta-analysis of 12 randomized trials
(1574 patients) examined herpesvirus and related outcomes following organ
transplantation over a range of acyclovir exposures (including valacyclovir).
Overall, cytomegalovirus (CMV) infection (odds ratio [OR], 0.44; 95% confidence
interval [CI], 0.34-0.57; P<.001), CMV disease (OR, 0.41; 95% CI, 0.31-0.54;
P<.001), death (OR, 0.60; 95% CI, 0.40-0.90; P=.01), opportunistic infection
(OR, 0.70; 95% CI, 0.53-0.91; P=.009), acute graft rejection (OR, 0.67; 95% CI,
0.52-0.86; P<.001), herpes simplex virus disease (OR, 0.17; 95% CI,
0.12-0.24; P<.001), and varicella-zoster virus disease (OR, 0.06; 95% CI,
0.01-0.25; P<.001) were significantly reduced. Increased acyclovir exposure
influenced more end points: Maximum efficacy resulted from valacyclovir (8
g/day). Increasing acyclovir exposure to that achieved with valacyclovir
extends benefits of prophylaxis to include impact on graft rejection and
opportunistic infections.
----------------------------------------------------
[16]
TÍTULO / TITLE: - The history and future
of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic
hematopoietic stem cell transplantation.
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: <> 2001 Dec 1;98(12):3192-204.
AUTORES
/ AUTHORS: - Ho VT; Soiffer RJ
INSTITUCIÓN
/ INSTITUTION: - Department of Adult Oncology, Dana-Farber
Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA, USA. N. Ref:: 244
----------------------------------------------------
[17]
TÍTULO / TITLE: - Immunisations in
solid-organ transplant recipients.
REVISTA
/ JOURNAL: - Lancet 2002 Mar 16;359(9310):957-65.
AUTORES
/ AUTHORS: - Stark K; Gunther M; Schonfeld C; Tullius
SG; Bienzle U
INSTITUCIÓN
/ INSTITUTION: - Institute of Tropical Medicine, Charite,
Humboldt University, Berlin, Germany. starkk@rki.de
RESUMEN
/ SUMMARY: - Solid-organ transplant recipients are at
increased risk of various infectious diseases, some of which are vaccine
preventable mmunisations are among the most efficient interventions available.
Solid-organ tranplant recipients would greatly benefit from effective
immunisations, provided the recommendations are based on a careful risk-benefit
analysis in which the effectiveness of the vaccine is weighed against possible
adverse reactions, including graft rejection. In this review, we summarise the
data from studies on relevant immunisations in solid-organ transplant
recipients. The major issues are the immunogenicity and safety of immunisations,
the factors associated with poor immune response, and recommendations for
immunisation schemes. N.
Ref:: 94
----------------------------------------------------
[18]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
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 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular
mammography, according to national recommendations where available. N. All
renal transplant recipients should undergo a faecal occult-blood testing as a
screening for colorectal cancer and other (pre-malignant) lesions, according to
national recommendations where available. O. In all these conditions, it is
recommended to reduce immunosuppression whenever possible.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Survival after
HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation
for hematologic malignancies: meta-analysis of randomized controlled trials.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Aug;32(3):293-8.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1704112
AUTORES
/ AUTHORS: - Horan JT; Liesveld JL; Fernandez ID; Lyman
GH; Phillips GL; Lerner NB; Fisher SG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Rochester School of Medicine and Dentistry, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - The impact of peripheral blood stem cell
transplantation (PBSCT) on survival relative to bone marrow transplantation
(BMT) remains poorly defined. Several randomized controlled trials (RCTs)
comparing HLA-matched related PBSC- and BMT for patients with hematologic
malignancies have been published, yielding differing results. We conducted a
meta-analysis of published RCTs to more precisely estimate the effect of PBSCT
on survival. Seven trials that assessed survival were identified and included
in our analysis. Using a fixed effects model, and combining the results of all
seven trials, the summary odds ratio for mortality after PBSCT was 0.81 (95%
CI, 0.62-1.05) when compared to BMT. Subgroup analysis revealed no association
between the median PBSCT 34+ cell dose and relative risk for morality after
PBSCT. However, there was an association between the proportion of patients
enrolled with advanced-stage disease and the summary odds ratio for mortality.
The pooled estimate was 0.64 for studies where patients with
intermediate/advanced disease comprised at least 25% of enrollment, and was
1.07 for the studies enrolling a smaller proportion. This finding substantiates
results from previously published studies that have demonstrated a survival
advantage with PBSCT limited to patients with advanced disease.
----------------------------------------------------
[20]
TÍTULO / TITLE: - One-year survival in
patients with acute myocardial infarction and a saphenous vein graft culprit
treated with primary angioplasty.
REVISTA
/ JOURNAL: - Am J Cardiol 2003 May 15;91(10):1250-4.
AUTORES
/ AUTHORS: - Nguyen TT; O’Neill WW; Grines CL; Stone
GW; Brodie BR; Cox DA; Grines LL; Boura JA; Dixon SR
INSTITUCIÓN
/ INSTITUTION: - William Beaumont Hospital, Royal Oak,
Michigan 48073, USA.
----------------------------------------------------
[21]
TÍTULO / TITLE: - Guidelines for
preventing opportunistic infections among hematopoietic stem cell transplant
recipients. Recommendations of CDC, the Infectious Disease Society of America,
and the American Society of Blood and Marrow Transplantation.
REVISTA
/ JOURNAL: - Cytotherapy 2001;3(1):41-54.
●●
Enlace al texto completo (gratuito o de pago) 1080/146532401753156403
----------------------------------------------------
[22]
TÍTULO / TITLE: - Calcium channel
blockers for preventing acute tubular necrosis in kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003421.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003421.pub2
AUTORES
/ AUTHORS: - Shilliday I; Sherif M
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Monklands Hospital, Monkscourt
Avenue, Airdrie, UK, ML6 0JS.
RESUMEN
/ SUMMARY: - BACKGROUND: The incidence of delayed graft
function in cadaveric grafts has increased over the last few years due in part
to the large demand for cadaveric kidneys necessitating the use of kidneys from
marginal donors. Calcium channel blockers have the potential to reduce the
incidence of post-transplant acute tubular necrosis (ATN) if given in the
peri-operative period. However, there is controversy surrounding their use in
this situation with no consensus as to their efficacy. OBJECTIVES: To evaluate
the benefits and harms of using calcium channel blockers in the peri-transplant
period in patients at risk of ATN following cadaveric kidney transplantation.
SEARCH STRATEGY: We searched the Cochrane Renal Group’s specialised register,
the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane
Library issue 2, 2003) MEDLINE (1966 to January 2003) and EMBASE (1980 -
January 2003). The Trials Search Coordinator was contacted to develop the
search strategy. SELECTION CRITERIA: Randomised controlled trials comparing
calcium channel blockers given in the peri-transplant period with controls were
included. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS:
Data was extracted and quality assessed independently by two reviewers, with
differences resolved by discussion. Dichotomous outcomes are reported as
relative risk (RR) and measurements on continuous scales are reported as
weighted mean differences (WMD) with 95% confidence intervals (CI). MAIN
RESULTS: Nine trials were suitable for inclusion. Treatment with calcium
channel blockers in the peri-transplant period was associated with a
significant decrease in the incidence of post transplant ATN (RR 0.57, 95%CI
0.40 to 0.82) and delayed graft function (RR 0.44, 95% CI 0.28 to 0.69). There
was no difference between control and treatment groups in graft loss,
mortality, requirement for haemodialysis. There was insufficent information to
comment on adverse events. REVIEWER’S CONCLUSIONS: These results suggest that
calcium channel blockers given in the peri-operative period may reduce the
incidence of ATN post-transplantation. The result should be treated with
caution due to the heterogeneity of the trials which made comparison of studies
and pooling of data difficult.
----------------------------------------------------
[23]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
cancers: prevention and treatment.
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 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[24]
TÍTULO / TITLE: - Induction of immune
tolerance by dendritic cells: implications for preventative and therapeutic
immunotherapy of autoimmune disease.
REVISTA
/ JOURNAL: - Immunol Cell Biol 2002 Dec;80(6):509-19.
AUTORES
/ AUTHORS: - Thompson AG; Thomas R
INSTITUCIÓN
/ INSTITUTION: - Centre for Immunology and Cancer Research,
Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.
RESUMEN
/ SUMMARY: - Dendritic cells (DC) have a key role in
controlling the immune response, by determining the outcome of antigen
presentation to T cells. Through costimulatory molecules and other factors, DC
are involved in the maintenance of peripheral tolerance through modulation of
the immune response. This modulation occurs both constitutively, and in
inflammation, in order to prevent autoimmunity and to control established
immune responses. Dendritic cell control of immune responses may be mediated
through cytokine or cell-contact dependent mechanisms. The molecular and
cellular basis of these controls is being understood at an increasingly more
complex level. This understanding is reaching a level at which DC-based
therapies for the induction of immune regulation in autoimmunity can be tested
in vivo. This review outlines the current state of knowledge of DC in immune
tolerance, and proposes how DC might control both T cell responses, and
themselves, to prevent autoimmunity and maintain peripheral tolerance. N. Ref:: 135
----------------------------------------------------
[25]
TÍTULO / TITLE: - The treatment of
glomerular disease—a compromise between the standard and the individual
approach.
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: <> 2003 Jul;18 Suppl 5:v31-3.
AUTORES
/ AUTHORS: - Kiperova B
INSTITUCIÓN
/ INSTITUTION: - Medical University of Sofia, University
Hospital Alexandrovska, Clinic of Nephrology, Sofia, Bulgaria. bkiperova@yahoo.com
RESUMEN
/ SUMMARY: - Chronic glomerulonephritis (GN) is one of
the leading causes of end-stage renal disease (ESRD). The possibilities for
successful treatment in the earliest stages are still limited.
Immunosuppressive treatment leads to complete or partial remission only in some
patients. Even then, a non-immunological evolution to chronic renal
insufficiency often enters a progressive course. By applying a consistent
strategy for their individual evaluation and management, it is possible to
improve the outcome of patients with GN. The early referral to a nephrologist
and an early histomorphological diagnosis; the precise assessment of the type
of injury, i.e. proliferative or non-proliferative; the indices of activity and
chronicity; and the prognostic indicators are helpful for the therapeutic
approach. The goal of the management of GN has to be to suppress the disease
with minimum side effects of the treatment. Many unanswered questions and
controversies remain concerning the immunosuppressive therapy. A precise distinction
is needed between the problematic assertions and evidence-based protocols. A
common task for the treatment of all types of chronic GN should be the
protection of renal structure and function: control of blood pressure, action
on renal haemodynamics and proteinuria via pharmacological inhibition of the
renin-angiotensin system, control of hyperlipidaemia and limitation of
fibrosis. Some novel and promising pharmacological approaches to extracellular
matrix accumulation and chronic interstitial fibrosis are in progress. N. Ref:: 15
----------------------------------------------------
[26]
TÍTULO / TITLE: - Mycophenolate mofetil
versus azathioprine therapy is associated with a significant protection against
long-term renal allograft function deterioration.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1341-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062833.14843.4B
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Steffen BJ; Hochberg
AM; Gordon RD; Liebman MN; Morris JA; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Florida College of Medicine, Gainesville, FL 32610-0224, USA. meierhu@medicine.ufl.edu.
RESUMEN
/ SUMMARY: - BACKGROUND: To evaluate the association of
long-term continuous mycophenolate mofetil (MMF) versus azathioprine (AZA)
therapy and renal allograft function, as measured by the slope of reciprocal
creatinine, we analyzed 49,666 primary renal allograft recipients reported to
the United States Renal Data System between October 31, 1988 and June 30, 1998.
METHODS: The primary study endpoint was defined as a greater than 20% decrease
below a 6-month baseline of 1/serum creatinine (SCr) (slope of reciprocal
creatinine) at or beyond 1 year after transplantation. A secondary endpoint was
defined as reaching an SCr value greater than 1.6 mg/dL. Univariate
Kaplan-Meier analysis and multivariate Cox proportional hazard models were used
to investigate the risk of reaching the study endpoints. Multivariate analyses
were corrected for potential confounding covariates. RESULTS: According to the
Cox proportional hazard model, 12-month continued therapy of MMF versus AZA was
associated with a protective effect against declining renal function, as
measured by the slope of reciprocal creatinine (relative risk [RR]=0.84,
confidence interval 0.78-0.91, P<0.001). For 24-month continued therapy of
MMF versus AZA, MMF was associated with a further decreased risk for a decline
in renal function (RR=0.66, confidence interval=0.57-0.77, P<0.001).
Furthermore, MMF was associated with a protective effect against reaching the
SCr threshold of 1.6 mg/dL (RR=0.80, P<0.001) beyond 12 months
posttransplantation. CONCLUSIONS: Continuous use of MMF versus AZA was
associated with a protective effect against declining renal function beyond 1
year after transplantation. Further study is needed to confirm that continued
MMF therapy is protective against long-term deterioration in renal function.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Evaluation of
thalidomide for treatment or prevention of chronic graft-versus-host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Jul;44(7):1141-6.
AUTORES
/ AUTHORS: - Flowers ME; Martin PJ
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Research, Fred
Hutchinson Cancer Research Center, 1100 Fairview Avenue N., DS-290, PO Box
19024, Seattle, WA 98109-1024, USA. mflowers@fhcrc.org
RESUMEN
/ SUMMARY: - During the past 5 years, better
understanding of immunomodulatory and anti-angiogenesis properties of
thalidomide has increased interest in the use of this agent for a wider variety
of clinical applications. This article reviews the clinical evaluation of
thalidomide for treatment or prevention of chronic
graft-versus-host-disease. N.
Ref:: 38
----------------------------------------------------
[28]
TÍTULO / TITLE: - Dry eye as a major
complication associated with chronic graft-versus-host disease after
hematopoietic stem cell transplantation.
REVISTA
/ JOURNAL: - Cornea 2003 Oct;22(7 Suppl):S19-27.
AUTORES
/ AUTHORS: - Ogawa Y; Kuwana M
INSTITUCIÓN
/ INSTITUTION: - Institute for Advanced Medical Research,
and Department of Ophthalmology, Keio University School of Medicine, Tokyo,
Japan. yoko@sc.itc.keio.ac.jp
RESUMEN
/ SUMMARY: - PURPOSE: To review the condition of dry
eye associated with chronic graft-versus-host disease (GVHD). METHODS: The
immunopathogenic processes and therapeutic options for lacrimal gland chronic
GVHD are discussed. RESULTS: Dry eye is the most frequent ocular complication
after hematopoietic stem cell transplantation. The condition typically occurs
around 6 months post-operation and is recognized as a complication of chronic
GVHD. Lacrimal gland specimens from patients with dry eye show prominent
fibrosis and an increase in CD34+ stromal fibroblasts in the glandular
interstitium in addition to infiltration of T cells into the periductal areas.
In periductal areas, CD4+ and CD8+ T cells colocalize with stromal fibroblasts
that express the full component of surface molecules necessary for antigen
presentation. These findings strongly suggest that periductal fibroblasts are
involved in fibrogenic and immune processes by interacting with T cells in the
lacrimal gland of patients with chronic GVHD, resulting in rapidly progressive
dry eye. Current therapies for dry eye related to chronic GVHD include tear
supplements and nonspecific immunosuppressants. CONCLUSION: We report a
significant role for stromal fibroblasts in the pathogenic processes of dry eye
related to chronic GVHD. Although several supportive therapies can reduce the
symptoms, specific therapies that suppress fibrotic and immune processes in the
lacrimal glands are necessary to control dry eye associated with chronic
GVHD. N. Ref:: 49
----------------------------------------------------
[29]
TÍTULO / TITLE: - Perioperative
single-dose glucocorticoid administration: pathophysiologic effects and
clinical implications.
REVISTA
/ JOURNAL: - J Am Coll Surg 2002 Nov;195(5):694-712.
AUTORES
/ AUTHORS: - Holte K; Kehlet H
INSTITUCIÓN
/ INSTITUTION: - Department of Surgical Gastroenterology,
Hvidovre University Hospital, Denmark. N.
Ref:: 138
----------------------------------------------------
[30]
TÍTULO / TITLE: - Prevention of
transfusion-associated graft-versus-host disease by inactivation of T cells in platelet
components.
REVISTA
/ JOURNAL: - Semin Hematol 2001 Oct;38(4 Suppl
11):34-45.
AUTORES
/ AUTHORS: - Luban NL
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine and
Pathology and the Transfusion Medicine/Donor Center, Children’s National
Medical Center, Washington, DC 20010, USA.
RESUMEN
/ SUMMARY: - Patients with hematological malignancies
and infants with congenital immunodeficiencies who received blood are two of
many populations at risk for transfusion-associated graft-versus-host disease
(TA-GVHD). Of the methodologies (eg, photoinactivation, peglyation, ultraviolet
light, and irradiation) that can be used to prevent TA-GVHD, only irradiation
of whole blood and cellular components is currently accepted practice of the US
Food and Drug Administration (FDA). Among the newer methods that have been
developed to reduce the risks of bacterial and viral contaminants of platelet
transfusions, photochemical treatment (PCT) using psoralens and long-wavelength
ultraviolet (UVA) irradiation modifies bacterial and viral genomes sufficiently
to inhibit replication. Among a broad group of compounds, the synthetic
psoralen compound amotosalen hydrochloride (HCl) (S-59) has been shown to be
particularly effective in inactivating bacteria and viruses, without adversely
affecting in vitro and in vivo platelet function. N. Ref:: 92
----------------------------------------------------
[31]
TÍTULO / TITLE: - Pregnancy outcome after
cyclosporine therapy during pregnancy: a meta-analysis.
REVISTA
/ JOURNAL: - Transplantation 2001 Apr 27;71(8):1051-5.
AUTORES
/ AUTHORS: - Bar Oz B; Hackman R; Einarson T; Koren G
INSTITUCIÓN
/ INSTITUTION: - The Motherisk Program, Division of
Clinical Pharmacology/Toxicology, The Hospital for Sick Children, Toronto, Ontario,
Canada.
RESUMEN
/ SUMMARY: - BACKGROUND: Cyclosporine (CsA) therapy
must often be continued during pregnancy to maintain maternal health in such
conditions as organ transplantation and autoimmune disease. This meta-analysis
was performed to determine whether CsA exposure during pregnancy is associated
with an increased risk of congenital malformations, preterm delivery, or low
birthweight. METHODS: Various health science databases were searched to
identify relevant articles. Articles selected for inclusion in the study were
required to be free of any apparent selection bias and report outcomes in at
least 10 newborns exposed to CsA in utero, specifically commenting on the
presence or absence of congenital malformations. Article selection and data extraction
were performed by two independent reviewers, with adjudication in cases of
disagreement. To assess risks of CsA exposure, a summary odds ratio was
calculated. Prevalence of malformations was calculated as a rate for all
cyclosporine-exposed live births and for the subgroups identified. Ninety-five
percent confidence intervals were constructed for both the odds ratio and
prevalence rates. RESULTS: Fifteen studies (6 with control groups of transplant
without use of cyclosporine; total patients: 410) met the inclusion criteria
for major malformations, 10 for preterm delivery (4 with control groups; total
patients: 379) and 5 for low birth weight (1 with control groups; total number
of patients: 314). The calculated odds ratio of 3.83 for malformations did not
achieve statistical significance (CI 0.75-19.6). The overall prevalence of
major malformations in the study population (4.1%) also did not vary
substantially from that reported in the general population. OR for prematurity
[1.52 (CI 1.00-2.32)] did not reach statistical significance although the
overall prevalence rate was 56.3%. The OR for low birth weight [1.5 (CI
0.95-2.44 based on 1 study)]. CONCLUSIONS: CsA does not appear to be a major
human teratogen. It may be associated with increased rates of prematurity. More
research is needed to evaluate whether cyclosporine increases teratogenic risk.
----------------------------------------------------
[32]
TÍTULO / TITLE: - Meta-analysis of
prophylaxis of CMV disease in solid organ transplantation: is Ganciclovir a
superior agent to Acyclovir?
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):1870-2.
AUTORES
/ AUTHORS: - Gourishankar S; Wong W; Dorval M
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology (S.G.), University
of Alberta, Edmonton, Alberta, Canada.
----------------------------------------------------
[33]
TÍTULO / TITLE: - Protocol core needle
biopsy and histologic Chronic Allograft Damage Index (CADI) as surrogate end
point for long-term graft survival in multicenter studies.
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):773-9.
AUTORES
/ AUTHORS: - Yilmaz S; Tomlanovich S; Mathew T;
Taskinen E; Paavonen T; Navarro M; Ramos E; Hooftman L; Hayry P
INSTITUCIÓN
/ INSTITUTION: - Data Analysis Center, Division of
Transplantation, Department of Surgery, University of Calgary, Alberta, Canada.
RESUMEN
/ SUMMARY: - This study is an investigation of whether
a protocol biopsy may be used as surrogate to late graft survival in
multicenter renal transplantation trials. During two mycophenolate mofetil
trials, 621 representative protocol biopsies were obtained at baseline, 1 yr,
and 3 yr. The samples were coded and evaluated blindly by two pathologists, and
Chronic Allograft Damage Index (CADI) score was constructed. At 1 yr, only 20%
of patients had elevated (>l.5 mg/100 ml) serum creatinine, whereas 60% of
the biopsies demonstrated an elevated (>2.0) CADI score. The mean CADI score
at baseline, 1.3 +/- 1.1, increased to 3.3 +/- 1.8 at 1 yr and to 4.1 +/- 2.2
at 3 yr. The patients at 1 yr were divided into three groups, those with CADI
<2, between 2 and 3.9, and >4.0, the first two groups having normal (1.4
+/- 0.3 and 1.5 +/- 0.6 mg/dl) and the third group pathologic (1.9 +/- 0.8
mg/dl) serum creatinine. At 3 yr, there were no lost grafts in the low CADI
group, six lost grafts (4.6%) in the in the elevated CADI group, and 17 lost
grafts (16.7%) in the high CADI group (P < 0.001). One-year histologic CADI
score predicts graft survival even when the graft function is still normal.
This observation makes it possible to use CADI as a surrogate end point in
prevention trials and to identify the patients at risk for intervention trials.
----------------------------------------------------
[34]
TÍTULO / TITLE: - Alicaforsen. Isis
Pharmaceuticals.
REVISTA
/ JOURNAL: - Curr Opin Investig Drugs 2001
Oct;2(10):1401-6.
AUTORES
/ AUTHORS: - Gewirtz AT; Sitaraman S
INSTITUCIÓN
/ INSTITUTION: - Emory University School of Medicine,
Department of Pathology and Laboratory Medicine, Atlanta, GA 30322, USA. agewirt@emory.edu
RESUMEN
/ SUMMARY: - Alicaforsen (ISIS-2302) is an RNase
H-dependent antisense inhibitor of the intercellular adhesion molecule ICAM-1
under development by Isis Pharmaceuticals, for the potential treatment of a
variety of inflammatory disorders [175741]. As of April 1997 it was in phase
III trials for Crohn’s disease (CD); however, the trial failed and, in December
1999, the company suspended development for this indication [352801]. In
October 2000, the company re-initiated development in CD [384820] and new phase
III trials had begin by May 2001 [409704]. In August 2000, phase II studies of
alicaforsen in an enema formulation for ulcerative colitis and a topical
formulation for psoriasis were ongoing [378715]. Development of the compound
for the potential treatment of rheumatoid arthritis (RA) was discontinued in
1999 [347579]. By the end of 1998, alicaforsen was in phase II trials for
kidney transplant rejection. At this time, these trials were expected to finish
in mid-1999 [343460]. However, they were ongoing in September 1999, although no
further development has been reported for this indication since that time
[338672]. In February 1995, Isis Pharmaceuticals and Boehringer Ingelheim (BI)
signed a collaborative agreement on cell adhesion inhibitors, including
alicaforsen [174111]. By early 1999, Isis and BI were to decide on the next
developmental step for alicaforsen following further analyses of its
performance against CD [292915], [315439]. Their joint development agreement
was terminated in 1999; Isis regained rights to the product and by September
1999 was in talks to license alicaforsen to another partner for CD [338672]. In
June 2000, Cytogenix entered into a sponsored research agreement with Baylor
College of Medicine at the Texas Medical Center Houston for the use of its
ssDNA expression system for the development of antisense strategies directed
against intercellular adhesion molecules for the purpose of reducing lung
inflammation and injury in disease states and conditions [369677]. US-05514788,
and other patents, cover antisense cell adhesion molecule inhibitors [212289],
[234792]. N. Ref:: 45
----------------------------------------------------
[35]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.13 Analysis of patient and graft survival.
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 4:60-7.
RESUMEN
/ SUMMARY: - GUIDELINES: A. It is important for a
transplant unit to follow-up on the results of their transplant activities. In
order to achieve correct reports on graft and patient outcome in all patients,
it is necessary to have sufficient resources, such as a computerized database,
and continuous updates of patient information. All data collected should be
subjected to validation procedures to ensure completeness and accuracy. B.
Improved outcomes following implementation of new protocols, based on
evaluation of clinical multi-centre trials, should be verified at local
transplant centres since centres often include a range of patients different
from those selected for the trial. C. The most widely accepted descriptor of
outcome is the Kaplan-Meier probability estimate of patient and graft survival.
Survival estimates should be calculated at intervals of time after
transplantation and should always be expressed with their 95% confidence
intervals. D. Kaplan-Meier survival estimates may be calculated in three ways.
(i) ‘Patient survival’ should be calculated from the date of transplantation to
the date of death or the date of the last follow-up. (ii) ‘Graft survival’
(non-censored for death) should be calculated from the date of transplantation
to the date of irreversible graft failure signified by return to long-term
dialysis (or retransplantation) or the date of the last follow-up during the
period when the transplant was still functioning or to the date of death. Here,
death with graft function is treated as graft failure. (iii) ‘Graft survival censored
for death with a functioning graft’ (death-censored graft survival) should be
calculated from the date of transplantation to the date of irreversible graft
failure signified by return to long-term dialysis (or retransplantation) or the
date of last follow-up during the period when the transplant was still
functioning. In the event of death with a functioning graft, the follow-up
period is censored at the date of death. E. The outcome of transplants carried
out at a centre should be compared with those achieved across a range of data
from centres collated by national and international multi-centre registries.
Interpretation of a centre’s performance should take into account the number of
transplants performed and the prevalence of major risk factors. F. Major risk
factors that influence transplant outcome are identifiable by applying
multivariate analytical methods to large multi-centre follow-up databases.
Although these major risk factors may not be identifiable in individual centre
data, they should nonetheless be taken into account in patient management. G.
When designing a clinical trial or evaluating data from a recent trial, the
expected improvement in graft survival resulting from a reduction in acute
rejection may be estimated from a knowledge of the rejection and graft survival
rates that existed prior to the introduction of the new therapeutic regimen. H.
When designing or evaluating a clinical trial, it is important to analyse the
power of the study to verify statistically the difference (in graft survival)
that might be expected and its statistical significance. A study resulting in
absence of statistically significant differences between two treatment groups
with insufficient statistical power to verify a difference at the expected
level should not be taken as evidence of absence of a true difference.
----------------------------------------------------
[36]
TÍTULO / TITLE: - Posttransplantation
diabetes: a systematic review of the literature.
REVISTA
/ JOURNAL: - Diabetes Care. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://care.diabetesjournals.org/
●●
Cita: Diabetes Care: <> 2002 Mar;25(3):583-92.
AUTORES
/ AUTHORS: - Montori VM; Basu A; Erwin PJ; Velosa JA;
Gabriel SE; Kudva YC
INSTITUCIÓN
/ INSTITUTION: - Division of Endocrinology, Diabetes,
Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota
55905, USA.
RESUMEN
/ SUMMARY: - OBJECTIVES: To systematically review the
incidence of posttransplantation diabetes (PTD), risk factors for its
development, prognostic implications, and optimal management. RESEARCH DESIGN
AND METHODS: We searched databases (MEDLINE, EMBASE, the Cochrane Library, and
others) from inception to September 2000, reviewed bibliographies in reports
retrieved, contacted transplantation experts, and reviewed specialty journals.
Two reviewers independently determined report inclusion (original studies, in
all languages, of PTD in adults with no history of diabetes before
transplantation), assessed study methods, and extracted data using a
standardized form. Meta-regression was used to explain between-study
differences in incidence. RESULTS: Nineteen studies with 3,611 patients were
included. The 12-month cumulative incidence of PTD is lower (<10% in most
studies) than it was 3 decades ago. The type of immunosuppression explained 74%
of the variability in incidence (P = 0.0004). Risk factors were patient age,
nonwhite ethnicity, glucocorticoid treatment for rejection, and
immunosuppression with high-dose cyclosporine and tacrolimus. PTD was
associated with decreased graft and patient survival in earlier studies; later
studies showed improved outcomes. Randomized trials of treatment regimens have
not been conducted. CONCLUSIONS: Physicians should consider modification of
immunosuppressive regimens to decrease the risk of PTD in high-risk transplant
recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering
agents in transplant recipients, paying particular attention to interactions
with immunosuppressive drugs. N.
Ref:: 79
----------------------------------------------------
[37]
TÍTULO / TITLE: - Calcineurin inhibition
and cardiac hypertrophy: a matter of balance.
REVISTA
/ JOURNAL: - Proc Natl Acad Sci U S A. Acceso gratuito
al texto completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.pnas.org/
●●
Cita: Proc Natl Acad Sci USA (PNAS): <> 2001 Mar 13;98(6):2947-9.
●●
Enlace al texto completo (gratuito o de pago) 1073/pnas.051033698
AUTORES
/ AUTHORS: - Leinwand LA
INSTITUCIÓN
/ INSTITUTION: - Department of Molecular, Cellular, and
Developmental Biology, Porter Addition, Room A3B40, University of Colorado,
Boulder, CO 80309-0347, USA. leinwand@stripe.colorado.edu N. Ref:: 18
----------------------------------------------------
[38]
TÍTULO / TITLE: - Mycophenolate mofetil
for the prevention and treatment of graft-versus-host disease following stem
cell transplantation: preliminary findings.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2001
Jun;27(12):1255-62.
AUTORES
/ AUTHORS: - Vogelsang GB; Arai S
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, Johns Hopkins
Oncology Center, Baltimore, MD 21287-8943, USA.
RESUMEN
/ SUMMARY: - The therapeutic benefits of allogeneic
stem cell transplantation in patients with hematologic disorders are limited by
the significant morbidity and mortality of graft-versus-host disease (GVHD).
Current agents for the prevention and treatment of GVHD have limited efficacy
and often result in toxic side-effects. Mycophenolate mofetil (MMF) is a new
immunosuppressant with a selective mechanism of action. When employed following
solid organ transplantation, MMF reduces the incidence and severity of acute
rejection episodes. By selectively targeting activated lymphocytes, the active
metabolite of MMF, mycophenolic acid (MPA), appears to augment the actions of
standard immunosuppressant agents without adding overlapping toxicities.
Studies of combination regimens that include MMF report that this agent permits
a dose reduction of cyclosporine, tacrolimus, or corticosteroid, without
increasing the incidence of acute rejection in solid organ transplants. Reports
on the efficacy of MMF following stem cell transplantation in animal studies
were mixed. However, the use of a non-myeloablative conditioning regimen with a
post-graft immunosuppressive regimen of MMF and cyclosporine was able to
sustain stable mixed chimeras in 60% to 80% of dogs who received hematopoietic
grafts from DLA-identical littermates. MMF has demonstrated activity in
preliminary clinical trials for GVHD prophylaxis, and treatment of acute or
chronic GVHD. Larger clinical trials are warranted to determine the optimum
dose and route of MMF administration for GVHD, as well as the comparative
safety and efficacy of MMF-containing regimens. N. Ref:: 36
----------------------------------------------------
[39]
TÍTULO / TITLE: - Review of the
antiproliferative properties of mycophenolate mofetil in non-immune cells.
REVISTA
/ JOURNAL: - Int J Clin Pharmacol Ther 2003
Oct;41(10):465-9.
AUTORES
/ AUTHORS: - Morath C; Zeier M
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University of
Heidelberg, Germany. christian_morath@med.uni-heidelberg.de
RESUMEN
/ SUMMARY: - Mycophenolate mofetil (MMF), the prodrug
ofmycophenolic acid (MPA), is a selective, non-competitive and reversible
inhibitor of inosine monophosphate dehydrogenase (IMPDH) and of the type II
isoform in particular. IMPDH is the rate-limiting enzyme in the de novo
biosynthesis of guanosine nucleotides. MMF strongly inhibits both T- and B
lymphocyte proliferation and has been used in the prevention of acute and
chronic allograft rejection since the mid 1990s. Recent evidence, however,
suggests that MMF is also capable of inhibiting the proliferation of non-immune
cells. In various cell lines, i.e. smooth muscle cells, renal tubular cells and
mesangial cells, MPA reduced or even abrogated proliferation in response to
proliferative stimuli. Furthermore, data from our own laboratory demonstrate a
dose-dependent inhibition of dermal fibroblast proliferation by MPA. In animal
studies, MMF ameliorated renal lesions in immune-mediated disease, i.e. in the
anti-thy 1.1 model and experimental lupus nephritis, but was also effective in
non-immune-mediated renal damage in the rat remnant-kidney model. These
observations prompted several investigators to study the effects of MMF in
proliferating (renal) disease of non-immune origin in humans. MMF significantly
reduced proteinuria in minimal-change disease and focal segmental
glomerulosclerosis. In addition, MMF showed beneficial effects in the treatment
of chronic allograft nephropathy and calcineurin inhibitor toxicity through
reduction of immune- and non-immune-mediated renal damage. MMF is well
tolerated and has proven to be a relatively safe drug causing only minor bone
marrow suppression. Taken together, there is a growing body of evidence
pointing to therapeutic applications of MMF other than immunosuppression, in
particular the prevention of fibrosis. N.
Ref:: 39
----------------------------------------------------
[40]
TÍTULO / TITLE: - Efficacy of
pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis
of randomized trials.
REVISTA
/ JOURNAL: - Vaccine 2001 Sep 14;19(32):4780-90.
AUTORES
/ AUTHORS: - Cornu C; Yzebe D; Leophonte P; Gaillat J;
Boissel JP; Cucherat M
INSTITUCIÓN
/ INSTITUTION: - Service of Clinical Pharmacology, EA643,
Lyon University Hospital, Faculte de Medicine RTH Laennec, BP 8071, 69376,
Cedex 08, Lyon, France. catherine.cornu@upcl.univ-lyon1.fr
RESUMEN
/ SUMMARY: - The use of pneumococcal polysaccharide
vaccine (PPV) is low in some countries, maybe because of doubts regarding its
efficacy. This meta-analysis aims at combining evidence from randomized trials
of PPV assessing its efficacy in preventing Streptococcus pneumoniae related
diseases in immunocompetent adults. In the fourteen trials totalling 48,837
patients retrieved, PPV prevents definite pneumococcal pneumonia by 71%,
presumptive pneumococcal pneumonia by 40%, and mortality due to pneumonia by
32%, but not all-cause pneumonia or death. No preventive effect was seen in the
subgroup of patients aged 55 years or more, possibly due to a lack of
statistical power.
----------------------------------------------------
[41]
TÍTULO / TITLE: - Introduction to the
Immunocompromised Host Society consensus conference on epidemiology, prevention,
diagnosis, and management of infections in solid-organ transplant patients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Jul 1;33 Suppl
1:S1-4.
AUTORES
/ AUTHORS: - Rubin RH; Schaffner A; Speich R
INSTITUCIÓN
/ INSTITUTION: - Center for Experimental Pharmacology and
Therapeutics, Harvard-MIT Division of Health Sciences and Technology,
Cambridge, MA 02142-1308, USA. rhrubin@mit.edu
RESUMEN
/ SUMMARY: - Infectious complications are still a
significant cause of morbidity and death in solid-organ transplant patients,
with significant infection being found in up to two-thirds of these
individuals. The risk of infection in the organ transplant patient,
particularly of opportunistic infection, is largely determined by 3 factors:
the net state of immunosuppression, the epidemiologic exposures the patient
encounters, and the consequences of the invasive procedures to which the
patient is subjected. The most important principles of patient treatment are
prevention, early diagnosis, and specific therapy. This issue is designed as a
position paper by a group of experts on epidemiology, prevention, diagnosis,
and management of infections in solid-organ transplant patients. We feel that
our efforts may serve as an important first step in the development of
guidelines in this area. N.
Ref:: 25
----------------------------------------------------
[42]
TÍTULO / TITLE: - Potential prophylactic
measures against postoperative immunosuppression: could they reduce recurrence
rates in oncological patients?
REVISTA
/ JOURNAL: - Ann Surg Oncol. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.annalssurgicaloncology.org/
●●
Cita: Ann Surg Oncol: <> 2003 Oct;10(8):972-92.
AUTORES
/ AUTHORS: - Shakhar G; Ben-Eliyahu S
INSTITUCIÓN
/ INSTITUTION: - Neuroimmunology Research Unit, Department
of Psychology, Tel Aviv University, Tel Aviv, Israel.
RESUMEN
/ SUMMARY: - BACKGROUND: Removing the primary tumor is
indispensable for eliminating the major pool of metastasizing cells, but the
surgical procedure itself is suspected of promoting metastases. This adverse
effect is attributed to several mechanisms acting in synergy, including
mechanical release of tumor cells, enhanced angiogenesis, secretion of growth
factors, and immunosuppression. Here we provide new insights into mechanisms of
postoperative immunosuppression and assess the assumptions underlying the
hypothesis that, by suppressing cell-mediated immunity (CMI), surgery may
render the patient vulnerable to metastases that otherwise could have been
controlled. METHODS: An extensive review of relevant articles in English
identified by using the MEDLINE database and cross-referencing. RESULTS:
Current literature suggests that (1) CMI can control minimal residual disease,
especially if surgery is performed early; (2) major surgery transiently but
markedly suppresses CMI through multiple mechanisms now better understood; (3)
surgical stress promotes experimental metastasis through immunosuppression, but
the clinical evidence remains indirect because of ethical limitations.
CONCLUSIONS: Minimizing postoperative immunosuppression seems feasible, may limit
recurrence, and should be introduced into the broader array of considerations
when planning oncological surgeries. In the short run, physicians could try to
avoid immunosuppressive anesthetic approaches, inadvertent hypothermia,
excessive blood transfusions, and untended postoperative pain. When feasible,
minimally invasive surgery should be considered. In the long run, clinical
trials should evaluate prophylactic measures, including perioperative
immunostimulation and several antagonists to cytokines and hormones specified
herein. N. Ref:: 252
----------------------------------------------------
[43]
TÍTULO / TITLE: - Prevention by dietary
(n-6) polyunsaturated phosphatidylcholines of intrahepatic cholestasis induced
by cyclosporine A in animals.
REVISTA
/ JOURNAL: - Life Sci 2003 Jun 13;73(4):381-92.
AUTORES
/ AUTHORS: - Chanussot F; Benkoel L
INSTITUCIÓN
/ INSTITUTION: - INSERM U. 476, Faculte de Medecine, 27 bd
Jean Moulin, 13385 Marseille cedex 05, France. Francoise.Chanussot@medecine.univ-mrs.fr
RESUMEN
/ SUMMARY: - Previous findings showed that dietary
(n-6) polyunsaturated phosphatidylcholines (vegetable lecithin) could
efficiently prevent intrahepatic cholestasis induced by cyclosporine A in rats.
Mechanistic studies showed that expressions in rat liver of Na(+), K(+)-ATPase,
Ca(2+), Mg(2+)-ATPase and F-actin were both decreased by drug administration
and both enhanced by (n-6) lecithin enriched diet. There is a possible direct effect
of phosphatidylcholines, vectors of polyunsaturated fatty acids provided by the
metabolism of the dietary lecithin, on the aforesaid hepatic parameters. Such
modulations by drug and diet result in reversed modifications of membrane
composition and fluidity. Final outcome is decreased and enhanced bile lipid
secretion by cyclosporine and vegetable lecithin enriched diet respectively.
Moreover, we advance the hypothesis of a bypass process including a separate
and functional actin-independent way for the non micellar and
phospholipid-dependent secretion of bile lipids. The relationships between the
ATPases, the microfilament components such as F-actin and the different
transporters still remain to be clarified. Furthermore, one can speculate on
beneficial effects in humans of diets enriched in vegetable lecithins that
might prevent cholestasis induced by cyclosporine A. N. Ref:: 75
----------------------------------------------------
[44]
TÍTULO / TITLE: - The current status of
T-cell depleted allogeneic stem-cell transplants in adult patients with AML.
REVISTA
/ JOURNAL: - Cytotherapy 2001;3(3):175-88.
●●
Enlace al texto completo (gratuito o de pago) 1080/146532401753174007
AUTORES
/ AUTHORS: - Bunjes D
INSTITUCIÓN
/ INSTITUTION: - Stem Cell Transplantation Programme,
Department of Haematology/Oncology, Ulm University Hospital, FRG. N. Ref:: 186
----------------------------------------------------
[45]
TÍTULO / TITLE: - Shared epitopes and
rheumatoid arthritis: disease associations in Greece and meta-analysis of
Mediterranean European populations.
REVISTA
/ JOURNAL: - Semin Arthritis Rheum 2002
Jun;31(6):361-70.
AUTORES
/ AUTHORS: - Ioannidis JP; Tarassi K; Papadopoulos IA;
Voulgari PV; Boki KA; Papasteriades CA; Drosos AA
INSTITUCIÓN
/ INSTITUTION: - Clinical and Molecular Epidemiology Unit,
Department of Hygiene and Epidemiology and the Division of Rheumatology,
University of Ioannina School of Medicine, Ioannina, Greece.
RESUMEN
/ SUMMARY: - OBJECTIVES: To assess the strength of the
associations between HLA shared epitopes (SE) and rheumatoid arthritis (RA)
susceptibility, articular disease severity, and extra-articular features in
Mediterranean European populations. METHODS: One hundred and seventy-four Greek
RA patients and 103 controls were evaluated. Data were then included in a meta-analysis
of 9 studies of Mediterranean European populations (959 RA patients and 1,405
controls). RESULTS: In our study population, SE alleles were significantly more
common in RA patients than in controls (odds ratio [OR], 2.5; 95% confidence
interval [CI], 1.4-4.3). Larsen radiologic score was predicted by SE and
disease duration. SE did not increase the risk of any extra-articular
manifestation. The meta-analysis showed a pooled OR of 3.7 (95% CI, 2.6-5.2)
for susceptibility to RA conferred by SE (OR, 3.4 v 3.9 in Greek v non-Greek
populations). CONCLUSIONS: SE determine articular destruction without
increasing the risk of extra-articular manifestations. The immunogenetic
associations of RA susceptibility are consistent, but their strength may depend
on the SE prevalence in different ethnic groups.
----------------------------------------------------
[46]
TÍTULO / TITLE: - Ganciclovir: an update
of its use in the prevention of cytomegalovirus infection and disease in
transplant recipients.
REVISTA
/ JOURNAL: - Drugs 2001;61(8):1153-83.
AUTORES
/ AUTHORS: - McGavin JK; Goa KL
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Mairangi Bay,
Auckland, New Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Ganciclovir is a nucleoside guanosine
analogue which incorporates ganciclovir triphosphate (the active moiety) into
DNA during elongation, thereby inhibiting viral replication. Comparative
studies of pre-emptive and prophylactic ganciclovir therapies in bone marrow
transplant (BMT) recipients have shown similar rates of cytomegalovirus (CMV)
infection, disease and patient mortality. Long term prophylaxis with either
oral, or sequential intravenous/oral, ganciclovir has shown efficacy in renal
allograft recipients, including high risk patients or those receiving
antilymphocyte antibody therapy. A preliminary study indicates that ganciclovir
is more efficacious than aciclovir in paediatric patients. Both oral and
intravenous prophylactic ganciclovir regimens have shown efficacy compared with
no antiviral treatment in lung transplant recipients; initial reports have
shown similar efficacy between pre-emptive and prophylactic ganciclovir. Oral
ganciclovir monotherapy is as efficacious as sequential intravenous/oral
ganciclovir therapy in liver transplant recipients. Pre-emptive treatment was
equally as effective as long term ganciclovir prophylaxis in high risk
patients. Ganciclovir prophylaxis for 4 weeks appears ineffective in heart
allograft recipients treated with antithymocyte globulin. Long term sequential
intravenous/ oral ganciclovir therapy has shown greater efficacy in preventing
CMV disease than sequential ganciclovir/aciclovir therapy. in these patients.
Initial reports indicate that pre-emptive therapy may be beneficial in this
patient group. although this remains to be determined. Ganciclovir in
therapeutic dosage regimens generally has acceptable tolerability with adverse
effects usually of a haematological or neurological nature. Neutropenia, thrombocytopenia
and anaemia are the primary dose-limiting toxicities associated with
ganciclovir therapy. Overall, neutropenia occurs less frequently with
administration of oral ganciclovir than with intravenous ganciclovir.
Monitoring of renal function is recommended as serum creatinine levels may rise
during ganciclovir therapy. In addition, ganciclovir prophylaxis appears more
cost effective than the majority of other currently available therapies for CMV
with oral ganciclovir more cost effective than intravenous ganciclovir. In
conclusion, it is unlikely that a single strategy will be able to be applied to
all transplant patients for the prevention of CMV disease. An optimal strategy
will probably be arisk-adapted approach. Prophylactic treatment with ganciclovir
appears the best strategy to implement in high risk patients: oral ganciclovir
formulations may be best employed where lower toxicity is required. Pre-emptive
treatment with ganciclovir appears most efficacious in patients identified as
lower risk or, in the case of BMT recipients, where lower toxicity may be
desirable. Ganciclovir remains an important therapeutic option for the
prevention and treatment of CMV disease in transplant recipients. N. Ref:: 105
----------------------------------------------------
[47]
TÍTULO / TITLE: - Prevention of and
treatment for hepatitis B virus infection after liver transplantation in the
nucleoside analogues era.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Mar;3(3):250-8.
AUTORES
/ AUTHORS: - Papatheodoridis GV; Sevastianos V;
Burroughs AK
INSTITUCIÓN
/ INSTITUTION: - 2nd Academic Department of
Medicine, Hippokration General Hospital, Athens, Greece. gpapath@cc.uoa.gr
RESUMEN
/ SUMMARY: - Post-transplant prophylaxis with hepatitis
B immune globulin (HBIG) has significantly reduced hepatitis B virus (HBV)
recurrence rates, but it is rather ineffective in patients with pretransplant
viremia. Moreover, long-term HBIG administration is very expensive and may be
associated with emergence of escape HBV mutants. Lamivudine has been widely
used in the management of HBV transplant patients. Pretransplant lamivudine
lowers HBV viremia, decreasing the risk of post-transplant HBV recurrence, but
to try and minimize development of resistant HBV strains, it should start
within the last 6 months of the anticipated transplantation timing. Preemptive
post-transplant lamivudine monotherapy is associated with progressively
increasing HBV recurrence rates, but combined therapy with lamivudine and HBIG
at relatively low dosage is currently the most effective approach in this
setting, even in HBV-DNA-positive patients, who also receive lamivudine in the
pretransplant period. The most frequent therapy for post-transplant HBV
recurrence is lamivudine, but the increasing resistance rates represent a
rather challenging problem. Adefovir dipivoxil and entecavir are currently the
most promising agents for lamivudine-resistant HBV strains. All these advances
in anti-HBV therapy have made HBV liver disease an indication for liver
transplantation irrespective of viral replication status, a complete turn
around from 10 years ago. N.
Ref:: 93
----------------------------------------------------
[48]
TÍTULO / TITLE: - The role of monoclonal
antibodies in stem cell transplantation.
REVISTA
/ JOURNAL: - Semin Oncol 2004 Feb;31(1):83-9.
AUTORES
/ AUTHORS: - Wasil T; Rai KR; Mehrotra B
INSTITUCIÓN
/ INSTITUTION: - Long Island Jewish Medical Center,
Division of Hematology-Oncology, New Hyde Park, NY 11040, USA.
RESUMEN
/ SUMMARY: - Monoclonal antibodies directed at the
lymphoid antigens have become established treatments for hematological
malignancies either alone or in combination with chemotherapy. However, their
incorporation in the transplant setting remains investigational. This review
focuses on the currently available data for in vitro and in vivo purging with
these antibodies as well as their role in modulating graft-versus-host disease
(GVHD). N. Ref:: 44
----------------------------------------------------
[49]
TÍTULO / TITLE: - A benefit-risk
assessment of basiliximab in renal transplantation.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2004;27(2):91-106.
AUTORES
/ AUTHORS: - Boggi U; Danesi R; Vistoli F; Del Chiaro
M; Signori S; Marchetti P; Del Tacca M; Mosca F
INSTITUCIÓN
/ INSTITUTION: - Division of General Surgery and
Transplants, Department of Oncology, Transplants and Advanced Technologies in
Medicine, University of Pisa, Pisa, Italy. uboggi@med.unipi.it
RESUMEN
/ SUMMARY: - Interleukin-2 (IL-2) and its receptor
(IL-2R) play a central role in T lymphocyte activation and immune response
after transplantation. Research on the biology of IL-2R allowed the
identification of key signal transduction pathways involved in the generation
of proliferative and antiapoptotic signals in T cells. The alpha-chain of the
IL-2R is a specific peptide against which monoclonal antibodies have been
raised, with the aim of blunting the immune response by means of inhibiting
proliferation and inducing apoptosis in primed lymphocytes. Indeed,
basiliximab, one of such antibodies, has proved to be effective in reducing the
episodes of acute rejection after kidney and pancreas transplantation. The use
of basiliximab was associated with a significant reduction in the incidence of
any treated rejection episodes after kidney transplantation in the two major
randomised studies (placebo 52.2% vs basiliximab 34.2% at 6 months, European
study; placebo 54.9% vs basiliximab 37.6% at 1 year, US trial). Basiliximab and
equine antithymocyte globulin (ATG) administration resulted in a similar rate
of biopsy-proven acute rejection at 6 months (19% for both) and at 12 months
(19% and 20%, respectively). The use of basiliximab appears not to be
associated with an increased incidence of adverse events as compared with
placebo in immunosuppressive regimens, including calcineurin inhibitors,
mycophenolate mofetil or azathioprine and corticosteroids, and its safety
profile is superior to ATG. Moreover, a similar occurrence of infections is
noted in selected studies (65.5% after basiliximab vs 65.7% of controls),
including cytomegalovirus infection (17.3% vs 14.5%), and cytokine-release
syndrome is not observed. Finally, economic analysis demonstrated lower costs
of overall treatment in patients treated with basiliximab. Therefore, the use
of basiliximab entails a very low risk, allows safe reduction of corticosteroid
dosage and reduces the short- and mid-term rejection rates. However, the
improvement in the long-term survival of kidney grafts in patients treated
according to modern immunosuppressive protocols is still to be demonstrated.
These conclusions are based on a systematic review of the scientific
literature, indexed on Medline database, concerning the mechanism of action,
therapeutic activity, safety and pharmacoeconomic evaluation of basiliximab in
renal transplantation. N.
Ref:: 62
----------------------------------------------------
[50]
TÍTULO / TITLE: - Self major
histocompatibility complex class-II-specific regulatory CD4 T cells prevent
both Th1- and Th2-mediated autoimmune diseases in the rat.
REVISTA
/ JOURNAL: - Microbes Infect 2001 Sep;3(11):955-60.
AUTORES
/ AUTHORS: - Pelletier L; Savignac M; Xystrakis E;
Duplan V; Druet P; Abdelhadi S
INSTITUCIÓN
/ INSTITUTION: - Inserm U28, Hopital Purpan, place du D
Baylac, 31059, Toulouse, France. Lucette.Pelletier@purpan.inserm.fr
RESUMEN
/ SUMMARY: - It is clear that functional heterogeneity
of T cells may be explained by differential cytokine production. The aim of
this paper was to review evidence for regulatory cells, generated after
HgCl(2)-exposure. They differ from classical Th1 and Th2 cells, produce
transforming growth factor-beta and interleukin-10 and exert their regulatory
functions in a Th1/Th2-unrestricted fashion.
N. Ref:: 46
----------------------------------------------------
[51]
TÍTULO / TITLE: - Drug-eluting stents and
glycoprotein IIb/IIIa inhibitors: combination therapy for the future.
REVISTA
/ JOURNAL: - Am Heart J 2003 Oct;146(4 Suppl):S13-7.
●●
Enlace al texto completo (gratuito o de pago) 1016/j.ahj.2003.09.004
AUTORES
/ AUTHORS: - Leon MB; Bakhai A
RESUMEN
/ SUMMARY: - BACKGROUND: Although coronary stenting has
improved the results of coronary interventions compared to coronary angioplasty
alone, in-stent restenosis remains a significant limitation of this procedure.
Drug-eluting stents with or without glycoprotein IIb/IIIa inhibitor therapy
represent an additional advance in the evolution of this strategy. METHODS: We
review the currently available trials comparing studies of non-drug-eluting and
drug-eluting stents using sirolimus and paclitaxel agents and their
derivatives. RESULTS: Ten studies are available that compare drug-eluting to
traditional non-drug-eluting stents. A variety of antiplatelet regimes have
been used. The majority of these studies are in the process of being published.
No head-to-head studies comparing different drug-eluting stents are available.
CONCLUSIONS: Drug-eluting stents using sirolimus and paclitaxel in combination
with enhanced antiplatelet strategies represent an important advantage over
non-drug-eluting stents for the reduction of in-stent restenosis. The rate at
which drug-eluting stents are adapted into widespread practice depends heavily
on whether they are safe, efficacious, and cost-effective in various clinical
settings. N. Ref:: 28
----------------------------------------------------
[52]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia.
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 4:36-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Approximately 5% of
patients develop Pneumocystis carinii pneumonia (PCP) after renal
transplantation if they do not receive prophylaxis. PCP is a severe disease,
with a very high fatality rate. Therefore, all renal transplant recipients
should receive PCP prophylaxis. The treatment of choice is
trimethoprim-sulfamethoxazole (TMP-SMX), at a dose of 80/400 mg/day or 160/800
mg every other day, for at least 4 months. Patients who are treated for
rejection should receive TMP-SMX prophylaxis for 3-4 months. B. In the case of
TMP-SMX intolerance, aerosolized pentamidine (300 mg once or twice per month)
is an alternative for prophylaxis. C. The first-line treatment of PCP is
high-dose TMP-SMX. Patients with a PaO2 of <70 mmHg initially should be
treated parenterally, and the administration of additional steroids should be
considered.
----------------------------------------------------
[53]
TÍTULO / TITLE: - Hereditary
hemochromatosis: perspectives of public health, medical genetics, and primary
care.
REVISTA
/ JOURNAL: - Genet Med 2003 Jan-Feb;5(1):1-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.GIM.0000047946.94270.34
AUTORES
/ AUTHORS: - Imperatore G; Pinsky LE; Motulsky A; Reyes
M; Bradley LA; Burke W
INSTITUCIÓN
/ INSTITUTION: - National Canter for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, Georgia 30341, USA.
RESUMEN
/ SUMMARY: - Hereditary hemochromatosis (HHC) is a
condition characterized by excess iron in body tissues, resulting in
complications such as cirrhosis, cardiomyopathy, diabetes, and arthritis. These
complications usually manifest during adulthood. Two methods of screening for
the detection of early stage of HHC are available: serum iron measures and
molecular testing to detect mutations in the gene. These phenotypic and
genotypic screening tests are of particular interest because a simple
treatment-periodic phlebotomy-can be used to prevent iron accumulation and
clinical complications. HHC might represent the first adult-onset genetic
disorder for which universal population-based screening would be appropriate.
Therefore, HHC has been proposed as a paradigm for the introduction of adult
genetic diseases into clinical and public health practice. However, universal
screening for HHC has not been recommended because of the uncertainty about the
natural history of the iron overload or HHC and, in particular, uncertainty
about the prevalence of asymptomatic iron overload and the likelihood that it
will progress to clinical complications. If universal screening is not
appropriate based on current data, what other measures might reduce the disease
burden of iron overload? New studies provide more systematic information about
the penetrance of the C282Y mutation and shed further light on the natural
history of the disorder. The authors review these data and consider their
implications for public health, medical genetics, and primary care. N. Ref:: 64
----------------------------------------------------
[54]
TÍTULO / TITLE: - Immunocompromised Host
Society Consensus Conference on Epidemiology, Prevention, Diagnosis, and
Management of Infections in Solid-Organ Transplant Patients. Davos,
Switzerland, 23 June 1998, fully updated summer 2000.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Jul 1;33 Suppl
1:S1-65. N. Ref:: 0
----------------------------------------------------
[55]
TÍTULO / TITLE: - Monoclonal antibodies
for the prevention and treatment of graft-versus-host disease.
REVISTA
/ JOURNAL: - Semin Oncol 2003 Aug;30(4):509-19.
AUTORES
/ AUTHORS: - Bruner RJ; Farag SS
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow Transplantation Program, The
Ohio State University Comprehensive Cancer Center, Columbus, USA.
RESUMEN
/ SUMMARY: - Acute and chronic graft-versus-host
disease (GvHD) remain major obstacles to successful allogeneic hematopoietic
stem cell transplantation, contributing substantially to morbidity and
non-relapse mortality. Better understanding of the immunopathophysiology of
GvHD has identified a number of targets for intervention. Among newly developed
agents suitable for the prevention and treatment of GvHD, monoclonal antibodies
hold much promise. Monoclonal antibodies currently available, such as
infliximab and anti-interferon-gamma (anti-IFN-gamma), are capable of blocking
of the action of initiating and effector cytokines. Antibodies directed against
activated T cells, including daclizumab, visilizumab and ABX-CBL, may offer
more specificity than the more broadly acting pan-T-cell-depleting agents.
Finally, the clinical investigation of antibodies to adhesion molecules (such
as LFA-1), or distal effector mechanisms (such as FasL) may offer another level
of specificity. Many of these monoclonal antibodies have already undergone
clinical testing. Campath-1H has been used for the prevention of acute GvHD
with success. Daclizumab, infliximab, visilizumab, and ABX-CBL have shown
promising activity in steroid-resistant acute GvHD in early clinical testing.
This review summarizes current experience with monoclonal antibodies in the
management of acute and chronic GvHD. Over the next decade, however, the
challenge will be to define the relative place of these antibodies in the
therapeutic armamentarium for GvHD and their impact on long-term survival. N. Ref:: 101
----------------------------------------------------
[56]
TÍTULO / TITLE: - Genetic predisposition
to infectious pathogens: a review of less familiar variants.
REVISTA
/ JOURNAL: - Pediatr Infect Dis J 2003
May;22(5):457-61.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.inf.0000068205.82627.55
AUTORES
/ AUTHORS: - Somech R; Amariglio N; Spirer Z; Rechavi G
INSTITUCIÓN
/ INSTITUTION: - Pediatric Hemato-Oncology, Chaim Sheba
Medical Center, Tel Hashomer, Israel.
RESUMEN
/ SUMMARY: - The susceptibility and clinical
manifestations of infectious diseases in human populations are influenced by a
variety of factors, among them host genetics. Obvious examples for the effect
of host genetics on predisposition to unique infections are the primary
immunodeficiency diseases. Minor gene variants that influence the host immune
system are much more common. The iceberg model can be used to illustrate the
epidemiology of immunodeficiency states. Accordingly only a few individuals
have known and severe recognized primary immunodeficiencies, whereas many more
patients have mild immunodeficiencies that may remain undiagnosed and are
predisposed to a unique infectious disease. We review some of the less common
variants that influence the host defense and predispose to certain infectious
agents or change their outcome. N.
Ref:: 43
----------------------------------------------------
[57]
TÍTULO / TITLE: - HFE gene and hereditary
hemochromatosis: a HuGE review. Human Genome Epidemiology.
REVISTA
/ JOURNAL: - Am J Epidemiol 2001 Aug 1;154(3):193-206.
AUTORES
/ AUTHORS: - Hanson EH; Imperatore G; Burke W
INSTITUCIÓN
/ INSTITUTION: - United States Air Force School of
Aerospace Medicine, Brooks Air Force Base, San Antonio, TX, USA. erichansonmdmph@yahoo.com
RESUMEN
/ SUMMARY: - Hereditary hemochromatosis (HHC) is an
autosomal recessive disorder of iron metabolism characterized by increased iron
absorption and deposition in the liver, pancreas, heart, joints, and pituitary
gland. Without treatment, death may occur from cirrhosis, primary liver cancer,
diabetes, or cardiomyopathy. In 1996, HFE, the gene for HHC, was mapped on the
short arm of chromosome 6 (6p21.3). Two of the 37 allelic variants of HFE
described to date (C282Y and H63D) are significantly correlated with HHC.
Homozygosity for the C282Y mutation was found in 52-100% of previous studies on
clinically diagnosed probands. In this review, 5% of HHC probands were found to
be compound heterozygotes (C282Y/H63D), and 1.5% were homozygous for the H63D
mutation; 3.6% were C282Y heterozygotes, and 5.2% were H63D heterozygotes. In
7% of cases, C282Y and H63D mutations were not present. In the general
population, the frequency of the C282Y/C282Y genotype is 0.4%. C282Y
heterozygosity ranges from 9.2% in Europeans to nil in Asian, Indian
subcontinent, African/Middle Eastern, and Australasian populations. The H63D
carrier frequency is 22% in European populations. Accurate data on the
penetrance of the different HFE genotypes are not available. Extrapolating from
limited clinical observations in screening studies, an estimated 40--70% of
persons with the C282Y homozygous genotype will develop clinical evidence of
iron overload. A smaller proportion will die from complications of iron
overload. To date, population screening for HHC is not recommended because of
uncertainties about optimal screening strategies, optimal care for susceptible
persons, laboratory standardization, and the potential for stigmatization or
discrimination. N.
Ref:: 103
----------------------------------------------------
[58]
TÍTULO / TITLE: - Preventing saphenous
vein graft failure: does gene therapy have a role?
REVISTA
/ JOURNAL: - Ann Thorac Surg 2003 Sep;76(3):959-66.
AUTORES
/ AUTHORS: - Akowuah EF; Sheridan PJ; Cooper GJ; Newman
C
INSTITUCIÓN
/ INSTITUTION: - Cardiovascular Research Group, The
University of Sheffield, Sheffield, United Kingdom. akowuah@yahoo.com
RESUMEN
/ SUMMARY: - Gene therapy potentially allows local
delivery and expression of cytokines, growth factors, and other mediators. In
spite of increasing knowledge of the human genome, applications in clinical
practice are only just beginning. The main limitations of effective clinical
gene therapy are safety and low transfection efficiency. Saphenous vein grafts
permit the transfection of the conduit ex vivo. This allows a variety of
transfection techniques to be used, enhancing the transfection efficiency while
limiting the risk of systemic complications. This review examines the potential
mechanisms of gene delivery and genetic targets that may be applied to
saphenous vein graft failure. N.
Ref:: 68
----------------------------------------------------
[59]
TÍTULO / TITLE: - Cost advantages of oral
drug therapy for managing cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S9-12.
AUTORES
/ AUTHORS: - Somerville KT
INSTITUCIÓN
/ INSTITUTION: - University of Utah Health Sciences Center,
Department of Pharmacy Services, Salt Lake City, UT, USA. troy.somerville@hsc.utah.edu
RESUMEN
/ SUMMARY: - Cost advantages of the oral route of drug
therapy administration over the intravenous route for managing cytomegalovirus
(CMV) disease are described. The overall costs usually are lower for the oral
route of administration than for the intravenous route, although the cost to
the patient depends on insurance coverage. Other advantages of the oral route
include greater safety and convenience, which may improve patient adherence and
quality of life. In patients with acquired immunodeficiency syndrome (AIDS),
the use of oral ganciclovir instead of intravenous ganciclovir to treat the
maintenance phase of CMV retinitis reduced the incidence of neutropenia and
sepsis, outpatient and inpatient resource use, and costs. Oral therapy also
improved patient quality of life. A cost-effectiveness model for liver
transplant recipients found that CMV prophylaxis is warranted for all patients,
ganciclovir is preferred over CMV immune globulin i.v. and oral acyclovir for
prophylaxis, and the oral route of administration is more cost-effective than
the intravenous route for ganciclovir. Valganciclovir, the oral prodrug of
ganciclovir, was not included in this model. Oral maintenance therapy is
usually cost-effective, safer, and more convenient than intravenous therapy in
the management of CMV. N.
Ref:: 8
----------------------------------------------------
[60]
TÍTULO / TITLE: - Graft function and
other risk factors as predictors of cardiovascular disease outcome.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S16-9.
AUTORES
/ AUTHORS: - Forsythe JL
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, The Royal Infirmary of
Edinburgh, UK. john.forsythe@luht.scot.nhs.uk
RESUMEN
/ SUMMARY: - The high incidence of cardiovascular
disease after renal transplantation is related to a high prevalence and
accumulation of risk factors before and after transplantation. Hypertension,
posttransplantation diabetes, and hyperlipidemia are well-recognized risk
factors for the development of cardiovascular events after renal
transplantation and are strongly associated with immunosuppressive therapy.
Hyperhomocysteinemia is a potential risk factor for cardiovascular disease in
renal transplant recipients, but although a growing matter of study, a direct
association with immunosuppressive agents is not yet proven. In addition to
treatment intervention, risk management should also involve tailoring the
immunosuppressive regimen to minimize the more indirect cardiovascular risk
factors such as renal dysfunction and acute rejection. N. Ref:: 41
----------------------------------------------------
[61]
TÍTULO / TITLE: - Treatment-related
mortality and graft-versus-leukemia activity after allogeneic stem cell
transplantation for chronic lymphocytic leukemia using intensity-reduced
conditioning.
REVISTA
/ JOURNAL: - Leukemia 2003 May;17(5):841-8.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.leu.2402905
AUTORES
/ AUTHORS: - Dreger P; Brand R; Hansz J; Milligan D;
Corradini P; Finke J; Deliliers GL; Martino R; Russell N; Van Biezen A;
Michallet M; Niederwieser D
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology, Allgemeines
Krankenhaus St Georg, Hamburg, Germany.
RESUMEN
/ SUMMARY: - Allogeneic stem cell transplantation (SCT)
using reduced-intensity conditioning (RIC) has potential to be a promising
treatment of aggressive chronic lymphocytic leukemia (CLL). Since available
clinical data obtained with this novel approach are very limited, we have
performed a survey on this issue. Data of 77 patients were collected from 29 European
Group for Blood and Marrow Transplantation centers. Median age was 54 (30-66)
years, and the median number of previous chemotherapy regimens was 3 (0-8).
HLA-identical sibling donors were used in 81% of the cases. Moderate
conditioning regimens (mainly low-dose total body irradiation (TBI) or
fludarabine-cyclophosphamide combinations) were administered to 56% of the
patients, whereas the remainder received more intense conditioning consisting
of fludarabine-busulfan or high-dose melphalan combinations. In 40% of the
patients, in vivo T-cell depletion (TCD) with anti-thymocyte globulin or
CAMPATH-1H was part of the conditioning regimen. Cumulative treatment-related
mortality (TRM) was 18% (95% CI 9; 27) after 12 months. Complete chimerism as
well as best response was not achieved immediately post-transplant but took a
median of 3 months to develop. The 2-year probability of relapse was 31% (95%
CI 18; 44), with no event occurring later than 12 months post transplant in the
absence of TCD. With one exception, relapses were not observed after onset of
chronic graft-versus-host disease. Event-free and overall survival at 24 months
were 56% (95% CI 43; 69) and 72% (95% CI 61; 83), respectively. The median
follow-up was 18 (1-44) months. Donor lymphocyte infusions or secondary
transplants were performed in 19 patients with insufficient disease control
and/or incomplete donor chimerism post-transplant, leading to a response in
seven patients (37%). Preliminary multivariate analysis identified less than PR
at transplant (hazard ratio (HR) 3.5; P&<0.01) and alternative donor (HR
3.1; P=0.02) as significant risk factors for relapse, whereas number of
previous regimens >2 (HR 5.4; P=0.03), TBI (HR 2.5; P=0.05), and alternative
donor (HR 2.3; P=0.08) were risk factors for survival. We conclude that RIC
might favorably influence the outcome after allogeneic SCT for CLL by reducing
TRM while preserving graft-versus leukemia activity. N. Ref:: 28
----------------------------------------------------
[62]
TÍTULO / TITLE: - Prevention of
cytomegalovirus disease in recipients of solid-organ transplants.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Feb 15;32(4):596-603.
Epub 2001 Feb 6.
AUTORES
/ AUTHORS: - Paya CV
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases and
Transplant Center, Mayo Clinic, Rochester, MN 55905. USA. paya@mayo.edu
RESUMEN
/ SUMMARY: - The introduction and combination of
more-potent immunosuppressive regimens, and the increased transplantation of
organs into more severely ill patients, have again placed cytomegalovirus (CMV)
disease in the spotlight of posttransplantation complications. Both direct and
associated complications related to CMV need to be considered in understanding
the pathogenesis of CMV infection after solid-organ transplantation. New
diagnostic methods with higher sensitivity for the detection of CMV and the
ability to quantify CMV indicate that low levels of CMV replication are present
in many patients who don’t have clinical symptoms ascribed to CMV infection.
How these low levels of CMV replication impact the outcome of the transplanted
graft remains unknown. In addition, there needs to be further study regarding
whether only patients at high risk for developing CMV disease or, also, those
with clinically asymptomatic levels of CMV replication should be the target of
effective preventive regimens. This review summarizes our current knowledge of
the pathogenesis of CMV infection after solid-organ transplantation, and it
outlines different effective preventive regimens and approaches. N. Ref:: 47
----------------------------------------------------
[63]
TÍTULO / TITLE: - Electrostatic potential
on human leukocyte antigen: implications for putative mechanism of chronic
beryllium disease.
REVISTA
/ JOURNAL: - Environ Health Perspect. Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://ehpnet1.niehs.nih.gov/docs/montharch.html
●●
Cita: Environmental Health Perspectives: <> 2003 Nov;111(15):1827-34.
AUTORES
/ AUTHORS: - Snyder JA; Weston A; Tinkle SS; Demchuk E
INSTITUCIÓN
/ INSTITUTION: - Health Effects Laboratory Division,
National Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, 1095 Willowdale Road, Morgantown, WV 26505, USA.
RESUMEN
/ SUMMARY: - The pathobiology of chronic beryllium
disease (CBD) involves the major histocompatibility complex class II human
leukocyte antigen (HLA). Although occupational exposure to beryllium is the
cause of CBD, molecular epidemiologic studies suggest that specific
(Italic)HLA-DPB1(/Italic) alleles may be genetic susceptibility factors. We
have studied three-dimensional structural models of HLA-DP proteins encoded by
these genes. The extracellular domains of HLA-DPA1*0103/B1*1701, *1901, *0201,
and *0401, and HLA-DPA1*0201/B1*1701, *1901, *0201, and *0401 were modeled from
the X-ray coordinates of an HLA-DR template. Using these models, the
electrostatic potential at the molecular surface of each HLA-DP was calculated
and compared. These comparisons identify specific characteristics in the
vicinity of the antigen-binding pocket that distinguish the different HLA-DP
allotypes. Differences in electrostatics originate from the shape, specific
disposition, and variation in the negatively charged groups around the pocket.
The more negative the pocket potential, the greater the odds of developing CBD
estimated from reported epidemiologic studies. Adverse impact is caused by
charged substitutions in positions 55, 56,
69, 84, and 85, namely, the exact same loci identified
as genetic markers of CBD susceptibility as well as cobalt-lung hard metal
disease. These findings suggest that certain substitutions may promote an
involuntary cation-binding site within a putatively metal-free peptide-binding
pocket and therefore change the innate specificity of antigen recognition. N. Ref:: 31
----------------------------------------------------
[64]
TÍTULO / TITLE: - New strategies for
prevention and treatment of graft-versus-host disease and for induction of
graft-versus-leukemia effects.
REVISTA
/ JOURNAL: - Int J Hematol 2003 Jan;77(1):15-21.
AUTORES
/ AUTHORS: - Deeg HJ
INSTITUCIÓN
/ INSTITUTION: - Fred Hutchinson Cancer Research Center and
University of Washington, Seattle, Washington 98109-1024, USA. jdeeg@fhcrc.org
RESUMEN
/ SUMMARY: - Graft-versus-host disease (GVHD) continues
to be a problem in allogeneic hemopoietic stem cell transplantation; however,
our understanding of the basic pathophysiology of GVHD has improved. Although
not all data obtained from murine or other animal models can be extrapolated to
the clinic, there are leads that deserve to be pursued. The skin, intestinal
tract, and liver are the 3 major target organs of GVHD and share the feature of
presenting a barrier to the “environment” of the host. There is evidence that
the damage inflicted to these organs, the epithelial and endothelial cells in
particular, by the conditioning regimen causes a release of various cytokines
and a penetration of endotoxin into the systemic circulation. According to
these observations, the nonimmunologic aspects of GVHD have been likened to an
inflammatory process. If this characterization is valid, blocking these
nonspecific inflammatory changes would ameliorate GVHD without interfering with
the graft-versus-leukemia (GVL) reaction. In fact, one study has shown a
substantial amelioration of GVHD with a molecule that directly blocks
endotoxin. Clinical data also suggest that patients with organ dysfunction
early after transplantation that is presumed to be treatment related may
benefit from preemptive interventions aimed at controlling GVHD. Furthermore,
there is growing evidence that the mechanisms involved in GVHD may differ from
organ to organ (for example, Fas/Fas-ligand interactions in the liver versus
tumor necrosis factor alpha/receptor interactions in the intestinal tract), and
from a therapeutic point of view, the time of onset of clinical GVHD may be
important in choosing the appropriate therapy. Thus, combinations of
interventions chosen and timed appropriately may be more effective in
preventing and managing GVHD than are the standard across-the-board approaches
that have been used so far. Such a strategy may also be successful in
maintaining a GVL effect and possibly in incorporating direct antileukemic
therapy, such as the use of cytotoxic T-cells directed at minor
histocompatibility antigens, without increasing the risk of GVHD. The
development of nonmyeloablative conditioning regimens and the observations on GVHD
kinetics and the progression or eradication of leukemia with that strategy are
likely to add new insights into how one can optimally combine various
modalities to achieve engraftment, prevent GVHD, and at the same time maintain
a GVL effect. N.
Ref:: 75
----------------------------------------------------
[65]
TÍTULO / TITLE: - Prevention of acute
graft-versus-host-disease by selective depletion of T cells reactive with minor
histocompatibility antigens on epithelial cells.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2001 Jan;40(3-4):385-91.
AUTORES
/ AUTHORS: - Otten HG; Van Dyk AM; Verdonck LF
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology, University
Hospital Utrecht, The Netherlands. H.G.Otten@lab.azu.nl
RESUMEN
/ SUMMARY: - Graft-versus-host disease (GVHD) is a
major obstacle in allogeneic hematopoietic stem cell transplantation (HSCT).
Mature donor T-cells present in the graft play a pivotal role in the
development of acute GVHD. On the other hand, mature donor T-cells in the graft
are also crucial for the elimination of residual tumor cells still present in
the patient after HSCT. Whether donor T cells act non-specifically against the
patient, including an overlapping GVHD/GVL reactivity, or some donor T cells
have GVHD reactivity while other donor T cells have GVL reactivity is still
unclear. Some in-vitro data are suggestive that selective T cell depletion
techniques are possible by which GVHD-reactive T cells can be eliminated while
GVL-reactive T cells are preserved. Here we update some approaches of selective
T cell depletion that have been developed in our laboratory. N. Ref:: 50
----------------------------------------------------
[66]
TÍTULO / TITLE: - Formulary
considerations for drugs used to prevent cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S17-21.
AUTORES
/ AUTHORS: - Pescovitz MD
INSTITUCIÓN
/ INSTITUTION: - Organ Transplant Program, Indiana
University Medical Center, Indianapolis, IN, USA. mpescov@iupui.edu
RESUMEN
/ SUMMARY: - Four types of therapeutic strategies for
managing cytomegalovirus (CMV) in solid organ transplant recipients, the
mechanisms of action and efficacy of drugs used for prophylaxis, and the
criteria for evaluating drugs for inclusion in a formulary are described.
Universal and selective prophylaxis are simple to implement and effective for
CMV prophylaxis, but they are costly and patient nonadherence and viral
resistance can develop. Preemptive therapy may cause less resistance and cost
less, but it is more complex and associated with a higher incidence of
infection, which may have no effect on secondary effects from CMV infection,
and higher recurrence of disease than prophylactic therapy. Treatment of active
disease may be less costly for the drug than other approaches, but intravenous
access is required and the rates of infection recurrence and mortality are
higher compared with prophylaxis and preemptive therapy. Criteria for deciding
which CMV prophylactic drugs to include in a formulary include efficacy,
safety, convenience, and cost. CMV immune globulin i.v. is costly and exhibits
reduced efficacy when used alone in patients at high risk for CMV disease.
Intravenous ganciclovir is effective, but it is costly because of infusion
costs. Intravenous drug therapies are inconvenient and associated with a risk
of bacterial and fungal infection. Oral acyclovir is safe to use and
inexpensive (since a genetic exists), but it has poor efficacy and is
inconvenient because of the need for four large daily doses. Valacyclovir is
more convenient and with similar safety and probably better efficacy than
acyclovir, but it is more costly. Oral ganciclovir and oral valganciclovir have
similar safety and costs, with greater efficacy than acyclovir. The single
daily dose and lack of resistance to valganciclovir are advantages over oral
ganciclovir, which requires three daily doses and can result in the development
of resistance. N.
Ref:: 20
----------------------------------------------------
[67]
TÍTULO / TITLE: - Clinical epidemiology
of cardiac disease in renal transplant recipients.
REVISTA
/ JOURNAL: - Semin Dial 2003 Mar-Apr;16(2):106-10.
AUTORES
/ AUTHORS: - Rigatto C
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, St. Boniface General Hospital, University of Manitoba, Winnipeg,
Canada. crigatto@sbgh.mb.ca
RESUMEN
/ SUMMARY: - Cardiovascular disease (CVD) is the major
cause of death among renal transplant recipients (RTRs), accounting for 17-50%
of deaths. Both cardiomyopathy (congestive heart failure [CHF] and left
ventricular hypertrophy [LVH]) and ischemic heart disease (IHD) are important
complications of renal transplantation, although the morbid impact of
cardiomyopathy has been overlooked until recently. Echocardiographic disorders
and clinical CHF occur far more frequently in RTRs than in the general
population, suggesting that renal transplantation may be a state of accelerated
heart failure. In contrast, the incidence of IHD in RTRs is similar to that in
the Framingham cohort. Age, diabetes, and gender remain important markers of
risk for both disorders. Smoking, hyperlipidemia, and hypertension appear to be
the major reversible risk factors for IHD, while anemia and hypertension are
major reversible risk factors for cardiomyopathy. Definitive evidence on
optimal intervention is lacking. Clinical trials are needed to define optimum
targets for treatment of these risk factors, especially hypertension and
anemia. N. Ref:: 33
----------------------------------------------------
[68]
TÍTULO / TITLE: -
Ischemia-reperfusion-induced lung injury.
REVISTA
/ JOURNAL: - Am J Respir Crit Care Med. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajrccm.atsjournals.org/
●●
Cita: Am J. of Respir & Crit Care Med: <> 2003 Feb 15;167(4):490-511.
●●
Enlace al texto completo (gratuito o de pago) 1164/rccm.200207-670SO
AUTORES
/ AUTHORS: - de Perrot M; Liu M; Waddell TK; Keshavjee
S
INSTITUCIÓN
/ INSTITUTION: - Toronto Lung Transplant Program, Toronto
General Hospital, University Health Network, University of Toronto, Toronto,
Ontario, Canada.
RESUMEN
/ SUMMARY: - Ischemia-reperfusion-induced lung injury
is characterized by nonspecific alveolar damage, lung edema, and hypoxemia
occurring within 72 hours after lung transplantation. The most severe form may
lead to primary graft failure and remains a significant cause of morbidity and
mortality after lung transplantation. Over the past decade, better
understanding of the mechanisms of ischemia-reperfusion injury, improvements in
the technique of lung preservation, and the development of a new preservation
solution specifically for the lung have been associated with a reduction in the
incidence of primary graft failure from approximately 30 to 15% or less.
Several strategies have also been introduced into clinical practice for the
prevention and treatment of ischemia-reperfusion-induced lung injury with
various degrees of success. However, only three randomized, double-blinded,
placebo-controlled trials on ischemia-reperfusion-induced lung injury have been
reported in the literature. In the future, the development of new agents and
their application in prospective clinical trials are to be expected to prevent
the occurrence of this potentially devastating complication and to further
improve the success of lung transplantation.
N. Ref:: 340
----------------------------------------------------
[69]
TÍTULO / TITLE: - TOR inhibitors and
cardiac allograft vasculopathy: is inhibition of intimal thickening an adequate
surrogate of benefit?
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
May;22(5):501-4.
AUTORES
/ AUTHORS: - Mehra MR; Uber PA
INSTITUCIÓN
/ INSTITUTION: - Cardiomyopathy and Heart Transplantation
Center, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA. mmehra@ochsner.org N. Ref:: 30
----------------------------------------------------
[70]
TÍTULO / TITLE: - Improving immune
reconstitution while preventing graft-versus-host disease in allogeneic stem
cell transplantation.
REVISTA
/ JOURNAL: - Semin Hematol 2002 Jan;39(1):32-40.
AUTORES
/ AUTHORS: - Cavazzana-Calvo M; Andre-Schmutz I;
Hacein-Bey-Abina S; Bensoussan D; Le Deist F; Fischer A
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Therapie Cellulaire et
Genique, INSERM U429, Hopital Necker-Enfants Malades, Paris, France.
RESUMEN
/ SUMMARY: - Allogeneic hematopoietic stem cell
transplantation (HSCT) is the treatment of choice for many hematologic
malignancies or inherited disorders. Ex vivo T-cell depletion (TCD) of the
graft and post-transplantation immunosuppression efficiently prevent the
development of graft-versus-host disease (GVHD). However, the consequence of
these nonspecific approaches is a long-lasting immunodeficiency associated with
increased disease relapse, graft rejection, and reactivation of viral
infections. Donor lymphocyte infusion, to treat leukemic relapse after
allogeneic HSCT, can cause severe GVHD. Several strategies are being optimized
to specifically inactivate anti-host T cells while preserving antileukemic or
antimicrobial immunocompetence, based on ex vivo or in vivo elimination of
anti-host T cells or on the modulation of their anti-host activity. N. Ref:: 80
----------------------------------------------------
[71]
TÍTULO / TITLE: - Chemokines, their receptors,
and transplant outcome.
REVISTA
/ JOURNAL: - Transplantation 2002 Jul 27;74(2):149-55.
AUTORES
/ AUTHORS: - Colvin BL; Thomson AW
INSTITUCIÓN
/ INSTITUTION: - Thomas E. Starzl Transplantation Institute
and Departments of Surgery, Molecular Genetics and Biochemistry, and
Inmunology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
RESUMEN
/ SUMMARY: - Organ transplant rejection is mediated
largely by circulating peripheral leukocytes induced to infiltrate the graft by
various inflammatory stimuli. Of these, chemotactic cytokines called
chemokines, expressed by inflamed graft tissues, as well as by early
innate-responding leukocytes that infiltrate the graft, are responsible for the
recruitment of alloreactive leukocytes. This report discusses the impact of
these leukocyte-directing proteins on transplant outcome and novel therapeutic
approaches for antirejection therapy based on targeting of chemokines and/or
their receptors. N.
Ref:: 70
----------------------------------------------------
[72]
TÍTULO / TITLE: - Prevention and
treatment of cytomegalovirus infections in solid organ transplant recipients.
REVISTA
/ JOURNAL: - Pediatr Infect Dis J 2002 May;21(5):432-4.
AUTORES
/ AUTHORS: - Danziger-Isakov LA; Storch GA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Washington
University School of Medicine, St. Louis, MO, USA. N. Ref:: 17
----------------------------------------------------
[73]
- Castellano -
TÍTULO / TITLE:Incidencia, factores de riesgo e
influencia sobre la supervivencia de las complicaciones infecciosas en el
trasplante hepatico. Incidence, risk factors and influence on survival of
infectious complications in liver transplantation.
REVISTA
/ JOURNAL: - Enferm Infecc Microbiol Clin. Acceso
gratuito al texto completo.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Enfermedades Infecciosas y Microbiologia Clinica: <> 2003
May;21(5):224-31.
AUTORES
/ AUTHORS: - Echaniz A; Pita S; Otero A; Suarez F;
Gomez M; Guerrero A
INSTITUCIÓN
/ INSTITUTION: - Unidad de Enfermedades Infecciosas.
Complejo Hospitalario Juan Canalejo. A Coruna. España. aechaniz@hcii.insalud.es
RESUMEN
/ SUMMARY: - INTRODUCTION: Orthotopic liver transplantation
(OLT) is successful therapy for patients with end-stage liver disease.
Infection is currently a life-threatening complication for these patients. The
aims of this study are to determine the incidence of various infections in
patients with OLT, to study overall survival rates and survival as related to
individual infections, and to investigate the risk factors associated with
first episodes of bacterial (BI), fungal (FI), invasive fungal (IFI) and
cytomegalovirus (CMV) infections. METHODS: The study includes 165 OLTs
performed in 152 recipients from May 1994 to May 1998. A descriptive analysis
estimating the 95% confidence interval was performed with 100 variables
stratified according to preoperative, operative and postoperative conditions. Cox
regression analysis was used to identify the variables associated with
infection. Survival studies were carried out with the Kaplan-Meier method.
RESULTS: Among the total, 66% of patients developed infection: 41.8% viral,
33.9% BI, 20.6% FI and 4.2% IFI. One-year and 4-year survival rates after
transplantation were 90% and 75%, respectively. All the infections decreased
survival. Multivariate analyses identified the following risk factors for the
specific infections: BI - dialysis, mechanical ventilation, and time of organ
ischemia during harvesting; FI - number of hours of surgery and
pretransplantation plasma albumin concentrations; IFI - number of blood units
transfused, pretransplantation plasma albumin and retransplantation.
Cytomegalovirus infection was associated with FI and IFI in the univariate
analysis, but the multivariate analysis identified no variables that
independently increased the risk of developing this infection. N. Ref:: 39
----------------------------------------------------
[74]
TÍTULO / TITLE: - FTY720: altered
lymphocyte traffic results in allograft protection.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 15;72(5):764-9.
AUTORES
/ AUTHORS: - Brinkmann V; Pinschewer DD; Feng L; Chen S
INSTITUCIÓN
/ INSTITUTION: - Novartis Pharma AG, Transplantation
Research, WSJ-386.1.01, CH-4002 Basel, Switzerland. N. Ref:: 52
----------------------------------------------------
[75]
TÍTULO / TITLE: - Prevention and
treatment of viral infections in stem cell transplant recipients.
REVISTA
/ JOURNAL: - Br J Haematol 2002 Jul;118(1):44-57.
AUTORES
/ AUTHORS: - Ljungman P
INSTITUCIÓN
/ INSTITUTION: - Department of Haematology, Huddinge
University Hospital, Karolinska Institutet, Stockholm, Sweden. Per.Ljungman@medhs.ki.se N. Ref:: 147
----------------------------------------------------
[76]
TÍTULO / TITLE: - Basiliximab: a review
of its use as induction therapy in renal transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(24):2803-35.
AUTORES
/ AUTHORS: - Chapman TM; Keating GM
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Basiliximab (Simulect), a chimeric
(human/murine) monoclonal antibody, is indicated for the prevention of acute
organ rejection in adult and paediatric renal transplant recipients in
combination with other immunosuppressive agents.Basiliximab significantly
reduced acute rejection compared with placebo in renal transplant recipients
receiving dual- (cyclosporin microemulsion and corticosteroids) or
triple-immunotherapy (azathioprine- or mycophenolate mofetil-based); graft and
patient survival rates at 12 months were similar. Significantly more
basiliximab than placebo recipients were free from the combined endpoint of
death, graft loss or acute rejection 3 years, but not 5 years, after
transplantation.The incidence of adverse events was similar in basiliximab and
placebo recipients, with no increase in the incidence of infection, including
cytomegalovirus (CMV) infection. Malignancies or post-transplant
lymphoproliferative disorders after treatment with basiliximab were rare, with
a similar incidence to that seen with placebo at 12 months or 5 years
post-transplantation. Rare cases of hypersensitivity reactions to basiliximab
have been reported.The efficacy of basiliximab was similar to that of equine
antithymocyte globulin (ATG) and daclizumab, and similar to or greater than
that of muromonab CD3. Basiliximab was as effective as rabbit antithymocyte
globulin (RATG) in patients at relatively low risk of acute rejection, but less
effective in high-risk patients. Numerically or significantly fewer patients
receiving basiliximab experienced adverse events considered to be related to
the study drug than ATG or RATG recipients. The incidence of infection,
including CMV infection, was similar with basiliximab and ATG or
RATG.Basiliximab plus baseline immunosuppression resulted in no significant
differences in acute rejection rates compared with baseline immunosuppression
with or without ATG or antilymphocyte globulin in retrospective analyses
conducted for small numbers of paediatric patients. Limited data from
paediatric renal transplant recipients suggest a similar tolerability profile
to that in adults. Basiliximab appears to allow the withdrawal of
corticosteroids or the use of corticosteroid-free or calcineurin
inhibitor-sparing regimens in renal transplant recipients.Basiliximab did not
increase the overall costs of therapy in pharmacoeconomic studies.CONCLUSION:
Basiliximab reduces acute rejection without increasing the incidence of adverse
events, including infection and malignancy, in renal transplant recipients when
combined with standard dual- or triple-immunotherapy. The overall incidence of
death, graft loss or acute rejection was significantly reduced at 3 years;
there was no significant difference for this endpoint 5 years after
transplantation. Malignancy was not increased at 5 years. The overall efficacy,
tolerability, ease of administration and cost effectiveness of basiliximab make
it an attractive option for the prophylaxis of acute renal transplant
rejection. N. Ref:: 85
----------------------------------------------------
[77]
TÍTULO / TITLE: - A refined understanding
of immunosuppressives and cancer risk.
REVISTA
/ JOURNAL: - Kidney Int 2003 Mar;63(3):1160-1.
AUTORES
/ AUTHORS: - Strom TB; Sukhatme VP N. Ref:: 16
----------------------------------------------------
[78]
TÍTULO / TITLE: - Gene transfer of
cytoprotective and immunomodulatory molecules for prevention of cardiac
allograft rejection.
REVISTA
/ JOURNAL: - Eur J Cardiothorac Surg 2003
Nov;24(5):794-806.
AUTORES
/ AUTHORS: - Vassalli G; Fleury S; Li J; Goy JJ;
Kappenberger L; von Segesser LK
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiology, BH-10, CHUV,
University of Lausanne Medical School, Rue du Bugnon 46, 1011 Lausanne,
Switzerland. guiseppe.vassalli@chuv.hospvd.ch
RESUMEN
/ SUMMARY: - Current treatments of heart
transplantation are limited by incomplete effectiveness, significant toxicity,
and failure to prevent chronic rejection. Genetic manipulation of the donor
heart at the time of removal offers the unique opportunity to produce a
therapeutic molecule within the graft itself, while minimizing systemic
effects. Cytoprotective approaches including gene transfer of heme oxygenase
(HO)-1, endothelial nitric oxide synthase, and antisense oligodeoxynucleotides
specific for nuclear factor (NF)-kappa B or intercellular adhesion molecule
(ICAM)-1 reduced ischaemia-reperfusion injury and delayed cardiac allograft
rejection in small animals. Exogenous overexpression of immunomodulatory
cytokines such as interleukin (IL)-4, IL-10 and transforming growth
factor-beta, as well as gene transfer of inhibitors of pro-inflammatory
cytokines also delayed graft rejection. Gene transfer-based blockade of T-cell
costimulatory activation with CTLA4-Ig or CD40-Ig resulted in long-lasting
graft survival and donor-specific unresponsiveness, as manifested by acceptance
of a second graft from the original donor strain but rejection of third-party
grafts. Similar results were obtained with donor major histocompatibility
complex class I gene transfer into bone marrow cells. Gene therapy approaches
to chronic rejection included gene transfer of HO-1, soluble Fas, tissue
plasminogen activator and antisense oligodeoxynucleotides specific for the
anti-apoptotic mediator Bcl-x or the E2F transcription factor. Despite major
experimental advances, however, gene therapy for heart transplantation has not
entered the clinical arena yet. Fundamental questions regarding the most
suitable vector, the best gene, and safety issues remain unanswered.
Well-controlled studies that compare gene therapy with established treatments
in non-human primates are needed before clinical trials can be started. N. Ref:: 105
----------------------------------------------------
[79]
TÍTULO / TITLE: - De novo thrombotic
microangiopathy in renal transplant recipients: a comparison of hemolytic
uremic syndrome with localized renal thrombotic microangiopathy.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Feb;41(2):471-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/ajkd.2003.50058
AUTORES
/ AUTHORS: - Schwimmer J; Nadasdy TA; Spitalnik PF;
Kaplan KL; Zand MS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Nephrology Unit,
University of Rochester Medical Center, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Thrombotic microangiopathy
(TMA) is a well-recognized and serious complication of renal transplantation,
affecting 3% to 14% of patients administered calcineurin-inhibitor-based
immunosuppression. METHODS: We reviewed 1,219 biopsy reports of 742 kidney and
kidney-pancreas transplants performed during 15 years at our center and found
21 biopsy-confirmed cases of TMA. RESULTS: On presentation, the majority (62%)
had systemic TMA with manifest hemolysis and thrombocytopenia, whereas a subset
had TMA localized only to the graft (38%). There were no statistically
significant differences in sex, type of transplant, age, race, or type of
immunosuppression. Patients with systemic TMA were more likely to be treated
with plasma exchange (38% versus 13%; P < 0.05), more often required
dialysis therapy (54% versus 0%; P = 0.01), and had a greater rate of graft
loss (38% versus 0%; P < 0.05). No patient with the localized variant had
TMA-related graft loss. Patients with localized TMA often responded to
reduction, conversion, or temporary discontinuation of
calcineurin-inhibitor-based immunosuppression therapy and did not routinely
require plasma exchange for graft salvage. We compare our findings with the
literature regarding the prognosis of TMA. CONCLUSION: Classifying patients
with post-renal transplantation TMA into those with localized and systemic
disease is clinically useful because each group has distinct characteristics
and clinical courses. N.
Ref:: 37
----------------------------------------------------
[80]
TÍTULO / TITLE: - Hepatic venoocclusive
disease in blood and bone marrow transplantation in children: incidence, risk
factors, and outcome.
REVISTA
/ JOURNAL: - J Pediatr Hematol Oncol 2002
Dec;24(9):706-9.
AUTORES
/ AUTHORS: - Vogelsang GB; Dalal J N. Ref:: 59
----------------------------------------------------
[81]
TÍTULO / TITLE: - Parainfluenza virus
infection in adult lung transplant recipients: an emergent clinical syndrome
with implications on allograft function.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Feb;3(2):116-20.
AUTORES
/ AUTHORS: - Vilchez RA; Dauber J; McCurry K; Iacono A;
Kusne S
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Pittsburgh Medical Center, Pittsburgh, PA, USA.
RESUMEN
/ SUMMARY: - Parainfluenza virus is a common cause of
seasonal upper respiratory tract infections in children and adults. Studies
indicate that parainfluenza virus may play an important role in the etiology of
respiratory tract infections in lung transplant recipients with an estimated
incidence of 5.3 per 100 patients. Parainfluenza virus type 3 is the most
frequent serotype in lung transplant patients. The rate of lower respiratory
tract infections with parainfluenza virus among lung transplant recipients is
between 10 and 66% of cases. In addition, trans-bronchial biopsy at the time of
parainfluenza infection shows signs of acute allograft rejection. Subsequently,
32% of patients have been found to have active bronchiolitis obliterans at a
median time of 6 months (range 1-14) postviral infection. These findings
indicate that parainfluenza virus infections may have long-term implications
for lung transplant recipients. Further studies are required to identify the
mechanisms of immunomodulation of parainfluenza virus among these patients. In
addition, controlled studies are needed to evaluate the efficacy of aerosolized
ribavarin in the treatment of parainfluenza virus infection and to determine
whether vaccines may be effective in these high-risk patients. N. Ref:: 39
----------------------------------------------------
[82]
TÍTULO / TITLE: - Prevention of
cytomegalovirus disease in recipients of allogeneic stem cell transplants.
REVISTA
/ JOURNAL: - Clin Microbiol Rev. Acceso gratuito al
texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://cmr.asm.org/
●●
Cita: Clinical Microbiology Reviews: <> 2003 Oct;16(4):647-57.
AUTORES
/ AUTHORS: - Meijer E; Boland GJ; Verdonck LF
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology, University
Medical Center, Utrecht, The Netherlands. emeijer@digd.azu.nl
RESUMEN
/ SUMMARY: - The main risk factors for cytomegalovirus
(CMV) disease in recipients of allogeneic stem cell transplants (SCT) are
recipient CMV seropositivity and acute graft-versus-host disease. Currently,
two antiviral strategies, prophylactic or preemptive antiviral treatment, are
used for prevention of CMV disease. Preemptive treatment is most favorable when
short-term (14-day) treatment is applied. Several methods are available for
monitoring of CMV reactivation. PCR-based CMV DNA detection assays are the most
sensitive methods; however, the clinical benefit of this high sensitivity is
unclear. Even more, there is lack of clarity whether PCR tests can better be
performed with plasma, whole blood, or peripheral blood leukocyte samples.
Recovery of a CMV-specific CD8(+) cytotoxic-T-lymphocyte (CTL) response is
necessary for preventing CMV reactivation and disease. Reconstitution of
absolute CMV-specific CTL counts to values above 10 x 10(6) to 20 x 10(6)
CTLs/liter is associated with protection from CMV disease. In the near future,
preemptive therapy might be withheld in patients with CMV reactivation who are
shown to have adequate CMV-specific cytotoxic T-cell levels. Antiviral therapy
with (val)acyclovir has been studied only as prophylactic treatment for
prevention of CMV infection. High-dose oral valacyclovir is more effective than
acyclovir when used in addition to preemptive treatment of CMV reactivation
with ganciclovir or foscarnet. Three antiviral drugs have been tested for
preemptive therapy of CMV reactivation and/or treatment of CMV disease. Although
intravenous ganciclovir is considered the drug of choice, foscarnet has similar
efficacy and less toxicity, especially hematologic toxicity. Cidofovir has not
been tested extensively, but so far the results are disappointing. Oral
valganciclovir for preemptive treatment of SCT recipients is currently being
studied. In addition to antiviral therapy, adoptive immunotherapy with
CMV-specific cytotoxic T cells as prophylactic or preemptive therapy is a very
elegant strategy; however, generation of these cells is expensive and
time-consuming, and therefore the therapy is not available at every
transplantation center. Magnetic selection of CMV-specific CD8(+) T cells from
peripheral blood by using HLA class I-peptide tetramers may be very promising,
making this strategy more accessible. N.
Ref:: 102
----------------------------------------------------
[83]
- Castellano -
TÍTULO / TITLE:La enfermedad linfoproliferativa
difusa postrasplante renal y su relacion con el virus Epstein-Barr. Experiencia
de un centro. Diffuse lymphoproliferative disease after renal transplantation
and its relation with Epstein-Barr virus. Experience at one center.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22(5):463-9.
AUTORES
/ AUTHORS: - Franco A; Jimenez L; Aranda I; Alvarez L;
Gonzalez M; Rocamora N; Olivares J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital General
Alicante Maestro Alonso, 109 03010 Alicante. franco_ant@gva.es
RESUMEN
/ SUMMARY: - Post-transplant lymphoproliferative disorders
(PTLD) are a group of heterogeneous lymphoid proliferations in chronic
immunosuppressed recipients which appear to be related to Epstein Barr Virus
(EBV). Receptor EBV seronegativity, use of antilymphocyte antibodies and CMV
disease have been identified as risk factors that may tigger development of
PTLD. We have studied the incidence of PTLD and its relationship with EBV in
588 adult renal transplant recipients who were transplanted in our hospital
from 1988 to 2001. We have also evaluated the diagnostic and therapeutic
methods used, the risk factors and outcome of the patients who developed PTLD.
We identified 8 recipients (4 males and 4 females), range from 18 to 67 years
(mean age 45.6 years) with a median time between grafting and PTLD of 4.1 years
(0.1-7 years), who developed PTLD (1.3%). Only 1 patient received OKT3 and had
CMV disease, two of them (25%) had been treated with hight doses of
prednisolone, another was EBV seronegative, but the rest of them (50%) had no
risk factors. Two patients were diagnosed at autopsy, the diagnosis of 5 was
based on the histology of biopsy and the last one by CT scans of chest-abdomen
and cytology. The presence of EBV in the lymphoproliferative cells was assessed
in 5 out of the 7 studied patients (71.4%). The outcome of our recipients was
poor. Five out of 8 patients died shortly after diagnosis as a direct
consecuence of PTLD and another of an infectious complication of the treatment
(75%). The 2 patients alive started dialysis and 1 of them died 2 years later of
a non-related cause. In conclusion, PTLD is a relatively frequent disease with
a poor prognosis in renal transplant patients. It seems to have a close
relationship with EBV and can develop in the absence of the classical risk
factors. N. Ref:: 18
----------------------------------------------------
[84]
TÍTULO / TITLE: - Current status of renal
transplantation. Patient evaluations and outcomes.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):677-86.
AUTORES
/ AUTHORS: - Barry JM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology and Renal
Transplantation, Department of Surgery, Oregon Health Sciences University,
Portland, Oregon, USA.
RESUMEN
/ SUMMARY: - A systematic team approach to the
assessment of renal transplant candidates is one of several factors that have
resulted in improved kidney transplant and recipient survival rates, rates that
were only imagined 4 decades ago. N.
Ref:: 47
----------------------------------------------------
[85]
TÍTULO / TITLE: - Treatment of
nonmelanoma skin cancer in organ transplant recipients: review of responses to
a survey.
REVISTA
/ JOURNAL: - J Am Acad Dermatol 2003 Sep;49(3):413-6.
AUTORES
/ AUTHORS: - Clayton AS; Stasko T
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Mohs Micrographic
Surgery Clinic, Vanderbilt University Medical Center, Nashville, Tennessee,
USA.
RESUMEN
/ SUMMARY: - There are approximately 100,000 US organ
transplant recipients, many with nonmelanoma skin cancers. To better understand
how clinicians treat them, we e-mailed a survey to the International
Transplant-Skin Cancer Collaborative and the Association of Academic
Dermatologic Surgeons. Twenty-five physicians responded. The majority use
topical 5-fluorouracil, cryosurgery, electrodesiccation and curettage, and surgery.
We review when these modalities are used.
N. Ref:: 18
----------------------------------------------------
[86]
TÍTULO / TITLE: - Summary of the
Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem
Cell Transplant Recipients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Jul 15;33(2):139-44.
Epub 2001 Jun 14.
AUTORES
/ AUTHORS: - Dykewicz CA
INSTITUCIÓN
/ INSTITUTION: - Centers for Disease Control and
Prevention, National Center for Infectious Diseases, Division of AIDS, STD, and
TB Laboratory Research, Atlanta, GA 30333, USA. cad3@cdc.gov
RESUMEN
/ SUMMARY: - This article contains highlights of
“Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem
Cell Transplant Recipients: Recommendations of the CDC, the Infectious Diseases
Society of America, and the American Society of Blood and Marrow
Transplantation,” which was published in the Morbidity and Mortality Weekly
Report. There are sections on the prevention of bacterial, viral, fungal,
protozoal, and helminth infections and on hospital infection control,
strategies for safe living following transplantation, immunizations, and
hematopoietic stem cell safety. The guidelines are evidence-based, and
prevention strategies are rated by both the strength of the recommendation and
the quality of evidence that supports it. Recommendations are given for
preventing cytomegalovirus disease with prophylactic or preemptive gancyclovir,
herpes simplex virus disease with prophylactic acyclovir, candidiasis with
fluconazole, and Pneumocystis carinii pneumonia with
trimethoprim-sulfamethoxazole. Hopefully, following the recommendations made in
the guidelines will reduce morbidity and mortality from opportunistic
infections in hematopoietic stem cell transplant recipients.
----------------------------------------------------
[87]
TÍTULO / TITLE: - Predicting long-term
survival in multiple myeloma patients following autotransplants.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 May;44(5):749-58.
AUTORES
/ AUTHORS: - Fassas AB; Van Rhee F; Tricot G
INSTITUCIÓN
/ INSTITUTION: - Myeloma Institute for Research and
Therapy, University of Arkansas for Medical Sciences, 4301 W. Markham St.,
Little Rock, AK 72205, USA. fassasathanasios@uams.edu
RESUMEN
/ SUMMARY: - Multiple myeloma is a B-cell malignancy
with a highly variable outcome. Despite the marked recent improvements in its
management, especially due to the widespread application of high-dose treatment
and autologous stem cell transplantation, relapses eventually occur in the
majority of patients. Systematic research at University of Arkansas over the
last 10 years, has revealed that the absence of unfavorable cytogenetic
abnormalities (deletion of chromosome 13 and hypodiploidy), low beta-2
microglobulin levels prior to transplant, a normal lactate dehydrogenase level
at diagnosis and early application of high-dose treatment (< 12 months of
preceding standard treatment) define a subgroup of myeloma patients with a high
likelihood of long (> 5 years) event-free survival; a sizable minority of
these patients may be considered cured. Recognition of the importance of these
prognostic factors should lead to routine cytogenetic evaluation of all patients
and early referral to specialized transplant centers. Furthermore, patients
with less favorable outcome should be identified early in their disease course
and should be managed with novel and hopefully more effective treatments. N. Ref:: 59
----------------------------------------------------
[88]
TÍTULO / TITLE: - Prophylaxis, empirical
therapy, or pre-emptive therapy of fungal infections in immunocompromised
patients: which is better for whom?
REVISTA
/ JOURNAL: - Curr Opin Infect Dis 2002 Aug;15(4):369-75.
AUTORES
/ AUTHORS: - Leather HL; Wingard JR
INSTITUCIÓN
/ INSTITUTION: - Department of Pharmacy, College of
Medicine, University of Florida, Gainesville, Florida, USA. wingajr@medicine.ufl.edu
RESUMEN
/ SUMMARY: - Immunocompromised patients are at risk of
developing fungal infections. Over time, the incidence of fungal infections and
the spectrum of causative organisms have changed. In addition, treatment
strategies in this high-risk population have also changed. Traditional
approaches (using polyene-based therapy and older azoles), including empirical
treatment strategies, have evolved to include prophylaxis in populations at the
greatest risk. These strategies, although effective against Candida species,
have not really impacted infections caused by Aspergillus spp. With the recent
approval of antifungal agents with demonstrated activity against Aspergillus
and other mould infections, there is hope for better outcomes in the treatment
of established infections. Several agents, with activity against Aspergillus,
have been shown to be effective in the empirical setting. The role of these new
antifungal agents in the prophylactic setting remains unknown at present, but
the potential for reducing Aspergillus infections is promising and requires
ongoing study. The other area of significant research in fungal infections has
been the search for accurate, non-invasive, rapid diagnostic tests. Over the
past year, several publications have indicated that early diagnosis is possible
in immunocompromised patients. These new diagnostics have paved the way for a
new strategy, called pre-emptive therapy, enabling infected patients to be
identified at an earlier stage of infection. This strategy will permit targeted
antifungal therapy in those at greatest risk, and will avoid unnecessary,
potentially toxic therapy in those not infected. Validations of the various
techniques show promise and are reviewed in this paper. N. Ref:: 49
----------------------------------------------------
[89]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.10. Pregnancy in renal transplant recipients.
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 4:50-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Renal transplantation
restores fertility, and successful pregnancies have been reported in renal
transplant women. In women with normal graft function, pregnancy usually has no
adverse effect on graft function and survival. Therefore, women of childbearing
age who consider pregnancy should receive complete information and support from
the transplant team. B. Pregnancy could be considered safe about 2 years after
transplantation in women with good renal function, without proteinuria, without
arterial hypertension, with no evidence of ongoing rejection and with normal
allograft ultrasound. C. Pregnancy after transplantation should be considered a
high-risk pregnancy and should be monitored by both an obstetrician and the
transplant physician. Pregnancy should be diagnosed as early as possible. The
principal risks are infection, proteinuria, anaemia, arterial hypertension and
acute rejection for the mother, and prematurity and low birth weight for the
foetus. D. Pregnant women and transplanted patients are at increased risk of
infections, especially bacterial urinary tract infections and acute
pyelonephritis of the graft. Urine cultures should be performed monthly and all
asymptomatic infections should be treated. Monitoring of viral infections is
also recommended. (Evidence level B) E. Acute rejection episodes are uncommon
but may occur after delivery. Therefore, immunosuppression should be
re-adjusted immediately after delivery. F. Because pre-eclampsia develops in
30% of pregnant patients, especially those with prior arterial transplant
hypertension, blood pressure, renal function, proteinuria and weight should be
monitored every 2-4 weeks, with more attention during the third trimester.
Anti-hypertensive agents should be changed to those tolerated during pregnancy.
ACE inhibitors and angiotensin II receptor antagonists are absolutely
contra-indicated. G. Immunosuppressive therapy based on cyclosporine or
tacrolimus with or without steroids and azathioprine may be continued in renal
transplant women during pregnancy. Other drugs, such as mycophenolate mofetil
and sirolimus, are not recommended based on current information available.
Because of drug transfer into maternal milk, breastfeeding is not recommended. H.
Vaginal delivery is recommended, but caesarean section is required in at least
50% of cases. Delivery should occur in a specialized centre. In the puerperium,
renal function, proteinuria, blood pressure, cyclosporine/tacrolimus blood
levels and fluid balance should be closely monitored.
----------------------------------------------------
[90]
TÍTULO / TITLE: - Epidemiology of Candida
species infections in critically ill non-immunosuppressed patients.
REVISTA
/ JOURNAL: - Lancet Infect Dis 2003 Nov;3(11):685-702.
AUTORES
/ AUTHORS: - Eggimann P; Garbino J; Pittet D
INSTITUCIÓN
/ INSTITUTION: - Medical Clinic II, the Medical Intensive
Care Unit and the Infection Control Programme, Department of Internal Medicine,
University of Geneva Hospitals, Geneva, Switzerland.
RESUMEN
/ SUMMARY: - A substantial proportion of patients
become colonised with Candida spp during hospital stay, but only few
subsequently develop severe infection. Clinical signs of severe infection
manifest early but lack specificity until late in the course of the disease,
thus representing a particular challenge for diagnosis. Mostly nosocomial,
invasive candidiasis occurs in only 1-8% of patients admitted to hospitals, but
in around 10% of patients housed in intensive care units where it can represent
up to 15% of all nosocomial infections. We review the epidemiology of invasive
candidiasis in non-immunocompromised, critically ill patients with special
emphasis on disease trends over time, pathophysiology, diagnostic approach,
risk factors, and impact. Recent epidemiological data suggesting that the
emergence of non-albicans candida strains with reduced susceptibility to
azoles, previously linked to the use of new antifungals for empiric and
prophylactic therapy in immunocompromised patients, may not have occurred in
the critically ill. Management of invasive candidiasis in these patients will
be addressed in the December issue of The Lancet Infectious Diseases. N. Ref:: 177
----------------------------------------------------
[91]
TÍTULO / TITLE: - Cryptococcus neoformans
infection in organ transplant recipients: variables influencing clinical
characteristics and outcome.
REVISTA
/ JOURNAL: - Emerg Infect Dis. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.cdc.gov/
●●
Cita: Emerging Infectious Diseases: <> 2001 May-Jun;7(3):375-81.
AUTORES
/ AUTHORS: - Husain S; Wagener MM; Singh N
INSTITUCIÓN
/ INSTITUTION: - Veterans Affairs Medical Center and
University of Pittsburgh, Thomas E. Starzl Transplantation Institute,
Pittsburgh, Pennsylvania 15240, USA.
RESUMEN
/ SUMMARY: - Unique clinical characteristics and other
variables influencing the outcome of Cryptococcus neoformans infection in organ
transplant recipients have not been well defined. From a review of published
reports, we found that C. neoformans infection was documented in 2.8% of organ
transplant recipients (overall death rate 42%). The type of primary immunosuppressive
agent used in transplantation influenced the predominant clinical manifestation
of cryptococcosis. Patients receiving tacrolimus were significantly less likely
to have central nervous system involvement (78% versus 11%, p =0.001) and more
likely to have skin, soft-tissue, and osteoarticular involvement (66% versus
21%, p = 0.006) than patients receiving nontacrolimus- based immunosuppression.
Renal failure at admission was the only independently significant predictor of
death in these patients (odds ratio 16.4, 95% CI 1.9-143, p = 0.004).
Hypotheses based on these data may elucidate the pathogenesis and may
ultimately guide the management of C. neoformans infection in organ transplant
recipients. N. Ref:: 74
----------------------------------------------------
[92]
- Castellano -
TÍTULO / TITLE:Virus del herpes humano tipo 6 y
tipo 7 en receptores de trasplantes. Human herpesvirus type 6 and type 7 in
transplant recipients.
REVISTA
/ JOURNAL: - Enferm Infecc Microbiol Clin. Acceso
gratuito al texto completo.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Enfermedades Infecciosas y Microbiologia Clinica: <> 2003
Oct;21(8):424-32.
AUTORES
/ AUTHORS: - Benito N; Moreno A; Pumarola T; Marcos MA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Infecciones. Institut Clinic
d’Infeccions i Inmunologia. Hospital Clinic Universitari-IDIBAPS. Barcelona.
España. nbenito@clinic.ub.es
RESUMEN
/ SUMMARY: - Recent years have witnessed a growing
interest in the role of human herpesvirus (HHV) type 6 and type 7 as emerging
pathogens or copathogens in transplant recipients. Both HHV-6 and HHV-7 belong
to the beta-herpesvirus family and are closely related to another member of the
family, cytomegalovirus. After the primary infection, these viruses remain
latent in the human host and can reactivate after transplantation. Various
clinical processes such as fever, rash, pneumonitis, encephalitis, hepatitis,
and myelosuppression have been described in association with herpesvirus.
Moreover, a growing body of evidence suggests that the major impact of HHV-6
and HHV-7 reactivation in transplantation is related to indirect effects, such
as their association with cytomegalovirus disease, increased opportunistic
infections, and graft dysfunction and rejection. The pathogenesis of HHV-6 and
HHV-7 during the post-transplantation period, the methods used for their
diagnosis, and the evaluation of antiviral drugs and strategies for their
prevention and treatment are now the subject of extensive research. N. Ref:: 104
----------------------------------------------------
[93]
TÍTULO / TITLE: - Understanding the
alloresponse: new approaches to graft-versus-host disease prevention.
REVISTA
/ JOURNAL: - Semin Hematol 2002 Jan;39(1):15-22.
AUTORES
/ AUTHORS: - Teshima T; Ferrara JL
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Michigan Cancer Center, Ann Arbor, MI 48109-0942, USA.
RESUMEN
/ SUMMARY: - Graft-versus-host disease (GVHD) has been
the primary limitation to the wider application of allogeneic bone marrow
transplantation (BMT). GVHD occurs when donor T cells react to host antigens on
antigen-presenting cells (APCs) and attack host tissues, with sequential
activation of donor T cells and monocytes/macrophages. The net effects of
dysregulated cytokine production in this complex system are the severe
inflammatory manifestations that we recognize as clinical acute GVHD. Long-term
outcomes are also adversely affected by chronic GVHD, which has distinctive
clinical and pathologic manifestations that mimic autoimmune disease, although
its exact pathogenesis remains ambiguous. The ultimate goal for preventing GVHD
is the induction of specific tolerance to host antigens, thereby maintaining
favorable aspects of donor immunity. Tolerance may be achieved by costimulatory
blockade, deletion of activated cells, suppression by regulatory T cells, and
immune deviation. This report will focus on these mechanisms as they relate to
the pathophysiology of acute GVHD. N.
Ref:: 80
----------------------------------------------------
[94]
TÍTULO / TITLE: - The impact of the model
for end-stage liver disease on recipient selection for adult living liver
donation.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Oct;9(10 Suppl
2):S54-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50223
AUTORES
/ AUTHORS: - Freeman RB
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, Tufts-New
England Medical Center, Boston, MA 02111, USA. rfreeman@tufts-nemc.org N. Ref:: 11
----------------------------------------------------
[95]
TÍTULO / TITLE: - Genetic epidemiology of
rheumatoid arthritis.
REVISTA
/ JOURNAL: - Tissue Antigens 2002 Dec;60(6):465-73.
AUTORES
/ AUTHORS: - Harney S; Wordsworth BP
INSTITUCIÓN
/ INSTITUTION: - Oxford University Institute of
Musculosketal Science, Botnar Center, Nuffield Othopaedic Center, Oxford, UK.
RESUMEN
/ SUMMARY: - Building on the spectacular success of
molecular genetics in defining the biological basis of many rare single gene
disorders over the past decade, epidemiologists have turned their attention to
unravelling the complex genetic mysteries of common disorders, such as
rheumatoid arthritis (RA). As a prelude to any such endeavour it is obviously
important to establish that there is a significant genetic component to the
disease. The classical approaches of twin and other family recurrence risk
studies, coupled with prevalence studies in different ethnic and migrant
populations, have been used to estimate the environmental and genetic
contributions to RA. However, developing a consensus on these estimates has
proved difficult, thereby providing an early warning to the unwary investigator
that the road to gene discovery in RA is likely to be a rough ride. N. Ref:: 61
----------------------------------------------------
[96]
TÍTULO / TITLE: - Transplant center
characteristics and clinical outcomes after hematopoietic stem cell
transplantation: what do we know?
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Mar;31(6):417-21.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703873
AUTORES
/ AUTHORS: - Loberiza FR Jr; Serna DS; Horowitz MM;
Rizzo JD
INSTITUCIÓN
/ INSTITUTION: - International Bone Marrow Transplant
Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI
53226, USA.
RESUMEN
/ SUMMARY: - Center effects are differences in outcome
among treatment centers that cannot be explained by identifiable differences in
patients treated or specific treatments applied and are presumed to result from
differences in the ways health care is delivered. This paper will briefly
review studies of association between treatment center factors and clinical
outcomes in general medicine and surgery and look more closely at studies
involving hematopoietic stem cell transplantation. We will also attempt to
identify conceptual domains to study further the processes and mechanisms that
may be associated with better outcomes.
N. Ref:: 26
----------------------------------------------------
[97]
TÍTULO / TITLE: - Genetic basis of
remitting sarcoidosis: triumph of the trimolecular complex?
REVISTA
/ JOURNAL: - Am J Respir Cell Mol Biol. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajrcmb.atsjournals.org/
●●
Cita: Am J. of Respir Cell & Mol Biol: <> 2002 Oct;27(4):391-5.
AUTORES
/ AUTHORS: - Moller DR; Chen ES
INSTITUCIÓN
/ INSTITUTION: - The Johns Hopkins University School of
Medicine, Baltimore, Maryland 21224, USA. dmoller@mail.jhmi.edu N. Ref:: 59
----------------------------------------------------
[98]
TÍTULO / TITLE: - Liver transplantation
for primary biliary cirrhosis: indications and risk of recurrence.
REVISTA
/ JOURNAL: - J Hepatol 2003 Aug;39(2):142-8.
AUTORES
/ AUTHORS: - Neuberger J
INSTITUCIÓN
/ INSTITUTION: - Liver Unit, Queen Elizabeth Hospital, 3rd
Floor, Nuffield House, Edgbaston, Birmingham B15 2TH, UK. j.m.neuberger@bham.ac.uk N. Ref:: 67
----------------------------------------------------
[99]
TÍTULO / TITLE: - Prevention and
treatment of Epstein-Barr virus-associated lymphoproliferative disorders in
recipients of bone marrow and solid organ transplants.
REVISTA
/ JOURNAL: - Br J Haematol 2002 Dec;119(3):596-607.
AUTORES
/ AUTHORS: - Meijer E; Dekker AW; Weersink AJ;
Rozenberg-Arska M; Verdonck LF
INSTITUCIÓN
/ INSTITUTION: - Department of Haematology, University
Medical Centre, Utrecht, The Netherlands. emeijer@digd.azu.nl N. Ref:: 127
----------------------------------------------------
[100]
TÍTULO / TITLE: - Cardiovascular disease
and the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S36-43.
AUTORES
/ AUTHORS: - Kendrick E
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University of
California—Los Angeles Medical Center, Los Angeles, CA 90095, USA. ekendrick@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Cardiovascular complications contribute to
a significant proportion of the morbidity and mortality in renal transplant
patients. Underlying disease states such as diabetes and hypertension as well as
risk factors associated with chronic dialysis may cause many patients to have
established coronary artery and peripheral vascular disease at the time of
transplantation. Progression or new onset of disease can occur after
transplantation due to the continued presence of risk factors for
cardiovascular disease. The benefit of modification of these risk factors such
as hypertension and hyperlipidemia has been well established in the general
population and has more recently been explored in the renal transplant
population, although long-term studies documenting an improvement in morbidity
and mortality are not available. This article focuses on the potential benefit
of modification of risk factors in this setting. N. Ref:: 90
----------------------------------------------------
[101]
TÍTULO / TITLE: - How concerned should we
be about missing antibodies to low incidence antigens?
REVISTA
/ JOURNAL: - Transfusion 2003 Jul;43(7):844-7.
AUTORES
/ AUTHORS: - Garratty G N. Ref:: 26
----------------------------------------------------
[102]
TÍTULO / TITLE: - Prophylaxis of
herpesvirus infections in immunocompetent and immunocompromised older patients.
REVISTA
/ JOURNAL: - Drugs Aging 2002;19(5):343-54.
AUTORES
/ AUTHORS: - Fillet AM
INSTITUCIÓN
/ INSTITUTION: - Virology Department, Pitie-Salpetriere
Hospital and University, 83 Boulevard de l’Hopital, 75651 Paris, Cedex 13,
France. anne-marie.fillet@psl.ap-hop.paris.fr
RESUMEN
/ SUMMARY: - In older patients, prophylaxis of
herpesvirus infections mainly involves preventing the recurrence of herpes
simplex virus (HSV) and complications of herpes zoster in immunocompetent
patients, while in immunocompromised patients it is more concerned with the prevention
of opportunistic virus reactivation. HSV ocular infection is the most frequent
cause of corneal blindness in the US. The effectiveness of aciclovir 400mg
twice daily in preventing the recurrence of HSV eye disease in immunocompetent
patients has been well demonstrated. The issue of treatment duration for
patients with highly recurrent ocular herpes remains unresolved. Post-herpetic
neuralgia (PHN) is one of the most common neuralgic illnesses worldwide. Some
progress in prevention of PHN has been made with a combination of antiviral
therapy (famciclovir or valaciclovir), started within 72 hours of onset of the
rash, and analgesic treatment. However, the best prevention of PHN is the
prevention of herpes zoster disease, and the varicella vaccine is an option
which over the next few years will be tested in clinical trials. For
immunocompromised patients of any age, restoring immunity prevents herpesvirus
disease, as demonstrated for cytomegalovirus (CMV) in AIDS patients receiving
highly active antiretroviral therapy. Specific antiviral therapy during the
initial period after transplantation could prevent reactivation of HSV or CMV
in seropositive recipients. Whether pre-emptive therapy or prophylaxis with
ganciclovir is the optimal approach against CMV remains controversial, and the
relative merits and limitations of each approach may guide the choice. In stem
cell transplantation, pre-emptive therapy with foscarnet avoids the neutropenia
and related complications associated with ganciclovir. In renal transplant
recipients, universal prophylaxis of CMV infection with valaciclovir has the
same efficacy as ganciclovir. Although it is relatively toxic, cidofovir should
be further evaluated because of its in vitro activity against most DNA viruses. N. Ref:: 70
----------------------------------------------------
[103]
TÍTULO / TITLE: - Epidemiology and
clinical features of Cryptosporidium infection in immunocompromised patients.
REVISTA
/ JOURNAL: - Clin Microbiol Rev. Acceso gratuito al
texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://cmr.asm.org/
●●
Cita: Clinical Microbiology Reviews: <> 2002 Jan;15(1):145-54.
AUTORES
/ AUTHORS: - Hunter PR; Nichols G
INSTITUCIÓN
/ INSTITUTION: - School of Medicine, Health Policy and
Practice, University of East Anglia, Norwich, United Kingdom. paul.hunter@uea.ac.uk
RESUMEN
/ SUMMARY: - Cryptosporidium spp. are a major cause of
diarrheal disease in both immunocompetent and immunodeficient individuals. They
also cause waterborne disease in both the United States and United Kingdom.
Studies on the mechanisms of immunity to cryptosporidiosis indicate the
importance of the T-cell response. The spectrum and severity of disease in
immunocompromised individuals with cryptosporidiosis reflect this importance
since the most severe disease is seen in individuals with defects in the T-cell
response. The most commonly studied group is that of patients with AIDS. These
patients suffer from more severe and prolonged gastrointestinal disease that
can be fatal; in addition, body systems other than the gastrointestinal tract
may be affected. The widespread use of antiretroviral therapy does appear to be
having a beneficial effect on recovery from cryptosporidiosis and on the
frequency of infection in human immunodeficiency virus-positive patients. Other
diseases that are associated with increased risk of severe cryptosporidiosis,
such as primary immunodeficiencies, most notably severe combined
immunodeficiency syndrome, are also predominantly associated with T-cell
defects. Of the remaining groups, children with acute leukemia seem to be most
at risk from cryptosporidiosis. There is less evidence of severe complications
in patients with other malignant diseases or in those receiving
immunosuppressive chemotherapy. N.
Ref:: 132
----------------------------------------------------
[104]
TÍTULO / TITLE: - Mechanisms and
consequences of arterial hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S9-12.
AUTORES
/ AUTHORS: - Koomans HA; Ligtenberg G
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Hospital Utrecht, The Netherlands. h.a.koomans@digd.azu.nl
RESUMEN
/ SUMMARY: - The high incidence of hypertension after
renal transplantation contributes to the risk of cardiovascular morbidity and
mortality in renal transplant recipients. Although cyclosporine has been
influential in the improvement of transplant outcome, it has emerged as a major
cause of hypertension after organ transplantation. The underlying
pathophysiological mechanisms of cyclosporine-induced hypertension include
enhanced sympathetic nervous system activity, renal vasoconstriction, and
sodium/water retention. Hypertension is also significantly associated with
reduced graft survival and thereby requires aggressive treatment intervention.
Calcium channel blockers may offer some advantages over angiotensin-converting
enzyme inhibitors for the treatment of hypertension in stable renal transplant
recipients. Nevertheless, selection of the most appropriate antihypertensive
agent should take into account the possibility of pharmacokinetic interactions
with immunosuppressive agents. There is evidence to suggest that the use of
tacrolimus-based immunosuppression induces less hypertension compared with
cyclosporine. Not only do patients receiving tacrolimus tend to require less
antihypertensive therapy, but converting patients from cyclosporine to
tacrolimus has been shown to result in significant reductions in blood
pressure. Thus, tacrolimus may be associated with an improved cardiovascular
risk profile in renal transplant recipients.
N. Ref:: 26
----------------------------------------------------
[105]
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
----------------------------------------------------
[106]
TÍTULO / TITLE: - Preemptive therapy
versus universal prophylaxis with ganciclovir for cytomegalovirus in solid
organ transplant recipients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Mar 1;32(5):742-51.
Epub 2001 Feb 20.
AUTORES
/ AUTHORS: - Singh N
INSTITUCIÓN
/ INSTITUTION: - Veterans Affairs Medical Center and
University of Pittsburgh, Thomas E. Starzl Transplantation Institute,
Pittsburgh, PA 15240, USA. nis5+@pitt.edu
RESUMEN
/ SUMMARY: - Whether preemptive therapy or universal
prophylaxis with ganciclovir is the optimal approach against cytomegalovirus
(CMV) remains unresolved. Controversy abounds with respect to the efficacy of
preemptive therapy, the reliability of preemptive therapy tools, the logistical
difficulties in conducting surveillance monitoring for CMV, the cost of
prophylaxis, the effect of prophylaxis on indirect sequelae of CMV and
epidemiology of CMV, and the potential for emergence of ganciclovir-resistant
CMV. Although neither approach is wholly adequate, a discussion of the relative
merits and limitations of the 2 approaches may guide the selection of a
rational approach toward prevention of CMV infection in organ transplant
recipients. N. Ref:: 90
----------------------------------------------------
[107]
TÍTULO / TITLE: - Effect of
immunosuppressive treatment protocol on malignancy development in renal
transplant patients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2133-5.
AUTORES
/ AUTHORS: - Haberal M; Moray G; Karakayali H; Emiroglu
R; Basaran O; Sevmis S; Demirhan B
INSTITUCIÓN
/ INSTITUTION: - Baskent University Faculty of Medicine,
Ankara, Turkey. melekk@baskent-ank.edu.tr
----------------------------------------------------
[108]
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.
----------------------------------------------------
[109]
TÍTULO / TITLE: - What is the role of
genetic testing in diagnosis of haemochromatosis?
REVISTA
/ JOURNAL: - Ann Clin Biochem 2001 Jan;38(Pt 1):3-19.
AUTORES
/ AUTHORS: - Worwood M
INSTITUCIÓN
/ INSTITUTION: - Department of Haematology, University of
Wales College of Medicine, Cardiff, UK. worwood@cardiff.ac.uk N. Ref:: 116
----------------------------------------------------
[110]
TÍTULO / TITLE: - Immunization of
children after solid organ transplantation.
REVISTA
/ JOURNAL: - Pediatr Clin North Am 2003
Dec;50(6):1435-49, ix-x.
AUTORES
/ AUTHORS: - Lopez MJ; Thomas S
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0718, USA. jamlopez@umich.edu
RESUMEN
/ SUMMARY: - The array of immunizations commonly used
in childhood has risen in an attempt to prevent many of the potentially serious
infections of infancy and childhood. In this article, the authors provide
rational guidelines for vaccination of these children. The authors briefly
review the susceptibilities caused by immunosuppression in these patients,
discuss the problems with various immunizations, and make individual
recommendations regarding the use of each vaccine. Most recommendations are
based on inferences from populations that may not be directly comparable to the
transplantation population (patients with HIV or cancer or patients who have
undergone bone marrow transplant), from case reports, and from small series of
patients. The best recommendations ultimately must await the results of
controlled trials of immunization. N.
Ref:: 87
----------------------------------------------------
[111]
TÍTULO / TITLE: - Selected populations at
increased risk from respiratory syncytial virus infection.
REVISTA
/ JOURNAL: - Pediatr Infect Dis J 2003 Feb;22(2
Suppl):S40-4; discussion S44-5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.inf.0000053884.21238.13
AUTORES
/ AUTHORS: - Meissner HC
INSTITUCIÓN
/ INSTITUTION: - New England Medical Center, Tufts University
School of Medicine, Boston, MA, USA.
RESUMEN
/ SUMMARY: - Respiratory syncytial virus (RSV) is the
principal cause of bronchiolitis and pneumonia in infants and young children
worldwide. Deficits in cellular immunity appear to promote severe RSV disease
in children with malignancies, those undergoing chemotherapy and bone marrow
transplant recipients. Respiratory syncytial virus infection appears to
exacerbate pulmonary symptoms of cystic fibrosis. In such patients RSV disease
may result in a prolonged hospital course, which is often complicated by the
need for mechanical ventilation. Retrospective analyses of hospital admissions
for RSV bronchiolitis among Native American and Alaskan Native children younger
than 1 year of age have demonstrated rates of 62 per 1000 or higher, compared
with the national average of 34 per 1000. Among these ethnic groups, specific
host factors as well as environmental factors appear to contribute to these
comparatively high rates of hospitalization for RSV infection. Respiratory
syncytial virus has the potential to cause disease in all age groups. A 3-year
observational study found that individuals who lived in a community setting, or
who cared for young children on a consistent basis, experienced acute
respiratory infections more commonly than those living independently or whose
interaction with children was limited. N.
Ref:: 31
----------------------------------------------------
[112]
TÍTULO / TITLE: - Donor morbidity
associated with right lobectomy for living donor liver transplantation to adult
recipients: a systematic review.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Feb;8(2):110-7.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.31315
AUTORES
/ AUTHORS: - Beavers KL; Sandler RS; Shrestha R
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Division
of Digestive Diseases and Nutrition, University of North Carolina School of
Medicine, Chapel Hill, NC 27599-7080, USA.
RESUMEN
/ SUMMARY: - The aim if this study is to determine
donor morbidity associated with right lobectomy for living donor liver
transplantation (LDLT) to adult recipients through a systematic review of the
published literature. Data sources were English-language reports on donor
outcome after LDLT. MEDLINE (1995 to June 2001) was searched using the MeSH
terms “living donors” and “liver transplantation.” Limits were set for human
only and English language only. Bibliographies of retrieved references were
cross-checked to identify additional reports; 211 reports were obtained.
Population studies and consecutive and nonconsecutive series were included. All
studies reported at least one of the following outcomes specific to living
donors (LDs) of right hepatic lobes to adult recipients: surgical and hospital
complications, length of hospital stay, readmissions, recovery time, return to
predonation occupation, health-related quality of life, or mortality. Abstracts
of relevant articles were reviewed independently using predetermined criteria,
and appropriate articles were retrieved. Study design and results were
summarized in evidence tables. Summary statistics of combined data were
performed when possible. Twelve studies met the inclusion criteria. Data on
donor morbidity associated with right lobectomy are limited. On the basis of
reported data, morbidity associated with LD right lobectomy ranges from 0% to
67%. In conclusion, reported morbidity associated with right lobe donation for
LDLT varies widely. Standardized definitions of morbidity and better methods
for observing and measuring outcomes are necessary to understand and
potentially improve morbidity. Future studies assessing LD outcomes should
report donor outcome more explicitly. N.
Ref:: 26
----------------------------------------------------
[113]
TÍTULO / TITLE: - Potential therapeutic
interventions to avoid or treat chronic allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS52-7.
AUTORES
/ AUTHORS: - Kahan BD
INSTITUCIÓN
/ INSTITUTION: - University of Texas Medical School
Houston, United States.
RESUMEN
/ SUMMARY: - Despite the significant improvements that
have occurred since the introduction of CsA, long-term renal allograft survival
continues to be an area of concern. Management strategies that involve the use
of sirolimus offer some promise. A number of observations suggest that
sirolimus may have the ability to reduce the rates or slow the progression of
chronic nephropathy. First, sirolimus has been shown to inhibit growth-factor-driven
proliferation of endothelial and smooth muscle cells in vitro (55, 56).
Sirolimus also disrupts signal transduction by a variety of other cytokines
such as EGF and PDGE This is significant because cytokine- and
growth-factor-stimulated proliferation of endothelial cells, smooth muscle
cells, parenchymal cells, and fibroblasts appears to underlie the development
of chronic nephropathy (see Fellstrom, this supplement). Second, sirolimus has
been demonstrated in various animal models to inhibit the arterial intimal
thickening that typically follows alloimmune or mechanical injury (56-60; see
Morris, this supplement). This transplant vasculopathy is a prominent feature
in chronic rejection of other organ transplants. Moreover, at least 1 published
study has suggested that sirolimus may be able to stabilize and possibly
reverse chronic graft vascular disease (61). However, the relative doses of
sirolimus used in these animal studies have been higher than those used in
humans, so the relationship of these effects to the clinical setting needs to
be further studied to define the relevance of these findings. Third, sirolimus,
used in combination with CsA, reduces the incidence of acute rejection episodes
in humans, one of the most significant predictors of shortened renal allograft
survival (62, 63). Thus, an effect of sirolimus to reduce acute rejection
episodes or delay their onset is expected to reduce renal allograft loss.
Furthermore, clinical trials suggest that sirolimus treatment may allow dose
reductions of CsA or a delay in inception of CsA therapy, which might reduce
the acute and chronic nephrotoxicity associated with CsA and other CNIs. Since
nephrotoxicity may promote or aggravate renal injury and appears to be common
in chronic nephropathy (see Fellstrom and Paul, this supplement), reduced
exposure to CNIs may translate into reduced rates of chronic renal allograft
dysfunction. There are no currently effective therapies for chronic
nephropathy, which is a common cause of late renal allograft loss. Preliminary
evidence suggests that sirolimus may eventually prove useful as prophylaxis of
or treatment for chronic nephropathy. Thus, sirolimus has come to be regarded
as the foundation for maintenance immunosuppressive regimens. N. Ref:: 63
----------------------------------------------------
[114]
TÍTULO / TITLE: - Drug-eluting stents:
potential applications for peripheral arterial occlusive disease.
REVISTA
/ JOURNAL: - J Vasc Interv Radiol 2003
Mar;14(3):291-301.
AUTORES
/ AUTHORS: - Duda SH; Poerner TC; Wiesinger B; Rundback
JH; Tepe G; Wiskirchen J; Haase KK
INSTITUCIÓN
/ INSTITUTION: - Department of Diagnostic Radiology,
University of Tuebingen, Germany. stephan.duda@med.uni-tuebingen.de
RESUMEN
/ SUMMARY: - Many different approaches have been
evaluated to prevent restenosis in stents after vascular implantation.
Currently, drug-eluting stents are extremely promising in suppressing
neointimal hyperplasia. Various animal studies and randomized trials in humans
have shown excellent results in terms of safety and efficacy during
intermediate-term follow-up. This article will give an overview of experimental
and clinical data of the different agents in published and ongoing trials. N. Ref:: 87
----------------------------------------------------
[115]
TÍTULO / TITLE: - Cytomegalovirus in
“immunocompetent”, critically ill, intensive care patients.
REVISTA
/ JOURNAL: - Crit Care Med 2001 Mar;29(3):681-2.
AUTORES
/ AUTHORS: - Marik PE; Weinmann A N. Ref:: 28
----------------------------------------------------
[116]
TÍTULO / TITLE: - Normal responses to
injury prevent systemic inflammation and can be immunosuppressive.
REVISTA
/ JOURNAL: - Am J Respir Crit Care Med. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajrccm.atsjournals.org/
●●
Cita: Am J. of Respir & Crit Care Med: <> 2001 Feb;163(2):316-21.
AUTORES
/ AUTHORS: - Munford RS; Pugin J
INSTITUCIÓN
/ INSTITUTION: - Molecular Host Defense Laboratory,
Division of Infectious Diseases, Department of Internal Medicine, University of
Texas Southwestern Medical Center, Dallas, Texas 75390-9113, USA. Robert.munford@utsouthwestern.edu N. Ref:: 35
----------------------------------------------------
[117]
TÍTULO / TITLE: - Engineered CD3
antibodies for immunosuppression.
REVISTA
/ JOURNAL: - Clin Exp Immunol 2003 Sep;133(3):307-9.
AUTORES
/ AUTHORS: - Renders L; Valerius T N. Ref:: 30
----------------------------------------------------
[118]
TÍTULO / TITLE: - Safety and efficacy of
an imported fire ant rush immunotherapy protocol with and without prophylactic
treatment.
REVISTA
/ JOURNAL: - J Allergy Clin Immunol 2002
Mar;109(3):556-62.
AUTORES
/ AUTHORS: - Tankersley MS; Walker RL; Butler WK; Hagan
LL; Napoli DC; Freeman TM
INSTITUCIÓN
/ INSTITUTION: - Allergy and Immunology Department, Wilford
Hall Medical Center, Lackland Air Force Base, TX, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Hypersensitivity to the sting
of the imported fire ant (IFA) is a growing and significant cause of morbidity
and mortality in the United States. Conventional immunotherapy with IFA whole
body extract (WBE) has been shown to be effective; however, rush immunotherapy
(RIT) with IFA WBE has not been studied. OBJECTIVE: In this study, we evaluated
the safety and efficacy of RIT with IFA WBE and sought to determine whether
prophylactic pretreatment with antihistamines and steroids reduces the systemic
reaction rate associated with RIT. METHODS: Patients with IFA hypersensitivity
were randomized to placebo or twice-daily terfenadine 60 mg, ranitidine 150 mg,
and prednisone 30 mg initiated 2 days before RIT in a double-blinded study. The
2-day RIT protocol consisted of hourly injections to achieve a final dose of
0.3 mL 1:100 wt/vol. Patients returned on day 8 to receive 2 hourly injections
of 0.25 mL 1:100 wt/vol (total, 0.5 mL) and again on day 15 for a single
injection of 0.5 mL 1:100 wt/vol. Efficacy of the protocol was determined on
day 22, a pair of IFA sting challenges being performed 2 hours apart. RESULTS:
Fifty-nine patients were enrolled into the study; a total of 58 patients (age
range, 18 to 49 years) initiated the 2-day RIT. Only 3 patients (5.2%)
experienced a mild systemic reaction during the protocol. Among those
experiencing a systemic reaction with RIT, there was no statistical difference
between the 2 premedication groups (3.6% active and 6.7% placebo; P =.87).
Sting challenges were performed on 56 patients for a total of 112+ stings; only
1 mild systemic reaction occurred (efficacy, 98.2%). CONCLUSION: RIT with IFA
WBE for IFA hypersensitivity is both safe and efficacious; the rate of mild
systemic reactions is low. Premedication is not necessary, inasmuch as
prophylactic pretreatment with antihistamines and steroids did not reduce the
systemic reaction rate associated with RIT.
----------------------------------------------------
[119]
TÍTULO / TITLE: - Progressive multifocal
leukoencephalopathy in acquired immunodeficiency syndrome: explaining the high
incidence and disproportionate frequency of the illness relative to other
immunosuppressive conditions.
REVISTA
/ JOURNAL: - J Neurovirol 2003;9 Suppl 1:38-41.
●●
Enlace al texto completo (gratuito o de pago) 1080/13550280390195261
AUTORES
/ AUTHORS: - Berger JR
INSTITUCIÓN
/ INSTITUTION: - Department of Neurology, University of
Kentucky College of Medicine, Lexington, Kentucky 40536-0284, USA. jrbneuro@pop.uky.edu
RESUMEN
/ SUMMARY: - In the era of the AIDS pandemic,
progressive multifocal leukoencephalopathy (PML) has ceased being a rare
disease. Prevalence estimates from clinical and pathological series suggest
that up to 5% of all HIV-infected persons will develop PML. The extraordinary
frequency with which PML attends HIV infection vastly exceeds its appearance in
association with other predisposing conditions and has resulted in it no longer
being considered a rare disorder. Why PML appears to be far more common with
AIDS than with other underlying immunosuppressive conditions remains
unexplained. Potential explanations include an alteration of the CNS milieu by
HIV facilitating JC viral entry into the brain and activation of the JCV by HIV
proteins, e.g., tat, and by inflammatory byproducts of HIV infection. It is
quite likely that multiple diverse mechanisms are at play. N. Ref:: 32
----------------------------------------------------
[120]
TÍTULO / TITLE: - Risk factors for
bronchiolitis obliterans: a systematic review of recent publications.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2002
Feb;21(2):271-81.
AUTORES
/ AUTHORS: - Sharples LD; McNeil K; Stewart S; Wallwork
J
INSTITUCIÓN
/ INSTITUTION: - Medical Research Council (MRC)
Biostatistics Unit, University Forvie Site, Papworth Everard, Cambridge, United
Kingdom. linda.sharples@mrc-bsu.cam.ac.uk
RESUMEN
/ SUMMARY: - BACKGROUND: Obliterative bronchiolitis
remains the major limitation to long-term survival after lung transplantation.
A thorough understanding of the factors that confer high risk of developing
obliterative bronchiolitis or its physiologic surrogate bronchiolitis
obliterans syndrome is important to help define therapeutic strategies.
METHODS: We performed a systematic review of studies published since the
beginning of 1990. The review excluded non-human studies, publications before
1990, small (less than 25 patients) studies that were predominantly concerned
with investigating the pathogenesis of obliterative bronchiolitis, studies
solely concerned with diagnosis or treatment of obliterative bronchiolitis, and
overlapping studies from the same center. Onset of bronchiolitis obliterans
syndrome or obliterative bronchiolitis was the outcome of interest. RESULTS:
Acute rejection plays an important role in obliterative bronchiolitis and
bronchiolitis obliterans syndrome onset, and late rejection is a significant
risk factor. Lymphocytic bronchitis/bronchiolitis is also a risk factor, with
some evidence that late onset is associated with greater risk. The effects of
cytomegalovirus, other infectious organisms, and human leukocyte antigen
matching are less clear and require further confirmation. There is little
evidence that recipient and donor characteristics play a major role.
CONCLUSIONS: This systematic review supports the view that obliterative
bronchiolitis arises from alloimmunologic injury marked by clinically apparent
acute rejection episodes and that inflammatory conditions, including viral
infections or ischemic injury, may also play a role. Implications for therapy
are discussed. N.
Ref:: 28
----------------------------------------------------
[121]
TÍTULO / TITLE: - Prevention of infection
caused by Pneumocystis carinii in transplant recipients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Oct
15;33(8):1397-405. Epub 2001 Sep 14.
AUTORES
/ AUTHORS: - Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division and
Transplantation Unit, Massachusetts General Hospital, Harvard Medical School,
Boston, MA 02114, USA. Jfishman@partners.org
RESUMEN
/ SUMMARY: - Pneumocystis carinii remains an important
pathogen in patients who undergo solid-organ and hematopoietic transplantation.
Infection results from reactivation of latent infection and via de novo
acquisition of infection from environmental sources. The risk of infection
depends on the intensity and duration of immunosuppression and underlying
immune deficits. The risk is greatest after lung transplants, in individuals
with invasive cytomegalovirus disease, during intensive immunosuppression for
allograft rejection, and during periods of neutropenia. Prophylaxis with
trimethoprim-sulfamethoxazole (TMP-SMZ) prevents many opportunistic infections,
including infection with P. carinii, Toxoplasma gondii, and community-acquired
respiratory, gastrointestinal, and urinary tract pathogens. Intolerance of
TMP-SMZ is common; desensitization is useful less often in transplant patients
than in patients with AIDS. Alternative agents provide a narrower spectrum of
protection than does TMP-SMZ and less adequate protection against Pneumocystis
species. Clinically, the diagnosis of breakthrough Pneumocystis pneumonia often
requires invasive procedures. Strategies for the prevention of Pneumocystis
infection must be individualized on the basis of a stratification of risk for
each patient. N.
Ref:: 111
----------------------------------------------------
[122]
TÍTULO / TITLE: - Hospital infection
control in hematopoietic stem cell transplant recipients.
REVISTA
/ JOURNAL: - Emerg Infect Dis. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.cdc.gov/
●●
Cita: Emerging Infectious Diseases: <> 2001 Mar-Apr;7(2):263-7.
AUTORES
/ AUTHORS: - Dykewicz CA
INSTITUCIÓN
/ INSTITUTION: - Centers for Disease Control and Prevention,
Atlanta, Georgia 30333, USA. cad3@cdc.gov
RESUMEN
/ SUMMARY: - Guidelines for Preventing Opportunistic
Infections Among Hematopoietic Stem Cell Transplant Recipients contains a
section on hospital infection control including evidence-based recommendations
regarding ventilation, construction, equipment, plants, play areas and toys,
health-care workers, visitors, patient skin and oral care, catheter-related
infections, drug-resistant organisms, and specific nosocomial infections. These
guidelines are intended to reduce the number and severity of hospital
infections in hematopoietic stem cell transplant recipients. N. Ref:: 37
----------------------------------------------------
[123]
TÍTULO / TITLE: - Cardiac allograft
vasculopathy: prevention and treatment options.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1847-9.
AUTORES
/ AUTHORS: - Weis M
INSTITUCIÓN
/ INSTITUTION: - Stanford University School of Medicine,
Division of Cardiovascular Medicine, Stanford, California, USA. michaelweis@yahoo.com N. Ref:: 24
----------------------------------------------------
[124]
TÍTULO / TITLE: - Pregnancy in female
pediatric solid organ transplant recipients.
REVISTA
/ JOURNAL: - Pediatr Clin North Am 2003
Dec;50(6):1543-60, xi.
AUTORES
/ AUTHORS: - Armenti VT; Moritz MJ; Davison JM
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation, Department of
Surgery, Thomas Jefferson University, 1025 Walnut Street, 605 College Building,
Philadelphia, PA 19107, USA. vincent.armenti@jefferson.edu
RESUMEN
/ SUMMARY: - This article from the National
Transplantation Pregnancy Registry (NTPR) describes the pregnancy outcomes of
female transplant recipients who received a solid organ transplant when younger
than 21 years old. The analysis includes kidney, liver, liver-kidney, heart,
and lung recipients. No recipients in the registry received a pancreas-kidney
or heart-lung transplant before age 21. To date, the NTPR has not received
report of a pregnancy in a small bowel recipient. This article also reviews
immunosuppressive medications with regard to pregnancy safety. N. Ref:: 34
----------------------------------------------------
[125]
TÍTULO / TITLE: - SCAI statement on
drug-eluting stents: practice and health care delivery implications.
REVISTA
/ JOURNAL: - Catheter Cardiovasc Interv 2003
Mar;58(3):397-9.
●●
Enlace al texto completo (gratuito o de pago) 1002/ccd.10513
AUTORES
/ AUTHORS: - Hodgson JM; King SB 3rd;
Feldman T; Cowley MJ; Klein LW; Babb JD
INSTITUCIÓN
/ INSTITUTION: - Heart and Vascular Center, MetroHealth
Medical Center, Cleveland, Ohio 44109, USA. jhodgson@metrohealth.org
----------------------------------------------------
[126]
TÍTULO / TITLE: - Calcium-channel
antagonists and nitrates in coronary artery bypass patients receiving radial
artery grafts.
REVISTA
/ JOURNAL: - Ann Pharmacother. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.theannals.com/
●●
Cita: Annals of Pharmacotherapy: <> 2001 May;35(5):631-5.
AUTORES
/ AUTHORS: - Kalus JS; Lober CA
INSTITUCIÓN
/ INSTITUTION: - College of Pharmacy, University of Toledo,
OH, USA. kalusjs@musc.edu
RESUMEN
/ SUMMARY: - OBJECTIVE: To review the literature
assessing the role of vasodilators for the prevention of vasospasm leading to
graft failure in patients receiving the radial artery (RA) as a conduit in
coronary artery bypass grafting (CABG). DATA SOURCE: A MEDLINE search (January
1966-May 2000) was performed using calcium-channel antagonists, nitrates,
radial artery, and coronary artery bypass as key words. English-language
articles were identified, and the references of these articles were used to
further identify pertinent articles. DATA SYNTHESIS: RAs can be used as
conduits in CABG. It has been suggested that failure of these grafts may be due
to vasospasm, leading to occlusion observed angiographically. Calcium-channel
antagonists and nitrates have been proposed as a means of preventing vasospasm
and subsequent graft failure. CONCLUSIONS: Currently published data on the use
of calcium-channel antagonist or nitrate therapy as prophylaxis against
vasospasm in patients receiving RA grafts are inconclusive. Systematic
evaluations of currently available pharmacologic agents are needed to guide
clinical practice in this area. N.
Ref:: 17
----------------------------------------------------
[127]
TÍTULO / TITLE: - Use of nonsteroidal
topical immunomodulators for the treatment of atopic dermatitis in the
pediatric population.
REVISTA
/ JOURNAL: - J Pediatr 2001 Feb;138(2):163-8.
AUTORES
/ AUTHORS: - Paller AS
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Children’s
Memorial Hospital, Northwestern University Medical School, Chicago, Illinois,
USA. N. Ref:: 39
----------------------------------------------------
[128]
TÍTULO / TITLE: - Strongyloides
stercoralis in the Immunocompromised Population.
REVISTA
/ JOURNAL: - Clin Microbiol Rev. Acceso gratuito al
texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://cmr.asm.org/
●●
Cita: Clinical Microbiology Reviews: <> 2004 Jan;17(1):208-17.
AUTORES
/ AUTHORS: - Keiser PB; Nutman TB
INSTITUCIÓN
/ INSTITUTION: - Helminth Immunology Section, Laboratory of
Parasitic Diseases, National Institute of Allergy and Infectious Diseases,
National Institutes of Health, Bethesda, Maryland 20892, USA.
RESUMEN
/ SUMMARY: - Strongyloides stercoralis is an intestinal
nematode of humans that infects tens of millions of people worldwide. S.
stercoralis is unique among intestinal nematodes in its ability to complete its
life cycle within the host through an asexual autoinfective cycle, allowing the
infection to persist in the host indefinitely. Under some conditions associated
with immunocompromise, this autoinfective cycle can become amplified into a
potentially fatal hyperinfection syndrome, characterized by increased numbers
of infective filariform larvae in stool and sputum and clinical manifestations
of the increased parasite burden and migration, such as gastrointestinal
bleeding and respiratory distress. S. stercoralis hyperinfection is often
accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid
treatment and human T-lymphotropic virus type 1 infection are the two
conditions most specifically associated with triggering hyperinfection, but
cases have been reported in association with hematologic malignancy,
malnutrition, and AIDS. Anthelmintic agents such as ivermectin have been used
successfully in treating the hyperinfection syndrome as well as for primary and
secondary prevention of hyperinfection in patients whose exposure history and
underlying condition put them at increased risk. N. Ref:: 136
----------------------------------------------------
[129]
TÍTULO / TITLE: - The porcine coronary
model of in-stent restenosis: current status in the era of drug-eluting stents.
REVISTA
/ JOURNAL: - Catheter Cardiovasc Interv 2003
Dec;60(4):515-23.
●●
Enlace al texto completo (gratuito o de pago) 1002/ccd.10705
AUTORES
/ AUTHORS: - Lowe HC; Schwartz RS; Mac Neill BD; Jang
IK; Hayase M; Rogers C; Oesterle SN
INSTITUCIÓN
/ INSTITUTION: - Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts, USA. h.lowe@unsw.edu.au
RESUMEN
/ SUMMARY: - Drug-eluting stents are revolutionizing
interventional cardiology. Sirolimus-eluting stents are in widespread clinical
use, associated with well-documented remarkably low restenosis rates, and a
number of other agents appear promising in clinical trials. These human studies
have been preceded by numerous animal studies, foremost among them the pig
coronary model of in-stent restenosis (ISR). The histologic response to porcine
coronary stenting was described over a decade ago. Porcine stenting studies now
provide examinations not only of histology, but also mechanisms of action,
toxicity, and biocompatibility. This review therefore examines the current
status of this porcine coronary model of ISR. Contemporary methods of pig
coronary stenting are discussed. The morphometric, cellular, and molecular
analyses of the responses to stent injury are then described. Finally, recent
pig coronary drug-eluting stent studies are examined, with a discussion of
their advantages, limitations, and possible future modifications. N. Ref:: 51
----------------------------------------------------
[130]
TÍTULO / TITLE: - Ambulatory blood
pressure after renal transplantation.
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: <> 2001;16 Suppl 1:110-3.
AUTORES
/ AUTHORS: - Fernandez-Vega F; Tejada F; Baltar J;
Laures A; Gomez E; Alvarez J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia 1, Hospital Central
de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, España.
RESUMEN
/ SUMMARY: - Renal transplantation has been a usual
medical practice in developed countries for several decades. A large number of
studies report the excellent results obtained with such a practice. The
survival of the graft, although able to be improved, is excellent and gives a
great deal of hope to patients with renal insufficiency. The high level of
investigation into immunosuppressor drugs offers, almost continuously, more
efficient and better tolerated products. Paradoxically, the usual problems of
patients with a renal transplant are not immunological but cardiovascular.
Elevated serum cholesterol levels, obesity, diabetes and other cardiovascular
risk factors (CVRFs) are usual in these patients, arterial hypertension (AHT)
being the most frequent. Nephrologists are increasingly using ambulatory blood
pressure monitoring (ABPM) on a daily basis. In the last 10 years, we have
obtained highly valuable and interesting results with this technique which have
allowed us to study and understand with greater precision the relationship of
AHT to the kidney. Here we analyse and review the most relevant aspects of ABPM
in the different stages of kidney disease, with special emphasis on renal
transplantation. N.
Ref:: 40
----------------------------------------------------
[131]
TÍTULO / TITLE: - Monoclonal antibodies
in immune and inflammatory diseases.
REVISTA
/ JOURNAL: - Curr Opin Biotechnol 2002
Dec;13(6):615-20.
AUTORES
/ AUTHORS: - Andreakos E; Taylor PC; Feldmann M
INSTITUCIÓN
/ INSTITUTION: - Kennedy Institute of Rheumatology
Division, Faculty of Medicine, Imperial College of Science, Technology and
Medicine, 1 Aspenlea Road, Hammersmith, W6 8LH, London, UK. evangelos.andreakos@ic.ac.uk
RESUMEN
/ SUMMARY: - The era of monoclonal antibody-based
therapeutics has arrived. Monoclonal antibodies of high quality targeting
almost any antigen can now be engineered and manufactured in large quantities.
In the clinic, monoclonal antibodies are proving to be safe and effective for
the treatment of a wide range of diseases including rheumatoid arthritis,
Crohn’s disease, spondyloarthropathies, psoriasis and allograft rejection. N. Ref:: 46
----------------------------------------------------
[132]
TÍTULO / TITLE: - Drug-eluting stents in
peripheral vascular disease: eliminating restenosis.
REVISTA
/ JOURNAL: - Mt Sinai J Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.mssm.edu/msjournal/
●●
Cita: Mount Sinai J. of Medicine, New York: <> 2003 Nov;70(6):417-9.
AUTORES
/ AUTHORS: - Ellozy SH; Carroccio A
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Mount Sinai School
of Medicine, One East 100th Street, New York, NY 10029, USA. sharif.ellozy@msnyuhealth.org
RESUMEN
/ SUMMARY: - Transcatheter endovascular therapy for
peripheral atherosclerotic disease has become more popular. In general, good
results have been reported in focal aortoiliac disease. However, the long-term
patency of angioplasty in longer, more distal lesions has been less
satisfactory. Stenting has not been shown to improve long-term patency compared
to angioplasty alone. Drug-eluting stents have shown promise in preventing
coronary restenosis, and preliminary results in peripheral arterial disease are
encouraging. This review article will discuss the current status of
endovascular therapy of aortoiliac and femoropopliteal atherosclerotic disease,
the theoretic and experimental basis for the use of drug-eluting stents, and
the preliminary results in human studies.
N. Ref:: 48
----------------------------------------------------
[133]
TÍTULO / TITLE: - Tolerance, mixed
chimerism and protection against graft-versus-host disease after total lymphoid
irradiation.
REVISTA
/ JOURNAL: - Philos Trans R Soc Lond B Biol Sci. Acceso
gratuito al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.pubs.royalsoc.ac.uk/
●●
Cita: Philos Trans R Soc Lond B Biol Sci: <> 2001 May
29;356(1409):739-48.
AUTORES
/ AUTHORS: - Field EH; Strober S
INSTITUCIÓN
/ INSTITUTION: - Department of Veterans Affairs Medical
Center, Iowa City, IA 52246, USA.
RESUMEN
/ SUMMARY: - Total lymphoid irradiation (TLI),
originally developed as a non-myeloablative treatment for Hodgkin’s disease,
has been adapted for the induction of immune tolerance to organ allografts in
rodents, dogs and non-human primates. Moreover, pretransplantation TLI has been
used in prospective studies to demonstrate the feasibility of the induction of
tolerance to cadaveric kidney allografts in humans. Two types of tolerance,
chimeric and non-chimeric, develop after TLI treatment of hosts depending on
whether donor bone marrow cells are transplanted along with the organ
allograft. An advantageous feature of TLI for combined marrow and organ
transplantation is the protection against graft-versus-host disease (GVHD) and
facilitation of chimerism afforded by the predominance of CD4+ NK1.1(+) -like T
cells in the irradiated host lymphoid tissues. Recently, a completely
post-transplantation TLI regimen has been developed resulting in stable mixed
chimerism and tolerance that is enhanced by a brief course of cyclosporine. The
post-transplantation protocol is suitable for clinical cadaveric kidney
transplantation. This review summarizes the evolution of TLI protocols for
eventual application to human clinical transplantation and discusses the
mechanisms involved in the induction of mixed chimerism and protection from
GVHD. N. Ref:: 74
----------------------------------------------------
[134]
TÍTULO / TITLE: - Identifying and
addressing potentially preventable causes of renal allograft loss.
REVISTA
/ JOURNAL: - Kidney Int 2002 Aug;62(2):718-9.
AUTORES
/ AUTHORS: - Langone AJ; Helderman JH N. Ref:: 9
----------------------------------------------------
[135]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[136]
TÍTULO / TITLE: - Bronchiolitis
obliterans syndrome: utility of the new guidelines in single lung transplant
recipients.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003 Apr;22(4):427-32.
AUTORES
/ AUTHORS: - Nathan SD; Barnett SD; Wohlrab J; Burton N
INSTITUCIÓN
/ INSTITUTION: - Inova Transplant Center, Inova Fairfax
Hospital, Falls Church, Virginia 22042, USA. steven.nathan@inova.com
RESUMEN
/ SUMMARY: - BACKGROUND: Bronchiolitis obliterans
syndrome is defined by a >20% decrease from baseline in the forced
expiratory volume in 1 second (FEV(1)). Recently, a consensus panel under the
auspices of the International Society for Heart and Lung Transplantation
proposed a new stage, designated “potential BOS” or BOS 0-p. This study sought
to validate retrospectively this new stage in a cohort of single-lung
transplant recipients. METHODS: A retrospective analysis of serial pulmonary
function tests in 43 single-lung transplant recipients was performed. Baseline
FEV(1) and midflow rate (FEF(25-75%)) were determined and compared with the
most recent set of pulmonary function tests in clinically stable patients.
RESULTS: The sensitivity of the FEF(25-75%) at <or=75% of baseline for
subsequently detecting BOS Stage 1 was 80%, with a specificity of 82.6%. For
the patients with idiopathic pulmonary fibrosis, the sensitivity was 62.5% and
the specificity was 100.0%, whereas in the patients with chronic obstructive
lung disease, the sensitivity was 91.7% and the specificity was 69.2%.
Different cutoff points for the FEF(25-75%) also were tested and are shown in
receiver operator curves. Likelihood ratios for the different cutoff points
also were calculated. Five of 9 (55.6%) patients qualified for BOS 0-p using
the FEV(1) parameter (FEV(1) of 81-90% of baseline) alone. CONCLUSION: The
FEF(25-75%) seems to be a useful criterion for predicting BOS development in
single-lung transplant recipients. The FEF(25-75%) might best be used with
likelihood ratios for different values rather than for 1 defined cutoff point
of or=75% of baseline. The value of the second criterion that constitutes BOS
0-p (FEV(1), 81-90%of baseline) remains uncertain.
----------------------------------------------------
[137]
TÍTULO / TITLE: - New targets for the
prevention of transplant vascular disease.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2332-3.
AUTORES
/ AUTHORS: - Hayry P
INSTITUCIÓN
/ INSTITUTION: - Transplantation Laboratory, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland. N. Ref:: 23
----------------------------------------------------
[138]
TÍTULO / TITLE: - Utility of intravenous
immune globulin in kidney transplantation: efficacy, safety, and cost
implications.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jun;3(6):653-64.
AUTORES
/ AUTHORS: - Jordan S; Cunningham-Rundles C; McEwan R
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology &
Transplant Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. sjordan@cshs.org
RESUMEN
/ SUMMARY: - Intravenous immunoglobulin preparations
(IVIG) are known to be effective in the treatment of various autoimmune and
inflammatory disorders into their immunomodulatory, immunoregulatory, and
anti-inflammatory properties. Recently, IVIG has been utilized in the
management of highly sensitized patients awaiting renal transplantation. The
mechanisms of suppression of panel reactive antibodies (PRA) in patients
awaiting transplantation are currently under investigation and appear to be
related to anti-idiotypic antibodies present in IVIG preparations. In this
review, the various immunomodulatory mechanisms attributable to IVIG and their
efficacy in reducing PRAs will be described. In addition, the use of IVIG in
solid organ transplant recipients will be reviewed. The adverse events, safety
considerations, and economic impact of IVIG protocols for patients awaiting
solid organ transplantation will be discussed.
N. Ref:: 67
----------------------------------------------------
[139]
TÍTULO / TITLE: - Donor and recipient
outcomes after adult living donor liver transplantation.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Oct;9(10 Suppl
2):S42-4.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50219
AUTORES
/ AUTHORS: - Humar A
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Minnesota, Minneapolis, MN 55455, USA. humar001@umn.edu N. Ref:: 11
----------------------------------------------------
[140]
- Castellano -
TÍTULO / TITLE:Presentacion de canceres en
receptores trasplantados con organo solido. Presentation of cancers in
recipients of a solid-organ transplant.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21(6):528-37.
AUTORES
/ AUTHORS: - Lampreabe I; Gomez-Ullate P; Amenabar JJ;
Zarraga S; Gainza FJ; Urbizu JM
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital de
Cruces, Facultad de Medicina, Universidad del Pais Vasco. ilampreave@hcru.osakidetza.net N. Ref:: 35
----------------------------------------------------
[141]
TÍTULO / TITLE: - Limited dose monoclonal
IL-2R antibody induction protocol after primary kidney transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jul;2(6):568-73.
AUTORES
/ AUTHORS: - Ahsan N; Holman MJ; Jarowenko MV; Razzaque
MS; Yang HC
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplant Division,
University of Medicine and Dentistry of New Jersey, New Brunswick 08904, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - This study prospectively compared
immunoprophylaxis with a single intraoperative dose (2 mg/kg) of monoclonal
interleukin-2 receptor (IL-2R) antibody vs. noninduction in kidney transplant
recipients treated with tacrolimus (FK 506), mycophenolate mofetil (MMF) and a
prednisone-based immunosuppression regimen. One hundred recipients of
first-kidney transplant were enrolled into the study to receive either
anti-IL-2R monoclonal antibody, daclizumab (2 mg/kg intraoperatively, limited
anti-IL-2R) or no induction (control). Each patient also received oral
tacrolimus (dosed to target trough level 10-15 ng/mL), MMF (500 mg bid) and
prednisone. The primary efficacy end-point was the incidence of biopsy proven
acute rejection during the first 6 months post-transplant. The patients were
also followed for 12-month graft function, and graft and patient survival
rates. Other than the donor’s age being significantly lower in the control
group, both groups were comparable with respect to age, weight, gender, race, human
leukocyte antigen (HLA)-DR mismatch, panel reactive antibody (%PRA), cold
ischemic time, cytomegalovirus (CMV) status, causes of renal failure, and
duration and modes of renal replacement therapy (RRT). During the first 6
months, episodes of first biopsy confirmed acute rejection was 3/50 (6%) in the
limited anti-IL-2R group and 8/50 (16%) in the controls (p < 0.05).
Twelve-month patient 100/98 (%) and graft survival 100/96 (%) were not
statistically different. The group receiving limited anti-IL-2R did not have
any adverse reactions. Our study demonstrates that a limited (single) 2 mg/kg
immunoprophylaxis dose with monoclonal IL-2R antibody (daclizumab) when
combined with tacrolimus/MMF/steroid allows significant reduction in early
renal allograft rejection to the single digit level. The therapy with
anti-IL-2R antibody is simple and is well tolerated.
----------------------------------------------------
[142]
TÍTULO / TITLE: - Complete freedom from
rejection after intestinal transplantation using a new tolerogenic protocol
combined with low immunosuppression.
REVISTA
/ JOURNAL: - Transplantation 2002 Mar 27;73(6):966-8.
AUTORES
/ AUTHORS: - Pirenne J; Koshiba T; Geboes K; Emonds MP;
Ferdinande P; Hiele M; Nevens F; Waer M
INSTITUCIÓN
/ INSTITUTION: - Catholic University Hospitals Leuven,
Herestraat 49, B-3000 Leuven, Belgium. Jacques.Pirenne@ uz.kuleuven.ac.be.
RESUMEN
/ SUMMARY: - BACKGROUND: Intestinal transplantation
(Itx) remains the most difficult form of transplantation. This is due to the high
immunogenicity of the bowel that currently obligates Itx patients to heavy
immunosuppression, which causes infection, posttransplant lymphoproliferative
disease (PTLD), and drug toxicity. Wider application of Itx depends on the
development of tolerogenic strategies to promote engraftment while reducing the
need for immunosuppression. We applied a strategy to clinical Itx that combines
intraportal donor-specific blood transfusion with a deliberately low
immunosuppression protocol (no high-dose steroids; lower tacrolimus level).
METHODS: A 55-year-old patient received a combined liver/Itx. Donor-specific
whole blood was taken from the donor during procurement and transfused in the
recipient portal vein after graft reperfusion. For induction immunosuppression,
no intravenous bolus of steroids was given; only two doses of anti-interleukin
2 receptor antibody were administered. The patient received posttransplantation
maintenance immunosuppression with lower tacrolimus levels than average (15
ng/ml first month; 5-10 ng/ml thereafter), low-dose azathioprine (1 mg/kg first
to third months; 0.5 mg/kg thereafter), and low-dose steroids (Medrol 8 mg
twice daily first and second months; 4 mg twice thereafter). The patient was
monitored for rejection, graft-versus-host disease, infection, and PTLD.
Protocol biopsy specimens were taken from the distal ileum (2 per week).
RESULTS: Clinical, endoscopic, and histologic signs of rejection did not
develop. Chimerism was identified at day 28. Graft-versus-host disease was absent
clinically. Chimerism was self-limiting and disappeared without modifying
baseline immunosuppression and without observing a change in graft function.
The patient remained free of systemic opportunistic infections, PTLD, and drug
toxicity. Total parenteral nutrition was stopped at 7 weeks after
transplantation. The patient remains free of total parenteral nutrition and
free of rejection at 14 months after transplantation. CONCLUSIONS: We describe
an Itx patient who remained rejection free despite receiving significantly
lower immunosuppression than average. We hypothesize that intraoperative
immunomodulation via intraportal donor-specific blood transfusion in the
absence of nonspecific overimmunosuppression promoted Itx acceptance.
----------------------------------------------------
[143]
TÍTULO / TITLE: - Antioxidant nutrients
protect against cyclosporine A nephrotoxicity.
REVISTA
/ JOURNAL: - Toxicology 2003 Jul 15;189(1-2):99-111.
AUTORES
/ AUTHORS: - Parra Cid T; Conejo Garcia JR; Carballo
Alvarez F; de Arriba G
INSTITUCIÓN
/ INSTITUTION: - Unidad de Investigacion, Hospital
Universitario de Guadalajara, C/Donante de Sangre s/n, 19.002 Guadalajara,
España. tparracid@hotmail.com
RESUMEN
/ SUMMARY: - The immunosuppressive drug cyclosporine A
(CsA) has been successfully used in several diseases with immunological basis
and in transplant patients. Nephrotoxicity is the main secondary effect of CsA
treatment. Although the mechanisms of nephrotoxitity are not completely
defined, there is evidence that suggests the role of reactive oxygen species
(ROS) in its pathogenesis. It has been demonstrated in numerous in vivo and in
vitro experiments that CsA induced renal failure and increased the synthesis of
ROS, thromboxane (TX) and lipid peroxidation products in the kidney.
Furthermore, CsA modified the expression and activity of several renal enzymes
(ciclooxygenase, superoxide-dismutase, catalase and glutathione-peroxidase).
Antioxidant nutrients (e.g. Vitamins E and C) can neutralize some of the
effects that CsA produced in the kidney. Thus, Vit E inhibited the synthesis of
ROS and TX and the lipid peroxidation process induced by CsA in kidney
structures. Antioxidants can also improve renal function and histological
damage produced by CsA administration. Although there are few data in humans
treated with CsA, the possibility exists that antioxidants can also neutralize
CsA nephrotoxicity and LDL oxidation. Thus, antioxidant nutrients could have a
therapeutic role in transplant patients treated with CsA. N. Ref:: 79
----------------------------------------------------
[144]
TÍTULO / TITLE: - Psychological stress
and antibody response to immunization: a critical review of the human
literature.
REVISTA
/ JOURNAL: - Psychosom Med. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.psychosomaticmedicine.org/
●●
Cita: Psychosomatic Medicine: <> 2001 Jan-Feb;63(1):7-18.
AUTORES
/ AUTHORS: - Cohen S; Miller GE; Rabin BS
INSTITUCIÓN
/ INSTITUTION: - Department of Psychology, Carnegie Mellon
University, Pittsburgh, PA 15213, USA. scohen@andrew.cmu.edu
RESUMEN
/ SUMMARY: - OBJECTIVE: The objective of this review
was to evaluate the evidence for the hypothesis that psychological stress
influences antibody response to immunization in humans. METHODS: A critical
review of the literature was conducted. RESULTS: The evidence supports an
association between psychological stress and suppression of humoral immune
(antibody) response to immunization. This association is convincing in the case
of secondary immune response but weak for primary response. The lack of
consistent evidence for a relation with primary response may be attributed to a
failure to consider the critical points when stress needs to be elevated in the
course of the production of antibody. Lower secondary antibody responses were found
among patients with chronically high levels of stress (severe enduring problems
or high levels of trait negative affect). These responses were found most
consistently among older adults. Lower secondary responses were also found for
those reporting acute stress or negative affect, but only in studies of
secretory immunoglobulin A antibody in which psychological and antibody
measures were linked very closely in time. Health practices did not mediate
relations between stress and antibody responses; however, there were
indications that elevated cortisol levels among stressed patients could play a
role. Evidence also suggests the possible influences of dispositional
stress-reactivity and low positive affect in the inhibition of antibody
production. CONCLUSIONS: The literature supports a relationship between
psychological stress and antibody responses to immunizations. The data are
convincing in the case of secondary response but weak for primary response.
More attention to the kinetics of stress and antibody response and their
interrelations is needed in future research.
N. Ref:: 51
----------------------------------------------------
[145]
TÍTULO / TITLE: - Role of prostanoids and
endothelins in the prevention of cyclosporine-induced nephrotoxicity.
REVISTA
/ JOURNAL: - Prostaglandins Leukot Essent Fatty Acids
2001 Apr-May;64(4-5):231-9.
●●
Enlace al texto completo (gratuito o de pago) 1054/plef.2001.0265
AUTORES
/ AUTHORS: - Darlametsos IE; Varonos DD
INSTITUCIÓN
/ INSTITUTION: - Centre Franco-Hellenique de Recherches
Biomedicales, Nikolaos Papanikolaou, Corporation of the Municipality Agrinion,
Agrinion, 30100, Greece. darlamet@otenet.gr
RESUMEN
/ SUMMARY: - Cyclosporine A nephrotoxicity includes
both functional toxicity and histological changes, whose seriousness is
dependent upon the dose and the duration of the drug administration. Several
vasoactive agents have been found to be implicated in cyclosporine induced
nephrotoxicity, among which prostanoids and endothelins are the most important.
In previous studies we were able to prevent the early stage (7 days) of
cyclosporine (37.4 micromol [45 mg]/kg/day) induced nephrotoxicity in rats
either by the administration, i) of OKY-046, a thromboxane A(2)synthase
inhibitor, ii) of ketanserine, an antagonist of S(2)serotonergic,
a(1)adrenergic, and H(1)histaminergic receptors and iii) of nifedipine, a
calcium channel blocker, or by diet supplementation either with evening
primrose oil or fish oil. All these protective agents elevated ratios of
excreted renal prostanoid vasodilators (prostaglandins E(2), 6ketoF(1 alpha))
to vasoconstrictor (thromboxane B(2)), a ratio which was decreased by the
administration of cyclosporine alone. Nifedipine averted the cyclosporine
induced increase of urinary endothelin-1 release. All protections were
associated with the reinstatement of glomerular filtration rate forwards normal
levels whereas renal damage defence, consisting of a decrease of the
cyclosporine induced vacuolizations, was variable. Ketanserine and evening
primrose oil were the only agents which prevented the animal body weight loss.
These data suggest that prostanoids and endothelin-1 may mediate functional
toxicity while thromboxane A(2)is involved the morphological changes too,
provoked in the early stage of cyclosporine treatment. However, other
nephrotoxic factors and additional mechanisms could also be implicated in the
cyclosporine induced nephrotoxicity. N.
Ref:: 91
----------------------------------------------------
[146]
TÍTULO / TITLE: - Clinical epidemiology:
diagnostic and prognostic tests.
REVISTA
/ JOURNAL: - Curr Opin Rheumatol 2003 Mar;15(2):104-9.
AUTORES
/ AUTHORS: - Ward MM
INSTITUCIÓN
/ INSTITUTION: - Intramural Research Program, National
Institute of Musculoskeletal and Skin Diseases, National Institutes of Health,
Bethesda, Maryland, USA. wardm1@mail.nih.gov
RESUMEN
/ SUMMARY: - Recent studies of diagnostic and
prognostic tests have commonly examined serological tests and new imaging
techniques. Antifilaggrin antibodies have been found to be highly specific for
the diagnosis of rheumatoid arthritis (RA), but uncertainty remains about the
sensitivity of this test, particularly in early RA. Magnetic resonance imaging
and ultrasound continue to be explored as methods to detect synovitis and
erosions in RA. Several recent studies have confirmed the association between
the human leukocyte antigen DRB1 shared epitope and worse radiographic outcomes
in patients with RA. Interlaboratory variation in detecting autoantibodies
remains a concern, as does overuse of tests for antineutrophil cytoplasmic
autoantibodies. N.
Ref:: 53
----------------------------------------------------
[147]
TÍTULO / TITLE: - Tailoring tolerance to
prevent chronic rejection.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 27;72(8
Suppl):S10-2.
AUTORES
/ AUTHORS: - Madsen JC
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston 02114, USA. madsen@helix.mgh.harvard.edu N. Ref:: 29
----------------------------------------------------
[148]
TÍTULO / TITLE: - Successful allogeneic
bone marrow transplantation. Crucial roles of stromal cells in prevention of
graft rejection.
REVISTA
/ JOURNAL: - Acta Haematol 2001;105(3):172-8.
AUTORES
/ AUTHORS: - Ikehara S
INSTITUCIÓN
/ INSTITUTION: - First Department of Pathology,
Transplantation Center, Kansai Medical University, Moriguchi City, Japan.
RESUMEN
/ SUMMARY: - We have previously found that a major
histocompatibility complex (MHC) restriction exists between pluripotent
hemopoietic stem cells (P-HSCs) and stromal cells. Based on this finding, we
have recently found using chimerism-resistant mouse combinations that
successful allogeneic (allo) BMT can be executed by recruiting donor bone
marrow stromal cells. The strategies include donor bone grafts under the skin,
injection of whole bone marrow cells (BMCs) including stromal cells via the
portal vein (PV), and injection of whole BMCs directly into the bone marrow
cavity (intra-bone marrow [IBM] injection). In this paper, we show how stromal
cells play crucial roles in overcoming chimerism-resistant allo BMT. N. Ref:: 23
----------------------------------------------------
[149]
TÍTULO / TITLE: - The impact of advancing
donor age on histologic recurrence of hepatitis C infection: the perils of
ignored maternal advice.
REVISTA
/ JOURNAL: - Liver Transpl 2003 May;9(5):535-7.
●●
Enlace al texto completo (gratuito o de pago) 1002/lt.500090516
AUTORES
/ AUTHORS: - Charlton M
INSTITUCIÓN
/ INSTITUTION: - William J. von Liebig Transplant Center,
Division of Gastroenterology and Hepatology Mayo Clinic and Foundation,
Rochester, MN, USA. N.
Ref:: 15
----------------------------------------------------
[150]
TÍTULO / TITLE: - New strategies to
reduce nephrotoxicity.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12 Suppl):S99-104.
AUTORES
/ AUTHORS: - Kreis H
RESUMEN
/ SUMMARY: - Since the introduction of cyclosporine,
CNIs have formed the basis of immunosuppressive therapy in renal
transplantation. The propensity of these agents to ultimately damage the very
organs they were intended to protect was always recognized, but largely ignored
due to their impressive ability to improve short-term outcomes. With the
availability of equally powerful new immunosuppressive agents devoid of major
nephrotoxicity, the irony of this situation has become all too apparent, and
investigators are beginning to reevaluate the role of CNIs in renal
transplantation. In this paper, we looked at strategies using MMF or sirolimus
to reduce, withdraw, or replace CNIs in renal transplantation. Although MMF has
proved effective in combination with CNIs, particularly in reducing acute
rejection rates, its use as base therapy to allow CNI therapy to be withdrawn
or eliminated is questionable. On the basis of initial trials, sirolimus holds
promise for use as base therapy. To date, it is probably the only agent used in
renal transplantation that provides immunosuppression comparable to
cyclosporine or tacrolimus, which may someday allow sirolimus to replace. CNIs
or allow early withdrawal of CNI therapy. Further study is needed to better
clarify the role of sirolimus in improving long-term renal transplantation
outcomes. N. Ref:: 61
----------------------------------------------------
[151]
TÍTULO / TITLE: - Molecular actions of
sirolimus: sirolimus and mTor.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):227S-230S.
AUTORES
/ AUTHORS: - Kirken RA; Wang YL
INSTITUCIÓN
/ INSTITUTION: - Department of Integrative Biology and
Pharmacology, The University of Texas Health Science Center at Houston,
Houston, Texas 77030, USA. robert.a.kirken@uth.tmc.edu
RESUMEN
/ SUMMARY: - Recent therapeutic strategies to combat
organ allograft rejection have focused on T-cell signaling pathways and the
molecules that comprise them. The macrolide antibiotic produced by the
bacterium Streptomyces hygroscopicus, known as sirolimus or rapamycin, has
shown great therapeutic potential in the transplant setting. Sirolimus alone or
in combination with other immunosuppressive agents can block acute rejection,
chronic graft destruction, and promote permanent allograft acceptance.
Sirolimus targets a unique serine-threonine kinase, mammalian target of
rapamycin (mTor), which plays a key role in mitogenic and nutritional cells
signals. Within T cells, mTor regulates a number of proteins likely dependent
on T cell growth factors such as interleukin 2. This review is focused on the
molecular mechanisms by which mTor may regulate T-cell signaling cascades and
affect T-cell responsiveness, and how sirolimus likely uncouples this
activity. N. Ref:: 32
----------------------------------------------------
[152]
TÍTULO / TITLE: - Dextrans in
microsurgery: A review.
REVISTA
/ JOURNAL: - Microsurgery 2003;23(1):78-80.
●●
Enlace al texto completo (gratuito o de pago) 1002/micr.10077
AUTORES
/ AUTHORS: - Jallali N
INSTITUCIÓN
/ INSTITUTION: - Department of Plastic and Recostructive
Surgery, Addenbrooke’s Hospital, Cambridge, United Kingdom. navidjallali@hotmail.com
RESUMEN
/ SUMMARY: - This articles reviews the use of dextrans
in free tissue transfer. Current recommended regimes, indications, and
complications are discussed. In conclusion, dextrans cannot be used as a
substitute for good surgical technique, and should be utilized cautiously,
especially in the elderly. N.
Ref:: 17
----------------------------------------------------
[153]
TÍTULO / TITLE: - The CD52 antigen and development
of the CAMPATH antibodies.
REVISTA
/ JOURNAL: - Cytotherapy 2001;3(3):137-43.
●●
Enlace al texto completo (gratuito o de pago) 1080/146532401753174098
AUTORES
/ AUTHORS: - Hale G
INSTITUCIÓN
/ INSTITUTION: - Sir William Dunn School of Pathology,
University of Oxford, Oxford, UK. N.
Ref:: 51
----------------------------------------------------
[154]
TÍTULO / TITLE: - Prevention of fungal
infections in the immunocompromised host.
REVISTA
/ JOURNAL: - Curr Opin Investig Drugs 2003
Aug;4(8):974-90.
AUTORES
/ AUTHORS: - Mahfouz T; Anaissie E
INSTITUCIÓN
/ INSTITUTION: - Myeloma Institute for Research and
Treatment, Arkansas Cancer Research Center, University of Arkansas for Medical
Sciences, Little Rock, AR 72205, USA. mahfouztahsine@uams.edu
RESUMEN
/ SUMMARY: - The incidence and severity of invasive
fungal infections have significantly increased among immunocompromised hosts
leading to excessive morbidity and mortality. Several preventative antifungal
strategies (prophylaxis, empirical and pre-emptive) have been developed to
improve the outcome of these infections. Although effective, these strategies
are associated with toxicity, high cost and potential emergence of resistance.
An alternative strategy, in the attempt to optimize the use of antifungal
agents in preventing fungal infections, is a risk-adjusted approach based on
the risk for, and severity of, infection in a given patient. This strategy has
the potential to provide patients likely to suffer severe fungal infection the
benefits of antifungal agents while avoiding the negative aspects (toxicity,
cost and risk of resistance) in patients at low risk for these infections. In
this review we focus on this strategy in cancer patients but it may also be
applied to other immunocompromised hosts.
N. Ref:: 143
----------------------------------------------------
[155]
TÍTULO / TITLE: - Morbidity risk in HFE
associated hereditary hemochromatosis C282Y heterozygotes.
REVISTA
/ JOURNAL: - Toxicology 2002 Nov 15;180(2):169-81.
AUTORES
/ AUTHORS: - Fuchs J; Podda M; Packer L; Kaufmann R
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Medical School,
J.W. Goethe University, Frankfurt, Germany. jurgenfuchs@t-online.de
RESUMEN
/ SUMMARY: - Hereditary hemochromatosis (HHC) is a
late-onset, autosomal recessive disorder leading to a chronic iron overload
syndrome, finally causing diabetes, cardiomyopathy and liver disease. HHC is
the most common single gene disorder in northern Europeans that occurs with a
frequency of approximately 0.5%, and most of these patients carry the C282Y and
H63D mutation in the HFE gene on chromosome 6p21.3. The vast majority of HHC
patients are homozygous for the C282Y mutation, but HHC phenotypes are observed
in other genotypes. Expression of the disease, in those homozygous for the
C282Y mutation, is highly variable depending on the various features of the
population studied. C282Y heterozygotes have slightly increased iron stores and
in absence of other genetic and/or environmental factors do usually not develop
the HHC phenotype. It is currently a matter of debate whether C282Y
heterozygotes may have an increased risk for morbidity. Different studies
investigating the association of C282Y heterozygocity with morbidity have given
conflicting results, as is exemplified by extrahepatic cancers, cardiovascular
diseases, alcoholic liver disease, and diabetes. However, there are examples of
clear and unambiguous disease associations, such as with sporadic pophyria
cutanea tarda. It remains to be seen whether a strong correlation between the
C282Y heterozygous state and distinct pathological conditions will exist and
large-scale genotyping studies will help to identify such potential risk groups
in the future. N.
Ref:: 110
----------------------------------------------------
[156]
TÍTULO / TITLE: - Long-term kidney
transplant survival.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S44-50.
AUTORES
/ AUTHORS: - Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Froedert Memorial Hospital, Medical
College of Wisconsin, Milwaukee, WI 53226, USA. hari@mcw.edu
RESUMEN
/ SUMMARY: - With improvements in short-term kidney
graft survival, focus has shifted towards long-term survival. There has also
been a substantial improvement in long-term survival as measured by kidney
half-life. Long-term graft failure is secondary to chronic allograft
nephropathy (CAN), recurrent disease, and death with a functioning graft. CAN is
secondary to a combination of chronic rejection, chronic cyclosporine toxicity,
and/or donor kidney disease. Risk factors for chronic rejection have been
attributed to both immunological and nonimmunological causes. With a marked
reduction in acute rejection rates-an important risk factor for CAN-there is a
substantial improvement in kidney half-life. There are still nonimmunological
factors, such as donor age, that adversely affect long-term graft survival. In
addition, African-American recipients continue to have a shorter graft
half-life. Recurrent disease is becoming an important cause of late graft
failure. Despite the introduction of various potent immunosuppressive agents,
there has been little or no impact on the prevalence as well as progression of
recurrent diasease. With the reduction of acute rejection rates and improved
short- and long-term graft survival, further improvements of long-term graft
survival will be an important focus in the 21st century. N. Ref:: 45
----------------------------------------------------
[157]
TÍTULO / TITLE: - New immunosuppressants
in BMT/GVHD.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2220-2.
AUTORES
/ AUTHORS: - Basara N; Gunzelmann S; Willenbacher W;
Fauser AA; Kiehl MG
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology/Oncology, BMT
Unit, Oberstein, Germany. N.
Ref:: 18
----------------------------------------------------
[158]
TÍTULO / TITLE: - Multidrug-resistant
tuberculosis in a lung transplant recipient.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
Oct;22(10):1168-73.
AUTORES
/ AUTHORS: - Lee J; Yew WW; Wong CF; Wong PC; Chiu CS
INSTITUCIÓN
/ INSTITUTION: - Tuberculosis and Chest Unit, Grantham
Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong SAR, China. josephlee59@yahoo.com
RESUMEN
/ SUMMARY: - Tuberculosis infection has been a
relatively rare complication after lung transplantation. However, as more
countries in which Mycobacterium tuberculosis infection remains endemic embark
on lung transplant programs, the occurrence of multidrug-resistant tuberculosis
after transplantation is a genuine threat. We report the first case of
multidrug-resistant tuberculosis in a double-lung transplant recipient who
probably acquired the disease from the donor. We discuss the problems in
clinical management of post-transplant tuberculosis infection and of
drug-resistance. N.
Ref:: 28
----------------------------------------------------
[159]
TÍTULO / TITLE: - Prevention strategies
for type 1 diabetes mellitus: current status and future directions.
REVISTA
/ JOURNAL: - BioDrugs 2003;17(1):39-64.
AUTORES
/ AUTHORS: - Winter WE; Schatz D
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Florida, Gainesville, Florida 32610, USA. winter@pathology.ufl.edu
RESUMEN
/ SUMMARY: - Type 1 diabetes mellitus affects about 1
in 300 people in North America and Europe. Epidemiological studies indicate
that the incidence and thus prevalence of type 1 diabetes is rising worldwide.
Intervention in autoimmune type 1a diabetes could occur at the time of
diagnosis or, preferably, prior to clinical presentation during the
‘prediabetic’ period (e.g. prevention). Prediabetes is best recognised by the detection
of islet autoantibodies in the serum. Promising intervention strategies include
monoclonal antibody therapies (e.g. anti-CD3, anti-CD25, anti-CD52 or anti-CD20
monoclonal antibodies), immunosuppression (e.g. calcineurin inhibitors, B7
blockade, glucocorticoids, sirolimus (rapamycin), azathioprine or mycophenolate
mofetil), immunomodulatory therapies (e.g. plasmapheresis, intravenous
immunoglobulin, cytokine administration, adoptive cellular gene therapy) and
tolerisation interventions (e.g. autoantigen administration or avoidance,
altered peptide ligand or peptide-based therapies). To date, islet and pancreas
transplantation have essentially been reserved for patients with long-standing
diabetes who have complications and are also in need of a concurrent kidney
transplant. None of the therapies attempted to date has produced long-term
remissions in new-onset type 1 diabetes patients and no therapies have been
shown to prevent the disease. Nevertheless, with advances in our understanding
of basic immunology and the cellular and molecular mechanisms of tolerance
induction and maintenance, successful intervention therapies will be developed.
The balance between safety and efficacy is critical. Higher rates of adverse
events might be more tolerable in new-onset type 1 diabetes patients if the
therapy is extremely effective at inducing a permanent remission. However,
therapies must not harm the beta-cells themselves or any organ system that is a
potential target of diabetes complications, such as the nervous system, retina,
cardiovascular system or kidney. In the treatment of prediabetes, successful
therapies should provide a level of safety similar to that of currently used
vaccines and a high level of efficacy. N.
Ref:: 244
----------------------------------------------------
[160]
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
----------------------------------------------------
[161]
TÍTULO / TITLE: - Viral infections in
immunocompromised patients: what’s new with respiratory viruses?
REVISTA
/ JOURNAL: - Curr Opin Infect Dis 2002
Aug;15(4):355-67.
AUTORES
/ AUTHORS: - Ison MG; Hayden FG
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases,
University of Virginia, Charlottesville, Virginia 22908, USA. mgison@alumni.grinnell.edu
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: The leading cause of
death in solid organ and hematopoietic stem cell transplant recipients is
infection. The respiratory viruses, particularly respiratory syncytial virus,
influenza, parainfluenza, adenovirus, and picornaviruses, are increasingly
recognized as significant pathogens in these populations. RECENT FINDINGS:
Respiratory syncytial virus has again been found to be the most common of the
respiratory viruses causing severe infections in transplant recipients.
Advances in prevention, particularly with regard to infection control
practices, and to lesser extent treatment have had a substantial impact on the
frequency and outcomes of this infection. New studies have clarified the impact
of influenza in the hematopoietic stem cell transplant recipients and have
provided evidence to support the use of M2 and neuraminidase inhibitors for
early treatment. The epidemiology of parainfluenza and adenovirus in transplant
recipients has been clarified, although therapeutic modalities are still
limited and understudied. New antiviral medications may bring improved outcomes
of picornavirus infections in this population. Finally, a new virus, the human
metapneumovirus, has recently been described and may be a significant
respiratory pathogen in immunocompromised transplant recipients. SUMMARY:
Studies published over the past year have documented a new respiratory
pathogen. They have also resulted in improved understanding of the epidemiology
of all of the respiratory virus pathogens, and have contributed to improve
management of respiratory syncytial virus and influenza infection in
hematopoietic stem cell transplant and solid organ transplant recipients. N. Ref:: 119
----------------------------------------------------
[162]
TÍTULO / TITLE: - Delayed graft function.
Influence on outcome and strategies for prevention.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):721-32.
AUTORES
/ AUTHORS: - Shoskes DA; Shahed AR; Kim S
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Renal
Transplantation, Cleveland Clinic Florida, Weston, Florida, USA. dshoskes@urol.com
RESUMEN
/ SUMMARY: - Delayed graft function remains a prevalent
problem in cadaveric renal transplantation that increases rejection, decreases
graft and patient survival, increases the cost of transplantation, and
complicates patient management. Although current medical and surgical
strategies can reduce the incidence of DGF to 20% or less, newer therapies that
focus on nonimmune and immune forms of renal injury are needed to improve
outcomes further. N.
Ref:: 105
----------------------------------------------------
[163]
TÍTULO / TITLE: - Novel
pharmacotherapeutic approaches to prevention and treatment of GVHD.
REVISTA
/ JOURNAL: - Drugs 2002;62(6):879-89.
AUTORES
/ AUTHORS: - Jacobsohn DA; Vogelsang GB
INSTITUCIÓN
/ INSTITUTION: - Oncology and Pediatrics, The Johns Hopkins
University School of Medicine, Baltimore, Maryland, USA. jacobda@jhmi.edu
RESUMEN
/ SUMMARY: - Acute and chronic graft versus host
disease (GVHD) remain the major barriers to successful hematopoietic cell
transplantation. The induction of GVHD may be divided into three phases:
recipient conditioning;donor T-cell activation; andeffector cells mediating
GVHD. This review examines GVHD prevention and treatment using this conceptual
model as framework. The various pharmacological agents discussed impact on different
phases of the GVHD cascade. For example, keratinocyte growth factor and
interleukin (IL)-11 are cytokines that may be useful in disrupting phase I of
the GVHD cascade by blocking gastrointestinal tract damage, and lowering serum
levels of lipopolysaccharide and tumour necrosis factor (TNF)-alpha.
Cyclosporin, tacrolimus (FK-506) and sirolimus (rapamycin) are some of the main
agents that disrupt phase II (donor T-cell activation). Mycophenolate mofetil
and tresperimus probably act on this phase as well. Other novel drugs that
affect phase II are tolerance-induction agents such as CTLA-4 and
anti-CD40-ligand monoclonal antibodies, and preliminary results using CTLA-4
monoclonal antibody in GVHD prevention are encouraging. Examples of agents that
disrupt phase III are the IL-2 receptor antagonist daclizumab and the
anti-TNFalpha monoclonal antibody infliximab. These anti-cytokine antibodies
have shown promising results in early studies. The most effective approach to
GVHD prevention will probably be a combination regimen where the three phases
of the GVHD cascade are disrupted. Once GVHD has occurred, all three phases of
the cascade are activated. Developments of combination therapy for treatment of
both acute and chronic GVHD are likely to yield better results than
monotherapy. The numerous new treatment modalities presented should improve the
outlook for patients with acute and chronic GVHD. N. Ref:: 74
----------------------------------------------------
[164]
TÍTULO / TITLE: - Universal WBC
reduction: the case for and against.
REVISTA
/ JOURNAL: - Transfusion 2001 May;41(5):691-712.
AUTORES
/ AUTHORS: - Vamvakas EC; Blajchman MA
INSTITUCIÓN
/ INSTITUTION: - Blood Bank and Transfusion Service, New
York University Medical Center, New York, New York, USA. stephen.vamvakas@med.nyu.edu N. Ref:: 172
----------------------------------------------------
[165]
TÍTULO / TITLE: - Incidence and spectrum
of infections in lung transplanted patients: comparison of four different
immunosuppressive protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):1620-1.
AUTORES
/ AUTHORS: - Treede H; Reichenspurner H; Meiser BM; Kur
F; Furst H; Vogelmeier C; Briegel J; Reichart B
INSTITUCIÓN
/ INSTITUTION: - University Hospital Grosshadern, Munich,
Germany.
----------------------------------------------------
[166]
TÍTULO / TITLE: - Early clinical
experience with a novel rapamycin derivative.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):53-8.
AUTORES
/ AUTHORS: - Nashan B
INSTITUCIÓN
/ INSTITUTION: - Klinik fur Viszeral-und
Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
nashan@tx-amb.mh-hannover.de
RESUMEN
/ SUMMARY: - SDZ RAD (everolimus, Certican is a novel
macrolide immunosuppressant that blocks growth factor-driven transduction
signals in the T-cell response to alloantigen. After stimulation of the IL-2
receptor on the activated T-cell, SDZ RAD inhibits p70S6 kinase, acting at a
later stage in the T-cell mediated response than do cyclosporine and other
calcineurin inhibitors (CNIs). Unlike the CNIs, SDZ RAD is a proliferation
signal inhibitor, blocking growth factor-driven proliferation of both
hematopoietic and nonhematopoietic cells. These activities are complementary to
those of cyclosporine and provide a rationale for the addition of SDZ RAD to
cyclosporine-based immunosuppression, with the potential for minimizing CNI
nephrotoxicity, reducing the incidence of acute rejection, and favoring
long-term graft survival. Potential also exists for beneficial effects on other
factors that may influence the development of chronic rejection. These factors
include comorbid diseases such as hypertension, which may affect transplant
vasculopathy, and opportunistic infection with cytomegalovirus (CMV) and other
viruses, which may increase the risk of chronic rejection. The synergistic
effect of SDZ RAD and cyclosporine has been confirmed in preclinical models,
with graft survival being significantly prolonged in rat models of kidney and
heart allotransplantation. Clinical experience with SDZ RAD in
cyclosporine-based immunosuppression, including low-dose cyclosporine regimens,
has also resulted in predictable and favorable clinical outcomes. Low rates of
acute rejection, excellent rates of patient and graft survival, lower incidence
of CMV infections, better cholesterol, triglyceride and creatinine profiles,
and better renal function have been demonstrated with SDZ RAD and lower doses
of cyclosporine (Neoral; Novartis) in recipients of renal transplants. These
findings, combined with good tolerability rates and an acceptable side-effect
profile, indicate that the synergistic profile of SDZ RAD in combination with
nontoxic dosages of CNI’s and IL2 inhibitors will further improve longterm
results in renal transplantation. N.
Ref:: 48
----------------------------------------------------
[167]
TÍTULO / TITLE: - The role of newer
monoclonal antibodies in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):1000-1.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - University of California, San Francisco,
California, USA. N.
Ref:: 5
----------------------------------------------------
[168]
TÍTULO / TITLE: - Allergen immunotherapy:
a practice parameter. American Academy of Allergy, Asthma and Immunology.
American College of Allergy, Asthma and Immunology.
REVISTA
/ JOURNAL: - Ann Allergy Asthma Immunol 2003 Jan;90(1
Suppl 1):1-40.
----------------------------------------------------
[169]
TÍTULO / TITLE: - Daclizumab: a review of
its use in the management of organ transplantation.
REVISTA
/ JOURNAL: - BioDrugs 2001;15(11):745-73.
AUTORES
/ AUTHORS: - Carswell CI; Plosker GL; Wagstaff AJ
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - The humanised monoclonal antibody
daclizumab is an immunosuppressive agent that reduces acute rejection in solid
organ transplantation. It is specific for the alpha subunit (Tac/CD25) of the
interleukin (IL)-2 receptor on activated T cells and achieves immunosuppression
by competitive antagonism of IL-2-induced T cell proliferation. When added to
standard triple immunosuppression regimens, daclizumab significantly reduces
the rate of acute rejection at 1 year in renal transplantation by 36% and there
are indications that it may be effective in other solid organ transplantations.
Three-year outcomes of two phase III clinical trials in renal transplantation
indicate similar values for graft and patient survival between daclizumab and
placebo when given in addition to triple immunosuppression; however, these
pivotal trials were not designed with sufficient power to demonstrate any
statistical significance. The addition of daclizumab induction shows potential
in allowing calcineurin inhibitor- and corticosteroid-sparing regimens without
increasing the rate of acute graft rejection or adverse effects in renal and
liver transplantation. Preliminary reports indicate that daclizumab may also be
a useful agent in delayed graft function and graft versus host disease (GVHD).
Further investigation of its efficacy in these groups and in children is
needed. Data from clinical trials show daclizumab to be well tolerated in solid
organ transplantation. It does not increase the incidence of infection,
including cytomegalovirus infection, when compared with placebo or no induction
groups. Preliminary comparative data with muromonab CD3 indicate that
daclizumab may be associated with a lower rate of infectious complications and
similar or better efficacy. CONCLUSIONS: In conclusion, daclizumab has been
proven to reduce acute rejection in renal transplant recipients when given in
addition to traditional baseline immunosuppression. It has shown potential to
reduce acute rejection in other solid organ transplants; however, well
designed, randomised studies are required to confirm this. Clinical experience
from trials to date indicate that daclizumab has a tolerability profile similar
to placebo with no significant effect on the incidence of infection. The
relative efficacy and tolerability of daclizumab compared with other induction
agents has yet to be defined. Available data suggest that daclizumab may allow
the use of calcineurin inhibitor-sparing and corticosteroid-sparing regimens
and may have potential in the treatment of GVHD. N. Ref:: 80
----------------------------------------------------
[170]
TÍTULO / TITLE: - Skin cancer in organ
transplant recipients: Epidemiology, pathogenesis, and management.
REVISTA
/ JOURNAL: - J Am Acad Dermatol 2002 Jul;47(1):1-17;
quiz 18-20.
AUTORES
/ AUTHORS: - Berg D; Otley CC
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Department of
Medicine, University of Washington, Seattle, WA, USA.
RESUMEN
/ SUMMARY: - In the United States more than 100,000
people are living with solid organ transplants. The intense immunosuppressive
regimens necessary for prolonged survival of allografts significantly increase
the rates of both internal and cutaneous malignancies in recipients of solid
organ transplants. Skin cancer is the most common cancer in patients after
transplantation. Because of the early onset and high tumor burden in transplant
recipients, dermatologists have significant challenges in managing the
treatment of these patients. This article describes the epidemiology and
clinical presentation of skin cancer during posttransplantation
immunosuppression, discusses pathogenic cofactors, and reviews the optimal
management for mild and severe skin cancer in transplant recipients. N. Ref:: 144
----------------------------------------------------
[171]
TÍTULO / TITLE: - Heme oxygenase-1, a
protective gene that prevents the rejection of transplanted organs.
REVISTA
/ JOURNAL: - Immunol Rev 2001 Dec;184:275-85.
AUTORES
/ AUTHORS: - Soares MP; Brouard S; Smith RN; Bach FH
INSTITUCIÓN
/ INSTITUTION: - Beth Israel Deaconess Medical Center,
Department of Surgery, Harvard Medical School, Boston, MA 02215, USA. msoares@caregroup.harvard.edu
RESUMEN
/ SUMMARY: - Endothelial cells (EC) play a pivotal role
in regulating inflammatory reactions such as those involved in the rejection of
transplanted organs. This occurs through the expression of a series of pro- and
anti-inflammatory genes that are associated with the activation of these cells.
Presumably, the expression of pro-inflammatory genes promotes events that lead
to graft rejection, while expression of anti-inflammatory (protective) genes
suppresses those events and thus contributes in sustaining graft survival.
Understanding how the expression of these genes is regulated and their
mechanism of action are important issues for the development of new therapeutic
strategies to suppress graft rejection. We have studied this phenomenon using
experimental models of transplantation in rats. We discuss here data that
supports the concept that grafts can express anti-inflammatory (protective) genes
that mitigate inflammatory reactions leading to graft rejection. The data
reviewed focus on the role of one of such genes, the stress responsive gene
heme oxygenase-1, and of its byproduct carbon monoxide, which can suppress
graft rejection and lead to long-term graft survival. N. Ref:: 92
----------------------------------------------------
[172]
TÍTULO / TITLE: - Impact of current
transplantation practices on the changing epidemiology of infections in
transplant recipients.
REVISTA
/ JOURNAL: - Lancet Infect Dis 2003 Mar;3(3):156-61.
AUTORES
/ AUTHORS: - Singh N
INSTITUCIÓN
/ INSTITUTION: - Veterans Affairs Medical Center and
University of Pittsburgh, Thomas E Starzl Transplantation Institute, Pittsburgh
15240, USA. nis5+@pitt.edu
RESUMEN
/ SUMMARY: - The spectrum of infections in transplant
recipients has been substantially affected by novel immunosuppressive regimens
and the use of antimicrobial agents. Epidemiology and presentation of
traditional opportunistic pathogens has changed. Invasive aspergillosis and
cytomegalovirus occur later in the post-transplant period. The incidence of
infections that were previously encountered rarely—eg, BK virus nephropathy—has
increased, the clinical course of hepatitis C virus recurrence has become more
aggressive, the risk factors for invasive aspergillosis have changed, and
non-aspergillus moulds are occurring more commonly in transplant recipients.
Recognition of these trends as they unfold has significant implications for the
clinical care of the transplant recipients, for providing insights into the
pathogenesis, and for continually improving the approaches to the management of
infections. N. Ref:: 51
----------------------------------------------------
[173]
TÍTULO / TITLE: - Recipient selection in
cardiac transplantation: contraindications and risk factors for mortality.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2002
Nov;21(11):1161-73.
AUTORES
/ AUTHORS: - Cimato TR; Jessup M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania, USA.
RESUMEN
/ SUMMARY: - Currently the only acknowledged,
definitive treatment for refractory heart failure is heart transplantation
(HTx). During the past 10 years, selection criteria for heart transplant
recipients have been developed that use an analysis of risk factors associated
with mortality, which were identified by consensus opinion and by single-center
and multi-center database review. A number of other studies also have been
designed to evaluate specific risk factors for transplant such as advanced age,
diabetes, and sex. This review identifies variables that continue to provoke
controversy during the candidate selection process or variables that have
changed from absolute to relative contraindications for HTx. Clinicians may use
the data summarized in this review as a guide to making decisions about patient
candidacy for HTx. One could conclude from this analysis that a more formalized
and objective scale to select patients and to assess risk of death after HTx is
necessary. Moreover, as alternative therapies to HTx become reality, a better
instrument for triaging patients to one form of therapy or another may be
necessary. N. Ref:: 61
----------------------------------------------------
[174]
TÍTULO / TITLE: - Aspergillus infections
in allogeneic stem cell transplant recipients: have we made any progress?
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2002
Dec;30(12):925-9.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703738
AUTORES
/ AUTHORS: - Jantunen E; Anttila VJ; Ruutu T
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Kuopio University
Hospital, Kuopio, Finland.
RESUMEN
/ SUMMARY: - Invasive aspergillosis (IA) is common in
allogeneic SCT recipients, with an incidence of 4-10%. The majority of these
infections are diagnosed several months after SCT and they are frequently
associated with GVHD. The diagnosis is difficult and often delayed. Established
IA is notoriously difficult to treat with a death rate of 80-90%. This review
summarises recent data on this problem to assess whether there has been any
progress. Effective prophylactic measures are still lacking. Severe
immunosuppression is the main obstacle to the success of therapy. Recent and
ongoing developments in diagnostic measures and new antifungal agents may
improve treatment results to some extent, but Aspergillus infections still remain
a formidable problem in allogeneic transplantation. Further studies in this
field will focus on the role of various cytokines and combinations of
antifungal agents. N.
Ref:: 65
----------------------------------------------------
[175]
TÍTULO / TITLE: - In-stent stenosis:
pathology and implications for the development of drug eluting stents.
REVISTA
/ JOURNAL: - Heart 2003 Feb;89(2):218-24.
AUTORES
/ AUTHORS: - Bennett MR
INSTITUCIÓN
/ INSTITUTION: - Addenbrooke’s Centre for Clinical
Investigation, Box 110, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK. mrb@mole.bio.cam.ac.uk N. Ref:: 20
----------------------------------------------------
[176]
TÍTULO / TITLE: - Glatiramer acetate
(Copaxone).
REVISTA
/ JOURNAL: - Int J Clin Pract 2001 Jul-Aug;55(6):394-8.
AUTORES
/ AUTHORS: - Francis DA
INSTITUCIÓN
/ INSTITUTION: - Queen Elizabeth Neuroscience Centre, Queen
Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
RESUMEN
/ SUMMARY: - Glatiramer acetate (Copaxone) is a novel
preparation of synthetic peptides composed of four amino acids. Laboratory
studies have shown that it prevents, or modifies, experimental allergic
encephalomyelitis, the animal model for multiple sclerosis (MS), in several mammalian
species. Its mode of action has not been fully elucidated but it is known to
induce suppresser T-cells, known to be deficient in MS, and competitively
inhibits the effect of CNS myelin antigens, thought to be important in the
pathogenesis of MS, through MHC blockade. Controlled clinical trials have shown
it to improve the natural history of MS by reducing both the relapse rate and
the resultant disability. GA shows similar efficacy to interferon-beta
(IFN-beta) but with fewer systemic side-effects and appears to be better
tolerated by patients. It has thus justified its place in the new era of
disease-modifying treatments for MS. While the evidence suggests GA should be
considered as first-line therapy in selected patients, its differing mechanism
of action also gives patients and doctors the option of an alternative agent
when the efficacy of IFN-beta is waning or side-effects predominate. N. Ref:: 61
----------------------------------------------------
[177]
TÍTULO / TITLE: - Strategies to reduce toxicities
and improve outcomes in renal transplant recipients.
REVISTA
/ JOURNAL: - Pharmacotherapy 2002 Mar;22(3):316-28.
AUTORES
/ AUTHORS: - Lo A; Alloway RR
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Cincinnati Medical Center, Ohio 45267-0585, USA.
RESUMEN
/ SUMMARY: - Ongoing improvements in immunosuppression
and posttransplantation care have dramatically improved patient and graft
outcomes after transplantation. The frequency of graft loss due to acute
rejection has declined considerably as a result of the availability of a
variety of more potent immunosuppressive agents and probably also because of
refined clinical care and follow-up. Complications of long-term administration
of corticosteroids (steroids) and calcineurin inhibitors, however, have become
increasingly apparent as patients live longer with their transplant, and
attention is shifting to long-term issues. Use of both steroids and calcineurin
inhibitors is associated with metabolic toxicities such as hypertension,
hyperlipidemia, diabetes, bone loss, and cataracts. These contribute to
posttransplantation morbidity and may negatively affect patient and allograft
survival. A variety of troublesome cosmetic side effects, such as hirsutism,
gingival hyperplasia, alopecia, obesity, and cushingoid appearance, also are
associated with these drugs. These effects can detract from patient self-esteem
and compliance with the immunosuppressive regimen. In the past 2 decades, the
introduction of second-generation immunosuppressive drugs, such as tacrolimus,
mycophenolate mofetil, sirolimus, and anti-interleukin-2 receptor monoclonal
antibodies, has provided some alternatives to classic immunosuppressant
choices. Patients experiencing undesirable adverse events now can be converted
to another immunosuppressive regimen that ultimately will improve graft and
patient survival rates and improve quality of life after transplantation. N. Ref:: 99
----------------------------------------------------
[178]
TÍTULO / TITLE: - Influenza vaccination
and chemotherapy: a shot in the dark?
REVISTA
/ JOURNAL: - Support Care Cancer 2002 Sep;10(6):462-5.
Epub 2002 Jan 31.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00520-001-0337-9
AUTORES
/ AUTHORS: - Ring A; Marx G; Steer C; Harper P
INSTITUCIÓN
/ INSTITUTION: - Department of Medical Oncology, Level 03,
Department of Medical Oncology, Thomas Guy House, Guys’ Hospital, London. SE1
9RT, England. ringalistair@hotmail.com
RESUMEN
/ SUMMARY: - Influenza infection is a potential cause
of excess morbidity in patients who are immunosuppressed because of
haemato-oncological malignancy or its treatment. Therefore vaccination against influenza
is recommended in these patient groups. This systematic review of the
literature and vaccine manafacturers’ data assesses the current levels of
knowledge concerning influenza vaccination in this patient group. There is a
paucity of data, and the patient groups in the studies are heterogeneous.
Serological responses are generally lower than expected in healthy controls and
may be critically dependent on the timing of vaccination relative to
chemotherapy. Antibody levels considered protective in healthy individuals may
not prevent clinical infection in those with malignant disease. There are no
data on protection from clinical infection. The vaccine appears to be well
tolerated in this patient group. It is reasonable to offer vaccination to
patients receiving treatment for haemato-oncological disorders. However, the
degree of clinical protection afforded may be inferior to that experienced by
healthy individuals. Further trials are warranted to assess the magnitude of
benefit and optimal schedules of vaccination.
N. Ref:: 31
----------------------------------------------------
[179]
TÍTULO / TITLE: - Immunosuppression:
practice and trends.
REVISTA
/ JOURNAL: - Am J Transplant 2003;3 Suppl 4:41-52.
AUTORES
/ AUTHORS: - Helderman JH; Bennett WM; Cibrik DM;
Kaufman DB; Klein A; Takemoto SK
INSTITUCIÓN
/ INSTITUTION: - Vanderbilt University, Nashville, TN, USA.
hal.helderman@Vanderbilt.edu N. Ref:: 11
----------------------------------------------------
[180]
TÍTULO / TITLE: - The spectrum of
complications of immunosuppression: is the time right for hand transplantation?
REVISTA
/ JOURNAL: - J Bone Joint Surg Am 2002
Oct;84-A(10):1861-70.
AUTORES
/ AUTHORS: - Brenner MJ; Tung TH; Jensen JN; Mackinnon
SE
INSTITUCIÓN
/ INSTITUTION: - Division of Plastic and Reconstructive
Surgery, Washington University School of Medicine, St. Louis, Missouri 63110,
USA. N. Ref:: 98
----------------------------------------------------
[181]
TÍTULO / TITLE: - Characteristics of
poliovirus strains from long-term excretors with primary immunodeficiencies.
REVISTA
/ JOURNAL: - Dev Biol (Basel) 2001;105:75-80.
AUTORES
/ AUTHORS: - Minor P
INSTITUCIÓN
/ INSTITUTION: - National Institute for Biological
Standards and Control, Potters Bar, UK.
RESUMEN
/ SUMMARY: - Individuals who are deficient in humoral
immunity are particularly at risk from infection with enteroviruses, and
poliovirus in particular, where antibodies are the main source of protection
from disease. Long-term excretion of vaccine strains of poliovirus has been
documented for many years and instances of paralytic poliomyelitis in
hypogammaglobulinaemic patients who were subsequently found to have been
excreting virus for prolonged periods have been reported in the U.S.A., Germany
and Japan. The identification of a healthy immunodeficient patient in the U.K.
who has probably been excreting type 2 poliovirus for 15 years will be
described, with the characteristics of the virus and the results of attempts at
treatment so far. Such individuals pose a significant risk to the eradication
programme unless they can be identified and treated. N. Ref:: 12
----------------------------------------------------
[182]
TÍTULO / TITLE: - An analysis of early
renal transplant protocol biopsies—the high incidence of subclinical tubulitis.
REVISTA
/ JOURNAL: - Am J Transplant 2001 May;1(1):47-50.
AUTORES
/ AUTHORS: - Shapiro R; Randhawa P; Jordan ML;
Scantlebury VP; Vivas C; Jain A; Corry RJ; McCauley J; Johnston J; Donaldson J;
Gray EA; Dvorchik I; Hakala TR; Fung JJ; Starzl TE
INSTITUCIÓN
/ INSTITUTION: - University of Pittsburgh, Thomas E. Starzl
Transplantation Institute, PA 15213, USA. shapiror@msx.upmc.edu
RESUMEN
/ SUMMARY: - To investigate the possibility that we
have been underestimating the true incidence of acute rejection, we began to
perform protocol biopsies after kidney transplantation. This analysis looks at
the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients
undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor
kidney transplantation, underwent 277 biopsies. We focused on the subset of
biopsies in patients without delayed graft function (DGF) and with stable or
improving renal function, who underwent a biopsy 8.2+/-2.6 d (range 3-18 d)
after transplantation (n = 28). Six (21%) patients with no DGF and with stable
or improving renal function had borderline histopathology, and 7 (25%) had
acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was
one (0.4%) serious hemorrhagic complication, in a patient receiving low
molecular weight heparin; she ultimately recovered and has normal renal
function. Her biopsy showed Banff 1B tubulitis. In patients with stable or
improving renal allograft function early after transplantation, subclinical
tubulitis may be present in a substantial number of patients. This suggests
that the true incidence of rejection may be higher than is clinically
appreciated.
----------------------------------------------------
[183]
TÍTULO / TITLE: - Maximizing optimal
hematopoietic stem cell donor selection from registries of unrelated adult
volunteers.
REVISTA
/ JOURNAL: - Tissue Antigens 2003 Jun;61(6):415-24.
AUTORES
/ AUTHORS: - Hurley CK; Fernandez Vina M; Setterholm M
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, CW Bill Young
Marrow Donor Recruitment and Research Program, Georgetown University Medical
Center, 3970 Reservoir Road NW, Washington, DC 20057, USA. hurleyc@georgetown.edu
RESUMEN
/ SUMMARY: - Today, more than 50 registries of
HLA-typed potential adult hematopoietic stem cell donors have been established
in 40 countries and include more than 7.5 million volunteers. HLA testing of
new volunteers includes HLA-A, -B and often -DR typing at low to intermediate
resolution. Searching patients are tested for these same loci, preferably at a
higher level of resolution. Over 95,000 patient searches are received by registries
annually resulting in approximately 4660 unrelated transplants. In 2001, nearly
one-third of transplants involved a patient in one country receiving stem cells
from a donor in another. The diversity of the HLA system complicates the search
process, requiring sophisticated registry algorithms for matching, and
expertise in allele and haplotype frequencies and associations to design search
strategies. Within registries, HLA frequency data have been used to evaluate
optimal registry size and composition. N.
Ref:: 76
----------------------------------------------------
[184]
TÍTULO / TITLE: - Mechanisms of action of
mycophenolate mofetil in preventing chronic rejection.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Nov;34(7):2863-6.
AUTORES
/ AUTHORS: - Allison AC
INSTITUCIÓN
/ INSTITUTION: - SurroMed Corporation, Mountain View,
California 94043, USA. aallison@surromed.com N. Ref:: 34
----------------------------------------------------
[185]
TÍTULO / TITLE: - Tacrolimus: a further
update of its use in the management of organ transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(12):1247-97.
AUTORES
/ AUTHORS: - Scott LJ; McKeage K; Keam SJ; Plosker GL
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Extensive clinical use has confirmed that
tacrolimus (Prograf) is a key option for immunosuppression after
transplantation. In large, prospective, randomised, multicentre trials in
adults and children receiving solid organ transplants, tacrolimus was at least
as effective or provided better efficacy than cyclosporin microemulsion in
terms of patient and graft survival, treatment failure rates and the incidence
of biopsy-proven acute and corticosteroid-resistant rejection episodes.
Notably, the lower incidence of rejection episodes after renal transplantation
in tacrolimus recipients was reflected in improved cost effectiveness. In bone
marrow transplant (BMT) recipients, the incidence of tacrolimus grade II-IV
graft-versus-host disease was significantly lower with tacrolimus than
cyclosporin treatment. Efficacy was maintained in renal and liver transplant
recipients after total withdrawal of corticosteroid therapy from
tacrolimus-based immunosuppression, with the incidence of acute rejection
episodes at up to 2 years’ follow-up being similar with or without
corticosteroids. Tacrolimus provided effective rescue therapy in transplant
recipients with persistent acute or chronic allograft rejection or drug-related
toxicity associated with cyclosporin treatment. Typically, conversion to
tacrolimus reversed rejection episodes and/or improved the tolerability
profile, particularly in terms of reduced hyperlipidaemia. In lung transplant
recipients with obliterative bronchiolitis, conversion to tacrolimus reduced
the decline in and/or improved lung function in terms of forced expiratory
volume in 1 second. Tolerability issues may be a factor when choosing a calcineurin
inhibitor. Cyclosporin tends to be associated with a higher incidence of
significant hypertension, hyperlipidaemia, hirsutism, gingivitis and gum
hyperplasia, whereas the incidence of some types of neurotoxicity, disturbances
in glucose metabolism, diarrhoea, pruritus and alopecia may be higher with
tacrolimus treatment. Renal function, as assessed by serum creatinine levels
and glomerular filtration rates, was better in tacrolimus than cyclosporin
recipients at up to 5 years’ follow-up. CONCLUSION: Recent well designed trials
have consolidated the place of tacrolimus as an important choice for primary
immunosuppression in solid organ transplantation and in BMT. Notably, in adults
and children receiving transplants, tacrolimus-based primary immunosuppression
was at least as effective or provided better efficacy than cyclosporin
microemulsion treatment in terms of patient and graft survival, treatment
failure and the incidence of acute and corticosteroid-resistant rejection
episodes. The reduced incidence of rejection episodes in renal transplant
recipients receiving tacrolimus translated into a better cost effectiveness
relative to cyclosporin microemulsion treatment. The optimal immunosuppression
regimen is ultimately dependent on balancing such factors as the efficacy of
the individual drugs, their tolerability, potential for drug interactions and
pharmacoeconomic issues. N.
Ref:: 261
----------------------------------------------------
[186]
TÍTULO / TITLE: - Smallpox and live-virus
vaccination in transplant recipients.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jul;3(7):786-93.
AUTORES
/ AUTHORS: - Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Transplant Infectious Disease and
Compromised Host Program, Infectious Disease Division, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, USA. jfishman@partners.org
RESUMEN
/ SUMMARY: - Recent bioterrorism raises the specter of
reemergence of smallpox as a clinical entity. The mortality of variola major
infection (‘typical smallpox’) was approximately 30% in past outbreaks.
Programs for smallpox immunization for healthcare workers have been proposed.
Atypical forms of smallpox presenting with flat or hemorrhagic skin lesions are
most common in individuals with immune deficits with historic mortality
approaching 100%. Smallpox vaccination, even after exposure, is highly
effective. Smallpox vaccine contains a highly immunogenic live virus, vaccinia.
Few data exist for the impact of variola or safety of vaccinia in
immunocompromised hosts. Both disseminated infection by vaccinia and
person-to-person spread after vaccination are uncommon. When it occurs,
secondary vaccinia has usually affected individuals with pre-existing skin
conditions (atopic dermatitis or eczema) or with other underlying immune
deficits. Historically, disseminated vaccinia infection was uncommon but often
fatal even in the absence of the most severe form of disease, “progressive
vaccinia”. Some responded to vaccinia immune globulin. Smallpox exposure would
be likely to cause significant mortality among immunocompromised hosts. In the
absence of documented smallpox exposures, immunocompromised hosts should not be
vaccinated against smallpox. Planning for bioterrorist events must include consideration
of uniquely susceptible hosts. N.
Ref:: 57
----------------------------------------------------
[187]
TÍTULO / TITLE: - Fibrogenesis in chronic
allograft rejection: underlying mechanisms and pharmacological control.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Nov;34(7):2867-71.
AUTORES
/ AUTHORS: - Eugui EM
INSTITUCIÓN
/ INSTITUTION: - Roche Bioscience, Palo Alto, California
94304, USA. elsie.eugui@roche.com N. Ref:: 35
----------------------------------------------------
[188]
TÍTULO / TITLE: - 1,25-Dihydroxyvitamin
D3 analogs as potential therapies in transplantation.
REVISTA
/ JOURNAL: - Curr Opin Investig Drugs 2002
Oct;3(10):1458-63.
AUTORES
/ AUTHORS: - Adorini L
INSTITUCIÓN
/ INSTITUTION: - BioXell, Milano, Italy. Luciano.Adorini@bioxell.com
RESUMEN
/ SUMMARY: - While immunosuppressive drugs now permit
good control of acute allograft rejection, chronic rejection remains an
important medical problem, and the induction of stable transplantation
tolerance has not yet been achieved in patients. 1,25-Dihydroxyvitamin D3
(1,25(OH)2D3), a secosteroid hormone that controls cell proliferation and
differentiation and exerts immunoregulatory activities in addition to
regulating calcium and bone metabolism, has the potential to contribute to the
management of allograft rejection. Recent advances in understanding the
immunomodulatory properties of 1,25(OH)2D3 and its analogs suggest the clinical
application of these hormones in transplantation, with the aim of facilitating
tolerance induction and preventing chronic graft rejection. N. Ref:: 62
----------------------------------------------------
[189]
TÍTULO / TITLE: - Infectious risks and
outcomes after stem cell transplantation: are nonmyeloablative transplants
changing the picture?
REVISTA
/ JOURNAL: - Curr Opin Infect Dis 2002
Aug;15(4):347-53.
AUTORES
/ AUTHORS: - Junghanss C; Marr KA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Rostock, School of Medicine, Rostock, Germany.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Opportunistic
infections contribute to morbidity and mortality after myeloablative allogeneic
stem cell transplantation. The development of nonmyeloablative or
toxicity-reduced conditioning regimens for allogeneic hematopoietic stem cell
transplantation might change this picture significantly. These regimens are in
general highly immunosuppressive, but effects on myelopoiesis and mucosal
toxicities are usually reduced compared with myeloablative hematopoietic stem
cell transplantation conditioning regimens. This review summarizes the
infectious risks associated with each type of hematopoietic stem cell
transplantation conditioning regimen, and presents the results of early
clinical studies. RECENT FINDINGS: Although the data are preliminary, the
results of recent studies suggest that nonmyeloablative conditioning regimens
may decrease the risks of bacterial infections associated with mucosal damage
and persistent neutropenia; however, risks for late viral and fungal infections
persist during severe graft versus host disease. Results of several case
reports and series emphasize that therapeutic outcomes of infections may be
improved in patients who receive nonmyeloablative conditioning regimens.
SUMMARY: Infectious risks and outcomes after hematopoietic stem cell
transplantation appear to be in evolution given the introduction of
alternative, nonmyeloablative conditioning regimens. Although infections remain
a prominent cause of transplant-related mortality, the timing and types of
infections may differ. Further studies are necessary to define appropriate
preventative strategies, and to determine whether patients with ongoing
infections might benefit from nonmyeloablative hematopoietic stem cell
transplantation. N.
Ref:: 61
----------------------------------------------------
[190]
TÍTULO / TITLE: - T cell
immunotherapeutic populations control viral infections in bone marrow
transplant recipients.
REVISTA
/ JOURNAL: - Immunol Res 2001;24(3):289-301.
AUTORES
/ AUTHORS: - Slobod KS; Benaim E; Woodruff L; Nooner S;
Houston J; Holladay M; Lockey T; Hurwitz JL
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases, St.
Jude Children’s Research Hospital, Memphis, TN 38105, USA.
RESUMEN
/ SUMMARY: - Immunotherapies designed to prevent
infection serve as an increasingly important adjunct to bone marrow
transplantation (BMT). T cell immunotherapies are particularly useful for the
control of virus infections, provided that T cell populations are free of
graft-vs-host (GVH) activity. In this review, we describe positive and negative
selection methods with which donor T cell populations devoid of GVH activity
can be prepared for transfer to the immunodeficient BMT recipient. The support
of patients with T cell immunotherapies may ultimately revolutionize BMT,
elevating the procedure from a salvage to a front-line treatment strategy for
otherwise fatal disorders. N.
Ref:: 49
----------------------------------------------------
[191]
TÍTULO / TITLE: - Post-liver transplant
obesity and diabetes.
REVISTA
/ JOURNAL: - Curr Opin Clin Nutr Metab Care 2003
Jul;6(4):457-60.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mco.0000078994.96795.d8
AUTORES
/ AUTHORS: - T D
Correia MI; Rego LO; Lima AS
INSTITUCIÓN
/ INSTITUTION: - Alfa Institute of Gastroenterology,
University Hospital, Federal University of Minas Gerais, Brazil. Isabel_correia@uol.com.br
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Post-liver transplant
patients present a vast array of metabolic changes in the early and late phase
which impact on their morbidity and mortality. The development of obesity and
diabetes in these patients has been widely described in the literature with
several hypotheses suggested: liver donor, nutritional and metabolic state, and
immunosuppressive drugs. RECENT FINDINGS: Most that is known about the
development of these metabolic derangements has been attributed to the drugs
used, especially the corticosteroids. When these have been used in higher doses
for longer periods to treat rejection, the incidence of diabetes and obesity
seems to be higher. However cyclosporine and to a lesser extent tacrolimus are
also related to these alterations. SUMMARY: As long-term survival improves in
liver transplant patients, cardiovascular complications associated with
dyslipidemia, obesity, and diabetes are emerging as risk factors for late
morbidity and mortality. Therefore, it is important to assess the potential
risk factors related to these complications, in order to prevent or decrease
their incidence. From what has been seen, immunossupressive drugs seem to be
the greatest risk factor for the development of metabolic derangements in
post-transplantation patients. However other risk factors might also be
involved, such as non-healthy eating habits and lack of exercise. The latter
can be preventable if counseling policies are targeted at these patients in the
pre-transplantation phase and continued after the operation. N. Ref:: 27
----------------------------------------------------
[192]
TÍTULO / TITLE: - Cutaneous neoplasms in
renal transplant recipients.
REVISTA
/ JOURNAL: - Eur J Dermatol 2002 Nov-Dec;12(6):532-5.
AUTORES
/ AUTHORS: - Rubel JR; Milford EL; Abdi R
INSTITUCIÓN
/ INSTITUTION: - Renal Division, MRB-4, Brigham and Women’s
Hospital, 75 Francis Street, Boston, MA 02115, USA. jrubel@massmed.org
RESUMEN
/ SUMMARY: - Cutaneous neoplasms are much more common
in renal transplant recipients than in the general population, and are the most
common malignancies in these patients. This is the case with basal cell
carcinoma, and even more so with squamous cell carcinoma. Many risk factors for
development of such malignancies are similar to those in the general
population. However, in the transplant population, such cancers appear at an
earlier age, behave more aggressively, and frequently appear at multiple sites.
Therefore, diligence on the part of the patient and on the part of his or her
health care providers is of utmost importance. Treatment options include
reduction in immunosuppression, but preventive maintenance remains the primary
focus of efforts to limit these malignancies.
N. Ref:: 37
----------------------------------------------------
[193]
TÍTULO / TITLE: - Sirolimus-based
immunosuppressive [correction of immunosuppresive] protocol for calcineurin
sparing in liver transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1522-3.
AUTORES
/ AUTHORS: - Heffron TG; Smallwood GA; Davis L;
Martinez E; Stieber AC
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Emory University
School of Medicine, Atlanta, GA 30322, USA.
----------------------------------------------------
[194]
TÍTULO / TITLE: - Immunosuppressive drug
use in pregnancy.
REVISTA
/ JOURNAL: - Autoimmunity 2003 Feb;36(1):51-6.
AUTORES
/ AUTHORS: - Petri M
INSTITUCIÓN
/ INSTITUTION: - Johns Hopkins University School of
Medicine, 1830 E. Monument Street, Suite 7500, Baltimore, MD 21205, USA.
RESUMEN
/ SUMMARY: - Ideally, immunosuppressive drugs would not
be necessary in pregnancy. However, in connective tissue disease (especially
systemic lupus erythematosus, SLE) vasculitis, and sometimes antiphospholipid
antibody syndrome, their use is necessary both to protect the health of the mother
and to insure the success of the pregnancy. The more commonly used drugs will
be reviewed, with an emphasis on human data, when available. Methotrexate and
leflunamide will not be considered, for they should never be used in pregnancy. N. Ref:: 105
----------------------------------------------------
[195]
TÍTULO / TITLE: - Immunosuppression
protocols for HLA identical renal transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3):1074-5.
AUTORES
/ AUTHORS: - Keitel E; Santos AF; Alves MA; Neto JP;
Schaefer PG; Bittar AE; Goldani JC; Pozza R; Bruno RM; See D; Garcia CD; Garcia
VD
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Santa Casa
Hospital, Porto Alegre, RS, Brazil. keitel@terra.com.br
----------------------------------------------------
[196]
TÍTULO / TITLE: - Contemporary
immunosuppression in renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):733-50.
AUTORES
/ AUTHORS: - Luke PP; Jordan ML
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery and Urology,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
RESUMEN
/ SUMMARY: - Over the past 3 decades, renal allograft
survival has improved significantly as a result of the development of powerful
immunosuppressive agents. Nevertheless, the overall half-life of renal
allografts has increased marginally during that time period, owing to
drug-related nephrotoxicity and chronic rejection. New immunosuppressive agents
are being evaluated because of the need for a reduction in the dose of
nephrotoxic calcineurin inhibitors and corticosteroids. Additional agents have
demonstrated the ability to retard the onset of chronic rejection in
preclinical transplant models. In concert with these efforts, approaches are in
development to alleviate the ever increasing shortage of donor organs,
including the as yet unrealized goals of successful and practical
xenotransplantation and the bioartificial kidney. Further identification and
development of novel agents that target the specific components of the
allograft response will provide the key to the achievement of donor-specific
tolerance, the “Holy Grail” of solid organ transplantation. N. Ref:: 165
----------------------------------------------------
[197]
TÍTULO / TITLE: - Squamous cell carcinoma
of the head and neck in solid organ transplant recipients.
REVISTA
/ JOURNAL: - Head Neck 2002 Apr;24(4):319-25.
●●
Enlace al texto completo (gratuito o de pago) 1002/hed.10055 [pii]
AUTORES
/ AUTHORS: - Preciado DA; Matas A; Adams GL
INSTITUCIÓN
/ INSTITUTION: - Department of Otolaryngology-Head and Neck
Surgery, University of Minnesota, Fairview University Medical Center, MMC 396,
420 Delaware Street SE, Minneapolis, MN 55455, USA. preci001@tc.umn.edu
RESUMEN
/ SUMMARY: - BACKGROUND: The increased incidence of
cancer after solid organ transplantation is well established in the literature,
yet outcome studies in this population are rare. Excluding skin cancers,
squamous cell carcinomas make up most head and neck cancers in transplant
recipients. METHODS: At our institution, of 5300 solid organ transplant
recipients, 34 have had head and neck cancer develop. We reviewed the records
of the 23 recipients whose cancer was treated here. RESULTS: Only 6 of the 23
recipients were alive at the time of our chart review. Of these, three had
already survived 5 years. The 10 recipients diagnosed early (stage I or II) had
significantly longer survival after cancer diagnosis than the 13 diagnosed at
an advanced stage (stage III or IV) (96.0 mo vs 9.0 mo, p <.001). In all, 14
(60.8%) of the 23 recipients died of cancer within 2 years after diagnosis, 12
(50.2%) within 12 months. The sum of the daily doses of immunosuppressive drugs
at cancer diagnosis was significantly greater for recipients who died within 2
years (p =.02). Furthermore, the difference in average doses of both prednisone
(p =.001) and azathioprine (p =.028) was also significantly greater for those
who died within 2 years. The average dose of cyclosporine was also greater, but
this difference did not reach statistical significance (p =.18). The average
dose of prednisone was significantly lower for recipients diagnosed early (p
=.001). This correlation between high immunosuppressive drug doses and worse
outcome has not been shown previously. CONCLUSIONS: Solid organ transplant
recipients who are diagnosed with advanced head and neck cancer while receiving
high doses of immunosuppressive drugs fare extremely poorly. High doses of
immunosuppressive drugs, most notably prednisone, correlate significantly with
advanced diagnosis of head and neck cancer and earlier death. N. Ref:: 30
----------------------------------------------------
[198]
TÍTULO / TITLE: - Stent-based
antirestenotic coatings (sirolimus/paclitaxel).
REVISTA
/ JOURNAL: - Catheter Cardiovasc Interv 2002 Mar;55(3):404-8.
●●
Enlace al texto completo (gratuito o de pago) 1002/ccd.10034 [pii]
AUTORES
/ AUTHORS: - Oberhoff M; Herdeg C; Baumbach A; Karsch
KR
INSTITUCIÓN
/ INSTITUTION: - Bristol Heart Institute, University of
Bristol, Bristol, U.K. martin.oberhoff@bristol.ac.uk N. Ref:: 49
----------------------------------------------------
[199]
TÍTULO / TITLE: - Bacillus cereus
bacteremia and meningitis in immunocompromised children.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 May
15;32(10):1456-62. Epub 2001 Apr 20.
AUTORES
/ AUTHORS: - Gaur AH; Patrick CC; McCullers JA; Flynn
PM; Pearson TA; Razzouk BI; Thompson SJ; Shenep JL
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases, St.
Jude Children’s Research Hospital, Memphis, TN 38105, USA.
RESUMEN
/ SUMMARY: - Two cases of Bacillus cereus meningitis in
immunocompromised children at our hospital within a 2-month period prompted us
to review B. cereus—related invasive disease. We identified 12 patients with B.
cereus isolated in blood cultures from September 1988 through August 2000 at
our institution. Three of these patients also had B. cereus isolated from CSF
specimens; 1 additional patient had possible CNS involvement (33%, group A),
whereas 8 patients had no evidence of CNS involvement (67%, group B). Patients
in group A were more likely to have neutropenia at the onset of sepsis and were
more likely to have an unfavorable outcome. They were also more likely to have
received intrathecal chemotherapy in the week before the onset of their
illness. Two patients from group A died. One survived with severe sequelae. The
fourth patient had mild sequelae at follow-up. No sequelae or deaths occurred
among patients in group B. In patients with unfavorable outcomes, the interval
from the time of recognition of illness to irreversible damage or death was
short, which demonstrates a need for increased awareness, early diagnosis, and
more-effective therapy, particularly that which addresses B. cereus
toxins. N. Ref:: 6
----------------------------------------------------
[200]
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
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