#06#
Revisiones-Clínica-Pronóstico
*** Reviews-Clinical-Prognosis
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: - Clinical practice
guidelines for managing dyslipidemias in kidney transplant patients: a report
from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the
National Kidney Foundation Kidney Disease Outcomes Quality Initiative.
REVISTA
/ JOURNAL: - Am J Transplant 2004;4 Suppl 7:13-53.
●●
Enlace al texto completo (gratuito o de pago) 1111/j.1600-6135.2004.0355.x
AUTORES
/ AUTHORS: - Kasiske B; Cosio FG; Beto J; Bolton K;
Chavers BM; Grimm R Jr; Levin A; Masri B; Parekh R; Wanner C; Wheeler DC;
Wilson PW
RESUMEN
/ SUMMARY: - The incidence of cardiovascular disease
(CVD) is very high in patients with chronic kidney (CKD) disease and in kidney
transplant recipients. Indeed, available evidence for these patients suggests
that the 10-year cumulative risk of coronary heart disease is at least 20%, or
roughly equivalent to the risk seen in patients with previous CVD. Recently,
the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative
(K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias
in patients with CKD, including transplant patients. It was the conclusion of
this Work Group that the National Cholesterol Education Program Guidelines are
generally applicable to patients with CKD, but that there are significant
differences in the approach and treatment of dyslipidemias in patients with CKD
compared with the general population. In the present document we present the
guidelines generated by this workgroup as they apply to kidney transplant
recipients. Evidence from the general population indicates that treatment of
dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests
that judicious treatment can be safe and effective in improving dyslipidemias.
Dyslipidemias are very common in CKD and in transplant patients. However, until
recently there have been no adequately powered, randomized, controlled trials
examining the effects of dyslipidemia treatment on CVD in patients with CKD.
Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results
of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been
presented and published. Based on information from randomized trials conducted
in the general population and the single study conducted in kidney transplant
patients, these guidelines, which are a modified version of the K/DOQI
dyslipidemia guidelines, were developed to aid clinicians in the management of
dyslipidemias in kidney transplant patients. These guidelines are divided into
four sections. The first section (Introduction) provides the rationale for the
guidelines, and describes the target population, scope, intended users, and
methods. The second section presents guidelines on the assessment of
dyslipidemias (guidelines 1-3), while the third section offers guidelines for
the treatment of dyslipidemias (guidelines 4-5). The key guideline statements
are supported mainly by data from studies in the general population, but there
is an urgent need for additional studies in CKD and in transplant patients.
Therefore, the last section outlines recommendations for research.
----------------------------------------------------
[2]
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
----------------------------------------------------
[3]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of Transplantation,
University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Early outcome after
sirolimus-eluting stent implantation in patients with acute coronary syndromes:
insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital
(RESEARCH) registry.
REVISTA
/ JOURNAL: - J Am Coll Cardiol 2003 Jun
4;41(11):2093-9.
AUTORES
/ AUTHORS: - Lemos PA; Lee CH; Degertekin M; Saia F;
Tanabe K; Arampatzis CA; Hoye A; van Duuren M; Sianos G; Smits PC; de Feyter P;
van der Giessen WJ; van Domburg RT; Serruys PW
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiology, Thoraxcenter,
Erasmus Medical Center, Dr Molewaterplein 40, NL-3015 GD Rotterdam, the
Netherlands.
RESUMEN
/ SUMMARY: - OBJECTIVES: This study evaluated the early
outcomes of patients with acute coronary syndromes (ACS) treated with
sirolimus-eluting stents (SES). BACKGROUND: The safety of SES implantation in
patients with a high risk for early thrombotic complications is currently
unknown. METHODS: Sirolimus-eluting stents have been utilized as the device of
choice for all percutaneous procedures in our institution, as part of the
Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH)
registry. After four months of enrollment, 198 patients with ACS had been
treated exclusively with SES (64% of those treated in the period) and were
compared with a control group composed of 301 consecutive patients treated with
bare stents in the same time period immediately before this study. The
incidence of major adverse cardiac events (MACE) during the first month was
evaluated (death, nonfatal myocardial infarction [MI], or re-intervention).
RESULTS: Compared with control patients, patients treated with SES had more
primary angioplasty (95% vs. 77%; p < 0.01), more bifurcation stenting (13%
vs. 5%; p < 0.01), less previous MI (28% vs. 45%; p < 0.01), and less
glycoprotein IIb/IIIa inhibitor utilization (27% vs. 42%; p < 0.01). The
30-day MACE rate was similar between both groups (SES 6.1% vs. control patients
6.6%; p = 0.8), with most complications occurring during the first week. Stent
thrombosis occurred in 0.5% of SES patients and in 1.7% of control patients (p
= 0.4). In multivariate analysis, SES utilization did not influence the
incidence of MACE (odds ratio 1.0 [95% confidence interval: 0.4 to 2.2]; p =
0.97). CONCLUSIONS: Sirolimus-eluting stent implantation for patients with ACS
is safe, with early outcomes comparable with bare metal stents. N. Ref:: 25
----------------------------------------------------
[5]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients
representing 0.84% of all reported malignancies. We identified 7 renal
transplant recipients with bladder cancer at our institution. Invasive
transitional cell carcinoma developed in 5 patients at a median of 2.8 years
after transplant. Three patients underwent uncomplicated radical cystectomy and
preservation of the renal allograft. Overall survival at 48 months was 60%.
CONCLUSIONS: Bladder cancer after renal transplantation is not common. For
patients who present with invasive disease, traditional extirpative surgery
should be considered. Moreover, the allograft is rarely the source of
transitional cell carcinoma and can be preserved. In our experience the cancer
and urinary outcomes compare favorably with nontransplant patient outcomes
after treatment. N.
Ref:: 21
----------------------------------------------------
[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: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[9]
TÍTULO / TITLE: - Cell survival and
clinical outcome following intrastriatal transplantation in Parkinson disease.
REVISTA
/ JOURNAL: - J Neuropathol Exp Neurol 2001
Aug;60(8):741-52.
AUTORES
/ AUTHORS: - Hagell P; Brundin P
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Neuroscience,
University Hospital, Lund University, Sweden.
RESUMEN
/ SUMMARY: - Intrastriatal transplantation of embryonic
dopaminergic neurons is currently explored as a restorative cell therapy for
Parkinson disease (PD). Clinical results have varied, probably due to
differences in transplantation methodology and patient selection. In this
review, we assess clinical trials and autopsy findings in grafted PD patients
and suggest that a minimum number of surviving dopaminergic neurons is required
for a favorable outcome. Restoration of [18F]-fluorodopa uptake in the putamen
to about 50% of the normal mean seems necessary for moderate to marked clinical
benefit to occur. Some studies indicate that this may require mesencephalic
tissue from 3-5 human embryos implanted into each hemisphere. The volume,
density and pattern of fiber outgrowth and reinnervation, as well as functional
integration and dopamine release. are postulated as additional important
factors for an optimal clinical outcome. For neural transplantation to become a
feasible therapeutic alternative in PD, graft survival must be increased and
the need for multiple donors of human embryonic tissue substantially decreased
or alternate sources of donor tissue developed. Donor cells derived from alternative
sources should demonstrate features comparable to those associated with
successful implantation of human embryonic tissue before clinical trials are
considered. N. Ref:: 62
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
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.
----------------------------------------------------
[12]
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.
----------------------------------------------------
[13]
TÍTULO / TITLE: - Prediction of an
HLA-DR-binding peptide derived from Wilms’ tumour 1 protein and demonstration
of in vitro immunogenicity of WT1(124-138)-pulsed dendritic cells generated
according to an optimised protocol.
REVISTA
/ JOURNAL: - Cancer Immunol Immunother 2002
Jul;51(5):271-81. Epub 2002 Apr 26.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00262-002-0278-2
AUTORES
/ AUTHORS: - Knights AJ; Zaniou A; Rees RC; Pawelec G;
Muller L
INSTITUCIÓN
/ INSTITUTION: - University of Tubingen, Section for
Transplantation Immunology and Immunohaematology, Second Department of Internal
Medicine, Zentrum fur Medizinische Forschung ZMF, Waldhornlestrasse 22, 72072
Tubingen, Germany.
RESUMEN
/ SUMMARY: - The Wilms’ tumour 1 (WT1) protein is over-expressed
in several types of cancer including leukaemias and might therefore constitute
a novel target for immunotherapy. Recently, human leucocyte antigen (HLA) class
I-binding WT1 peptides have been identified and shown to stimulate CD8(+) T
cells in vitro. For maximal CD8 cell efficacy, CD4(+) helper T cells responding
to major histocompatibility complex (MHC) class II-binding epitopes are
required. Here, we report that scanning the WT1 protein sequence using an
evidence-based predictive computer algorithm (SYFPEITHI) yielded a peptide
WT1(124-138) predicted to bind the HLA-DRB1*0401 molecule with high affinity.
Moreover, synthetic WT1(124-138)-peptide-pulsed dendritic cells (DC), generated
according to a protocol optimised in the present study, sensitised T cells in
vitro to proliferate and secrete interferon-gamma (IFN-gamma) when rechallenged
with specific peptide-pulsed DC, but not with peripheral blood mononuclear
cells (PBMC). These results suggest that the WT1 protein may yield epitopes
immunogenic to CD4 as well as CD8 T cells, and therefore constitute a novel
potential target for specific immunotherapy.
----------------------------------------------------
[14]
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.
----------------------------------------------------
[15]
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.
----------------------------------------------------
[16]
TÍTULO / TITLE: - Pulmonary infiltrates
in the non-HIV-infected immunocompromised patient: etiologies, diagnostic
strategies, and outcomes.
REVISTA
/ JOURNAL: - Chest. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.chestjournal.org/
●●
Cita: Chest: <> 2004 Jan;125(1):260-71.
AUTORES
/ AUTHORS: - Shorr AF; Susla GM; O’Grady NP
INSTITUCIÓN
/ INSTITUTION: - Pulmonary and Critical Care Medicine
Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. afshorr@dnamail.com
RESUMEN
/ SUMMARY: - Pulmonary complications remain a major
cause of both morbidity and mortality in immunocompromised patients. When such
individuals present with radiographic infiltrates, the clinician faces a
diagnostic challenge. The differential diagnosis in this setting is broad and
includes both infectious and noninfectious processes. Rarely are the
radiographic findings classic for one disease, and most potential etiologies
have overlapping clinical and radiographic appearances. In recent years,
several themes have emerged in the literature on this topic. First, an
aggressive approach to identifying a specific etiology is necessary; as a
corollary, diagnostic delay increases the risk for mortality. Second, the
evaluation of these infiltrates nearly always entails bronchoscopy.
Bronchoscopy allows identification of some etiologies with certainty, and often
allows for the exclusion of infectious agents even if the procedure is
otherwise unrevealing. Third, early use of CT scanning regularly demonstrates
lesions missed by plain radiography. Despite these advances, initial
therapeutic interventions include the use of broad-spectrum antibiotics and
other anti-infectives in order to ensure that the patients is receiving
appropriate therapy. With the results of invasive testing, these treatments are
then narrowed. Frustratingly, outcomes for immunocompromised patients with
infiltrates remain poor. N.
Ref:: 58
----------------------------------------------------
[17]
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.
----------------------------------------------------
[18]
TÍTULO / TITLE: - Renal function as a
predictor of long-term graft survival in renal transplant patients.
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 May;18 Suppl 1:i3-6.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - Research and Development, Fujisawa
Healthcare, Inc., Deerfield, IL 60015, USA. roy_first@fujisawa.com
RESUMEN
/ SUMMARY: - Acute rejection is a major risk factor for
kidney graft failure. However, as acute rejection has been progressively
reduced by recent immunosuppressive regimens, other risk factors are becoming
increasingly important. Evidence is accumulating that early renal function
predicts long-term outcome. A recent registry survey of more than 100 000
kidney transplants found that 6- and 12-month serum creatinine levels, as well
as the change between 6 and 12 months, are strongly associated with long-term
graft survival. A survey of paediatric renal transplant recipients showed that
poor creatinine clearance (<50 ml/min) as early as 30 days post-transplant
predicted an annual rate of graft loss of 13% compared with <3% in patients
with 30-day clearance >50 ml/min. This association between early renal
function and long-term outcome was confirmed in multicentre studies. Renal
transplant recipients (n=572) with 6-month serum creatinine levels >1.5
mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients with
levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving
tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with
cyclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study
(n=436) found that while glomerular filtration rate (GFR) at 6 months
post-transplant had remained stable over the last decade, the rate of loss of
renal function had decreased. A lower rate of GFR loss was associated with
absence of rejection, use of mycophenolate mofetil rather than azathioprine and
use of tacrolimus rather than cyclosporin (P<0.01). In conclusion, early
measures of renal function allow identification of those patients at highest
risk of graft failure and provide an invaluable tool for improving outcomes by
tailored immunosuppression. The choice of such immunosuppression should be
guided not only by its ability to prevent rejection, but also by its impact on
renal function. N.
Ref:: 11
----------------------------------------------------
[19]
TÍTULO / TITLE: - Hematopoietic cell
transplantation for inherited metabolic diseases: an overview of outcomes and
practice guidelines.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Feb;31(4):229-39.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703839
AUTORES
/ AUTHORS: - Peters C; Steward CG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Minnesota School of Medicine, Minneapolis, 55455, USA.
RESUMEN
/ SUMMARY: - For the past two decades, hematopoietic
cell transplantation (HCT) has been used as effective therapy for selected
inherited metabolic diseases (IMD) including Hurler (MPS IH) and Maroteaux-Lamy
(MPS VI) syndromes, childhood-onset cerebral X-linked adrenoleukodystrophy
(X-ALD), globoid-cell leukodystrophy (GLD), metachromatic leukodystrophy (MLD),
alpha-mannosidosis, osteopetrosis, and others. Careful pre-HCT evaluation is
critical and coordinated, multidisciplinary follow-up is essential in this
field of transplantation. The primary goals of HCT for these disorders have
been to promote long-term survival with donor-derived engraftment and to
optimize the quality of life. Guidelines for HCT and monitoring are provided; a
brief overview of long-term results is also presented. N. Ref:: 131
----------------------------------------------------
[20]
TÍTULO / TITLE: - Clinical outcomes and
insulin secretion after islet transplantation with the Edmonton protocol.
REVISTA
/ JOURNAL: - Diabetes. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://diabetes.diabetesjournals.org/
●●
Cita: Diabetes: <> 2001 Apr;50(4):710-9.
AUTORES
/ AUTHORS: - Ryan EA; Lakey JR; Rajotte RV; Korbutt GS;
Kin T; Imes S; Rabinovitch A; Elliott JF; Bigam D; Kneteman NM; Warnock GL;
Larsen I; Shapiro AM
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Surgical Medical
Research Institute, University of Alberta, Edmonton, Canada. edmond.ryan@ualberta.ca
RESUMEN
/ SUMMARY: - Islet transplantation offers the prospect
of good glycemic control without major surgical risks. After our initial report
of successful islet transplantation, we now provide further data on 12 type 1
diabetic patients with brittle diabetes or problems with hypoglycemia previous
to 1 November 2000. Details of metabolic control, acute complications
associated with islet transplantation, and long-term complications related to
immunosuppression therapy and diabetes were noted. Insulin secretion, both
acute and over 30 min, was determined after intravenous glucose tolerance tests
(IVGTTs). The median follow-up was 10.2 months (CI 6.5-17.4), and the longest
was 20 months. Glucose control was stable, with pretransplant fasting and meal
tolerance-stimulated glucose levels of 12.5+/-1.9 and 20.0+/-2.7 mmol/l,
respectively, but decreased significantly, with posttransplant levels of
6.3+/-0.3 and 7.5+/-0.6 mmol/l, respectively (P < 0.006). All patients have
sustained insulin production, as evidenced by the most current baseline
C-peptide levels 0.66+/-0.06 nmol/l, increasing to 1.29+/-0.25 nmol/l 90 min
after the meal-tolerance test. The mean HbA1c level decreased from 8.3+/-0.5%
to the current level of 5.8+/-0.1% (P < 0.001). Presently, four patients
have normal glucose tolerance, five have impaired glucose tolerance, and three
have post-islet transplant diabetes (two of whom need oral hypoglycemic agents
and low-dose insulin (<10 U/day). Three patients had a temporary increase in
their liver-function tests. One patient had a thrombosis of a peripheral branch
of the right portal vein, and two of the early patients had bleeding from the
hepatic needle puncture site; but these technical problems were resolved. Two
patients had transient vitreous hemorrhages. The two patients with elevated
creatinine levels pretransplant had a significant increase in serum creatinine
in the long term, although the mean serum creatinine of the group was
unchanged. The cholesterol increased in five patients, and lipid-lowering
therapy was required for three patients. No patient has developed
cytomegalovirus infection or disease, posttransplant lymphoproliferative
disorder, malignancies, or serious infection to date. None of the patients have
been sensitized to donor antigen. In 11 of the 12 patients, insulin
independence was achieved after 9,000 islet equivalents (IEs) per kilogram were
transplanted. The acute insulin response and the insulin area under the curve
(AUC) after IVGTT were consistently maintained over time. The insulin AUC from
the IVGTT correlated to the number of islets transplanted, but more closely
correlated when the cold ischemia time was taken into consideration (r = 0.83,
P < 0.001). Islet transplantation has successfully corrected labile type 1
diabetes and problems with hypoglycemia, and our results show persistent
insulin secretion. After a minimum of 9,000 IEs per kilogram are provided,
insulin independence is usually attained. An elevation of creatinine appears to
be a contraindication to this immunosuppressive regimen. For the subjects who
had labile type 1 diabetes that was difficult to control, the risk-to-benefit
ratio is in favor of islet transplantation.
----------------------------------------------------
[21]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.1. Organization of follow-up of transplant patients
after the first year.
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 4:3-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All renal transplant
recipients should undergo regular laboratory check-ups (at least every 2 or 3
months) and regular medical visits as out-patients (at least every 4-6 months)
after the first year post-transplant. B. All renal transplant recipients should
be seen at least once a year in the transplant centre where the transplantation
has been performed or referred to a closer transplant centre for a complete
annual evaluation.
----------------------------------------------------
[22]
TÍTULO / TITLE: - Cyclosporin trough
levels: is monitoring necessary during short-term treatment in psoriasis? A
systematic review and clinical data on trough levels.
REVISTA
/ JOURNAL: - Br J Dermatol 2002 Jul;147(1):122-9.
AUTORES
/ AUTHORS: - Heydendael VM; Spuls PI; Ten Berge IJ;
Opmeer BC; Bos JD; de Rie MA
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Academic
Medical Center, University of Amsterdam, PO Box 22660, the Netherlands.
RESUMEN
/ SUMMARY: - BACKGROUND: Cyclosporin is an effective
treatment for severe plaque psoriasis. Unfortunately, its use may be limited by
time- and dose-related nephrotoxicity. Serum trough levels may be useful for
monitoring the risk of nephrotoxicity. OBJECTIVES: To determine whether
monitoring of trough levels is necessary in psoriasis patients undergoing
short-term treatment with cyclosporin. METHODS: A computerized and manual
literature search identified studies on adults with plaque-type psoriasis
treated with cyclosporin < or = 5 mg kg-1 daily, in which trough levels were
measured in whole blood. Number of patients, treatment duration, formulation
and dosage, renal function tests and trough levels were extracted. The
association between renal function and trough levels was investigated.
Additionally, in a randomized controlled trial on cyclosporin vs. methotrexate
in moderate to severe psoriasis, cyclosporin trough levels were measured
frequently in 20 patients during 12 weeks of treatment. The Pearson correlation
coefficient between serum creatinine and cyclosporin trough levels was
calculated. RESULTS: Fifty-six articles were found concerning cyclosporin
trough level measurements in psoriasis patients, of which eight were analysed.
Many studies were excluded due to inappropriate cyclosporin dosages used. As
data were heterogeneous and lacked various key parameters, a correlation study
and a meta-analysis could not be performed. Instead, a quantitative description
of the literature was given. No high mean trough levels or elevations of serum
creatinine were described. In our clinical study, all the mean trough levels in
17 patients treated with cyclosporin 3 mg kg-1 daily were within the
therapeutic range (< 200 ng mL-1). Elevated trough levels were found in two
of three patients treated with cyclosporin 3-5 mg kg-1 daily. No signs of renal
dysfunction were seen. CONCLUSIONS: The literature does not provide a
definitive answer on whether monitoring cyclosporin trough levels in patients
with psoriasis should be standard practice. Our own data show no need for
cyclosporin trough level monitoring during short-term treatment with
cyclosporin 3 mg kg-1 daily. However, when cyclosporin doses are > 3 mg kg-1
daily, monitoring may be indicated. N.
Ref:: 32
----------------------------------------------------
[23]
TÍTULO / TITLE: - Prospects for treatment
of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for
better prediction of outcome: a systematic review.
REVISTA
/ JOURNAL: - Qjm. Acceso gratuito al texto completo a
partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://qjmed.oupjournals.org/
●●
Cita: QJM: <> 2003 Nov;96(11):809-24.
AUTORES
/ AUTHORS: - Eddleston M; Wilks MF; Buckley NA
INSTITUCIÓN
/ INSTITUTION: - Centre for Tropical Medicine, Nuffield
Department of Clinical Medicine, University of Oxford, UK. eddlestonm@eureka.lk
RESUMEN
/ SUMMARY: - BACKGROUND: Acute paraquat self-poisoning
is a significant problem in parts of Asia, the Pacific and the Caribbean.
Ingestion of large amounts of paraquat results in rapid death, but smaller
doses often cause a delayed lung fibrosis that is usually fatal.
Anti-neutrophil (‘immunosuppressive’) treatment has been recommended to prevent
lung fibrosis, but there is no consensus on efficacy. Aim: To review the
evidence for the use of immunosuppression in paraquat poisoning, and to
identify validated prognostic systems that would allow the use of data from
historical control studies and the future identification of patients who might
benefit from immunosuppression. DESIGN:Systematic review. METHODS: We searched
PubMed, Embase and Cochrane databases for ‘paraquat’ together with ‘poisoning’
or ‘overdose’. We cross-checked references and contacted experts, and searched
on [www.google.com] and [www.yahoo.com] using ‘paraquat’, ‘cyclophosphamide’,
‘methylprednisolone’ and ‘prognosis’. RESULTS: We found ten clinical studies of
immunosuppression in paraquat poisoning. One was a randomized controlled trial
(RCT). Seven used historical controls only; the other two were small (n = 1 and
n = 4). Mortality in controls and patients varied markedly between studies.
Three of the seven non-RCT controlled studies measured plasma paraquat;
analysis using Proudfoot’s or Hart’s nomograms did not suggest that
immunosuppression increased survival in these studies. Of 16 prognostic systems
for paraquat poisoning, none has been independently validated in a large
cohort. DISCUSSION: The authors of the RCT have performed valuable and
difficult research, but their results are hypothesis-forming rather than
conclusive; elsewhere, the use of historical controls is problematic. In the
absence of a validated prognostic marker, a large RCT of immunosuppression
using death as the primary outcome is required. This RCT should also
prospectively test and validate the available prognostic methods, so that
future patients can be selected for this and other therapies on admission. N. Ref:: 57
----------------------------------------------------
[24]
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
----------------------------------------------------
[25]
TÍTULO / TITLE: - Longitudinal profile of
bronchoalveolar lavage cell characteristics in patients with a good outcome
after lung transplantation.
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: <> 2002 Feb 15;165(4):501-7.
AUTORES
/ AUTHORS: - Slebos DJ; Scholma J; Boezen HM; Koeter
GH; van der Bij W; Postma DS; Kauffman HF
INSTITUCIÓN
/ INSTITUTION: - Department of Pulmonary Diseases,
University Hospital, University of Groningen, The Netherlands. D.Slebos@int.azg.nl
RESUMEN
/ SUMMARY: - Bronchoalveolar lavage fluid (BALF)
analysis is used in patients after lung transplantation (LTX) to obtain more
insight into pathological conditions such as acute and chronic allograft
rejection. Information on the normal course of BALF cell characteristics in
patients with “good outcome” after LTX is limited. Therefore we analyzed 169
BALF samples from 63 well-defined “good outcome” patients after LTX (no acute
or chronic transplant dysfunction, bacterial, fungal, or viral infections at
the time of BAL). Total cell count decreased from the first months: median
(range) 234 x 10(3) (70-610) cells/ml to 103 x 10(3) (10-840) cells/ml during
the second year posttransplantation (p < 0.001). Cell differential counts
did not change during the 2-yr study period. The CD4/CD8 ratio increased
significantly from 0.32 (0.11-0.46) just posttransplantation to 0.62
(0.16-4.27) the second year after LTX. This increasing ratio was mainly due to
a sharp decreasing CD8(+) cell count. Thus, characteristics of BAL cellular
patterns in patients with good outcomes after LTX show important changes over
time. We have defined control values for the BALF cellular profile in patients
without pathological airway conditions after LTX. We propose to use these
control values as a tool for diagnosing patients with pulmonary complications
after LTX and for the follow-up of treatment regimens. N. Ref:: 34
----------------------------------------------------
[26]
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
----------------------------------------------------
[27]
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
----------------------------------------------------
[28]
TÍTULO / TITLE: - Conventional treatment
of Crohn’s disease: objectives and outcomes.
REVISTA
/ JOURNAL: - Inflamm Bowel Dis 2001 May;7 Suppl 1:S2-8.
AUTORES
/ AUTHORS: - Rutgeerts PJ
INSTITUCIÓN
/ INSTITUTION: - Inflammatory Bowel Disease Unit,
University of Leuven, Belgium.
RESUMEN
/ SUMMARY: - Despite conventional medical and/or
surgical intervention, endoscopic and symptomatic relapse is common among
individuals with Crohn’s disease (CD). Treatment goals have therefore been
refocused to include achieving control of active disease and maintaining
remission with agents associated with a minimum of toxic adverse effects.
Conventional treatment regimens have been used with varying success in regard
to these therapeutic goals. Traditionally, aminosalicylates have been
considered effective in inducing a response in some patients with
mild-to-moderate CD but have demonstrated little or no long-term benefit in
controlled clinical trials. Glucocorticosteroid therapy is associated with
higher rates of response in patients with active CD; however, clinical benefits
are frequently offset by the common occurrence of corticosteroid-related
toxicity. Oral controlled-release budesonide has demonstrated comparable
efficacy to prednisolone with less risk for adverse effects, although many
questions remain regarding the long-term use of this agent. Response to
standard immunosuppressive agents such as azathioprine and 6-mercaptopurine in
patients with active disease may require 3 to 6 months from initiation of
treatment. These agents are therefore considered most valuable as maintenance
therapy, providing consistent long-term benefit in patients with chronic
refractory or corticosteroid-dependent disease. Although the incidence of
allergic adverse effects is relatively low with azathioprine/6-mercaptopurine,
more serious adverse effects, including bone marrow suppression,
hepatotoxicity, pancreatitis, and infectious complications, can occur. Limited
success in the treatment of perianal disease has been achieved with antibiotics
such as metronidazole and the immunosuppressives cyclosporine and azathioprine/6-mercaptopurine.
Although broader use of immunosuppressive agents has allowed improvement in the
maintenance of remission in patients with CD, long-term safety data with these
agents are lacking, concerns about toxicity and the potential risk for neoplasia
remain, and attenuation of response with chronic immunosuppressive use can
occur. Therefore, innovative therapeutic approaches are needed to meet key
treatment goals often not addressed by conventional therapies. N. Ref:: 48
----------------------------------------------------
[29]
TÍTULO / TITLE: - A systematic review of
psychosocial factors affecting survival after bone marrow transplantation.
REVISTA
/ JOURNAL: - Psychosomatics 2003 May-Jun;44(3):181-95.
AUTORES
/ AUTHORS: - Hoodin F; Weber S
INSTITUCIÓN
/ INSTITUTION: - Department of Psychology, Eastern Michigan
University, Ypsilani, MI 48197, USA. flora.hoodin@emich.edu
RESUMEN
/ SUMMARY: - An electronic database search identified
15 studies of psychosocial factors affecting survival after bone marrow
transplantation. The studies were assessed for methodological quality by two
reviewers using the procedures of Bland and colleagues. Although some studies
found that psychological variables affect survival after bone marrow
transplantation, the reviewers’ analysis of the methodologically sound studies
suggested that survival after bone marrow transplantation is not substantively
affected by depressed mood or other psychopathology in adults or by social
support in adults or children. Longer survival may be related to lower “anxious
preoccupation,” higher “fighting spirit,” and better quality of life ratings
before and soon after transplant in adults. Overall, however, the literature is
insufficiently developed to provide definitive evidence for a relationship
between psychological variables and survival after bone marrow transplantation.
Future primary studies in this area should be designed to maximize
replicability and generalizability. N.
Ref:: 50
----------------------------------------------------
[30]
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
----------------------------------------------------
[31]
TÍTULO / TITLE: - Early prognosis of the
development of renal chronic allograft rejection by gene expression profiling
of human protocol biopsies.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1323-30.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000068481.98801.10
AUTORES
/ AUTHORS: - Scherer A; Krause A; Walker JR; Korn A;
Niese D; Raulf F
INSTITUCIÓN
/ INSTITUTION: - Novartis Institutes for BioMedical
Research/Transplantation, Novartis Pharma AG, Basel, Switzerland.
RESUMEN
/ SUMMARY: - BACKGROUND: Chronic allograft rejection
(CR) is the major cause of failure of long-term graft survival and is so far
irreversible. Early prognosis of CR by molecular markers before overt
histologic manifestation would be a valuable aid for the optimization of
treatment regimens and the design of clinical CR trials. Oligonucleotide
microarray-based approaches have proven to be useful for the diagnosis and
prognosis of a variety of diseases and were chosen for the unbiased
identification of prognostic biomarkers. METHODS: Renal allograft biopsies were
taken at month 6 posttransplantation (PT) from two groups who were, at that
time, healthy recipients: one group developed CR at month-12 PT, the other
group remained healthy. Gene expression profiles from the two groups at month-6
PT biopsies were analyzed to identify differentially expressed genes with
prognostic value for CR development at month 12. RESULTS: A set of 10 genes was
identified that showed differential expression profiles between the two patient
groups and had a complete separation of the 15% to 85% quantile range for each
individual gene. This set of genes was sufficient to allow the correct
prediction of the occurrence or nonoccurrence of CR in 15 of 17 (88%) patients
using cross-validation (occurrence for a patient was predicted on the basis of
the other patients’ data only). In addition, a correct prediction could be made
that a recipient with a normal biopsy 12 months PT developed CR within the
following 6 months. CONCLUSIONS: Identified expression patterns seem to be
highly prognostic of the development of renal CR.
----------------------------------------------------
[32]
- 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
----------------------------------------------------
[33]
TÍTULO / TITLE: - Pharmacokinetic,
pharmacodynamic, and outcome investigations as the basis for mycophenolic acid
therapeutic drug monitoring in renal and heart transplant patients.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):17-22.
AUTORES
/ AUTHORS: - Shaw LM; Korecka M; DeNofrio D; Brayman KL
INSTITUCIÓN
/ INSTITUTION: - Departments of Pathology & Laboratory
Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. shawlmj@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Mycophenolate mofetil is widely used in
combination with either cyclosporine or tacrolimus for rejection prophylaxis in
renal and heart transplant patients. Although not monitored routinely nearly to
the degree that other agents such as cyclosporine or tacrolimus, there is an
expanding body of experimental evidence for the utility of monitoring
mycophenolic acid, the primary active metabolite of mycophenolate mofetil,
plasma concentration as an index of risk for the development of acute
rejection. The following are important experimentally-based reasons for
recommending the incorporation of target therapeutic concentration monitoring
of mycophenolic acid: (1) the MPA dose-interval
area-under-the-concentration-time curve, and less precisely, MPA predose
concentrations predict the risk for development of acute rejection; (2) the
strong correlation between mycophenolic acid plasma concentrations and
expression of important cell surface activation antigens, whole blood
pharmacodynamic assays of lymphocyte proliferation and median graft rejection
scores in a heart transplant animal model; (3) the greater than 10-fold
interindividual variation of MPA area under the concentration time curve values
in heart and renal transplant patients receiving a fixed dose of the parent
drug; (4) drug-drug interactions involving other immunosuppressives are such
that when switching from one to another (eg, from cyclosporine to tacrolimus or
vice-versa) substantial changes in MPA concentrations can occur in patients
receiving a fixed dose of the parent drug; (5) significant effects of liver and
kidney diseases on the steady-state total and free mycophenolic acid area under
the concentration time curve values; (6) the need to closely monitor
mycophenolic acid when a major change in immunosuppression is planned such as
steroid withdrawal. Current investigations are focused on determination of the
most optimal sampling time and for mycophenolic acid target therapeutic
concentration monitoring. Further investigations are needed to evaluate the
pharmacologic activity of the newly described acyl glucuronide metabolite of
mycophenolic acid which has been shown to inhibit, in vitro, inosine
monophosphate dehydrogenase. N.
Ref:: 37
----------------------------------------------------
[34]
TÍTULO / TITLE: - Prognostic use of human
leukocyte antigen genotyping for rheumatoid arthritis susceptibility, disease
course, and clinical stratification.
REVISTA
/ JOURNAL: - Rheum Dis Clin North Am 2002
Feb;28(1):17-37.
AUTORES
/ AUTHORS: - Wassmuth R; Wagner U
INSTITUCIÓN
/ INSTITUTION: - Institute for Transplantation Diagnostics
and Cell Therapeutics, Duesseldorf University Medical Center, University of
Duesseldorf, Duesseldorf, Germany. ralf.wassmuth@web.de
RESUMEN
/ SUMMARY: - HLA markers of the class II region are
important for determination of the predisposition to RA, clinical
manifestations, and rate of progression of joint destruction in this autoimmune
disease. Furthermore, evidence emerges indicating that HLA markers also have an
impact on treatment outcome in RA. Currently, several immunopathogenetic models
of HLA-dependent influences in RA are under debate. These models insufficiently
explain the graded influence of HLA-DR and HLA-DQ on manifestation and joint
destruction, however. Currently, there is not enough evidence to unequivocally
identify a primary susceptibility locus or to pinpoint the HLA-dependent
mechanism in RA. Overall, the influence of HLA class II markers on disease
susceptibility is rather restricted, and, in turn, their utility in
establishing the diagnosis of RA is of limited use. Although relative risks are
higher for the association of particular genotypes with extra-articular forms
of RA, HLA genotyping may not contribute to prognostication in individual
patients but may aid in disease stratification. In contrast, HLA genotyping in
early RA, particularly when combined with the determination of RFs and
determination of the presence of bony erosions, is of value to identify
patients at risk for poor outcome. In turn, these patients may benefit from
early aggressive therapy, and HLA genotyping should be useful to aid in risk
stratification in patients and thus helpful for the choice of treatment.
Lastly, disease and risk stratification based on HLA markers along with the
elucidation of HLA-dependent mechanisms may facilitate the development of
specific immunotherapy modalities. N.
Ref:: 98
----------------------------------------------------
[35]
TÍTULO / TITLE: - Stroke after bone
marrow transplantation: frequency, aetiology and outcome.
REVISTA
/ JOURNAL: - Brain. Acceso gratuito al texto completo a
partir de los 2 años de la publicación;
- http://brain.oupjournals.org/
●●
Cita: Brain: <> 2001 May;124(Pt 5):1043-51.
AUTORES
/ AUTHORS: - Coplin WM; Cochran MS; Levine SR; Crawford
SW
INSTITUCIÓN
/ INSTITUTION: - Division of Pulmonary and Critical Care
Medicine and the Department of Neurology, University of Washington, Seattle,
Washington, USA. wcoplin@med.wayne.edu
RESUMEN
/ SUMMARY: - Few data exist on the frequency, aetiology
and outcome of cerebrovascular complications of bone marrow transplantation
(BMT). We reviewed all patients undergoing BMT at the Fred Hutchinson Cancer
Research Center, Seattle, Wash., USA (a large referral institution) over 3
years. We reviewed ICD-9 (International Classification of Diseases) codes for
ischaemic stroke, seizure, intracranial haemorrhage and brain infection. Using
standardized forms, we paid detailed attention to clinical features and
demographics, oncological diagnosis, conditioning regimens, neurological
history, comorbidities, time from BMT to ictus, stroke subtype, radiological
and pathological features, and outcomes. We identified 36 patients with stroke
from 1245 patients who had BMT (2.9%) over 3 years. These patients’ median age
was 35 (range 5-60, interquartile range 25-45) years. The most common causes of
stroke were intracranial haemorrhage related to thrombocytopenia (38.9%) and
infarction or haemorrhage secondary to fungal infection (30.6%). Twenty-five
patients (69.4%) died from their stroke; none survived without disability.
Using a logistic regression model, we found that neither demographic (e.g. age,
gender) nor clinical (e.g. oncological diagnosis, type of BMT, time of stroke
after BMT) factors predicted outcome. Stroke occurs relatively frequently
(incidence almost 3%) after BMT, has a relatively high frequency of
infection-triggered events, has a neurological outcome not easily predicted
from available data and is often fatal.
N. Ref:: 49
----------------------------------------------------
[36]
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
----------------------------------------------------
[37]
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
----------------------------------------------------
[38]
TÍTULO / TITLE: - Effects of
catecholamine application to brain-dead donors on graft survival in solid organ
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):455-63.
AUTORES
/ AUTHORS: - Schnuelle P; Berger S; de Boer J; Persijn
G; van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - University Hospital Mannheim, Theodor
Kutzer Ufer 1-3, 68167 Mannheim, Germany. schnuell@rumms.uni-mannheim.de
RESUMEN
/ SUMMARY: - BACKGROUND: In a recent single-center
study, donor use of catecholamines was identified to reduce kidney allograft
rejection. This study investigates the effects of donor employment of
adrenergic agents on graft survival in a large data base, including liver and
heart transplants. METHODS: The study was based on the registry of the
Eurotransplant International Foundation including 2415 kidney, 755 liver, and
720 heart transplants performed between January 1 and December 31, 1993. A
total of 1742 donor record forms referring to the cadaveric donor activities in
1993 were systematically reviewed with regard to employment of adrenergic
agents. Catecholamine use was simply coded dichotomously and divided into three
strata according to zero, single, and combined application. Multivariate Cox
regression including age, gender, cause of brain death, cold ischemia,
HLA-mismatching, number of previous transplants, and urgency in liver
transplants was applied for statistical analysis. RESULTS: Donor employment of
catecholamines was associated with increased 4-year graft survival after kidney
transplantation (hazard ratio [HR], 0.85; 95% confidence interval [95% CI],
0.74-0.98). The benefit is conferred in a dose-dependent manner and compares in
quantitative terms with prospective HLA matching on class I and class II
antigens (HR, 0.90; 95% CI, 0.84-0.97). Use of norepinephrine was predictive of
initial nonfunction after heart transplantation (HR, 1.66; 95% CI, 1.14-2.43),
but did not compromise liver grafts (HR, 0.94; 95% CI, 0.67-1.32). CONCLUSIONS:
Optimizing the management of brain-dead organ donors, including the possibility
of selective administration of adrenergic agents, may provide a major benefit
on graft survival without adverse side effects for the recipients. Further
investigation on best use of adrenergic drugs, optimum dosage, and duration is
warranted.
----------------------------------------------------
[39]
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
----------------------------------------------------
[40]
TÍTULO / TITLE: - Successful outcome of
liver transplantation in a patient with hepatitis C and common variable immune
deficiency.
REVISTA
/ JOURNAL: - Transpl Int 2002 Jul;15(7):380-3. Epub
2002 Jun 4.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00147-002-0420-2
AUTORES
/ AUTHORS: - Gow PJ; Mutimer D
INSTITUCIÓN
/ INSTITUTION: - Liver and Hepatobiliary Unit, Third Floor,
Nuffield House, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
RESUMEN
/ SUMMARY: - A 43-year-old man with common variable
immune deficiency underwent liver transplantation for cirrhosis caused by
hepatitis C virus (HCV). HCV had been acquired from a contaminated batch of
immunoglobulin. He developed cirrhosis within 3 years of infection with the
virus, then liver failure requiring liver transplantation. The immediate
post-transplant course was uncomplicated. Five months after transplantation he
developed liver failure, and the histological appearances were those of severe
cholestatic hepatitis. Withdrawal of immunosuppression resulted in recovery
from liver failure. Clearance of the HCV from serum was also observed and has
been sustained during follow-up (despite the subsequent reintroduction of
low-dose immunosuppression). The patient is alive and well more than 5 years after
transplantation. His post-transplant course has been remarkable for the
aggressive recurrence then clearance of the HCV. N. Ref:: 15
----------------------------------------------------
[41]
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
----------------------------------------------------
[42]
TÍTULO / TITLE: - Liver transplantation
in advanced liver failure: neurologic outcome in acute versus chronic liver
disease.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Oct;8(10):937-8.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.35925
AUTORES
/ AUTHORS: - Youssef WI; Mullen KD N. Ref:: 21
----------------------------------------------------
[43]
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
----------------------------------------------------
[44]
TÍTULO / TITLE: - International
Federation of Clinical Chemistry/International Association of Therapeutic Drug
Monitoring and Clinical Toxicology working group on immunosuppressive drug
monitoring.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):59-67.
AUTORES
/ AUTHORS: - Holt DW; Armstrong VW; Griesmacher A;
Morris RG; Napoli KL; Shaw LM
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - Issues surrounding the measurement and
interpretation of immunosuppressive drug concentrations have been summarized in
a number of consensus documents. The Scientific Division of the International
Federation of Clinical Chemistry has formed a working group in collaboration
with the International Association of Therapeutic Drug Monitoring and Clinical
Toxicology. This paper sets out the goals of the working group in light of the
developments that have occurred in the field of immunosuppressive drug
monitoring since the publication of the last consensus documents.
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
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
----------------------------------------------------
[47]
TÍTULO / TITLE: - Neurodevelopmental
outcome of solid organ transplantation in children.
REVISTA
/ JOURNAL: - Pediatr Clin North Am 2003
Dec;50(6):1493-503, x.
AUTORES
/ AUTHORS: - Baum M; Freier MC; Chinnock RE
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Loma Linda
University Children’s Hospital, Loma Linda University School of Medicine, A1121
Coleman Pavilion, Loma Linda, CA 92354, USA.
RESUMEN
/ SUMMARY: - The literature regarding organ
transplantation has emphasized graft survival in the arena of organ
transplantation for life-threatening disease. The concept of “if you can’t get
it to work .. replace it” has been successful in the adult transplant
population and has found its way into the pediatric population. With the
improvement in patient and graft survival rates and management of
complications, the questions multiply concerning quality-of-life issues.
Neurodevelopmental outcome is emerging as one of the focal points for parents,
physicians, and education specialists as they request information regarding
early intervention and therapies for this growing population of children from
the successful era of organ transplantation.
N. Ref:: 39
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
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
----------------------------------------------------
[50]
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
----------------------------------------------------
[51]
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 Urol 2003 Sep;170(3):1055-6.
AUTORES
/ AUTHORS: - Goldfarb DA
----------------------------------------------------
[52]
TÍTULO / TITLE: - Dendritic cells,
tolerance induction and transplant outcome.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Apr;2(4):299-307.
AUTORES
/ AUTHORS: - Coates PT; Thomson AW
INSTITUCIÓN
/ INSTITUTION: - Thomas E Starzl Transplantation Institute,
Department of Surgery, University of Pittsburgh Medical Center, PA 15213,
USA. N. Ref:: 68
----------------------------------------------------
[53]
TÍTULO / TITLE: - St John’s wort
(Hypericum perforatum): drug interactions and clinical outcomes.
REVISTA
/ JOURNAL: - Br J Clin Pharmacol 2002 Oct;54(4):349-56.
AUTORES
/ AUTHORS: - Henderson L; Yue QY; Bergquist C; Gerden
B; Arlett P
INSTITUCIÓN
/ INSTITUTION: - Pharmacovigilance Group, Medicines Control
Agency, UK. leigh.henderson@mca.gsi.gov.uk
RESUMEN
/ SUMMARY: - AIMS: The aim of this work is to identify
the medicines which interact with the herbal remedy St John’s wort (SJW), and
the mechanisms responsible. METHODS: A systematic review of all the available
evidence, including worldwide published literature and spontaneous case reports
provided by healthcare professionals and regulatory authorities within Europe
has been undertaken. RESULTS: A number of clinically significant interactions
have been identified with prescribed medicines including warfarin,
phenprocoumon, cyclosporin, HIV protease inhibitors, theophylline, digoxin and
oral contraceptives resulting in a decrease in concentration or effect of the
medicines. These interactions are probably due to the induction of cytochrome
P450 isoenzymes CYP3A4, CYP2C9, CYP1A2 and the transport protein P-glycoprotein
by constituent(s) in SJW. The degree of induction is unpredictable due to
factors such as the variable quality and quantity of constituent(s) in SJW
preparations. In addition, possible pharmacodynamic interactions with selective
serotonin re-uptake inhibitors and serotonin (5-HT(1d)) receptor-agonists such
as triptans used to treat migraine were identified. These interactions are
associated with an increased risk of adverse reactions. CONCLUSIONS: In Sweden
and the UK the potential risks to patients were judged to be significant and
therefore information about the interactions was provided to health care
professionals and patients. The product information of the licensed medicines
involved has been amended to reflect these newly identified interactions and
SJW preparations have been voluntarily labelled with appropriate warnings. N. Ref:: 44
----------------------------------------------------
[54]
TÍTULO / TITLE: - Assessment of
functional outcome in hand transplantation patients.
REVISTA
/ JOURNAL: - Hand Clin 2003 Aug;19(3):505-9, x.
AUTORES
/ AUTHORS: - Herzberg G; Parmentier H; Erhard L
INSTITUCIÓN
/ INSTITUTION: - Orthopaedic Hand and Upper Extremity Unit,
Edouard Herriot Hospital, 5 Place d’Arsonval-Pavillon M, 69437, Lyon Cedex 03,
France. guillaume.herzberg@chu-lyon.fr
RESUMEN
/ SUMMARY: - The purpose of this article is to report
the criteria used for functional evaluation of hand transplant patients in a
one-page clinical examination chart. A satisfactory immunologic status is
mandatory for a functional evaluation to take place. N. Ref:: 17
----------------------------------------------------
[55]
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
----------------------------------------------------
[56]
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
----------------------------------------------------
[57]
TÍTULO / TITLE: - Rituximab: enhancing
outcome of autologous stem cell transplantation in non-Hodgkin’s lymphoma.
REVISTA
/ JOURNAL: - Semin Oncol 2003 Feb;30(1 Suppl 2):28-33.
●●
Enlace al texto completo (gratuito o de pago) 1053/sonc.2003.50022
AUTORES
/ AUTHORS: - Gisselbrecht C; Mounier N
INSTITUCIÓN
/ INSTITUTION: - Institut d’Hematologie, ERM 220, Hopital
Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - High-dose chemotherapy and autologous stem
cell transplantation (ASCT) is a potentially curative therapy for younger
patients with relapsed aggressive non-Hodgkin’s lymphoma, and is under
investigation as first-line treatment and as therapy for indolent and mantle
cell non-Hodgkin’s lymphoma. However, between 40% and 70% of all patients
relapse after ASCT because of contamination of the stem cell product or
persistence of residual tumor cells. Evidence is emerging that the
administration of rituximab as an in vivo purging agent before ASCT is
effective in eliminating lymphoma cell contamination, as measured by clearance
of bcl-2-positive cells from stem cell harvests. Furthermore, in vivo purging
with rituximab does not adversely affect the stem cell yield or function.
Maintenance therapy with rituximab post-transplantation has also been explored
as a means of eliminating residual tumor cells. Results suggest that rituximab
may eradicate minimal residual disease post-transplant and help prevent
relapse. The efficacy of both in vivo purging and maintenance therapy with
rituximab is currently being investigated in a large, multicenter, randomized
trial by the European Group for Blood and Bone Marrow Transplantation in patients
with follicular non-Hodgkin’s lymphoma. Results from this and other ongoing
trials will confirm the full potential of rituximab in ASCT. N. Ref:: 31
----------------------------------------------------
[58]
TÍTULO / TITLE: - Kidney transplantation
from living-unrelated donors: comparison of outcome with living-related and
cadaveric transplants under current immunosuppressive protocols.
REVISTA
/ JOURNAL: - Urology 2003 Dec;62(6):1002-6.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai E; Yussim A;
Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Centre of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - OBJECTIVES: Living-unrelated donors may
become an additional organ source for patients on the kidney waiting list. We
studied the impact of a combination of calcineurin inhibitors and
mycophenolate-mofetil together with steroids on the outcomes of living-related
(LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September
1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49)
kidney transplantation, and another 173 patients received a cadaveric kidney.
Immunosuppressive protocols consisted of mycophenolate-mofetil with
cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the
patient and graft survival data, rejection rate, and graft functional
parameters. RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8
years) and cadaver (43.7 years) donor recipients (P <0.001). HLA matching
was higher in LRD patients (P <0.001). Acute rejection developed in 28.6% of
LUR versus 27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P =
not significant). The creatinine level at 1, 2, and 3 years after transplant
was 1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR
patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not
significant), respectively. No difference in patient survival rates was found
among the groups. The 1, 2, and 3-year graft survival rates were significantly
better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR
transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney
recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS: Despite
HLA disparity, the rejection and survival rates of LUR transplants under
current immunosuppressive protocols are comparable to those of LRD and better
than those of cadaveric transplants.
----------------------------------------------------
[59]
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
----------------------------------------------------
[60]
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
----------------------------------------------------
[61]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressant drugs in clinical practice.
REVISTA
/ JOURNAL: - Clin Ther 2002 Mar;24(3):330-50;
discussion 329.
AUTORES
/ AUTHORS: - Kahan BD; Keown P; Levy GA; Johnston A
INSTITUCIÓN
/ INSTITUTION: - Division of Immunology and Organ
Transplantation, University of Texas Health Science Center at Houston Medical
School, 77030, USA. Barry.D.Kahan@uth.tmc.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Therapeutic drug monitoring
(TDM) is essential to maintain the efficacy of many immunosuppressant drugs
while minimizing their toxicity. TDM has become more refined with the
development of new monitoring techniques and more specific assays. OBJECTIVE:
This article summarizes current data on TDM of the following immunosuppressant
drugs used in organ transplantation: cyclosporine, tacrolimus, sirolimus,
everolimus, and mycophenolate mofetil. METHODS: Published data were identified
by a MEDLINE search of the English-language literature through March 2001 using
the terms therapeutic drug monitoring, cyclosporine, tacrolimus, sirolimus,
everolimus, and mycophenolate mofetil. Relevant conference abstracts were also
included. RESULTS: TDM of cyclosporine has been well studied, and recent
findings indicate that monitoring of drug levels 2 hours after dosing is a more
sensitive predictor of outcome than trough (C0) monitoring. C0 levels are being
used more widely in TDM of tacrolimus; however, the relationship between C0 and
area under the curve has varied widely in clinical trials, with correlations
ranging from 0.11 to 0.92. The use of TDM of sirolimus, everolimus, and
mycophenolate mofetil is evolving rapidly. CONCLUSIONS: TDM of
immunosuppressant drugs that have a narrow therapeutic index is an increasingly
useful tool for minimizing drug toxicity while maximizing prevention of graft
loss and organ rejection. N.
Ref:: 85
----------------------------------------------------
[62]
TÍTULO / TITLE: - Mycophenolate mofetil
for solid organ transplantation: does the evidence support the need for
clinical pharmacokinetic monitoring?
REVISTA
/ JOURNAL: - Ther Drug Monit 2003 Apr;25(2):137-57.
AUTORES
/ AUTHORS: - Cox VC; Ensom MH
INSTITUCIÓN
/ INSTITUTION: - Faculty of Pharmaceutical Sciences,
University of British Columbia, Vancouver, British Columbia, Canada.
RESUMEN
/ SUMMARY: - The need for clinical pharmacokinetic
monitoring (CPM) of the immunosuppressant mycophenolate mofetil (MMF) has been
debated. Using a previously developed algorithm, the authors reviewed the
evidence to support or refute the utility of CPM of MMF. First, MMF has proven
efficacy for prevention of organ rejection in renal and cardiac transplant
populations. In addition, the pharmacologically active form of MMF,
mycophenolic acid (MPA), can be measured readily in plasma, and relationships
between the incidence of rejection and MPA predose concentrations and MPA area
under the curve (AUC) have been reported. A lower limit of the therapeutic
range (MPA predose concentrations >1.55 microg/mL, as measured by enzyme
multiplied immunoassay technique [EMIT], or MPA AUC >30 or 40 microg. h/mL,
as measured by high-performance liquid chromatography [HPLC]) has been
suggested to prevent rejection in renal allograft patients. Similarly, in
cardiac transplant patients, decreased incidences of organ rejection have been
reported in patients with MPA concentrations >2 or 3 microg/mL (using EMIT)
and total AUC values >42.8 microg. h/mL (using HPLC). However, the
relationship between pharmacokinetic parameters and adverse events in renal and
cardiac transplant patients remains unclear. Due to the nature of antirejection
therapy, the pharmacologic response of MMF is not readily assessable, and
therapy is life-long. MPA pharmacokinetics exhibit large inter- and intrapatient
variability and may be altered in specific patient populations due to changes
in protein binding, concomitant disease states, or interactions with concurrent
immunosuppressants. Therefore, on the basis of current evidence, CPM can
provide more information regarding efficacy of MMF than clinical judgment alone
in select patient populations. However, further randomized, prospective trials
are required to clarify unresolved issues. Specifically, an upper limit of the
therapeutic range, above which the risk of side effects is increased, needs to
be elucidated for MMF therapy. Other future directions for research include
determining a practical limited sampling strategy for MPA AUC; clarifying the
relationship between free MPA concentrations, efficacy, and toxicity; and
defining the pharmacodynamic relationship between activity of inosine
monophosphate dehydrogenase (the enzyme inhibited by MPA) and risk of rejection
or adverse effects. N.
Ref:: 97
----------------------------------------------------
[63]
TÍTULO / TITLE: - Expanding the donor
pool: effect on graft outcome.
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: <> 2002
Oct;13(10):2590-9.
AUTORES
/ AUTHORS: - Ramos E; Aoun S; Harmon WE
INSTITUCIÓN
/ INSTITUTION: - Nephrology Division, University of
Maryland Medical System, Baltimore, Maryland 21201, USA. eramos@medicine.umaryland.edu N. Ref:: 106
----------------------------------------------------
[64]
TÍTULO / TITLE: - Loss of living donor
renal allograft survival advantage in children with focal segmental
glomerulosclerosis.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):328-33.
AUTORES
/ AUTHORS: - Baum MA; Stablein DM; Panzarino VM; Tejani
A; Harmon WE; Alexander SR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Because of concerns of
increased risk of graft loss with recurrent disease, living donor (LD)
transplantation in children with focal segmental glomerulosclerosis (FSGS) has
been controversial. METHODS: The North American Pediatric Renal Transplant
Cooperative Study (NAPRTCS) database from January 1987 to January 2000 was
examined to determine differences in demographics, treatment, and outcomes in
children with FSGS compared with other renal diseases. RESULTS: Data on 6484
children, 752 (11.6%) with FSGS, demonstrated that FSGS patients were more
likely to be older and black, and were less likely to receive either
pre-emptive or LD transplant (P < 0.001). No differences existed in human
lymphocyte antigen (HLA) matching or immunosuppression regimens. Acute tubular
necrosis occurred in more FSGS patients following LD (11.8 vs. 4.6%) or
cadaveric (CD; 27.9 vs. 16.3%) transplants (P < 0.001). Graft survival was
worse for LD FSGS patients (5 years 69%) compared with no FSGS (82%, P <
0.001) and was not significantly different than CD graft survival in the FSGS
(60%) and No FSGS groups (67%). The LD to CD ratios of relative risk of graft
failure were higher in FSGS patients (test for interaction, P = 0.01).
Recurrence of original disease was the only cause of graft failure that
differed between groups (P < 0.001). A greater percentage of LD FSGS graft
failures was attributed to recurrence (P = 0.06). CONCLUSIONS: The impact of
FSGS on graft survival in children is greatest in LD transplants, resulting in
loss of expected LD graft survival advantage. The rationale for LD grafts in
children with FSGS should be based on factors other than better outcomes
typically associated with LD transplantation.
----------------------------------------------------
[65]
TÍTULO / TITLE: - Therapeutic monitoring
of mycophenolate mofetil in organ transplant recipients: is it necessary?
REVISTA
/ JOURNAL: - Clin Pharmacokinet 2002;41(5):319-27.
AUTORES
/ AUTHORS: - Mourad M; Wallemacq P; Konig J; de Frahan
EH; Eddour DC; De Meyer M; Malaise J; Squifflet JP
INSTITUCIÓN
/ INSTITUTION: - Department of Kidney and Pancreas
Transplantation, University Hospital Saint Luc, Universite Catholique de
Louvain, Brussels, Belgium. Michel.Mourad@chir.ucl.ac.be
RESUMEN
/ SUMMARY: - Adequate immunosuppression minimising the
risk of organ rejection with acceptable tolerability of the used drugs is a
crucial step in organ transplantation. The primary goal is to maintain a
consistent time-dependent target concentration by tailoring individual dosage
leading to the best efficacy and tolerability combination. The use of
therapeutic drug monitoring (TDM) to optimise immunosuppressive therapy is
routinely employed for maintenance drugs such as cyclosporin and tacrolimus.
The question whether therapeutic monitoring of mycophenolic acid (MPA) in organ
transplant recipients treated with mycophenolate mofetil is necessary is not
definitely answered. The correlation of mycophenolic acid pharmacokinetic
parameters with efficacy and toxicity makes the therapeutic monitoring of this
drug promising. However, further studies are mandatory to draw the best
guidelines in order to achieve higher levels of evidence that MPA-TDM may
improve patient outcome. N.
Ref:: 63
----------------------------------------------------
[66]
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
----------------------------------------------------
[67]
TÍTULO / TITLE: - Thymic microchimerism
correlates with the outcome of tolerance-inducing protocols for solid organ
transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Dec;12(12):2815-26.
AUTORES
/ AUTHORS: - Noris M; Cugini D; Casiraghi F; Azzollini
N; De Deus Viera Moraes L; Mister M; Pezzotta A; Cavinato RA; Aiello S; Perico
N; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinics of
Organ Transplantation, Mario Negri Institute for Pharmacological Research, via
Gavazzeni 11, 24125 Bergamo, Italy. noris@marionegri.it
RESUMEN
/ SUMMARY: - This study found that pretransplant
infusion of donor peripheral blood leukocytes, either total leukocytes
(peripheral blood leukocytes) or peripheral blood mononuclear cells (PBMC),
under appropriate immunomodulating conditions was more effective than donor
bone marrow (BM) in prolonging the survival of rats that received kidney
grafts. A higher percentage of MHCII(+) cells was found in donor PBMC than in
BM cells, and depletion of MHCII(+) cells from donor PBMC abolished their
tolerogenic potential. By the analysis of microchimerism in rats infused with
donor cells and killed at different time points thereafter, the better
tolerogenic potential of leukocyte infusion related to a higher capability of
these cells to engraft the recipient thymus. PCR analysis on OX6-immunopurified
cells revealed the presence of donor MHCII(+) cells in the thymus of these
animals. The role of intrathymic microchimerism was reinforced by findings that
thymectomy at the time of transplant prevented tolerance induction by donor
leukocytes. Donor DNA was found in the thymus of most long-term graft animals
that survived, but in none of those that rejected their grafts. The presence of
intrathymic microchimerism correlated with graft survival, and microchimerism
in other tissues was irrelevant. PCR analysis of DNA from thymic cell
subpopulations revealed the presence of donor MHCII(+) cells in the thymus of
long-term surviving animals. Thus, in rats, donor leukocyte infusion is better
than donor BM for inducing graft tolerance, defined by long-term graft
survival, donor-specific T cell hyporesponsiveness, and reduced interferon
gamma production. This effect appears to occur through migration of donor
MHCII(+) cells in the host thymus.
----------------------------------------------------
[68]
TÍTULO / TITLE: - Immune tolerance
therapy dose as an outcome predictor.
REVISTA
/ JOURNAL: - Haemophilia 2003 Jul;9(4):382-6.
AUTORES
/ AUTHORS: - DiMichele D
INSTITUCIÓN
/ INSTITUTION: - New York Presbyterian Hospital Weill
Cornell Center, New York, NY 10021, USA. dmdimich@med.cornell.edu
RESUMEN
/ SUMMARY: - The question of dose as a successful ITT
outcome predictor in haemophilia A and B is an important one on many levels.
Increased morbidity associated with inhibitor development has been documented.
Currently, immune tolerance is the only proven method for inhibitor eradication.
Furthermore, given the morbidity and the high cost of less effective bypass
therapy, a study by Harvard health economists using Markov decision analysis
predicted an increased life expectancy of 4.5 years at a lifetime cost savings
of $1.6 million with the use of ITT rather than lifelong APCC therapy. However,
the immediate short-term cost of this expensive therapeutic intervention has
the capacity to strain the financial resources of many countries in the
developed world, regardless of the system of medical reimbursement. It also
assures the inaccessibility of this treatment modality to most of the world’s
inhibitor patients living in the developing world. Cost aside, recent
experience has taught us that clotting factor supply is precarious, not inexhaustible
as previously assumed. Finally, in the paediatric patient who is most likely to
require and undergo ITT, venous access for daily infusions is problematic with
or without a central venous access device. Indeed, for these reasons alone,
finding the answer to the question of optimal cost-effective dosing immune
tolerance is a matter of medical urgency and moral obligation to the global
haemophilia community. N.
Ref:: 25
----------------------------------------------------
[69]
TÍTULO / TITLE: - Impact of donor
infections on outcome of orthotopic liver transplantation.
REVISTA
/ JOURNAL: - Liver Transpl 2003 May;9(5):451-62.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50094
AUTORES
/ AUTHORS: - Angelis M; Cooper JT; Freeman RB
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation, Tufts-New
England Medical Center, Boston, MA 02111, USA.
RESUMEN
/ SUMMARY: - Infection occurs when microbial agents
enter the host, either through airborne transmission or by direct contact of a
substance carrying the infectious agent with the host. Human body fluids, solid
organs, or other tissues often are ideal vectors to support microbial agents
and can transmit infections efficiently from donor to recipient. In the case of
blood transfusion and tissue transplantation, the main consequence of such a
transmission is infection of the recipient. However, in the case of solid-organ
transplantation, and particularly for liver transplantation, donor infections
are not only transmitted to the recipient, the donor infection also may affect
the donated liver’s preservability and subsequent function in the recipient
irrespective of the systemic consequences of the infection. In addition, solid organ
recipients of infected organs are less able to respond to the infectious agent
because of their immunosuppressive treatment. Thus, transmission of infections
from organ donor to liver recipient represents serious potential risks that
must be weighed against a candidate’s mortality risk without the transplant.
However, the ever-increasing gap between the number of donors and those waiting
for liver grafts makes consideration of every potential donor, regardless of
the infection status, essential to minimize waiting list mortality. In this
review, we will focus on assessing the risk of transmission of bacterial,
fungal, viral, and parasitic infectious agents from cadaveric liver donors to
recipients and the effect such a transmission has on liver function, morbidity,
and mortality. We will also discuss risk-benefit deliberations for using organs
from infected donors for certain types of recipients. These issues are
critically important to maximize the use of donated organs but also minimize
recipient morbidity and graft dysfunction.
N. Ref:: 117
----------------------------------------------------
[70]
TÍTULO / TITLE: - Factors associated with
long-term renal allograft survival.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):36-9.
AUTORES
/ AUTHORS: - Kaplan B; Srinivas TR; Meier-Kriesche HU
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Shands University
Hospital, University of Florida, Gainesville, Florida 32610-0224, USA. kaplab@medicine.ufl.edu
RESUMEN
/ SUMMARY: - Major advances in immunosuppression and
reductions in the rates of acute rejection have led to increasing graft and
patient survival rates during the past two decades. Chronic dysfunction of the
renal allograft, however, remains a major clinical problem and probably
represents the end result of the complex interplay between donor and recipient
factors, immunologic injury, nonimmunologic insults, and drug-induced
nephrotoxicity. Optimal function of the renal allograft is obtained by
maintaining a balance between underimmunosuppression and acute rejection and
overimmunosuppression and drug-induced toxicities. To minimize side effects
while maintaining efficacy, immunosuppressive drugs are commonly used as
combination therapy. Pharmacokinetic and pharmacodynamic interactions between
these agents can affect graft survival and function. The evidence supporting
the role of therapeutic drug monitoring as applied to commonly used
immunosuppressants in modern transplantation is presented here, and the
increasing role of therapeutic drug monitoring in the optimization of graft and
patient survival rates in the modern era of renal transplantation is
discussed. N. Ref:: 52
----------------------------------------------------
[71]
TÍTULO / TITLE: - Simplified method of
heterotopic rat heart transplantation using the cuff technique: application to
sublethal dose protocol of methotrexate on allograft survival.
REVISTA
/ JOURNAL: - Microsurgery 2001;21(1):16-21.
●●
Enlace al texto completo (gratuito o de pago) 1002/1098-2752(2001)21:1<16::AID-MICR1003>3.0.CO;2-B
[pii]
AUTORES
/ AUTHORS: - Xiu D; Uchida H; To H; Sugimoto K;
Kasahara K; Nagai H; Fujimura A; Kobayashi E
INSTITUCIÓN
/ INSTITUTION: - Department of General Surgery, Third
Teaching Hospital, Beijing Medical University, People’s Republic of China.
RESUMEN
/ SUMMARY: - Rodent heterotopic heart transplantation
(HHT) models have been developed for the study of transplantation immunology.
Most of these transplantations are performed by hand-suture techniques,
requiring several months of training. We describe a modified technique of rat
HHT in the neck, using a cuff method that can be mastered by beginners within a
few weeks. Our main modification of the rat HHT in the neck is that the right
superior vena cava of the graft is chosen as an outflow duct, while the
pulmonary artery has been taken as an effluent drainage in the ordinary HHT
models. The aorta of the donor is anastomosed with the carotid artery of the
recipient. Donation can be completed within 5 min and vascular connections in
the recipient done within 3 min, resulting in a minimum of ischemia time. Using
this minimum surgical intervention model, we tested the immunosuppressive
effect of a sublethal dose of methotrexate (MTX), which has been widely used in
cancer therapy. Our results showed that high doses of MTX severely suppressed
the recipient bone marrow, but prolonged heart allografts for more than 365
days after HHT. In conclusion, the new model simplified the rat HHT procedure
and made it possible for the beginner of rodent transplantation to master this
skill within a few weeks. Using this minimized intervention technique, we found
that the high doses of MTX can significantly prolong the survival of fully
mismatched DA heart graft in PVG/c recipient.
----------------------------------------------------
[72]
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
----------------------------------------------------
[73]
TÍTULO / TITLE: - Role of chiral
chromatography in therapeutic drug monitoring and in clinical and forensic
toxicology.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Apr;24(2):290-6.
AUTORES
/ AUTHORS: - Williams ML; Wainer IW
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, Leicester
University, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - Advances in chiral chromatographic
separations have given pharmacologists and toxicologists the tools to examine
unexpected clinical results involving chiral drugs. The ability to unravel
complex phenomena associated with drug transport and drug metabolism is
presented in this manuscript. The relation between the chirality of the drug
mefloquine and the intracellular concentrations of the drug cyclosporine is
illustrated by examining the effect of the enantiomers of mefloquine on the
transport activity of P-glycoprotein (Pgp). These studies were conducted using
a liquid chromatographic column containing immobilized Pgp. The results
demonstrated that (+)-mefloquine competitively displaced the Pgp substrate
cyclosporine whereas (-)-mefloquine had no effect on cyclosporine-Pgp binding.
The data suggest that cyclosporine cellular and CNS concentrations can be
increased through the concomitant administration of (+)-mefloquine. The use of
chirality in clinical and forensic situations is also illustrated by the
metabolism of the enantiomers of ketamine (KET). The plasma concentrations of
(+)-KET and (-)-KET and the norketamine metabolites (+)-NK and (-)-NK were
measured in rat plasma using enantioselective gas chromatography. The
separations were accomplished using a gas chromatography chiral stationary
phase based on beta-cyclodextrin. The pharmacokinetic profiles of (+)-, (-)-KET
and (+)-, (-)-NK were determined in control and protein-calorie malnourished
(PCM) rats to determine the effect of PCM on ketamine metabolism and clearance.
The results indicate that PCM produced a significant and stereoselective
decrease in KET and NK metabolism. The data suggest that the effects of
environmental factors (smoking, alcohol use, diet) and drug interactions
(coadministered agents) can be measured using the changes in stereochemical
metabolic and pharmacokinetic patterns of KET and similar drugs. N. Ref:: 33
----------------------------------------------------
[74]
TÍTULO / TITLE: - Protocol core needle
biopsy and histological chronic allograft damage index as surrogate endpoint
for Long-Term graft survival.
REVISTA
/ JOURNAL: - Transplant Proc 2004 Jan-Feb;36(1):89-91.
●●
Enlace al texto completo (gratuito o de pago) 1016/j.transproceed.2003.11.006
AUTORES
/ AUTHORS: - Hayry P; Paavonen T; Taskinen E;
Tomlanovich E; Mathew T; Navarro M; Ramos E; Hooftman L; Vamvakopoulos J; Aavik
E; Yilmaz S
INSTITUCIÓN
/ INSTITUTION: - University of Helsinki Hospital, Helsinki,
Finland. pekka.hayry@helsinki.fi
RESUMEN
/ SUMMARY: - Following encouraging results from several
single-center studies showing that early histological manifestations of chronic
rejection are seen in the graft before a decline in transplant function, we
tested this concept in a multicenter study and investigated whether protocol
needle biopsy may be used as a surrogate to late graft survival in multicenter
renal transplantation trials. During two mycophenolate mofetil trials, 621
representative protocol biopsies were obtained at baseline, 1 year, and 3
years. The samples were coded and evaluated blindly by two pathologists and a
Chronic Allograft Damage Index (CADI) score was constructed. At 1 year only 20%
of patients had elevated (>1.5 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 year and to 4.1 +/- 2.2
at 3 years. The patients at 1 year were divided into 3 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 pathological (1.9 +/- 0.8
mg/dL) levels of serum creatinine. At 3 years there were no lost grafts in the
“low” CADI group, six lost grafts (4.6%) in the “elevated” CADI group, and 17
lost grafts (16.7%) in the “high” CADI group (P <.001). One-year
histological CADI score predicts graft survival even when the graft function is
still normal. This observation makes it possible to use CADI as a surrogate
endpoint in prevention trials and to identify the patients at risk for intervention
trials.
----------------------------------------------------
[75]
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
----------------------------------------------------
[76]
TÍTULO / TITLE: - A survival game of hide
and seek: cytomegaloviruses and MHC class I antigen presentation pathways.
REVISTA
/ JOURNAL: - Viral Immunol 2003;16(3):231-42.
●●
Enlace al texto completo (gratuito o de pago) 1089/088282403322396064
AUTORES
/ AUTHORS: - Basta S; Bennink JR
INSTITUCIÓN
/ INSTITUTION: - Laboratory of Viral Diseases, NIAID, NIH,
Bethesda, Maryland 20892-0440, USA.
RESUMEN
/ SUMMARY: - Cytomegaloviruses (CMV) are members of the
ubiquitous family of herpesviruses, which escape immunological clearance and
persist throughout life in the infected host. Cytomegaloviruses have developed
numerous strategies that permit them to co-exist with their host even as an
anti-virus immune response endangers their long-term survival. A considerable
number of these strategies are aimed at MHC class I presentation of viral
proteins to CD8+ T cells (TCD8+ ). Although the gamut of CMV immune evasion
will be briefly examined, the primary focus of this review is on the host
ability to counteract the strategies developed by CMV to inhibit antigen
processing and presentation. A primary mechanism used by the immune system is
the recognition of very early virus proteins including recognition of the
immunomodulatory proteins themselves. We further speculate that
cross-presentation of antigen is an adaptive immune response to the inhibition
of direct presentation. Other mechanisms, such as the evolution of pAPC
subsets, may also allow the immune system to adapt to a variety of different
infectious pathogens while preventing cytopathic infection of all pAPCs. N. Ref:: 85
----------------------------------------------------
[77]
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
----------------------------------------------------
[78]
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
----------------------------------------------------
[79]
TÍTULO / TITLE: - Improving outcomes in
transplantation.
REVISTA
/ JOURNAL: - Semin Oncol 2002 Apr;29(2 Suppl 6):23-6.
AUTORES
/ AUTHORS: - Brugger W
INSTITUCIÓN
/ INSTITUTION: - Eberhard-Karls Universitat, Hamatologie
und Onkologie, Medizinische Klinik II, Tubingen, Germany.
RESUMEN
/ SUMMARY: - Follicular lymphoma and mantle cell
lymphoma are incurable with standard chemotherapy regimens. One approach to
improve outcome in patients with these diseases is high-dose therapy and
autologous stem cell transplantation. Rituximab, an anti-CD20 monoclonal
antibody, is specific for the B-cell surface antigen and can be used in
autologous stem cell transplantation to eliminate lymphoma cells before the
harvest (in vivo purging) or to prevent regrowth of malignant cells following
transplant (post-transplant therapy). Preliminary data from an ongoing
multicenter study evaluating the safety and efficacy of rituximab as a
post-transplant consolidation therapy in patients with follicular lymphoma and
mantle cell lymphoma are presented. After high-dose therapy and autologous stem
cell transplantation together with rituximab treatment, 92% of patients are in
complete remission at the 18-month study follow-up, suggesting that rituximab
is a valuable and potentially curative treatment for patients with follicular
lymphoma and mantle cell lymphoma. Six months after treatment, all evaluable
patients became polymerase chain reaction-negative for the bcl-1 and bcl-2
chromosomal rearrangements and remained so during follow-up, indicating that
rituximab is able to eliminate minimal residual disease and bring about high
rates of durable remissions in these patients.
N. Ref:: 26
----------------------------------------------------
[80]
TÍTULO / TITLE: - Studies of Pediatric
Liver Transplantation (SPLIT): year 2000 outcomes.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):463-76.
INSTITUCIÓN
/ INSTITUTION: - c/o The EMMES Corporation, 401 N.
Washington Street, Suite 700, Rockville, MD 20850, USA. splitpub@emmes.com
RESUMEN
/ SUMMARY: - BACKGROUND: Initiated in 1995, the Studies
of Pediatric Liver Transplantation (SPLIT) registry database is a cooperative
research network of pediatric transplantation centers in the United States and
Canada. The primary objectives are to characterize and follow trends in
transplant indications, transplantation techniques, and outcomes (e.g.,
patient/graft survival, rejection, growth parameters, and immunosuppressive
therapy.) METHODS: As of June 15, 2000, 29 centers registered 1144 patients,
640 of whom received their first liver-only transplant while registered in
SPLIT. Patients are followed every 6 months for 2 years and yearly thereafter.
Data are submitted to a central coordinating center. RESULTS: One/two-year
patient survival and graft loss estimates are 0.85/0.82 and 0.77/0.72,
respectively. Risk factors for death include: in ICU at transplant (relative
risk (RR)=2.63, P<0.05) and height/weight deficits of two or more standard
deviations (RR=1.67, P<0.05). Risk factors for graft loss include: in ICU at
transplant (RR=1.77, P<0.05) and receiving a cadaveric split organ compared
with a whole organ (RR=2.3, P<0.05). The percentage of patients diagnosed
with hepatic a. and portal v. thrombosis were 9.7% and 7%, respectively; 15%
had biliary complications within 30 days. At least one re-operation was
required in 45%. One/two-year rejection probability estimates are 0.60/0.66.
Tacrolimus, as primary therapy posttransplant, reduces first rejection risk
(RR=0.70, P<0.05). Eighty-nine percent of school-aged children are in school
full-time, 18 months posttransplant. CONCLUSIONS: This report provides one of
the first descriptions of characteristics and clinical courses of a multicenter
pediatric transplant population. Observations are subject to patient selection
biases but are useful for generating hypothesis for future studies.
----------------------------------------------------
[81]
TÍTULO / TITLE: - Steroid side effects
and their impact on transplantation outcome.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S75-80.
AUTORES
/ AUTHORS: - Citterio F
RESUMEN
/ SUMMARY: - Steroids are a staple of immunosuppressive
therapy in transplantation. Despite the high incidence of side effects
associated with steroid therapy, the risk of increased rejection with steroid
discontinuation has often outweighed the potential benefits of improved quality
of life. With the advent of a number of newer immunosuppressive agents,
however, there has been a renewed and heightened focus on the possibility of
steroid avoidance or withdrawal protocols that do not place the patient or
graft at undue risk. Much of the work in this area is preliminary, and large
long-term trials are needed to reach definitive conclusions. Clinical trials
need to resolve patient selection criteria for steroid discontinuation,
effective and appropriate baseline immunosuppression, and the optimal timing of
steroid withdrawal. Appropriate monitoring parameters also need to be developed
to reduce the risk of acute rejection, and follow-up of patients who have been
withdrawn from steroids will become increasingly important. Nonetheless, the
hope is that newer immunosuppressive agents will soon allow for a reduction in
steroid use in appropriate patients, with an improvement in patients’ long-term
quality of life, and fewer healthcare-related costs. N. Ref:: 61
----------------------------------------------------
[82]
TÍTULO / TITLE: - New strategies to
optimize clinical outcomes with cyclosporine in liver transplantation.
REVISTA
/ JOURNAL: - Gastroenterol Hepatol. Acceso gratuito al
texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Gastroenterología & Hepatología: <> 2002 Apr;25(4):289-93.
AUTORES
/ AUTHORS: - Levy GA
INSTITUCIÓN
/ INSTITUTION: - Toronto General Hospital, University of
Toronto, Toronto, Ontario, Canada. N.
Ref:: 25
----------------------------------------------------
[83]
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
----------------------------------------------------
[84]
TÍTULO / TITLE: - The natural history and
outcome of liver transplantation in hepatitis C virus-infected recipients.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Nov;9(11):S28-34.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50248
AUTORES
/ AUTHORS: - Gane E
INSTITUCIÓN
/ INSTITUTION: - New Zealand Liver Transplant Unit,
Auckland Hospital, Auckland, New Zealand. e.gane@auckland.ac.nz
RESUMEN
/ SUMMARY: - 1. Recurrence of hepatitis C infection is
universal and immediate after liver transplantation. 2. Graft and patient
survival is reduced in liver transplantation recipients with recurrent
hepatitis C virus infection compared with hepatitis C virus-negative
recipients. 3. The natural history of chronic hepatitis C is accelerated after
liver transplantation compared with nontransplantation chronic hepatitis C; 20%
to 40% of patients progress to allograft cirrhosis within 5 years, compared
with less than 5% of nontransplantation patients. 4. The rate of fibrosis
progression is not uniform and may change over time. 5. The rate of progression
from cirrhosis to decompensation is accelerated after liver transplantation.
The rate of decompensation is >40% at 1 year and >60% at 3 years,
compared with <5% and <10%, respectively, in immunocompetent patients. 6.
The rate of progression from decompensation to death is also accelerated after
liver transplantation. The 3-year survival is <10% after the onset of
hepatitis C virus-related allograft failure, compared with 60% after
decompensation in immunocompetent patients.
N. Ref:: 92
----------------------------------------------------
[85]
TÍTULO / TITLE: - MHC-dependent survival
of naive T cells? A complicated answer to a simple question.
REVISTA
/ JOURNAL: - Microbes Infect 2002 Apr;4(5):547-54.
AUTORES
/ AUTHORS: - Dorfman JR; Germain RN
INSTITUCIÓN
/ INSTITUTION: - Laboratory of Immunology, National
Institute of Allergy and Infectious Diseases, Bldg. 10 Rm. 11N311, 10 Center
Dr. MSC-1892, National Institutes of Health, Bethesda, MD 20892, USA.
RESUMEN
/ SUMMARY: - The differentiation and survival of
developing alpha beta thymocytes depends on effective T-cell receptor (TCR)
signaling upon recognition of self peptide/major histocompatibility complex
(MHC) molecule ligands. Although this concept is uniformly accepted with regard
to immature thymocytes, there are conflicting reports as to whether or not MHC
recognition is required for survival of mature peripheral naive T cells. In
this review, we assess these reports critically and conclude that in many
cases, the differences observed in CD4(+) T-cell recovery between MHC-expressing
and MHC-deficient animals can be attributed to proliferation occurring only in
the MHC-expressing lymphopenic animals studied in these models systems, rather
than to effects of MHC recognition on cell viability per se. Still other
reports involve experimental manipulations that may have affected the
intrathymic development of the T cells such that they receive a “poor”
selecting signal, fail to fully mature, and thus behave more like thymocytes in
their survival characteristics (i.e., show MHC dependence). With respect to
CD8(+) T cells, we discuss data suggesting that some clones are more dependent
upon the presence of MHC class I for survival than others. We propose that some
CD8(+) T cells even in a wild-type host may behave like the manipulated CD4(+)
T cells just described, and fail to mature completely with respect to their
survival requirements. Although the proportion of CD8(+) cells in this
MHC-dependent state is not known, the corresponding fraction among CD4(+) T
cells seems to be rather small. Overall, our analysis of the available data
suggests that most or all mature CD4(+) (and perhaps also many CD8(+)) T
lymphocytes do not depend on self-recognition for their viability in the
periphery. N. Ref:: 39
----------------------------------------------------
[86]
TÍTULO / TITLE: - Minimization of
immunosuppression in kidney transplantation. The need for immune monitoring.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 27;72(8
Suppl):S32-5.
AUTORES
/ AUTHORS: - Hricik DE; Heeger PS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA. deh5@po.cwru.edu N. Ref:: 16
----------------------------------------------------
[87]
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.
----------------------------------------------------
[88]
TÍTULO / TITLE: - The impact of human
herpesvirus-6 and -7 infection on the outcome of liver transplantation.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Aug;8(8):651-8.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.34966
AUTORES
/ AUTHORS: - Razonable RR; Paya CV
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases and
Internal Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
RESUMEN
/ SUMMARY: - Human herpesvirus (HHV)-6 and -7 are novel
members of the beta-herpesvirus family that maintain latency in the human host
after primary infection. Reactivation from latency and/or increased degree of
viral replication occurs during periods of immune dysfunction. The clinical
effect of HHV-6 and HHV-7 reactivation in recipients of liver transplants is
now being recognized. Clinical illnesses such as fever, rash, pneumonitis,
encephalitis, hepatitis, and myelosuppression have been described in a number
of anecdotal reports. Moreover, a growing body of evidence suggests that the
more important effect of HHV-6 and HHV-7 reactivation on the outcomes of liver
transplantation may be mediated indirectly by their interactions with the other
beta-herpesvirus-cytomegalovirus (CMV). Coinfection among these three
beta-herpesviruses in clinical syndromes that were classically ascribed to be
solely caused by CMV has been shown and has raised substantial interest in the
potential role of HHV-6 and HHV-7 as copathogens in the direct and indirect
illnesses caused by CMV. This article reviews the current scientific data on
the role and the magnitude of impact of HHV-6 and HHV-7 infection on the
outcomes of liver transplantation. N.
Ref:: 66
----------------------------------------------------
[89]
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
----------------------------------------------------
[90]
TÍTULO / TITLE: - Donor specific
transfusion in kidney transplantation: effect of different immunosuppressive
protocols on graft outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2787-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Joubran N;
Dagher O; Kamel G
INSTITUCIÓN
/ INSTITUTION: - Department ofNephrology and
Transplantation, Rizk Hospital, Beirut, Lebanon.
----------------------------------------------------
[91]
TÍTULO / TITLE: - Kidney transplantation
in rats: an appraisal of surgical techniques and outcome.
REVISTA
/ JOURNAL: - Microsurgery 2003;23(4):387-94.
●●
Enlace al texto completo (gratuito o de pago) 1002/micr.10139
AUTORES
/ AUTHORS: - Schumacher M; Van Vliet BN; Ferrari P
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Inselspital, Berne,
Switzerland. martin.schumacher@insel.ch
RESUMEN
/ SUMMARY: - Renal transplantation in rats is an
essential experimental tool in transplantation research. The surgical procedure
per se could affect the outcome of an experiment, independent of the hypothesis
addressed, therefore requiring a standardized method which should be comparable
across studies. To date, however, there is little information on the optimal
surgical technique. We performed a Medline search on original articles
published between 1965-2001 in order to evaluate whether specific technical
issues affecting the outcome of the procedure could be defined. Articles that
reported on a novel microsurgical procedure, or whose main purpose was the
outcome of a surgical technique itself, were included in the analysis. From
2,060 retrieved publications, 34 corresponded to the selection criteria (rats
and microsurgery and technique and kidney or renal transplantation). Among the
essential determining factors for a good outcome, body weight >200 g and
warm ischemic time <30 min were identified. Other important factors were the
techniques used for vascular (end-to-end and end-to-side procedure or sleeve
technique) and ureteral (bladder patch or end-to-end procedure) anastomosis.
Gender, animal strain, type of anesthesia, prophylactic administration of
antibiotics, and type of flushing solution did not affect the success of renal
allografts. In order to avoid a bias related to the surgical procedure in rat
renal transplantation, a warm ischemia time <30 min in animals with a body
weight >200 g seems to be essential. Also, end-to-end or end-to-side
vascular anastomoses are preferable to the sleeve technique. Other factors do
not influence the immediate function of the graft. N. Ref:: 40
----------------------------------------------------
[92]
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
----------------------------------------------------
[93]
TÍTULO / TITLE: - Long-term outcome of
ABO-incompatible renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):769-80.
AUTORES
/ AUTHORS: - Toma H; Tanabe K; Tokumoto T
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Tokyo Women’s
Medical University, Tokyo, Japan. toma@kc.twmu.ac.jp
RESUMEN
/ SUMMARY: - Based on the long-term experience with
ABO-incompatible kidney transplantation, the following can be concluded: 1.
Renal transplantation across ABO incompatibility is an acceptable treatment for
patients with end-stage renal failure. [table: see text] 2. Long-term patient
and graft survival in ABO-incompatible kidney transplantation is influenced
primarily by acute rejection episodes occurring within 1 year. 3. Despite the
removal of anti-ABO natural antibodies before transplantation, hyperacute
rejection crises may occur in some cases. 4. Humoral rejection is the most
prominent type of rejection in ABO-incompatible renal transplantation. Even
though most of this rejection is controllable with anti-rejection therapy, the
prognosis for a graft that undergoes humoral rejection is significantly poor.
5. The maximum IgG titers of anti-A/B antibody before transplantation may have
a harmful effect on graft acceptance in ABO-incompatible kidney
transplantation. 6. Renal transplantation across ABO incompatibility is
principally the most significant risk factor to affect long-term allograft
function in ABO-incompatible living kidney transplantation. N. Ref:: 24
----------------------------------------------------
[94]
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.
----------------------------------------------------
[95]
TÍTULO / TITLE: - Recurrent autoimmune
hepatitis after liver transplantation: diagnostic criteria, risk factors, and
outcome.
REVISTA
/ JOURNAL: - Liver Transpl 2001 Apr;7(4):285-91.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2001.23085
AUTORES
/ AUTHORS: - Hubscher SG
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Birmingham, Birmingham, UK. s.g.hubscher@bham.ac.uk
RESUMEN
/ SUMMARY: - Approximately 20% to 30% of patients
undergoing liver transplantation for autoimmune hepatitis (AIH) develop
features of recurrent disease. Diagnostic criteria for recurrent AIH are
similar to those used in the nontransplanted liver and include, in varying
combinations, biochemical, serological, and histological abnormalities and
steroid dependency. However, these criteria are more difficult to apply in the
liver allograft because of potential interactions between recurrent AIH and
other complications of liver transplantation, particularly rejection, and the
uncertain effects of long-term immunosuppression. In the absence of other
reliable diagnostic markers, a number of studies have used the histological
finding of chronic hepatitis as the main or sole criterion for diagnosing
recurrent AIH. However, this also lacks diagnostic specificity because there
are many other possible causes of chronic hepatitis in the liver allograft. In
addition, approximately 20% to 40% of biopsies performed on patients as part of
routine annual review have histological features of chronic hepatitis, for
which no definite cause can be identified. Risk factors that have been
associated with the development of recurrent AIH include suboptimal
immunosuppression, HLA phenotype, disease type and severity in the native
liver, and duration of follow up. In many cases in which recurrent AIH seems to
be related to underimmunosuppression, biochemical and histological features
rapidly resolve once adequate immunosuppression is restored. However, in other
cases, recurrent AIH behaves more aggressively, with progression to cirrhosis
and graft failure. Areas that require further study include developing uniform
criteria for the diagnosis of recurrent AIH, identifying risk factors for
severe recurrent disease, and determining optimal levels of immunosuppression
that minimize the impact of disease recurrence without exposing patients to the
risks of overimmunosuppression. N.
Ref:: 58
----------------------------------------------------
[96]
TÍTULO / TITLE: - Conventional treatment
and outcome of Wegener’s granulomatosis and microscopic polyangiitis.
REVISTA
/ JOURNAL: - Cleve Clin J Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.ccjm.org/
●●
Cita: Cleveland Clinic J. of Medicine: <> 2002;69 Suppl 2:SII110-5.
AUTORES
/ AUTHORS: - Jayne DR
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Addenbrooke’s
Hospital, Cambridge, UK. dj106@cam.ac.uk N. Ref:: 68
----------------------------------------------------
[97]
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
----------------------------------------------------
[98]
TÍTULO / TITLE: - Prolonging organ
allograft survival: potential role of nitric oxide scavengers.
REVISTA
/ JOURNAL: - BioDrugs 2002;16(1):37-45.
AUTORES
/ AUTHORS: - Pieper GM; Khanna AK; Roza AM
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, Medical
College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. gmpieper@mcw.edu
RESUMEN
/ SUMMARY: - A growing number of studies suggest a key
role of nitric oxide (NO) derived from the inducible NO synthase (iNOS) isoform
as a signalling molecule leading to acute organ transplant rejection. Current
theory suggests that NO targets certain tissue proteins for nitrosylation or
nitration leading to inhibition of enzyme/protein function and to cell death
via apoptosis. Gene expression of iNOS and formation of nitrotyrosine residues
have been confirmed in biopsies of rejecting grafts in humans. Experimental
attempts to delay graft rejection by treatment with iNOS enzyme inhibitors have
yielded conflicting results. An alternative strategy to alter rejection
mediated by NO is to scavenge and/or neutralise the actions of excess NO,
thereby by-passing the inhibition of iNOS enzyme activity. This review
summarises recent laboratory evidence that new experimental NO
scavengers/neutralisers have potential value to prolong graft survival. To
date, various metal-based NO scavenging/neutralising compounds have been shown
to enhance cardiac allograft survival in the absence of immunosuppression. When
used in combination with low-dose cyclosporin, these agents produce a
synergistic action to enhance graft survival or even to produce “permanent
graft survival” under certain prolonged drug regimens. A portion of this
benefit may be accounted for by the property of some of these compounds to
display immunosuppressant and anti-inflammatory activity in vivo. These
properties are based on findings including the following: (i) attenuating cell
infiltration into the graft; (ii) attenuating activation of NFkappaB (a
transcription factor important for upregulation of various inflammatory genes);
(iii) attenuating cyclin D3 gene expression (a marker of cell proliferation;
(iv) antagonising autoimmune activation (as determined by attenuated cytokine
gene expression in splenocytes isolated from treated animals but stimulated for
several days ex vivo in mixed lymphocyte cultures). N. Ref:: 73
----------------------------------------------------
[99]
TÍTULO / TITLE: - Outcomes in kidney
transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 May;23(3):306-16.
AUTORES
/ AUTHORS: - Djamali A; Premasathian N; Pirsch JD
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and Surgery,
University of Wisconsin Medical School, Madison, WI 53792, USA.
RESUMEN
/ SUMMARY: - It is estimated that there are greater
than 100000 kidney transplant recipients with a functioning graft in the United
States. Recent advances in immunosuppression have improved short-term graft
survival rates and decreased early mortality by decreasing the incidence and
therapy for acute rejection episodes. For those accepted on the waiting list,
transplant prolongs patient survival compared with remaining on dialysis.
During the 1990s, 3 new immunosuppressive drugs were introduced in clinical
kidney transplantation. All were approved for use by the Food and Drug
Administration after large, controlled, randomized trials. Mycophenolate
mofetil (MMF), when combined with cyclosporine (CSA) and prednisone, lowered
acute rejection rates by nearly 50% compared with control. Tacrolimus compared
with CSA also significantly reduced acute rejection rates in kidney transplant
recipients, but was associated with a significant increase in posttransplant
diabetes mellitus (PTDM) in the early trials. When evaluated in combination
with MMF, the incidence of PTDM was much lower. At the end of the decade,
sirolimus was shown in several randomized trials to lower acute rejection rates
and is believed to be less nephrotoxic compared with calcineurin inhibitors.
All of the randomized trials were not statistically powered to assess long-term
superiority. Registry analyses have been performed that appear to show some
long-term benefit of immunosuppressive therapy with MMF. Other outcome
assessments in kidney transplant recipients include risk factors for chronic
allograft nephropathy, hypertension, hyperlipidemia, and bone disease. Although
there are few randomized trials, understanding of the significance of these
common complications has progressed and strategies for therapy and intervention
have been developed. This article focuses on the randomized trials of
immunosuppressive therapy and complications associated with use of these drugs.
In addition, we review the current management and intervention for the
comorbidities associated with the long-term clinical management of the kidney
transplant recipient. N.
Ref:: 78
----------------------------------------------------
[100]
TÍTULO / TITLE: - Marrow vs peripheral
blood: impact on transplant outcome.
REVISTA
/ JOURNAL: - Leukemia 2001 Apr;15(4):686-7.
AUTORES
/ AUTHORS: - Forman SJ
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology and Bone Marrow
Transplantation, City of Hope National Medical Center, Duarte, CA 91010-3000,
USA. N. Ref:: 9
----------------------------------------------------
[101]
TÍTULO / TITLE: - Stem-cell
transplantation in non-Hodgkin’s lymphoma: improving outcome.
REVISTA
/ JOURNAL: - Anticancer Drugs 2002 Nov;13 Suppl
2:S35-42.
AUTORES
/ AUTHORS: - Gianni AM; Berinstein NL; Evans PA;
Lopez-Guillermo A; Solano C
INSTITUCIÓN
/ INSTITUTION: - Division of Medical Oncology and Bone
Marrow Transplant, Milan Cancer Institute, Milan, Italy. Alessandro.Gianni@unimi.it
RESUMEN
/ SUMMARY: - High-dose therapy with stem-cell
transplantation is a potentially curative therapy for younger patients with
relapsed aggressive non-Hodgkin’s lymphoma (NHL) and is also under
investigation in relapsed indolent NHL. There are, however, risks associated
with this treatment strategy. Autologous stem-cell transplantation (ASCT)
continues to be associated with a high risk of relapse, while graft-versus-host
disease is a major limiting factor with allogeneic stem-cell transplantation.
The presence of minimal residual disease (MRD) in the harvested, re-infused
stem cells, or remaining in the patient following chemotherapy, is associated
with relapse after ASCT. As a result, monitoring and eradicating MRD has become
a major focus of many studies in NHL. Rearrangement and overexpression of the
bcl-1 and bcl-2 genes are the hallmarks of mantle-cell and follicular lymphoma,
respectively, and evidence suggests that they are promising surrogate markers
of MRD. Polymerase chain reaction analysis is a sensitive methodology used to
monitor the status of occult lymphoma cells bearing these genetic aberrations,
and results from trials of ASCT have shown that clearance of bcl-1/JH- and
bcl-2/JH-positive cells following treatment is associated with a significant
improvement in outcome. Rituximab, the anti-CD20 monoclonal antibody, is
increasingly used for in vivo purging and can effectively eradicate bcl-1/JH-
and bcl-2-positive cells. If the encouraging preliminary results with rituximab
are maintained with a longer follow-up, this agent could play a pivotal role in
improving outcome after stem-cell transplantation in NHL. N. Ref:: 29
----------------------------------------------------
[102]
TÍTULO / TITLE: - Clinical outcomes in
juvenile dermatomyositis.
REVISTA
/ JOURNAL: - Curr Opin Rheumatol 2002 Nov;14(6):658-62.
AUTORES
/ AUTHORS: - Ramanan AV; Feldman BM
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology, Department of
Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
RESUMEN
/ SUMMARY: - Juvenile dermatomyositis is a chronic
inflammatory illness of unknown etiology that affects primarily muscle and
skin. It has an incidence of 2-3 per 1,000,000, per year. The disease can
affect other organ systems, including the gastrointestinal tract, lungs, and
heart. In addition, calcinosis is seen in one-third of patients. The mainstay
of therapy is corticosteroids; some children require additional
immunosuppressive agents because of corticosteroid resistance or intolerance.
Functional outcomes have become good with modern treatments, but the disease
remains chronic in a large number of children and sequelae are often seen. N. Ref:: 41
----------------------------------------------------
[103]
TÍTULO / TITLE: - Promising early
outcomes with a novel, complete steroid avoidance immunosuppression protocol in
pediatric renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Jul 15;72(1):13-21.
AUTORES
/ AUTHORS: - Sarwal MM; Yorgin PD; Alexander S; Millan
MT; Belson A; Belanger N; Granucci L; Major C; Costaglio C; Sanchez J; Orlandi
P; Salvatierra O Jr
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Stanford University
Medical Center, 703 Welch Road, Suite H-5, Palo Alto, CA 94304, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Corticosteroids have been a
cornerstone of immunosuppression for four decades despite their adverse side
effects. Past attempts at steroid withdrawal in pediatric renal transplantation
have had little success. This study tests the hypothesis that a complete
steroid-free immunosuppressive protocol avoids steroid dependency for
suppression of the immune response with its accompanying risk of acute
rejection on steroid withdrawal. METHODS: An open labeled prospective study of
complete steroid avoidance immunosuppressive protocol was undertaken in 10
unsensitized pediatric recipients (ages 5-21 years; mean 14.4 years) of first
renal allografts. Steroids were substituted with extended daclizumab use, in
combination with tacrolimus and mycophenolate mofetil. Protocol biopsies were
performed in the steroid-free group at 0, 1, 3, 6, and 12 months
posttransplantation. Clinical outcomes were compared to a steroid-based group
of 37 matched historical controls. RESULTS: Graft and patient survival was 100%
in both groups. Clinical acute rejection was absent in the steroid-free group
at a mean follow-up time of 9 months (range 3-13.7 months). Protocol biopsies
in the steroid-free group (includes 10 patients at 3 months, 7 at 6 months, and
4 at 12 months) revealed only two instances of mild (Banff 1A) subclinical
rejection (reversed by only a nominal increase in immunosuppression) and no
chronic rejection. At 6 months the steroid-free group had no hypertension
requiring treatment (P=0.003), no hypercholesterolemia (P=0.007), and
essentially no body disfigurement (P=0.0001). Serum creatinines, Schwartz GFR,
and mean delta height Z scores trended better in the steroid-free group. In the
steroid-free group, one patient had cytomegalovirus disease at 1 month and
three had easily treated herpes simplex stomatitis, but with no significant
increase in bacterial infections or rehospitalizations over the steroid-based
group. The steroid-free group was more anemic early posttransplantation
(P=0.004), suggesting an early role of steroids in erythrogenesis;
erythropoietin use normalized hematocrits by 6 months. CONCLUSIONS: Complete
steroid-free immunosuppression is efficacious and safe in this selected group
of children with no early clinical acute rejection episodes. This protocol
avoids the morbid side effects of steroids without increasing infection, and
may play a future critical role in avoiding noncompliance, although optimizing
renal function and growth.
----------------------------------------------------
[104]
TÍTULO / TITLE: - Outcomes research in
glomerulonephritis.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 Jul;23(4):340-54.
AUTORES
/ AUTHORS: - Cattran DC
INSTITUCIÓN
/ INSTITUTION: - University of Toronto, Department of
Medicine, Toronto General Hospital, University Health Network, Ontario, Canada.
daniel.cattran@uhn.on.ca
RESUMEN
/ SUMMARY: - Glomerulonephritis remains the second or
third most common primary renal disease type to progress to end-stage renal
failure. This disease type is particularly important because its focus is
limited to the kidney and its reversal or stabilization ensures a return to a
normal quality of life for the individual. Also, because its highest incidence
rate is in childhood and early adulthood, the implications of effective therapy
in terms of preventing end-stage renal failure costs, benefits not only the
individual but also society. We focus on the 3 most common variants that
progress to end-stage renal failure (ie, membranous nephropathy [MGN], focal
segmental glomerulosclerosis [FSGS], and IgA nephropathy). Together these
represent approximately 80% of the primary glomerular diseases known to
progress. We discuss the outcome studies published over the past decade in
these disorders that permit the best insight into specific immunotherapy. We
provide this data in an evidence-based model so the reader can appreciate the
strengths and/or weaknesses of the therapies discussed and we provide a
framework for clinical management. N.
Ref:: 59
----------------------------------------------------
[105]
TÍTULO / TITLE: - Cervical spinal
stenosis: outcome after anterior corpectomy, allograft reconstruction, and
instrumentation.
REVISTA
/ JOURNAL: - J Neurosurg 2002 Jan;96(1 Suppl):10-6.
AUTORES
/ AUTHORS: - Mayr MT; Subach BR; Comey CH; Rodts GE;
Haid RW Jr
INSTITUCIÓN
/ INSTITUTION: - Department of Neurosurgery, Spine Section,
Emory University School of Medicine and the Emory Clinic, Atlanta, Georgia
30322, USA.
RESUMEN
/ SUMMARY: - OBJECT: The authors undertook a
retrospective single-institution review of 261 patients who underwent anterior
cervical corpectomy, reconstruction with allograft fibula, and placement of an
anterior plating system for the treatment of cervical spinal stenosis to assess
fusion rates and procedure-related complications. METHODS: Between October 1989
and June 1995, 261 patients with cervical stenosis underwent cervical
corpectomy, allograft fibular bone fusion, and placement of instrumentation for
spondylosis (197 patients), postlaminectomy kyphosis (27 patients), acute
fracture (25 patients), or ossification of the posterior longitudinal ligament
(12 patients). All patients suffered neck pain and cervical myelopathy or
radiculopathy refractory to medical management. Of the procedures, 133 involved
a single vertebral level (two disc levels and one vertebral body), 96 involved
two levels, 31 involved three levels, and a single patient underwent a
four-level procedure. Clinical and radiographic outcomes were assessed
postoperatively and at 6-month intervals. The mean follow-up period was 25.7
months (range 24-47 months). Successful fusion was documented in 226 patients
(86.6%). A stable, fibrous union developed in 33 asymptomatic patients (12.6%),
whereas an unstable pseudarthrosis in two patients (0.8%) required reoperation.
There were no cases of infection, spinal fluid leakage, or postoperative
hematoma. Complications included transient unilateral upper-extremity weakness
(two patients), dysphagia (35 transient and seven permanent), and hoarseness
(35 transient and two permanent). In 14 patients (5.4%) radiological studies
demonstrated evidence of hardware failure. CONCLUSIONS: Cervical corpectomy
with fibular allograft reconstruction and anterior plating is an effective
means of achieving spinal decompression and stabilization in cases of anterior
cervical disease. Symptomatic improvement was achieved in 99.2% of patients. In
their series the authors found a fusion rate of 86.6% and rates of permanent
hoarseness of 3.4%, dysphagia of 0.7%, and an instrumentation failure rate of
5.4%. N. Ref:: 49
----------------------------------------------------
[106]
TÍTULO / TITLE: - Monitoring of
mycophenolic acid in clinical transplantation.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):68-73.
AUTORES
/ AUTHORS: - Shaw LM; Pawinski T; Korecka M; Nawrocki A
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, University of Pennsylvania Medical Center, Philadelphia,
Pennsylvania, USA. shawlmj@mail.med.upenn.edu N. Ref:: 40
----------------------------------------------------
[107]
TÍTULO / TITLE: - Current issues in
therapeutic drug monitoring of mycophenolic acid: report of a roundtable discussion.
REVISTA
/ JOURNAL: - Ther Drug Monit 2001 Aug;23(4):305-15.
AUTORES
/ AUTHORS: - Shaw LM; Holt DW; Oellerich M; Meiser B;
van Gelder T
INSTITUCIÓN
/ INSTITUTION: - University of Pennsylvania Medical Center,
Philadelphia, Pennsylvania, USA. shawlmj@mail.med.upenn.edu N. Ref:: 52
----------------------------------------------------
[108]
TÍTULO / TITLE: - Two-hour cyclosporine
concentration determination: an appropriate tool to monitor neoral therapy?
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):40-6.
AUTORES
/ AUTHORS: - Oellerich M; Armstrong VW
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Chemistry,
Georg-August University, Gottingen, Germany. moeller@med.uni-goettingen.de
RESUMEN
/ SUMMARY: - Cyclosporine is a critical dose drug for
which individualisation by therapeutic drug monitoring is indisputable. Current
evidence suggests that a single concentration (C2) taken two hours after
cyclosporine administration with the microemulsion formulation better predicts
exposure and events than the trough concentration (C(0)), which is routinely
used for adjusting the dosage of this drug. Studies have shown that the
greatest calcineurin inhibition and the maximum inhibition of IL-2 production
occur in the first 1 to 2 hours after dosing. These findings support the
concept that the C2 level better reflects immunosuppressive efficacy than the
trough concentration. Preliminary data from an outcome study in liver
transplant recipients have shown that the incidence of biopsy proven moderate
to severe acute rejection was significantly lower in patients managed by C2
monitoring compared with those monitored by C(0). The critical importance of
achieving adequate cyclosporine exposure during the first 3 to 5 posttransplant
days to prevent acute rejection has been documented in prospective studies with
de novo renal and liver transplant recipients. Conversion of maintenance liver
and heart transplant patients to C2 monitoring resulted in an amelioration of
renal function. Time-dependent target values have been proposed for liver and
renal transplant recipients. These require further prospective validation. For
routine monitoring of C2 levels on-site validated dilution guidelines are
necessary for most of the available immunoassays. C2 monitoring necessitates
further organizational requirements which may be judged differently between
transplant centers. In particular during the early posttransplant period C2
monitoring is a promising new option to make immunosuppressive therapy with the
microemulsion formulation of cyclosporine safer and more efficient. N. Ref:: 38
----------------------------------------------------
[109]
TÍTULO / TITLE: - Drug-induced thrombotic
microangiopathy: incidence, prevention and management.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2001;24(7):491-501.
AUTORES
/ AUTHORS: - Pisoni R; Ruggenenti P; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Kidney Research, Mario Negri
Institute for Pharmacological Research, Bergamo, Italy.
RESUMEN
/ SUMMARY: - The term thrombotic microangiopathy (TMA)
describes syndromes characterised by microangiopathic haemolytic anaemia,
thrombocytopenia and variable signs of organ damage due to platelet thrombi in
the microcirculation. In children, infections with Shigella dysenteriae type 1
or particular strains of Escherichia coli are the most common cause of TMA; in
adults, a variety of underlying causes have been identified, such as bacterial
and viral infections, bone marrow and organ transplantation, pregnancy, immune
disorders and certain drugs. Although drug-induced TMA is a rare condition, it
causes significant morbidity and mortality. Antineoplastic therapy may induce TMA.
Most of the cases reported are associated with mitomycin. TMA has also been
associated with cyclosporin, tacrolimus, muromonab-CD3 (OKT3) and other drugs
such as interferon, anti-aggregating agents (ticlopidine, clopidogrel) and
quinine. The early diagnosis of drug-induced TMA may be vital. Strict
monitoring of renal function, urine and blood abnormalities, and arterial
pressure has to be performed in patients undergoing therapy with potentially
toxic drugs. The drug must be discontinued immediately in the case of suspected
TMA. Treatment modalities sometimes effective in other forms of TMA have been
used empirically. Although plasma exchange therapy seems to be of value, the
effectiveness of this approach has yet to be proved in multicentre, randomised
clinical studies. N.
Ref:: 113
----------------------------------------------------
[110]
TÍTULO / TITLE: - Immunosuppressant
drugs—the role of therapeutic drug monitoring.
REVISTA
/ JOURNAL: - Br J Clin Pharmacol 2001;52 Suppl
1:61S-73S.
AUTORES
/ AUTHORS: - Johnston A; Holt DW
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pharmacology, St
Bartholomew’s and The Royal London School of Medicine and Dentistry,
Charterhouse Square, London EC1M 6BQ, UK. A.Johnston@mds.qmw.ac.uk N. Ref:: 164
----------------------------------------------------
[111]
TÍTULO / TITLE: - HLA-specific
alloantibodies and renal graft outcome.
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 May;16(5):897-904.
AUTORES
/ AUTHORS: - Sumitran-Holgersson S
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Immunology,
Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden.
RESUMEN
/ SUMMARY: - HLA-specific humoral immunity, as a result
of recipient allosensitization, induces hyperacute rejection of allogenic
kidney grafts. Cross-match tests are performed to avoid this complication.
However, current techniques do not allow determination of HLA-specificity of
donor-reactive antibodies in the acute cadaver-donor situation. New methods are
described and discussed in this report as well as the alloantibody
specificities that are of clinical importance. Alloantibodies not only mediate
hyperacute rejection but may also participate in the acute rejection of organ
grafts. Clinical associations between early immunological complications, such
as acute rejection, in heart, liver and kidney allografted patients and
pre-transplantation humoral alloimmunity emphasize the need for proper
determination of donor-specific humoral immunity prior to transplantation. N. Ref:: 35
----------------------------------------------------
[112]
TÍTULO / TITLE: - How pharmacokinetic and
pharmacodynamic drug monitoring can improve outcome in solid organ transplant
recipients.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):211-4.
AUTORES
/ AUTHORS: - Klupp J; Holt DW; van Gelder T
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Charite, Virchow,
Berlin, Germany.
RESUMEN
/ SUMMARY: - Within the field of solid organ
transplantation there is an unprecedented interest in therapeutic drug monitoring
of immunosuppressive drugs. Ideally therapeutic drug monitoring should
cost-effectively lead to improved efficacy of the drug and to a reduction in
side effects. Therapeutic drug monitoring will be most effective if there is a
large interpatient variability and a small intrapatient variability.
Therapeutic drug monitoring in transplantation is largely based on correlations
between drug concentrations and toxicity or between drug concentrations and
efficacy. Pharmacodynamic monitoring of immunosuppressive drugs has not reached
the stage of widespread clinical application. In part this is caused by the
fact that most of the pharmacodynamic assays are time-consuming, costly and in
some cases only give a result after several days of incubation. Another reason
for the limited interest in pharmacodynamic monitoring is the lack of data
showing improved outcome if dose adjustment is based on pharmacodynamics rather
than pharmacokinetics. On the other hand, such data are also lacking for
pharmacokinetic monitoring. Prospective investigations on the contribution of
therapeutic drug monitoring may result in further improvement of the safety and
efficacy of our immunosuppressive regimens and more refined methods for
therapeutic drug monitoring. There is no contest between pharmacokinetic and
pharmacodynamic monitoring. Most likely the results of both ways of monitoring
will be complementary. N.
Ref:: 40
----------------------------------------------------
[113]
TÍTULO / TITLE: - Alpha-hemolytic
streptococcal infections among immunocompromised hosts: increasing incidence,
severity and antibiotic resistance.
REVISTA
/ JOURNAL: - Pediatr Infect Dis J 2002 Apr;21(4):343-5.
AUTORES
/ AUTHORS: - Bruckner L; Gigliotti F
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Rochester, NY, USA. N.
Ref:: 15
----------------------------------------------------
[114]
TÍTULO / TITLE: - The paradox of survival
results after heart transplantation for cardiomyopathy caused by Trypanosoma
cruzi. First Guidelines Group for Heart Transplantation of the Brazilian
Society of Cardiology.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2001 Jun;71(6):1833-8.
AUTORES
/ AUTHORS: - Bocchi EA; Fiorelli A
INSTITUCIÓN
/ INSTITUTION: - Brazilian Society of Cardiology, Sao
Paulo. dcledimar@incor.usp.br
RESUMEN
/ SUMMARY: - BACKGROUND: Donor supply limits heart
transplantation (HT) and relative priority should be given to cases with
greater chances of success. The objectives of this multicenter study were (1)
to determine the survival rate after heart transplantation for patients with
Chagas’ heart disease (ChHD) in comparison with other causes; and (2) to
identify the causes of death specifically due to reactivation of the
Trypanosoma cruzi infection. METHODS: We studied 720 patients who had undergone
orthotopic heart transplantation and were followed in 16 heart transplantation
centers. The etiology was idiopathic dilated cardiomyopathy in 407 patients,
ischemic cardiomyopathy in 196 patients, and ChHD in 117 patients. RESULTS:
Follow-up was 2.87 +/- 3.05 years (from 1 month to 13.85 years). Survival of
ischemic recipients at 1, 4, 8, and 12 years was 59%, 44%, 34%, and 22%,
respectively; for idiopathic dilated cardiomyopathy it was 69%, 57%, 40%, and
32%; and for ChHD it was 71%, 57%, 55%, and 46% (p < 0.027). In ischemic
recipients the most frequent causes of death were infection (15.3%), acute
graft failure (13.3%), and graft coronary artery disease/sudden death (7.7%).
In idiopathic dilated cardiomyopathy the causes were infection (11.1%),
rejection (9.6%), and acute graft failure (9.1%). In ChHD the causes were
infection (10.3%), rejection (10.3%), and neoplasm (4.3%). In ChHD,
reactivation of the cruzi infection was the cause of death in 2 patients.
CONCLUSIONS: The survival results after heart transplantation are paradoxical
according to the usually high expected death rates for Chagas’ disease. Heart
transplantation for ChHD should be regarded as a valuable treatment option.
----------------------------------------------------
[115]
TÍTULO / TITLE: - Survival pathways and
preconditioning in liver transplantation.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):239-41.
AUTORES
/ AUTHORS: - Dufour JF; Redaelli C
INSTITUCIÓN
/ INSTITUTION: - Institute for Clinical Pharmacology,
University of Bern, Switzerland. jf.dufour@ikp.unibe.ch N. Ref:: 24
----------------------------------------------------
[116]
TÍTULO / TITLE: - Improving the outcome
of unrelated donor stem cell transplantation by molecular matching.
REVISTA
/ JOURNAL: - Blood Rev 2001 Dec;15(4):167-74.
●●
Enlace al texto completo (gratuito o de pago) 1054/blre.2001.0163
AUTORES
/ AUTHORS: - Shaw BE; Madrigal JA; Potter M
INSTITUCIÓN
/ INSTITUTION: - Anthony Nolan Research Institute,
Hampstead, UK. bshaw@hgmp.mrc.ac.uk
RESUMEN
/ SUMMARY: - Volunteer unrelated donor (VUD) stem cell
transplantation is now a well-established procedure in the treatment for many
haematological and other disorders. The improved success of this modality of
treatment is related, in part, to the existence of large volunteer donor
registries (with well characterized tissue typing), as well as to the improved
understanding of the molecular factors that have an influence on
transplantation outcome. It is clear that close attention to human leukocyte
antigen (HLA) matching is essential in ensuring a satisfactory transplant
outcome, however the extent to which donor-recipient pairs need to be matched
is not yet clear. There is also an increased understanding that factors other
than HLA do affect clinical outcome. The ability to perform high resolution
molecular typing techniques has allowed researchers to begin assessing the
significance of mismatches at particular loci against an otherwise matched
background, and in this way highlight the effects of individual genetic factors
on transplantation outcome. N.
Ref:: 63
----------------------------------------------------
[117]
TÍTULO / TITLE: - African Americans and
renal transplantation: disproportionate need, limited access, and impaired
outcomes.
REVISTA
/ JOURNAL: - Am J Med Sci 2002 Feb;323(2):94-9.
AUTORES
/ AUTHORS: - Young CJ; Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Alabama at Birmingham, 35294-0006, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Renal transplantation is the
therapy of choice for patients with end-stage renal disease (ESRD). However,
African Americans’ (AA) access to this modality is not commensurate with that
of other races. This imbalance, coupled with AA disproportionately representing
those with ESRD, has kept AA disadvantaged compared with other races,
especially whites. METHODS: We reviewed published reports that examined the
connection between race and the incidence of chronic renal failure, access to
optimal therapy, and outcomes of renal transplantation. RESULTS: The incidence
of ESRD in AA is 4 times greater than in whites, but AA remain less likely than
whites to be referred for or undergo renal transplantation. Also, AA are at
greater risk than whites to experience premature graft failure. CONCLUSIONS:
ESRD management has improved dramatically with the advent of successful renal
transplantation. However, AA remain significantly disadvantaged in both access
and outcomes compared with whites. Further evaluation of underlying causes and
development of specific remedies is warranted.
N. Ref:: 81
----------------------------------------------------
[118]
TÍTULO / TITLE: - Intensive care and
immediate follow-up of children after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2821-4.
AUTORES
/ AUTHORS: - Seikaly MG; Sanjad SA
INSTITUCIÓN
/ INSTITUTION: - Children’s Medical Center of Dallas,
Nephrology Office, Dallas, Texas, USA. N.
Ref:: 16
----------------------------------------------------
[119]
TÍTULO / TITLE: - Retransplantation for
hepatic allograft failure: prognostic modeling and ethical considerations.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Apr;8(4):313-22.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.31746
AUTORES
/ AUTHORS: - Biggins SW; Beldecos A; Rabkin JM; Rosen
HR
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Portland Veterans
Affairs Medical Center and Oregon Health Sciences University, Portland, OR
97207, USA.
RESUMEN
/ SUMMARY: - Retransplantation already accounts for 10%
of all liver transplants performed, and this percentage is likely to increase
as patients live long enough to develop graft failure from recurrent disease.
Overall, retransplantation is associated with significantly diminished survival
and increased costs. This review summarizes the current causes of graft failure
after primary liver transplant, prognostic models that can identify the subset
of patients for retransplantation with outcomes comparable to primary
transplantation, and ethical considerations in this setting, i.e.,
outcomes-based versus urgency-based approaches. N. Ref:: 57
----------------------------------------------------
[120]
TÍTULO / TITLE: - Therapeutic drug
monitoring for immunosuppressants.
REVISTA
/ JOURNAL: - Clin Chim Acta 2001 Nov;313(1-2):241-53.
AUTORES
/ AUTHORS: - Wong SH
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Medical College
of Wisconsin, and Dynacare Laboratories, Milwaukee, WI 53206, USA. shwong@mcw.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Immunosuppressants have
significantly increased patient survival, e.g. in renal transplant up to 90%
for the first year. METHODS: Four immunosuppressants are used for clinical
applications in the United States: cyclosporine (CsA) (Sandimmune and Neoral),
FK 506-tacrolimus (ProGraf), mycophenolic mofetil (CellCept)--the prodrug for
the mycophenolic acid (MPA), and rapamycin (RAPA) (Sirolimus). For CsA and FK
506, the rationale for monitoring is due to the variable pharmacokinetics,
acute infection, dosage adjustment, non-compliance check, and for long-term
maintenance therapy. Targeted whole blood concentrations ranges are: for CsA,
100-400 ng/ml depending on the methods, therapy and organs; and for FK 506,
5-20 ng/ml. For MPA, drug bioavailability—the plasma area-under-curve up to 12
h of 32.2-60.6 mg h/l was correlated to the biopsy-proven rejection rate of
<10%. Monitoring is advocated for liver and renal transplants, for
pediatrics, and for checking for non-compliance. RAPA monitoring is useful to
check for variable pharmacokinetics, for non-compliance and others. The therapeutic
range is tentatively targeted for 5-15 ng/ml. Monitoring methodologies are: for
CsA, immunoassays such as fluorescence polarization immunoassay, and liquid
chromatography (LC); for FK 506, microparticle enzyme immunoassay (MEIA); for
MPA, enzyme multiplied immunoassay and LC; and for RAPA, MEIA, LC and LC-mass
spectrometry. Proficiency survey programs for CsA and FK 506 are available from
the US and Europe. CONCLUSIONS: Monitoring of immunosuppressants has become an
essential adjunct to the drug therapy for organ transplant patients. N. Ref:: 93
----------------------------------------------------
[121]
TÍTULO / TITLE: - Improved outcome with
organs from carbon monoxide poisoned donors for intrathoracic transplantation.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2001 Sep;72(3):709-13.
AUTORES
/ AUTHORS: - Luckraz H; Tsui SS; Parameshwar J;
Wallwork J; Large SR
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit Papworth Hospital,
Papworth Everard, Cambridgeshire, United Kingdom. heyman.luckraz@papworth-tr.anglox.nhs.uk
RESUMEN
/ SUMMARY: - BACKGROUND: The success of intrathoracic
organ transplantation has lead to a growing imbalance between the demand and
supply of donor organs. Accordingly, there has been an expansion in the use of
organs from nonconventional donors such as those who died from carbon monoxide
poisoning. We describe our experience with 7 patients who were transplanted
using organs after fatal carbon monoxide poisoning. METHODS: A retrospective
study of the 1,312 intrathoracic organ transplants between January 1979 and
February 2000 was completed. Seven of these transplants (0.5%) were fulfilled
with organs retrieved from donors after fatal carbon monoxide poisoning. There
were six heart transplants and one single lung transplant. The history of
carbon monoxide inhalation was obtained in all of these donors. RESULTS: Five
of 6 patients with heart transplant are alive and well with survival ranging
from 68 to 1,879 days (mean, 969 +/- 823 days). One patient (a 29-year-old
male) died 12 hours posttransplant caused by donor organ failure. The patient
who had a right single lung transplant did well initially after the transplant,
but died after 8 months caused by Pneumocystis carinii pneumonia. All those
recipients who were transplanted from carbon monoxide poisoned donors and
ventilated for more than 36 hours, survived for more than 30 days. Moreover,
these donors were assessed and optimized by the Papworth donor management
protocol. CONCLUSIONS: Carbon monoxide poisoned organs can be considered for
intrathoracic transplantation. In view of the significant risk of donor organ
failure, a cautious approach is still warranted. Ideally, the donor should be
hemodynamically stable for at least 36 hours from the time of poisoning and on
minimal support. A formal approach of invasive monitoring and active management
further improves the chances of successful outcome. N. Ref:: 33
----------------------------------------------------
[122]
TÍTULO / TITLE: - Hepatitis C and the
incidence of diabetes mellitus after renal transplant: influence of new
immunosuppression protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Aug;35(5):1748-50.
AUTORES
/ AUTHORS: - Gentil MA; Lopez M; Gonzalez-Roncero F;
Rodriguez-Algarra G; Pereira P; Lopez R; Martinez M; Toro J; Mateos J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital
Universitario Virgen del Rocio, Sevilla, España.
RESUMEN
/ SUMMARY: - BACKGROUND: Hepatitis C has been
associated with an increased incidence of diabetes mellitus (DM) following
renal transplantation (RT). METHODS: Patients who underwent RT between 1985 and
2001 were excluded if they showed DM prior to RT, graft survival of less than
90 days, and unknown anti-HCV status (n=15). Two groups (G1 and G2) were
distinguished according to the immunosuppressive regimen: G1 (transplanted
1985-1996) received steroids, azathioprine, and cyclosporine (n=330), whereas
G2 (1997-2000) received new drugs in several combinations (MMF in 87% and/or
tacrolimus in 35% [n=240]). Patients with HCV antibodies pre- and/or post-RT
were considered HCV-positive. Post-RT DM requiring prolonged treatment with
oral antidiabetics or insulin (>1 month) was assessed using Kaplan-Meier
curves and Cox analysis. RESULTS: G2 patients were significantly older, had a
greater body mass index (BMI), and suffered significantly less from acute
rejection episodes during the first year than G1 patients. Furthermore, fewer
required maintenance steroids. HCV-positivity was more common in G1 than in G2
(n=96, 29.1% vs n=27, 11.3%). Six G2 patients were successfully treated with
interferon pre-RT, achieving negative PCR-HCV status (maintained post-RT). DM
incidence at 4 years was similar in G1 and G2 (8.8% and 8.2%). G1 HCV-positive
patients showed a greater risk of developing DM than HCV-negative patients
(28.0% vs 6.2% at 10 years; P=001). In G1, multivariate analysis showed that
age, BMI, and HCV-positivity were significant risk factors predicting DM
(relative risk, 5.7; 95% confidence interval 2.7-12). In G2 patients, HCV was
not associated with an increased risk of DM; in the multivariate analysis only
age appeared to be a risk factor. CONCLUSIONS: The reported relationship
between hepatitis C and post-RT DM was not observed among patients receiving
new immunosuppressive treatments. Confirmation of this finding requires
extended follow up. The reduced use of steroids and effective pre-RT use of
interferon may also be responsible for the benefit.
----------------------------------------------------
[123]
TÍTULO / TITLE: - Cyclosporine
therapeutic drug monitoring.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):3003-5.
AUTORES
/ AUTHORS: - Jensen SA; Dalhoff KP
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pharmacology,
Rigshospitalet, Copenhagen, Denmark. sastrup@rh.dk N. Ref:: 36
----------------------------------------------------
[124]
TÍTULO / TITLE: - Outcome of renal
transplantation in fibrillary glomerulonephritis.
REVISTA
/ JOURNAL: - Clin Nephrol 2001 Feb;55(2):159-66.
AUTORES
/ AUTHORS: - Samaniego M; Nadasdy GM; Laszik Z; Nadasdy
T
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Johns Hopkins
University Baltimore, Maryland, USA.
RESUMEN
/ SUMMARY: - Fibrillary glomerulonephritis (FGN) is a
rare but progressive glomerular disease usually with end-stage renal disease
(ESRD) developing within months or few years following the diagnosis. Little is
known about the outcome of renal transplantation in patients with ESRD due to
FGN. We report four patients with FGN who received renal allografts. Two
patients developed recurrent FGN in their grafts. One patient was diagnosed to
have recurrent FGN 9 years post-transplant, and lost his graft 4 years
thereafter. Another patient had recurrent disease 2 years post-transplant but
has stable graft function after 7 years. One patient died with normal renal
allograft function 7 years following transplantation. The fourth patient has
chronic transplant nephropathy 34 months post-transplant without evidence of
recurrent FGN. A literature review revealed 10 additional patients who received
11 renal allografts due to ESRD caused by FGN. Four of these 10 patients had
biopsy-proven recurrence (one patient in two subsequent grafts), but this
caused graft loss only in 2 patients 56 months and 7 years post-transplant,
respectively. The earliest recurrence was diagnosed 2 years post-transplant. We
conclude that although the recurrence rate of FGN in renal transplants is high
(around 50%), the recurrent disease has a relatively benign course and
prolonged graft survival is possible. N.
Ref:: 16
----------------------------------------------------
[125]
TÍTULO / TITLE: - Pediatric heart
transplantation.
REVISTA
/ JOURNAL: - Curr Opin Pediatr 2002 Oct;14(5):611-9.
AUTORES
/ AUTHORS: - Boucek Jr RJ; Boucek MM
INSTITUCIÓN
/ INSTITUTION: - All Children’s Hospital, University of
South Florida, St. Petersburg, Florida, 33701, USA. boucekr@allkids.org
RESUMEN
/ SUMMARY: - Heart transplantation is now a treatment
option with good outcome for infants and children with end-stage heart failure
or complex, inoperable congenital cardiac defects. One-year and 5-year
actuarial survival rates are high, approximately 75% and 65%, respectively,
with overall patient survival half-life greater than 10 years. To date,
survival has been improving as a result of reducing early mortality. Further
reductions in late mortality, in part because of graft coronary artery disease
and rejection, will allow achievement of the goal of decades-long survival.
Quality of life in surviving children, as judged by activity, is usually
“normal.” Somatic growth is usually at the low normal range but linear growth
can be reduced. Of infant recipients, 85% evaluated at 6 years of age or older
were in an age-appropriate grade level. Long-term management of childhood heart
recipients requires the collaboration of transplant physicians, given the
increasing number of immunosuppressive agents and the balance between rejection
and infection. Currently, recipients are maintained on immunosuppressive
medications that target calcineurin (eg, cyclosporine, tacrolimus), lymphocyte
proliferation (eg, azathioprine, mycophenolate mofetil [MMF], sirolimus) and,
in some instances antiinflammatory corticosteroids. Emerging evidence now
suggests a favorable immunologic opportunity for transplantation in childhood
and, conversely, a higher mortality rate in children who have had prior cardiac
surgery. Further studies are needed to define age-dependent factors that are
likely to play a role in graft survival and possible graft-specific tolerance
(eg, optimal conditions for tolerance induction and how immunosuppressive
regimens should be changed with maturation of the immune system). As late
outcomes continue to improve, the need for donor organs likely will increase,
as transplantation affords a better quality and duration of life for children
with complex congenital heart disease, otherwise facing a future of multiple
palliative operations and chronic heart failure. N. Ref:: 63
----------------------------------------------------
[126]
TÍTULO / TITLE: - Living donor lung
transplantation: selection, technique, and outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3527-32.
AUTORES
/ AUTHORS: - Barr ML; Baker CJ; Schenkel FA; Bowdish
ME; Bremner RM; Cohen RG; Barbers RG; Woo MS; Horn MV; Wells WJ; Starnes VA
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiothoracic Surgery,
University of Southern California, Los Angeles, California 90033, USA. N. Ref:: 5
----------------------------------------------------
[127]
TÍTULO / TITLE: - New concepts in
cyclosporine monitoring.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):619-26.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040047.33359.86
AUTORES
/ AUTHORS: - Keown PA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
British Columbia, Vancouver, Canada. keown@interchange.ubc.ca
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Inadequate cyclosporine
exposure is a key risk factor for acute rejection, and may contribute to the
development of chronic rejection and graft failure. Pre-dose monitoring does
not accurately measure drug exposure because of extensive inter- and
intra-patient variability in cyclosporine absorption and metabolism. Limited
sampling, using individual timed specimens, offers a new, simple and accurate
alternative for clinical monitoring of cyclosporine. RECENT FINDINGS: The area
under the first 4 h of the concentration-time curve (AUC ) and the single-point
concentration at 2 h post-dose (C2) are key measures of cyclosporine exposure.
De novo studies show that achieving an AUC value of more than 4400 microg.h/l
or a C2 level of 1500-2000 microg/l during the first 5 days post-transplant
minimizes the risk of rejection and improves graft function. Maintenance
studies suggest that reducing the C2 level to approximately 800 microg/l after
3-6 months may improve the serum creatinine level, blood pressure, general
well-being and reduce adverse effects. SUMMARY: Single-point C2 monitoring can
be implemented quickly and simply with appropriate site and patient training.
The timing of phlebotomy is more critical, but immunoassay bias is lower with 2
h post-dose than with trough level measures. Single-point C2 monitoring may be
effective in liver and heart replacement, but initial target levels for liver
transplantation are lower because cyclosporine is transported directly to the
liver via the portal system. C2 monitoring is now being widely adopted as an
accurate and practical measure of drug exposure, and can be combined with pharmacodynamic
methods to optimize immunosuppression. N.
Ref:: 76
----------------------------------------------------
[128]
TÍTULO / TITLE: - Small bowel
transplantation: selection criteria, operative techniques, advances in specific
immunosuppression, prognosis.
REVISTA
/ JOURNAL: - Curr Opin Pediatr 2001 Oct;13(5):425-8.
AUTORES
/ AUTHORS: - Kaufman SS
INSTITUCIÓN
/ INSTITUTION: - Recanti/Miller Transplantation Institute,
Mount Sinai Hospital, Mount Sinai School of Medicine, New York, New York 10029-6574,
USA. stuart.kaufman@mountsinai.org
RESUMEN
/ SUMMARY: - Intestinal transplantation is now an
accepted therapy for intestinal failure when parenteral nutrition therapy
cannot be tolerated. During the past year, evidence has been provided
indicating that neither stomach nor colon need to be included in the
transplant, even if a primary motility disorder is the indication for surgery.
The liver should be included in the composite allograft when there are clinical
indications of portal hypertension resulting from parenteral nutrition
associated cholestasis. When liver disease develops, operations intended to
improve gut function should be avoided in preference of early listing for
transplantation. During the past year, initial attempts at adult to child
intestinal transplantation were carried out with some success; reduction in the
diameter of the adult donor bowel may not be uniformly necessary. New
immunosuppressive therapies have been employed recently, but few have been
subjected to peer review. Experimental models have clarified the pathology, if
not the immunobiology, of chronic intestinal allograft rejection and the
ability of the liver to promote tolerance of a cotransplanted intestinal allograft.
Treatment of posttransplant lymphoproliferative disease has been augmented by
the use of anti-CD 20 antibody that targets Epstein-Barr virus infected B-cells
for destruction with high specificity. N.
Ref:: 18
----------------------------------------------------
[129]
TÍTULO / TITLE: - Pre- and posttransplant
immunologic monitoring: why, when, and how?
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2482-4.
AUTORES
/ AUTHORS: - Masri MA; Stephan A; Barbari S; Rizk A;
Kamel G
INSTITUCIÓN
/ INSTITUTION: - Rizk Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 32
----------------------------------------------------
[130]
TÍTULO / TITLE: - The incidence of
inhibitors in hemophilia A and the induction of immune tolerance.
REVISTA
/ JOURNAL: - Adv Exp Med Biol 2001;489:89-97.
AUTORES
/ AUTHORS: - Briet E; Peters M
INSTITUCIÓN
/ INSTITUTION: - Department of internal medicine and
pediatrics, Academic medical center, Amsterdam, The Netherlands. N. Ref:: 26
----------------------------------------------------
[131]
TÍTULO / TITLE: - Adverse
gastrointestinal effects of mycophenolate mofetil: aetiology, incidence and
management.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2001;24(9):645-63.
AUTORES
/ AUTHORS: - Behrend M
INSTITUCIÓN
/ INSTITUTION: - Abteilung fur Viszeral- und
Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Behrend.Matthias@MH-Hannover.de
RESUMEN
/ SUMMARY: - Mycophenolate mofetil (MMF) is a
relatively new immunosuppressive drug. It inhibits inosine monophosphate
dehydrogenase, a key enzyme in the de novo pathway of purine synthesis, and
thus causes lymphocyte-selective immunosuppression. Large clinical trials have
revealed the efficacy of MMF in the prevention of allograft rejection when
administered together with cyclosporin or tacrolimus and corticosteroids.
Although the adverse effect profile of MMF is comparatively benign,
gastrointestinal adverse effects are a major concern. These effects are
partially explained by the increased immune suppression, by the mode of action
and by interactions, particularly with other immunosuppressants. The aetiology
of the rarest gastrointestinal adverse effects is still not completely clear.
Therapy depends upon the clinical gravity of the adverse effects and is therefore
a case of waiting and ob- serving. An adjustment of dosage of
immunosuppressants according to the clinical situation and, particularly in the
case of MMF, spreading the total dosage over more than 2 daily doses are often
sufficient. Should adverse effects persist for a longer period of time and be
of a more serious nature, a comprehensive invasive diagnostic process is
necessary, including endoscopy and biopsy and the search for opportunistic
infections. In this case, dosage reduction or the complete withdrawal of MMF
seems to be unavoidable. Severe gastrointestinal complications with MMF are
rare, but when they do occur they may require extensive diagnosis and
treatment. In the future, therapeutic drug monitoring and, where necessary,
pharmacological modifications of MMF could lead to a further reduction of
adverse effects with an equal or even increased efficacy. N. Ref:: 115
----------------------------------------------------
[132]
TÍTULO / TITLE: - C2 monitoring strategy
for optimising cyclosporin immunosuppression from the Neoral formulation.
REVISTA
/ JOURNAL: - BioDrugs 2001;15(5):279-90.
AUTORES
/ AUTHORS: - Levy GA
INSTITUCIÓN
/ INSTITUTION: - Multi-Organ Transplantation, The Toronto
Hospital, Toronto, Ontario, Canada. fg12@email.msn.com
RESUMEN
/ SUMMARY: - Profiling of absorption of cyclosporin
microemulsion (Neoral) is a concept in therapeutic drug monitoring (TDM)
designed to further optimise the clinical benefits of this formulation in transplant
recipients. A single blood concentration measurement 2 hours after Neoral
administration (C2) has been shown in both liver and kidney transplant
recipients to be a significantly more accurate predictor of drug exposure than
trough concentrations (C0), and its use results in a reduction in the incidence
and severity of cellular rejection. In a prospective trial in de novo renal
transplant recipients, patients who achieved target concentrations for area
under the concentration-time curve over the first 4 hours postdose (AUC(0-4h))
of 4500 to 5500 ng. h/ml within 5 days of transplantation had a 7% incidence of
histological acute rejection, compared with 37% rejection in those patients who
did not achieve this target level. Of the single sampling points, C2 correlates
best with AUC(0-4h) (r2 = 0.86); C(0) had the poorest correlation. In an
international study in 21 centres examining the absorption profiling, C2
samples were the most accurate predictors of AUC(0-4h) and freedom from
rejection. In liver transplant recipients receiving Neoral -based maintenance
immunosuppression, adoption of Neoral C2 monitoring identifies patients who are
both over- and under-dosed, which is not distinguished by C0 measurements.
Further adjustment of C2 to recommended targets, even at 5 and 10 years after
transplantation, results in reduction in nephrotoxicity without exposing the
patient to the risk of rejection. In summary, despite a level of simplicity
comparable to C0 measurement, Neoral absorption profiling, and specifically C2
measurement, is a much more sensitive approach to assessing the
pharmacokinetics and predicting the clinical effect of this formulation in the
individual patient, with a consequent marked reduction in the incidence of
acute cellular rejection and improved long term graft function. N. Ref:: 23
----------------------------------------------------
[133]
TÍTULO / TITLE: - Association of human
leukocyte antigen with outcomes of infectious diseases: the streptococcal
experience.
REVISTA
/ JOURNAL: - Scand J Infect Dis 2003;35(9):665-9.
AUTORES
/ AUTHORS: - Kotb M; Norrby-Teglund A; McGeer A; Green
K; Low DE
INSTITUCIÓN
/ INSTITUTION: - Veterans Affairs Medical Center, Research
Service, Memphis, Tennessee 38163, USA. mkotb@utmem.edu
RESUMEN
/ SUMMARY: - The role of host genetic factors in
determining susceptibility to infections has become more evident. Certain
individuals appear to be predisposed to certain infections, whereas others are
protected. By studying the immune response and the genetic makeup of
susceptible and resistant individuals a better understanding of the disease
process can be achieved. Infections caused by group A streptococci offer an
excellent model to study host-pathogen interactions and how the host genetic
variation can influence the infection outcome. These studies showed that the
same clone of these bacteria can cause severe or non-severe invasive disease.
This difference was largely related to the human leukocyte antigen class 11
type of the patient. Certain class II haplotypes present the streptococcal
superantigens in a way that results in responses, whereas others present the
same superantigens in a way that elicits very potent inflammatory responses
that can lead to organ failure and shock. These findings underscore the role of
host genetic factors in determining the outcome of serious infections and
warrants further investigations into how the same or different genetic factors
affect susceptibility to other emerging and re-emerging pathogens. N. Ref:: 29
----------------------------------------------------
[134]
TÍTULO / TITLE: - Outcome and toxicity of
salvage treatment on patients relapsing after autologous hematopoietic stem
cell transplantation—experience from a single center.
REVISTA
/ JOURNAL: - Hematology 2003 Jun;8(3):145-50.
●●
Enlace al texto completo (gratuito o de pago) 1080/1024533031000107479
AUTORES
/ AUTHORS: - Buchler T; Hermosilla M; Ferra C;
Encuentra M; Gallardo D; Berlanga J; Sarra J; Granena A
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Hematology,
“Institut Catala d’Oncologia”, Barcelona, España. tbuchler@fnbrno.cz
RESUMEN
/ SUMMARY: - Patients with hematological malignancies
who relapse after autologous stem cell transplantation (auto-SCT) generally
have poor prognosis. Salvage treatment is often associated with severe
toxicities. The aim of our study was to evaluate retrospectively the toxicity
and outcome of rescue therapy in patients with acute leukemias, non-Hodgkin’s
lymphoma (NHL), Hodgkin’s disease (HD) and multiple myeloma (MM) relapsing
after auto-SCT. Fifty-four of the 62 patients who relapsed received some form
of salvage chemotherapy. Six (10%) patients were treated by second stem cell transplantation,
which was allogeneic in 5 cases. Toxicity of the salvage therapy was
significant. As a result of adverse effects, salvage therapy had to be
discontinued or reduced in 14 patients (26%). The outcome of salvage was
evaluated after 90 days. Of the treated patients, 14 (26%) entered into
complete remission with another 5 (9%) reaching partial response. The disease
was stabilized in 5 patients (9%) but 30 (56%) patients were in progression or
dead. Overall survival of the patients was poor with the median survival of 8.7
months after relapse and the leading cause of death being progressive disease.
In conclusion, the development of new, more efficient regimens is critical if
disease-free survival is to be increased in patients who relapse after auto
SCT. N. Ref:: 12
----------------------------------------------------
[135]
TÍTULO / TITLE: - Treatment of
bifurcation coronary lesions: a review of current techniques and outcome.
REVISTA
/ JOURNAL: - J Interv Cardiol 2003 Dec;16(6):507-13.
AUTORES
/ AUTHORS: - Melikian N; Di Mario C
RESUMEN
/ SUMMARY: - Percutaneous treatment of coronary
bifurcation lesions, pose a number of technical challenges to the
interventional cardiologist. Each lesion has to be approached with its own,
targeted solution in the context of the clinical picture, anatomy, and
pathology. To achieve acceptable clinical outcomes a number of established
techniques are available. The exact anatomy of the lesion determines the
technique used. The most common approach is to stent the main vessel across the
ostium of the side branch. The side branch can be additionally treated with a
second stent or balloon angioplasty depending on the severity of the ostial
lesion and/or evidence of active ischemia. Other techniques involve stenting the
main branch up to the carina but sparing the side branches, multiple ‘kissing
stent’ approaches (‘Y’,’T’, and ‘V’) or the ‘culottes’ technique. Follow-up
data demonstrates a high (over 90%) technical success rate. Clinical outcome is
variable but with conventional stents restenosis rates higher than 30% have
been reported in most studies and there is no added advantage in routine
stenting of both main vessel and side branch. Recent introduction of
drug-eluting stents has resulted in a lower event rate and reduction of main
vessel restenosis in comparison with historical controls. Side branch ostial
restenosis remains a problem, which may require the development of novel
‘bifurcate’ stent designs to allow complete coverage with a single stent. N. Ref:: 36
----------------------------------------------------
[136]
TÍTULO / TITLE: - Impact of peritoneal
dialysis on patient and graft outcome after kidney transplantation.
REVISTA
/ JOURNAL: - Contrib Nephrol 2003;(140):226-41.
AUTORES
/ AUTHORS: - Lameire N; Van Biesen W; Vanholder R
INSTITUCIÓN
/ INSTITUTION: - Renal Division, University Hospital,
Ghent, Belgium. norbert.lameire@rug.ac.be N. Ref:: 49
----------------------------------------------------
[137]
TÍTULO / TITLE: - Adeno-associated virus
(AAV) as a vehicle for therapeutic gene delivery: improvements in vector design
and viral production enhance potential to prolong graft survival in pancreatic
islet cell transplantation for the reversal of type 1 diabetes.
REVISTA
/ JOURNAL: - Curr Mol Med 2001 May;1(2):245-58.
AUTORES
/ AUTHORS: - Kapturczak MH; Flotte T; Atkinson MA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Florida, Gainesville 32610, USA.
RESUMEN
/ SUMMARY: - Most viral gene delivery syslems utilized
to date have demonstrated significant limitations in practicality and safety
due to the level and duration of recombinant transgene expression as well as
their induction of host immunogenicity to vector proteins. Recombinant
adeno-associated virus (rAAV) vectors appear to offer a vehicle for safe,
long-term therapeutic gene transfer; factors afforded through the propensity of
rAAV to establish long-term latency without deleterious effects on the host
cell and the relative non-immunogenicity of the virus or viral expressed
transgenes. The principal historical limitation of this vector system,
efficiency of rAAV-mediated transduction, has recently observed a dramatic
increase as the titer, purity, and production capacity of rAAV preparations
have improved. In terms of systems that could benefit from such improvements,
rAAV gene therapy to enhance solid organ transplantation would appear an
obvious choice with islet transplantation forming a promising candidate due to
the ability to perform viral transductions ex vivo. Currently, islet
transplantation can be used to treat type 1 diabetes yet persisting alloimmune
and autoimmune responses represent major obstacles to the clinical success for
this procedure. The delivery of transgenes capable of interfering with
antigenic recognition and/or cell death [e.g., Fas ligand (FasL), Bcl-2,
Bcl-XL] as well as imparting tolerance/immunoregulation [e.g.,
interleukin(IL)-4, IL-10, transforming growth factor (TGF)-beta], or
cytoprotection [e.g., heme oxygenase-1 (HO-1), catalase, manganese superoxide
dismutase (MnSOD)] may prevent recurrent type 1 diabetes in islet
transplantation and offer a promising form of immunotherapy. Research
investigations utilizing such systems may also provide information vital to
understanding the immunoregulatory mechanisms critical to the development of
both alloimmune and autoimmune islet cell rejection mechanisms and recurrent
type 1 diabetes. N.
Ref:: 164
----------------------------------------------------
[138]
TÍTULO / TITLE: - Liver transplantation
for primary sclerosing cholangitis: timing, outcome, impact of inflammatory
bowel disease and recurrence of disease.
REVISTA
/ JOURNAL: - Best Pract Res Clin Gastroenterol 2001
Aug;15(4):667-80.
●●
Enlace al texto completo (gratuito o de pago) 1053/bega.2001.0212
AUTORES
/ AUTHORS: - Wiesner RH
INSTITUCIÓN
/ INSTITUTION: - Liver Transplant Center, Mayo Clinic, 200
First Street SW, Rochester, MN 55905, USA.
RESUMEN
/ SUMMARY: - Over the past decade, the outcome of liver
transplantation in primary sclerosing cholangitis (PSC) patients with end-stage
liver disease has improved significantly with many centres reporting 1-year
patient and graft survival of 90-97% and 85-88%, respectively. Based on these
results, liver transplantation has emerged as the treatment of choice for PSC
patients. Specific complications related to PSC remain problematical.
Inflammatory bowel disease (IBD) occurs in 70% of patients, and there is a
distinctly increased risk of colorectal neoplasia both pre- and
post-transplantation. Furthermore, symptoms related to IBD post-transplantation
can become severe and lead to the need for proctocolectomy. Cholangiocarcinoma
remains a major risk facing the PSC patient and develops in 15-30% of patients.
Markers to detect the early neoplastic changes of cholangiocarcinoma are not
available. To date, outcome following liver transplantation in PSC patients who
have associated cholangiocarcinoma has been dismal. However, those patients who
are found to have an incidental cholangiocarcinoma have an acceptable low
incidence of recurrence of disease. To assess optimal timing of liver
transplantation, natural history risk scores have been developed and utilized.
Utilizing such risk scores, estimated survival for the individual PSC patient
can be obtained. Finally, there is an increased incidence of both acute and
chronic rejection, hepatic artery thrombosis and biliary stricturing in PSC patients
undergoing liver transplantation. A late rise in serum alkaline phosphatase
level is almost always indicative of biliary stricturing and recurrence of
disease. Approximately 20% of patients followed for 5 years or more will have
recurrence of PSC documented both on cholangiography and histology. N. Ref:: 48
----------------------------------------------------
[139]
TÍTULO / TITLE: - Neoral monitoring 2
hours post-dose and the pediatric transplant patient.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Feb;7(1):25-30.
AUTORES
/ AUTHORS: - Dunn SP
INSTITUCIÓN
/ INSTITUTION: - Alfred I. duPont Hospital for Children,
Wilmington, Delaware 19899, USA. Sdunn@nemours.org
RESUMEN
/ SUMMARY: - Cyclosporin A therapy has evolved greatly
over the past 25 years of clinical experience. Sophisticated studies of CsA
pharmacokinetics and pharmacodynamics have led to a better understanding of the
relationship between dose response and biological effect. It has become apparent
that achieving target drug exposure is necessary for optimal clinical outcomes.
Monitoring dose response has become a key aspect of immunosuppressive
management. This review presents the information available supporting
cyclosporin drug concentration drawn two hours post dose (C-2) in children who
have been transplanted as the best single indicator of CsA exposure. Further
studies evaluating the clinical benefit of achieving C-2 targets in children
are indicated. N.
Ref:: 30
----------------------------------------------------
[140]
TÍTULO / TITLE: - Pregnancy in kidney
transplantation: satisfactory outcomes and harsh realities.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 Nov-Dec;16(6):792-806.
AUTORES
/ AUTHORS: - Stratta P; Canavese C; Giacchino F;
Mesiano P; Quaglia M; Rossetti M
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
Nephrology Section, University of Turin, S. Giovanni Molinette Hospital, Turin,
Italy. trattanefro@hotmail.com
RESUMEN
/ SUMMARY: - Since the first successful case of a
pregnancy reported 40 yrs ago in a woman receiving a kidney transplant from her
identical twin sister who did not receive immunosuppressive medications, the
dream of a pregnancy in a renal transplant recipient has become reality. In
women of childbearing age with a functioning transplant, the pregnancy rate has
improved from 2 to 5%. Approximately 35% of pregnancies do not progress beyond
the 1st trimester; the success rate is > 90% after the 1st
trimester. In this review, different aspects of this topic are discussed: the
consequences of pregnancy on renal grafts and maternal morbidity (hemodynamic
changes, immunological problems, hypertension/preeclampsia, urinary tract
infections and renal damage progression), the influence of renal grafts on
pregnancy (perinatal mortality, prematurity, intrauterine growth retardation,
low birth weight, malformations, handicaps and immunological problems) and the
role of drugs used for renal transplants. A pregnancy can have a successful
outcome if pre-conceptional graft function is good, if hypertension is absent
and if the interval from grafting is at least 2 yrs. However, the majority of
live-born outcomes are premature and many are low birth weight. Recipients must
be advised that their offspring can also suffer from immunological abnormalities,
malformations, long-term handicaps, and that the deleterious effects of
pregnancy on long-term graft function cannot be excluded. In conclusion, women
of childbearing age who have had renal transplantation should be counselled
before conception about possibility and risks of pregnancy. N. Ref:: 99
----------------------------------------------------
[141]
TÍTULO / TITLE: - Influence of one human
leukocyte antigen mismatch on outcome of allogeneic bone marrow transplantation
from related donors.
REVISTA
/ JOURNAL: - Hematology 2003 Feb;8(1):27-33.
●●
Enlace al texto completo (gratuito o de pago) 1080/1024533031000072054
AUTORES
/ AUTHORS: - Hasegawa W; Lipton JH; Messner HA; Jamal
H; Yi QL; Daly AS; Kotchetkova N; Kiss TL
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow Transplant Service, Princess
Margaret Hospital/University Health Network, Toronto, Ont, M5G 2M9, Canada.
RESUMEN
/ SUMMARY: - This study compares the clinical outcomes
of 60 consecutive patients who received an allogeneic blood or marrow stem cell
transplant (BMT) from one Human Leukocyte Antigen (HLA) mismatched related
donors with those of 120 matched patients who had HLA identical sibling donors.
The control patients were matched for diagnosis, disease status, conditioning
regimen, and age at BMT. All patients received standard CYA and MTX for GVHD
prophylaxis. The probability of overall survival (OS) at 5 years was 35% in the
study group compared to 56% in the control group. The relapse rates and acute
GVHD rates did not differ between the two groups. Graft failure was a
significant problem in the study group compared to the control group (13 vs.
0%, p < 0.0001). All cases of graft failure occurred in patients with a
mismatch in the host-versus-graft direction. BMT-related deaths were also
increased in the study group. Forty percent of deaths were caused by infection
in the study group vs. 19% in the control group (p < 0.01). In conclusion,
the OS of patients receiving marrow/stem cells from one antigen mismatched
related donors was inferior to that of controls with HLA-identical related
donors. There was an increase in mortality related to infections occurring in
the setting of an increased frequency of graft failure in these patients. N. Ref:: 21
----------------------------------------------------
[142]
TÍTULO / TITLE: - Strategies for the
augmentation of grafted dopamine neuron survival.
REVISTA
/ JOURNAL: - Front Biosci 2003 May 1;8:s522-32.
AUTORES
/ AUTHORS: - Sortwell CE
INSTITUCIÓN
/ INSTITUTION: - Department of Neurological Sciences,
Research Center for Brain Repair, Rush-Presbyterian-St. Luke’s Medical Center,
Suite 200, 2242 West Harrison Street, Chicago, IL 60612, USA. csortwel@rush.edu
RESUMEN
/ SUMMARY: - The percentage of grafted embryonic DA
neurons that survive transplantation is low, estimated at 5-20%. Significant
agreement has emerged from the work of research groups worldwide that specific
conditions associated with the transplant procedure and post-transplantation
interval render grafted mesencephalic cells susceptible to apoptotic death.
Detrimental triggers including hypoxia/ischemia, trophic factor withdrawal, and
oxidative stress appear to exert the most impact on grafted DA neuron survival.
Treatment strategies that aim to reduce or eliminate the triggers of grafted
cell death appear to be more successful than approaches that target the
intracellular apoptotic cascade. In particular, treatment of mesencephalic cell
suspensions with isolated neurotrophic factors (GDNF, BDNF, NT 4/5) as well as
glial-derived factors, antioxidant therapies and augmentation of graft
vasculature have demonstrated consistent survival promoting effects. Caspase
inhibition, although initially quite promising, has not been demonstrated to
reliably increase grafted cell survival. Bcl-2 overexpression similarly has yet
to prove beneficial, although this may be due to biologically irrelevant levels
of bcl-2 present during the critical immediate post-grafting interval. Future
strategies will target a “cocktail” approach in which effective treatment
agents are combined to maximize grafted DA neuron survival. Refinements in ex
vivo transduction parameters will allow for efficient sustained delivery of
survival promoting agents to grafted cells. Once identified, the optimal
survival-enhancing treatment of grafted primary embryonic DA neurons should
also benefit future transplant therapies utilizing alternatively derived DA
neurons. N. Ref:: 117
----------------------------------------------------
[143]
TÍTULO / TITLE: - Rising incidence of
hepatocellular carcinoma: the role of hepatitis B and C; the impact on
transplantation and outcomes.
REVISTA
/ JOURNAL: - Clin Liver Dis 2003 Aug;7(3):683-714.
AUTORES
/ AUTHORS: - Kaplan DE; Reddy KR
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, University of Pennsylvania School of Medicine, 3 Raydin, 3400
Spruce Street, Philadelphia, PA 19104, USA.
RESUMEN
/ SUMMARY: - Hepatocellular carcinoma caused by
hepatitis B and hepatitis C are global scourges but are likely to peak in
incidence in the next 2 decades and then decline. Universal vaccination has
been effective in stemming the incidence of chronic hepatitis B and early-onset
HCC in regions of high endemicity where implemented, but preventive measures in
HCV are not yet available. After the attrition of older affected generations,
the incidence of HCC will likely decline rapidly. While no vaccine is currently
available for hepatitis C, cases are projected to peak and decline because of a
marked reduction in transmission as a result of behavioral modification and
safeguarding of blood supplies. Until these epidemiologic projections come to
pass, management of hepatocellular carcinoma will continue to become a
progressively more frequently encountered clinical challenge. Therapy for
chronic hepatitis may ameliorate but will not eliminate the development of
tumors. The demand for orthotopic liver transplantation will continue to climb,
and palliative therapies for non-resectable cases will require studies aimed at
optimization of benefit. LDLT may remain an option for high-risk patients
affording tumor-free survival for some otherwise terminal patients. N. Ref:: 331
----------------------------------------------------
[144]
TÍTULO / TITLE: - Genetic regulation of
preimplantation embryo survival.
REVISTA
/ JOURNAL: - Int Rev Cytol 2001;210:1-37.
AUTORES
/ AUTHORS: - Levy R
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Biologie de la Reproduction
du Pr. J. L. Laurent, Hopital Nord, Saint Etienne, France.
RESUMEN
/ SUMMARY: - Mammalian embryonic death is the most
common outcome of fertilization. This review focuses on the recent advances
concerning genetic regulation of preimplantation embryo survival. The
predominant role of the Ped(preimplantation embryo development) gene, which
regulates fast or slow cleavage of preimplantation mouse embryos, and its
implication on embryo survival are discussed. Recent morphological and
biochemical observations suggested that programmed cell death was an essential
mechanism in preimplantation embryo fragmentation and survival, thus leading to
original investigations on apoptosis and apoptosis-related genes. Other genes,
transcripts, or proteins seem to be involved in embryo development and control
of survival. In particular, the role of heat shock proteins (HSP), telomerase
activity (human telomerase catalytic subunit hTCS), and the developmental
significance of regulatory protein polarization (leptin, STAT 3) in
preimplantation embryos are discussed. N.
Ref:: 155
----------------------------------------------------
[145]
TÍTULO / TITLE: - At-home self-care of
patients of long-term survival after renal transplantation: a survey of current
status.
REVISTA
/ JOURNAL: - Di Yi Jun Yi Da Xue Xue Bao 2002
Jan;22(1):86-7.
AUTORES
/ AUTHORS: - Wang JX; Shi HM
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Transplantation,
Nanfang Hospital, First Military Medical University, Guangzhou 510515.
RESUMEN
/ SUMMARY: - OBJECTIVE: To understand the current
status of at-home self-care implemented by patients with renal transplantation
of long-term survival, so as to provide the patients with adequate professional
advice and follow-up care after discharge from hospital. METHOD: A survey was
conducted in 248 patients who survived for over 3 years with functioning
transplanted kidneys by utilizing a self-designed questionnaire. RESULTS: The
at-home self-care was generally not well practiced by the patients with apparent
lack of self-care awareness and abilities. Though the current status
problematic, the survey showed that 96.32% of the patients wished to be
informed about self-care knowledge and skills. CONCLUSION: The patients
currently lack at-home self-care abilities and the medical staff should
carefully design self-care plans tailored to the needs of individual patient to
improve the survival of the patients and the transplanted kidneys as well.
----------------------------------------------------
[146]
TÍTULO / TITLE: - Advances in
immune-based therapies to improve solid organ graft survival.
REVISTA
/ JOURNAL: - Adv Intern Med 2001;47:293-331.
AUTORES
/ AUTHORS: - Rose SM; Turka L; Kerr L; Rotrosen D
INSTITUCIÓN
/ INSTITUTION: - Office of Clinical Applications, Division
of Allergy, Immunology, and Transplantation, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Md., USA. N. Ref:: 96
----------------------------------------------------
[147]
TÍTULO / TITLE: - The impact of delayed
graft function on the long-term outcome of renal transplantation.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Jan-Feb;15(1):17-21.
AUTORES
/ AUTHORS: - Geddes CC; Woo YM; Jardine AG
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Western Infirmary, Glasgow,
UK. Colin.Geddes.WG@NorthGlasgow.NHS.UK
RESUMEN
/ SUMMARY: - Recent studies provide conflicting
conclusions regarding the impact of delayed graft function (DGF) on the
long-term outcome of renal transplantation. Some centres report DGF as an
independent risk factor for reduced long-term graft and patient survival, while
others report no impact on long-term outcome. Further scrutiny of data from
these studies reveals differences in the definition of DGF, definition of
long-term outcome, and statistical methods that may partly explain the
variability. The commonest definition of DGF is the need for dialysis in the
first week post-transplant, but this may be less informative than definitions
that consider DGF as a continuous variable such as time to achieving creatinine
clearance > 10ml/min. Acute rejection (AR) occurs more commonly in patients
with DGF and variability in the impact of DGF may also relate to strategies to
detect and treat AR during DGF. Centres with a vigilant strategy are likely to
note a lower impact of DGF because the associated long-term adverse impact of
AR is minimised. Furthermore, many centres reduce the dose of calcineurin
inhibiting drugs and/or use polyclonal antibody therapy during DGF but the
long-term impact of this strategy is unclear. Newer agents such as humanised
anti-IL2 monoclonal antibodies and rapamycin may have a role, but controlled
studies are required to define the optimal immunosuppressive regimen for
patients with DGF. In the meantime, measures to minimise ischaemic damage to
the transplant kidney and intensive surveillance for AR with weekly renal
biopsy in patients with DGF are recommended.
N. Ref:: 49
----------------------------------------------------
[148]
TÍTULO / TITLE: - Post-transplant
diabetes: incidence, relationship to choice of immunosuppressive drugs, and
treatment protocol.
REVISTA
/ JOURNAL: - Adv Ren Replace Ther 2001 Jan;8(1):64-9.
AUTORES
/ AUTHORS: - Markell MS
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Nephrology, State
University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA. mmarkell@hscbklyn.edu
RESUMEN
/ SUMMARY: - Post-transplant diabetes mellitus (PTDM)
is one of the feared complications of immunosuppressive therapy. Despite
advances, including the introduction of the steroid-sparing calcineurin
inhibitors, cyclosporine and tacrolimus, the incidence rate remains greater than
10% to 30%, especially in minority populations. PTDM increases the subsequent
risk of both graft loss and patient death, and predisposes patients to all
complications of diabetes, including retinopathy and neuropathy. Patients
should be monitored closely, especially during the first 3 months
post-transplant, and treated aggressively, should glucose intolerance be
detected. Minimization of immunosuppression dose, diet, oral hypoglycemic
agents, and insulin have all been used in the treatment of PTDM, however, the
insulin-sensitizing agents have not been studied. It is hoped that newer
immunosuppressive regimens and, ultimately, the ability to achieve tolerance
will eventually solve the problem of PTDM.
N. Ref:: 53
----------------------------------------------------
[149]
TÍTULO / TITLE: - Immune profiling:
molecular monitoring in renal transplantation.
REVISTA
/ JOURNAL: - Front Biosci 2003 Sep 1;8:e444-62.
AUTORES
/ AUTHORS: - Hoffmann SC; Pearl JP; Blair PJ; Kirk AD
INSTITUCIÓN
/ INSTITUTION: - Transplantation Section, Transplantation
and Autoimmunity Branch, National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health, Department of Health and Human
Services, Bethesda, Maryland 20889, USA.
RESUMEN
/ SUMMARY: - Molecular techniques have become a
mainstay for most biomedical research. In particular, sensitive methods for
gene transcript detection and advanced flow cytometry have been crucial in
fostering our understanding of the basic mechanisms promoting allosensitization
and adaptive immune regulation. These technologies have been validated in
vitro, and in pre-clinical settings, and as such their clinical application is
now clearly appropriate. It is becoming increasingly clear that these robust
techniques hold much promise to better elucidate human transplant biology, and
more importantly, guide clinical decision making with mechanistically-based
information. This article will discuss our laboratory’s use of several novel
technologies, including gene polymorphism analysis, real-time polymerase chain
reaction transcript quantification, and multi-color flow cytometry in clinical
human renal transplantation. Specific technical methodology will be presented
outlining keys for effective clinical application. Clinical correlations will
be presented as examples of how these techniques may have clinical relevance.
Suggestions for the adaptation of these methods for therapeutic intervention
will be given. We propose that clinical transplantation should proceed in close
step with modern molecular diagnostics.
N. Ref:: 84
----------------------------------------------------
[150]
TÍTULO / TITLE: - Long-term outcome after
liver transplantation in children.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Feb;6(1):30-6.
AUTORES
/ AUTHORS: - Bucuvalas JC; Ryckman FC
INSTITUCIÓN
/ INSTITUTION: - Pediatric Liver Care Center, Children’s
Hospital Research Foundation, Cincinnati, Ohio 45229, USA. john.buc@chmcc.org
RESUMEN
/ SUMMARY: - Children (defined as under 18 yr of age)
account for approximately 12.5% of all liver transplants in the United States.
Even though the annual number of liver transplantation procedures remains
relatively constant, the population of long-term survivors of liver transplantation
has grown. Presently, the population of long-term survivors of liver
transplantation is 10-fold greater then the number of transplantations carried
out each year. For long-term survivors of liver transplantation, the goal is to
maintain graft function and wellness while decreasing the morbidity associated
with long-term immunosuppression. The primary diagnosis leading to liver
transplantation in children do not recur in the allograft. Consequently, many
of the complications of liver transplantation, both early and long term, relate
to the need for immunosuppression. Children may be at increased risk to develop
significant end-organ damage as a result of increased serum lipid levels,
elevated blood pressure, altered glucose metabolism, decreased renal function,
cancer, and diminished bone accretion that occur as a result of
immunosuppressive therapy or complications of therapy. As survival rates have
increased, health care providers have begun to assess health-related quality of
life. We will review our current knowledge of long-term outcome following
pediatric liver transplantation in children.
N. Ref:: 61
----------------------------------------------------
[151]
TÍTULO / TITLE: - Natural history of
hepatitis C and outcomes following liver transplantation.
REVISTA
/ JOURNAL: - Clin Liver Dis 2003 Aug;7(3):585-602.
AUTORES
/ AUTHORS: - Charlton M
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology and
Hepatology, Mayo Clinic and Foundation, Transplant Center CH-10, 200 First St.
S.W., Rochester, MN 55905, USA. charlton.michael@mayo.edu
RESUMEN
/ SUMMARY: - Hepatitis C-associated liver failure is
the most common indication for liver transplantation and the infection recurs
nearly universally following transplantation. Histologic evidence of recurrence
is apparent in approximately 50% of HCV-infected recipients in the first
postoperative year. Approximately 10% of HCV-infected recipients will die or
lose their allograft secondary to hepatitis C-associated allograft failure in
the medium term. HCV-infected recipients who undergo retransplantation
experience 5-year patient and graft survival rates that are similar to
recipients undergoing retransplantation who are not HCV-infected. While the
choice of calcineurin inhibitor or the use of azathioprine have not been
clearly shown to affect histologic recurrence of hepatitis C or the frequency
of rejection in HCV-infected recipients, cumulative exposure to corticosteroids
is associated with increased mortality, higher levels of HCV viremia, and more
severe histologic recurrence. In contrast to non-HCV-infected recipients,
treatment for acute cellular rejection is associated with attenuated patient
survival among recipients with hepatitis C. The development of
steroid-resistant rejection is associated with a greater than 5-fold increased
risk of mortality in HCV-infected liver transplant recipients. In lieu of large
studies in a posttransplant population, therapy with pegylated IFN (+/-
ribavirin) should be considered in recipients with histologically apparent
recurrence of hepatitis C before total bilirubin exceeds 3 mg/dl. The role of
hepatitis C immunoglobulin and new immunosuppression agents in the management
of posttransplant hepatitis C infection is still evolving. N. Ref:: 85
----------------------------------------------------
[152]
TÍTULO / TITLE: - DC2 effect on survival
following allogeneic bone marrow transplantation.
REVISTA
/ JOURNAL: - Oncology (Huntingt) 2002 Jan;16(1 Suppl
1):19-26.
AUTORES
/ AUTHORS: - Waller EK; Rosenthal H; Sagar L
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow and Stem Cell Transplant
Center, Emory University, Atlanta, Georgia 30322, USA.
RESUMEN
/ SUMMARY: - The graft-vs-tumor effect is an important
part of the curative potential of allogeneic transplantation. We characterized
the effect of transplanted donor mononuclear cells on relapse- and event-free
survival after allogeneic bone marrow transplantation (BMT). We studied 113
consecutive patients with hematologic malignancies who received
non-T-cell-depleted BMT from human leukocyte antigen (HLA)-matched siblings.
Most patients (n = 103) received busulfan (Myleran)-based conditioning, and all
patients received standard short-course methotrexate and tacrolimus (Prograf)
as graft-vs-host disease prophylaxis. Sixty-four patients had low-risk
diagnoses (acute lymphoblastic leukemia/acute myeloid leukemia [first complete
remission], myelodysplastic syndrome [refractory anemia/refractory anemia with
ring sideroblasts], and chronic myeloid leukemia [first chronic phase]); 49
patients had high-risk diagnoses (all others). Cox regression analyses
evaluated risk strata, age, gender, and the numbers of nucleated cells,
CD3-positive T cells, CD34-positive hematopoietic cells, and type 2 dendritic
cells (DC2) as covariates for event-free survival, relapse, and nonrelapse
mortality. Recipients of larger numbers of DC2 cells had significantly lower
event-free survival, a lower incidence of chronic graft-vs-host disease, and an
increased incidence of relapse. Recipients of larger numbers of CD34-positive
cells had improved event-free survival; recipients of fewer CD34-positive cells
had delayed hematopoietic engraftment and increased death from infections. In
conclusion, content of donor DC2 cells was associated with decreased chronic
graft-vs-host disease and graft-vs-leukemia effects consistent with Th2/Tc2
polarization of donor Tcells following allogeneic bone marrow
transplantation. N.
Ref:: 52
----------------------------------------------------
[153]
TÍTULO / TITLE: - Death with functioning
graft—a preventable cause of graft loss.
REVISTA
/ JOURNAL: - Ann Transplant 2001;6(4):17-20.
AUTORES
/ AUTHORS: - Evenepoel P; Vanrenterghem Y
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, University Hospital Leuven, Leuven, Belgium. Pieter.Evenepoel@uz.kuleuven.ac.be
RESUMEN
/ SUMMARY: - Patient death continues to be a leading
cause of renal transplant failure. This mortality of transplant patients is
mainly due to cardiovascular disease (CVD). Identification of predictions of
early CVD may provide targets for intervention. N. Ref:: 45
----------------------------------------------------
[154]
TÍTULO / TITLE: - Acute and long-term
neurodevelopmental outcomes in children following bone marrow transplantation.
REVISTA
/ JOURNAL: - Front Biosci 2001 Aug 1;6:G6-G12.
AUTORES
/ AUTHORS: - Armstrong FD
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Dept. of
Pediatrics (D-820), P.O. Box 016820, Miami, FL 33101, USA. darmstrong@miami.edu
RESUMEN
/ SUMMARY: - Bone marrow transplantation offers a
potential cure for a number of childhood cancers, sickle cell anemia, and
stabilization of a deteriorating and debilitating process in a number of
metabolic disorders and leukodystrophies. Depending upon the disease, treatment
prior to BMT, and natural history of the disease, BMT may increase the risk of
neuropsychological toxicity for children undergoing BMT, or may actually
improve their long-term neurodevelopmental outlook. The role of factors such as
pre-BMT therapy, age at time of treatment, presence or absence of total body
irradiation, and toxicities associated with GVHD are presented for
consideration. A developmental model for understanding the emergence of
neurocognitive effects of BMT is reviewed, and strategies for intervention are
considered. N. Ref:: 39
----------------------------------------------------
[155]
TÍTULO / TITLE: - Natural history of
hepatitis B and outcomes after liver transplantation.
REVISTA
/ JOURNAL: - Clin Liver Dis 2003 Aug;7(3):521-36.
AUTORES
/ AUTHORS: - Huang MA; Lok AS
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology, Department
of Internal Medicine, University of Michigan Medical Center, 3912 Taubman
Center, Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - HBV infection is the single most common
cause of cirrhosis globally although the prevalence rate is influenced by
geographic region. The natural course of HBV infection and the clinical outcome
is dependent on the interplay between host, virus, and environmental factors.
Understanding the natural history of HBV infection is important in determining
treatment strategies. OLT is the ultimate cure for patients with HBV-related
liver failure or HCC. The use of HBIG and new antiviral agents has resulted in
significant decrease in HBV re-infection rate and survival of patients
transplanted for hepatitis B in recent years is comparable to that of patients
transplanted for other liver disease. N.
Ref:: 82
----------------------------------------------------
[156]
TÍTULO / TITLE: - Predicting outcome in
hematological stem cell transplantation.
REVISTA
/ JOURNAL: - Arch Immunol Ther Exp (Warsz)
2002;50(6):371-8.
AUTORES
/ AUTHORS: - Dickinson AM; Cavet J; Cullup H; Wang XN;
Jarvis M; Sviland L; Middleton PG
INSTITUCIÓN
/ INSTITUTION: - University Department Haematology,
Tyneside Leukemia Research Laboratory, Royal Victoria Infirmary, Queen Victoria
Road, Newcastle upon Tyne, UK. a.m.dickinson@ncl.ac.uk
RESUMEN
/ SUMMARY: - This review summarizes recent results
investigating the role of certain cytokine gene polymorphisms, including those
of TNF-alpha, IFN-gamma, IL-6, IL-10 and IL-1 receptor antagonist (IL-1Ra), in
allogeneic stem cell transplantation. It discusses their role in predicting
outcome and the development of a genetic risk index for graft versus host disease
(GvHD) in HLA-matched sibling transplants. By the comparative use of an in
vitro human skin explant model, initial results suggest that certain cytokine
gene polymorphisms may be associated with more severe disease. N. Ref:: 62
----------------------------------------------------
[157]
TÍTULO / TITLE: - Aspergillosis in lung
transplantation: incidence, risk factors, and prophylactic strategies.
REVISTA
/ JOURNAL: - Transpl Infect Dis 2001 Sep;3(3):161-7.
AUTORES
/ AUTHORS: - Gordon SM; Avery RK
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Disease,
Infection Control, and Transplant Center, Cleveland Clinic Foundation,
Cleveland, Ohio 44195, USA. gordons@ccf.org
RESUMEN
/ SUMMARY: - Invasive aspergillosis remains a
significant cause of morbidity and mortality in transplantation, especially
lung and allogeneic bone marrow transplant recipients. The epidemiology,
classic and newly recognized risk factors, and incidence of aspergillosis are
reviewed. Risk factors include environmental exposures, airway colonization,
profound immunosuppression, neutropenia, prior cytomegalovirus infection, and
renal dysfunction. Clinical and radiographic presentations of invasive
aspergillosis are discussed, including some unusual manifestations in lung
transplant recipients. Early and accurate diagnosis of aspergillosis remains a
challenge, and diagnostic strategies are reviewed, with an emphasis on the
chest computerized tomography scan and on transbronchial or open lung biopsy.
Recent advances include prophylactic and pre-emptive antifungal strategies,
newer therapeutic agents, and improved risk stratification. N. Ref:: 85
----------------------------------------------------
[158]
TÍTULO / TITLE: - Natural history, prognosis,
and management of transplantation-induced diabetes mellitus.
REVISTA
/ JOURNAL: - Diabetes Metab 2002 Jun;28(3):166-75.
AUTORES
/ AUTHORS: - Benhamou PY; Penfornis A
INSTITUCIÓN
/ INSTITUTION: - Endocrinologie, CHU de Grenoble, France. benhamou@ujf-grenoble.fr
RESUMEN
/ SUMMARY: - Cardiovascular morbidity and mortality are
increased in transplant recipients, and diabetes mellitus is among the main
determinants of this increase. This review focuses on the influence of diabetes
on survival and functional outcomes in transplant recipients, the prevalences
of post-transplantation hyperglycaemia and diabetes, the mechanisms of diabetes
in transplant recipients, the respective roles of immunosuppressive drugs, the
predictive factors, and the practical implications. Although available studies
show that calcineurin inhibitors have diabetogenic effects and that these are
more marked with tacrolimus, emphasis should be put on the major diabetogenic
role of corticosteroids. This warrants efforts to develop immunosuppressive
regimens that eliminate or reduce the need for corticosteroids. N. Ref:: 52
----------------------------------------------------
[159]
TÍTULO / TITLE: - Prognostic factors for
early severe pulmonary complications after hematopoietic stem cell
transplantation.
REVISTA
/ JOURNAL: - Biol Blood Marrow Transplant
2001;7(4):223-9.
AUTORES
/ AUTHORS: - Ho VT; Weller E; Lee SJ; Alyea EP; Antin
JH; Soiffer RJ
INSTITUCIÓN
/ INSTITUTION: - Department of Adult Oncology, Dana-Farber
Cancer Institute, Boston, Massachusetts 02115, USA.
RESUMEN
/ SUMMARY: - Pulmonary complications are a significant
cause of early mortality (before day 100) after bone marrow transplantation
(BMT). To identify factors associated with development of early post-BMT severe
pulmonary complications (SPCs), we conducted a retrospective review of the
medical records of 339 consecutive patients who underwent hematopoietic stem
cell transplantation for hematologic disorders and identified pulmonary
complications that occurred before day 60 posttransplantation. SPCs, defined as
(1) diagnosis of diffuse alveolar hemorrhage, (2) need for mechanical
ventilation, or (3) death from respiratory failure, occurred in 48 (24%) of 199
patients receiving allogeneic transplants and 4 (2.9%) of 140 patients
receiving autologous transplants (P < .001). Multiple clinical variables
were analyzed to determine their influence on the development of SPCs in
allogeneic marrow recipients. The method of graft-versus-host disease (GVHD)
prophylaxis was the single most important factor affecting SPC incidence. Of
patients who received cyclosporine/methotrexate (CYA/MTX) as GVHD prophylaxis,
33% experienced SPCs compared with 8% of those receiving T-cell depletion (TCD)
alone (P < .0001). Multivariate analysis confirmed that TCD was associated
with a lower risk of SPCs (relative risk [RR], 0.18; P = .0006). In addition to
GVHD prophylaxis, a reduced pretransplantation FEV1 (forced expiratory volume
in 1 second) (< or = 80% of predicted) was associated with an increased risk
for SPCs (odds ratio, 4.4; P = .0025). Grades 2 to 4 acute GVHD, tobacco use,
age > or = 50 years, sex, unrelated donor, cytomegalovirus serologic status,
disease status at transplantation, pretransplantation carbon monoxide diffusing
capacity, and total body irradiation were not associated with development of
SPCs. We conclude that autologous BMT is associated with a significantly lower
incidence of SPCs compared with allogeneic BMT and that for allogeneic BMT,
GVHD prophylaxis using TCD is associated with a significantly lower risk for
SPCs compared with prophylaxis using CYA/MTX. Patients with pretransplantation
FEV1 of < or = 80% appear to have a higher risk for SPCs. N. Ref:: 40
----------------------------------------------------
[160]
TÍTULO / TITLE: - Pediatric stem cell
transplantation and critical care (an outcome evaluation).
REVISTA
/ JOURNAL: - Front Biosci 2001 Aug 1;6:G33-7.
AUTORES
/ AUTHORS: - Gale GB
INSTITUCIÓN
/ INSTITUTION: - Cardinal Glennon Children’s Hospital, 1465
S. Grand, St. Louis, MO 63104, USA.
RESUMEN
/ SUMMARY: - This paper reviews eight published studies
of children who required critical care following a stem cell transplant.
Approximately 14% of children required mechanical ventilation following stem
cell transplant. Sixteen percent of these children survived. Eleven percent of
children who had primary lung injury secondary to either infectious or
non-infectious causes survived. Patients with respiratory failure induced by
disease in organ systems other than the lungs had much better survival
(33-39%). Children reported to have a non-bacterial infectious lung disease had
very poor survival. Children who developed multi-organ system failure (MOSF) in
addition to lung disease also had poor survival. The majority of children died
of MOSF or pulmonary failure. N.
Ref:: 25
----------------------------------------------------
[161]
TÍTULO / TITLE: - The challenge of
rejection and cardiac allograft vasculopathy.
REVISTA
/ JOURNAL: - Heart Fail Rev 2001 Sep;6(3):227-40.
AUTORES
/ AUTHORS: - Cotts WG; Johnson MR
INSTITUCIÓN
/ INSTITUTION: - Heart Failure/Cardiac Transplant Program,
Northwestern Memorial Hospital, Chicago, Illinois 60611, USA. wcotts@nmh.org
RESUMEN
/ SUMMARY: - Since the first human heart
transplantation was performed in 1967, the field of heart transplantation has
advanced to the point where survival and acceptable quality of life are
commonplace. Despite remarkable progress in the clinical management of
rejection, rejection continues to limit survival and quality of life in the
heart transplant population. This review will discuss the biologic processes
involved in hyperacute rejection, acute rejection, and humoral (vascular)
rejection. The development of endomyocardial biopsy techniques represented a
significant advancement in the diagnosis of cardiac rejection, and
endomyocardial biopsy remains the ‘gold standard’ in the diagnosis of cellular
rejection. To date, no noninvasive parameters will diagnose rejection with
adequate sensitivity and specificity. Biopsy frequency and immunosuppressive
therapies may be tailored to the risk of rejection. Immunosuppression for
cardiac transplantation can be divided into three major phases: 1)
perioperative immunosuppression; 2) maintenance immunosuppression, and; 3)
treatment of rejection. The strategy for treating transplant rejection should
be influenced by several variables: 1) Histologic grade of rejection; 2) Evidence
of hemodynamic compromise by ejection fraction or right heart catheterization;
3) Severity of previous rejection episodes and types of immunosuppressives
used; and 4) Risk factors for rejection, including time after transplantation.
Future rejection therapy will involve more sophisticated attempts to alter host
responses toward the donor organ in a more specific and selective way. Despite
considerable advances in the care of the heart transplant recipient, long-term
survival is limited by cardiac allograft vasculopathy. The final section of
this chapter will review the pathology, immunopathology, nonimmunologic risk
factors, diagnosis, prevention and treatment of allograft vasculopathy. N. Ref:: 97
----------------------------------------------------
[162]
TÍTULO / TITLE: - Aspergillosis in liver
transplant recipients: successful treatment and improved survival using a
multistep approach.
REVISTA
/ JOURNAL: - South Med J 2002 Aug;95(8):897-9.
AUTORES
/ AUTHORS: - Duchini A; Redfield DC; McHutchison JG; Brunson
ME; Pockros PJ
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, Scripps Clinic, La Jolla, Calif 92037, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Invasive aspergillosis is a
life-threatening complication in liver transplant recipients, with a reported
mortality rate of more than 90%. Treatment is difficult, and no single agent is
uniformly effective in treating this patient population. METHODS: We
retrospectively reviewed all fungal cultures from 200 liver transplant patients
between 1996 and 1999 at a single tertiary referral center. RESULTS: A
diagnosis of aspergillosis was made in 6 patients. Five patients had pulmonary
involvement; 1 presented with an inguinal mass. Time from transplant to
infection ranged from 1 week to 34 months. Treatment included surgical
intervention and medical treatment. All patients infected with Aspergillus
fumigatus were treated with a sequential protocol of lipid complex amphotericin
followed by itraconazole. The major side effect of treatment was worsening
renal function. One patient died of intracranial hemorrhage during treatment.
CONCLUSION: Successful treatment of aspergillosis in liver transplant
recipients should include early diagnosis, sequential medical treatment with
lipid amphotericin B and itraconazole, and surgical intervention for invasive
disease. N. Ref:: 13
----------------------------------------------------
[163]
TÍTULO / TITLE: - Health-related quality
of life before and after solid organ transplantation. Measurement consideration,
reported outcomes, and future directions.
REVISTA
/ JOURNAL: - Minerva Chir 2002 Jun;57(3):257-71.
AUTORES
/ AUTHORS: - Feurer ID; Speroff T; Harrison C; Wright
Pinson C
INSTITUCIÓN
/ INSTITUTION: - Vanderbilt University Transplant Center,
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
RESUMEN
/ SUMMARY: - The initial focus in organ transplantation
clinical research was demonstrating acceptable technical and survival outcomes.
Both patient and graft survival have reached well-documented, laudable levels,
and solid organ (liver, heart, kidney, lung) transplantation procedures are now
relatively common. As with any complex medical procedure that entails
relatively high risk, financial costs, and life-long follow-up care, reliable and
valid assessments of the “quality” of the extended life years are of interest
to patients, their families, policy makers, and payers. This review focuses on
health-related quality of life (HRQOL) and functional performance in adults
following solid organ transplantation, with an emphasis on: 1) instruments and
methods; 2) outcomes in liver, heart, kidney, and lung transplant recipients;
and 3) future research directions. Practical considerations for developing
longitudinal HRQOL assessment strategies are reviewed. The current emphasis on
modeling demographic and clinical factors that promote or limit optimal HRQOL
is illustrated. These lines of research will help identify potential
interventions designed to promote better HRQOL in organ transplant recipients. N. Ref:: 106
----------------------------------------------------
[164]
TÍTULO / TITLE: - Watershed events in the
improvement of surgical outcomes in the elderly transplant (QLT) recipients.
REVISTA
/ JOURNAL: - J Okla State Med Assoc 2002 Jun;95(6):375-7.
AUTORES
/ AUTHORS: - Postier RG; O’Rourke LR
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Oklahoma Health Sciences Center, USA.
RESUMEN
/ SUMMARY: - The enactment of the Medicare legislation
and the establishment of a National Institute for Aging in the 1960s and 1970s
has spurred a number of developments which have proven to represent watershed
advances in the surgical care of the elderly. The development of a
multidisciplinary approach to both geriatric surgical care and research
ultimately may prove to be the greatest advance yet seen. N. Ref:: 18
----------------------------------------------------
[165]
TÍTULO / TITLE: - Renal
ischemia—reperfusion injury: an inescapable event affecting kidney
transplantation outcome.
REVISTA
/ JOURNAL: - Folia Microbiol (Praha) 2001;46(4):267-76.
AUTORES
/ AUTHORS: - Bohmova R; Viklicky O
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Immunology,
Institute for Clinical and Experimental Medicine, 140 00 Prague, Czechia.
RESUMEN
/ SUMMARY: - Ischemia—reperfusion (I-R) injury has been
shown to be a common cause of late and irreversible complications during a
variety of standard medical and surgical procedures. The pathogenesis of events
which follow the I-R involves both injured endothelium and activated leukocytes
and their interaction. In kidney transplantation, an I-R injury occurs in
situations such as graft harvesting, cold storage and surgery. Clinical
consequences of I-R injury have been considered to be delayed graft function
and acute rejection in the short term and chronic rejection late after
transplantation. Here we focused on current knowledge of pathophysiology of
renal I-R injury in kidney transplantation and on possibilities of experimental
therapy. N. Ref:: 70
----------------------------------------------------