#07#
Revisiones-Clínica-Complicaciones
*** Reviews-Clinical-Complications
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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Only articles written in Spanish and/or English are included.
[1]
TÍTULO / TITLE: - Routes to transplant
tolerance versus rejection; the role of cytokines.
REVISTA
/ JOURNAL: - Immunity 2004 Feb;20(2):121-31.
AUTORES
/ AUTHORS: - Walsh PT; Strom TB; Turka LA
INSTITUCIÓN
/ INSTITUTION: - University of Pennsylvania, 700 Clinical
Research Building, 415 Curie Boulevard, Philadelphia, PA 19104, USA.
RESUMEN
/ SUMMARY: - The alloimmune response can be divided
into specific junctures where critical decisions between tolerance and immunity
are made which define the outcome of the transplant. At these “decision nodes”
various cytokines direct alloresponsive T cells to develop either a
proinflammatory response aimed at graft destruction or an immunoregulatory
response facilitating graft acceptance. This review will focus on the role of
these cytokines in influencing the progression of an alloimmune response
leading ultimately to either allograft survival or rejection. N. Ref:: 97
----------------------------------------------------
[2]
TÍTULO / TITLE: - Skin cancers after
organ 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): <> 2003 Apr 24;348(17):1681-91.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra022137
AUTORES
/ AUTHORS: - Euvrard S; Kanitakis J; Claudy A
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Edouard Herriot
Hospital, Lyons, France. sylvie.euvrard@numericable.fr N. Ref:: 100
----------------------------------------------------
[3]
TÍTULO / TITLE: - Haematopoietic cell
transplantation as immunotherapy.
REVISTA
/ JOURNAL: - Nature 2001 May 17;411(6835):385-9.
●●
Enlace al texto completo (gratuito o de pago) 1038/35077251
AUTORES
/ AUTHORS: - Appelbaum FR
INSTITUCIÓN
/ INSTITUTION: - Clinical Research Division, Fred
Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-310, PO Box
19024, Seattle, Washington 98109-1024, USA.
RESUMEN
/ SUMMARY: - The graft-versus-tumour effect seen after
allogeneic (genetically different) haematopoietic cell transplantation for
human malignancies represents the clearest example of the power of the human
immune system to eradicate cancer. Recent advances in our understanding of the
immunobiology of stem-cell engraftment, tolerance and tumour eradication are
allowing clinicians to better harness this powerful effect. N. Ref:: 60
----------------------------------------------------
[4]
TÍTULO / TITLE: - Chronic graft-vs-host
disease.
REVISTA
/ JOURNAL: - JAMA. Acceso gratuito al texto completo.
●●
Enlace a la Editora de la Revista http://jama.ama-assn.org/search.dtl
●●
Cita: JAMA: <> 2003 Nov 19;290(19):2599-603.
●●
Enlace al texto completo (gratuito o de pago) 1001/jama.290.19.2599
AUTORES
/ AUTHORS: - Bhushan V; Collins RH Jr
INSTITUCIÓN
/ INSTITUTION: - Hematopoietic Cell Transplantation
Program, Department of Internal Medicine, University of Texas Southwestern
Medical Center, Dallas 75390-8852, USA.
N. Ref:: 26
----------------------------------------------------
[5]
TÍTULO / TITLE: - Ex vivo selection of
recipient-type alloantigen-specific CD4(+)CD25(+) immunoregulatory T cells for
the control of graft-versus-host disease after allogeneic hematopoietic
stem-cell transplantation.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S32-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106470.07410.CA
AUTORES
/ AUTHORS: - Trenado A; Fisson S; Braunberger E;
Klatzmann D; Salomon BL; Cohen JL
INSTITUCIÓN
/ INSTITUTION: - Biologie et Therapeutique des Pathologies
Immunitaires, Hopital Pitie-Salpetriere, Paris, France.
RESUMEN
/ SUMMARY: - Allogeneic hematopoietic stem-cell
transplantation (HSCT) is the treatment of choice for many malignant and
nonmalignant hematologic disorders. Donor T cells present in the hematopoietic
stem-cell transplant improve engraftment and immune reconstitution and
contribute to the graft-versus-leukemia effect, but are also responsible for
the life-threatening graft-versus-host disease (GVHD). CD4(+)CD25(+)
immunoregulatory T cells, which play a pivotal role in preventing
organ-specific diseases, can also modulate GVHD if administered in equal
numbers of T cells at the time of grafting. In this article, the authors
describe a procedure of ex vivo selection and expansion of regulatory T cells
specific for recipient-type alloantigens. These expanded regulatory T cells
controlled GVHD. Their therapeutic use in HSCT should allow specific
suppression of the activation of donor alloreactive T cells involved in GVHD
while preserving the beneficial effects of other T cells. N. Ref:: 27
----------------------------------------------------
[6]
TÍTULO / TITLE: - Hemochromatosis gene
modifies course of hepatitis C viral infection.
REVISTA
/ JOURNAL: - Gastroenterology 2003 May;124(5):1509-23.
AUTORES
/ AUTHORS: - Pietrangelo A
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Centre
for Hemochromatosis and Metabolic Liver Diseases, University of Modena and
Reggio Emilia, Modeno, Italy. antonello@unimore.it N. Ref:: 161
----------------------------------------------------
[7]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[8]
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
----------------------------------------------------
[9]
TÍTULO / TITLE: - Tolerogenic dendritic
cells induced by vitamin D receptor ligands enhance regulatory T cells
inhibiting allograft rejection and autoimmune diseases.
REVISTA
/ JOURNAL: - J Cell Biochem 2003 Feb 1;88(2):227-33.
●●
Enlace al texto completo (gratuito o de pago) 1002/jcb.10340
AUTORES
/ AUTHORS: - Adorini L; Penna G; Giarratana N;
Uskokovic M
INSTITUCIÓN
/ INSTITUTION: - BioXell, SpA, 20132 Milano, Italy. luciano.adorini@bioxell.com
RESUMEN
/ SUMMARY: - Dendritic cells (DCs) not only induce but
also modulate T cell activation. 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)]
induces DCs with a tolerogenic phenotype, characterized by decreased expression
of CD40, CD80, and CD86 costimulatory molecules, low IL-12 and enhanced IL-10
secretion. We have found that a short treatment with 1,25(OH)(2)D(3) induces
tolerance to fully mismatched mouse islet allografts that is stable to
challenge with donor-type spleen cells and allows acceptance of donor-type
vascularized heart grafts. This effect is enhanced by co-administration of
mycophenolate mofetil (MMF), a selective inhibitor of T and B cell
proliferation that has also effects similar to 1,25(OH)(2)D(3) on DCs. Graft
acceptance is associated with an increased percentage of CD4(+)CD25(+)
regulatory cells in the spleen and in the draining lymph node that can protect
100% of syngeneic recipients from islet allograft rejection. CD4(+)CD25(+)
cells, able to inhibit the T cell response to a pancreatic autoantigen and to
significantly delay disease transfer by pathogenic CD4(+)CD25(-) cells, are
also induced by treatment of adult nonobese diabetic (NOD) mice with
1,25-dihydroxy-16,23Z-diene-26,27-hexafluoro-19-nor vitamin D(3) (BXL-698).
This treatment arrests progression of insulitis and Th1 cell infiltration, and
inhibits diabetes development at non-hypercalcemic doses. The enhancement of
CD4(+)CD25(+) regulatory T cells, able to mediate transplantation tolerance and
to arrest type 1 diabetes development by a short oral treatment with VDR
ligands, suggests possible clinical applications of this approach. N. Ref:: 41
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Depletion of host
reactive T cells by photodynamic cell purging and prevention of graft versus
host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Nov;44(11):1871-9.
AUTORES
/ AUTHORS: - Goggins TF; Chao N
INSTITUCIÓN
/ INSTITUTION: - Hematology-Oncology, Duke University
Medical Center, 2400 Pratt Street, Ste. 1100, Durham, NC 27710, USA. goggi002@mc.duke.edu
RESUMEN
/ SUMMARY: - Graft versus Host Disease (GVHD) is the
principal cause of morbidity and mortality in patients undergoing allogeneic
stem cell transplant. T cell depletion has been recognized as a method of
reducing the incidence of GVHD in allogeneic transplants. Until recently, most
T cell depletion methods were non-selective in reducing lymphocytes. Rhodamine
purging is one method, which selectively reduces alloreactive T cells
preventing GVHD. We review here the methods of non-selective and selective T
cell depletion, particularly the newer method of photodynamic purging utilizing
rhodamine. N. Ref:: 129
----------------------------------------------------
[12]
- Castellano -
TÍTULO / TITLE:Guia de consenso sobre tuberculosis
y tratamiento de la enfermedad inflamatoria intestinal con infliximab.
Consensus guideline on tuberculosis and treatment of inflammatory bowel disease
with infliximab. Spanish Working Group on Crohn Disease and Ulcerative Colitis.
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: <> 2003 Jan;26(1):29-33.
AUTORES
/ AUTHORS: - Obrador A; Lopez San Roman A; Munoz P;
Fortun J; Gassull MA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Digestivo. Hospital Son
Dureta. Palma de Mallorca. España. N.
Ref:: 19
----------------------------------------------------
[13]
TÍTULO / TITLE: - Acute and chronic
graft-versus-host disease after allogeneic peripheral-blood stem-cell and bone
marrow transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Clin Oncol 2001 Aug 15;19(16):3685-91.
AUTORES
/ AUTHORS: - Cutler C; Giri S; Jeyapalan S; Paniagua D;
Viswanathan A; Antin JH
INSTITUCIÓN
/ INSTITUTION: - Division of Hematologic Oncology,
Dana-Farber Cancer Institute, and Harvard School of Public Health, Boston, MA
02115, USA. corey_cutler@dfci.harvard.edu
RESUMEN
/ SUMMARY: - PURPOSE: Controversy exists as to whether
the incidence of graft-versus-host disease (GVHD) is increased after
peripheral-blood stem-cell transplantation (PBSCT) when compared with bone
marrow transplantation (BMT). We performed a meta-analysis of all trials
comparing the incidence of acute and chronic GVHD after PBSCT and BMT reported
as of June, 2000. Secondary analyses examined relapse rates after the two
procedures. METHODS: An extensive MEDLINE search of the literature was
undertaken. Primary authors were contacted for clarification and completion of
missing information. A review of cited references was also undertaken. Sixteen
studies (five randomized controlled trials and 11 cohort studies) were included
in this analysis. Data was extracted by two pairs of reviewers and analyzed for
the outcomes of interest. Meta-analyses, regression analyses, and assessments
of publication bias were performed. RESULTS: Using a random effects model, the
pooled relative risk (RR) for acute GVHD after PBSCT was 1.16 (95% confidence
interval [CI], 1.04 to 1.28; P=.006) when compared with traditional BMT. The
pooled RR for chronic GVHD after PBSCT was 1.53 (95% CI, 1.25 to 1.88; P
<.001) when compared with BMT. The RR of developing clinically extensive
chronic GVHD was 1.66 (95% CI, 1.35 to 2.05; P <.001). The excess risk of
chronic GVHD was explained by differences in the T-cell dose delivered with the
graft in a meta-regression model that did not reach statistical significance.
There was a trend towards a decrease in the rate of relapse after PBSCT (RR = 0.81;
95% CI, 0.62 to 1.05). CONCLUSION: Both acute and chronic GVHD are more common
after PBSCT than BMT, and this may be associated with lower rates of malignant
relapse. The magnitude of the transfused T-cell load may explain the
differences in chronic GVHD risk.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Chemokines, chemokine
receptors, and allograft rejection.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):377-86.
AUTORES
/ AUTHORS: - Nelson PJ; Krensky AM
INSTITUCIÓN
/ INSTITUTION: - Medizinishe Poliklinik, Klinikum
Innenstadt, Ludwig-Maximilians-University, Schillerstrasse 42, 80336, Munich,
Germany. nelson@medpoli.med.uni-muenchen.de N. Ref:: 40
----------------------------------------------------
[15]
TÍTULO / TITLE: - Alpha E: no more
rejection?
REVISTA
/ JOURNAL: - J Exp Med. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jem.org/
●●
Cita: J. Exp Med: <> 2002 Oct 7;196(7):873-5.
AUTORES
/ AUTHORS: - Kilshaw PJ; Higgins JM
INSTITUCIÓN
/ INSTITUTION: - The Babraham Institute, Cambridge, CB2
4AT, United Kingdom. peter.kilshaw@bbsrc.ac.uk N. Ref:: 25
----------------------------------------------------
[16]
TÍTULO / TITLE: - Chronic rejection.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):387-97.
AUTORES
/ AUTHORS: - Libby P; Pober JS
INSTITUCIÓN
/ INSTITUTION: - Division of Cardiovascular Medicine,
Brigham and Women’s Hospital, Boston, MA 02115, USA. plibby@rics.bwh.harvard.edu N. Ref:: 60
----------------------------------------------------
[17]
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
----------------------------------------------------
[18]
TÍTULO / TITLE: - IL-6: a magic potion
for liver transplantation?
REVISTA
/ JOURNAL: - Gastroenterology 2003 Jul;125(1):256-9.
AUTORES
/ AUTHORS: - Selzner M; Graf R; Clavien PA N. Ref:: 42
----------------------------------------------------
[19]
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
----------------------------------------------------
[20]
TÍTULO / TITLE: - The immunological
barrier to xenotransplantation.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):437-46.
AUTORES
/ AUTHORS: - Cascalho M; Platt JL
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Mayo Clinic,
Rochester, MN 55905, USA. N.
Ref:: 55
----------------------------------------------------
[21]
TÍTULO / TITLE: - Gene therapy progress
and prospects: gene therapy in organ transplantation.
REVISTA
/ JOURNAL: - Gene Ther 2003 Apr;10(8):605-11.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.gt.3302020
AUTORES
/ AUTHORS: - Bagley J; Iacomini J
INSTITUCIÓN
/ INSTITUTION: - Transplantation Biology Research Center,
Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129,
USA.
RESUMEN
/ SUMMARY: - One major complication facing organ
transplant recipients is the requirement for life-long systemic immunosuppression
to prevent rejection, which is associated with an increased incidence of
malignancy and susceptibility to opportunistic infections. Gene therapy has the
potential to eliminate problems associated with immunosuppression by allowing
the production of immunomodulatory proteins in the donor grafts resulting in
local rather than systemic immunosuppression. Alternatively, gene therapy
approaches could eliminate the requirement for general immunosuppression by
allowing the induction of donor-specific tolerance. Gene therapy interventions
may also be able to prevent graft damage owing to nonimmune-mediated graft loss
or injury and prevent chronic rejection. This review will focus on recent
progress in preventing transplant rejection by gene therapy. N. Ref:: 47
----------------------------------------------------
[22]
TÍTULO / TITLE: - Suppression of
graft-versus-host disease by naturally occurring regulatory T cells.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S9-S11.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106475.38978.11
AUTORES
/ AUTHORS: - Zeng D; Lan F; Hoffmann P; Strober S
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology and Immunology,
Department of Medicine, Stanford University School of Medicine, Stanford, CA
94305, USA.
RESUMEN
/ SUMMARY: - Studies of graft-versus-host disease after
allogeneic bone marrow transplantation have shown that there are subsets of
freshly isolated donor T cells that induce the disease and subsets that
suppress the disease. The balance of subsets in the graft determines disease
severity. The authors’ work on the nature of the regulatory-suppressor T cells
and their mechanisms of action is summarized in this article. N. Ref:: 24
----------------------------------------------------
[23]
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
----------------------------------------------------
[24]
TÍTULO / TITLE: - Cytolytic pathways in
haematopoietic stem-cell transplantation.
REVISTA
/ JOURNAL: - Nat Rev Immunol 2002 Apr;2(4):273-81.
●●
Enlace al texto completo (gratuito o de pago) 1038/nri775
AUTORES
/ AUTHORS: - van den Brink MR; Burakoff SJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Memorial
Sloan-Kettering Cancer Center, New York, New York 10021, USA. vandenbm@mskcc.org
RESUMEN
/ SUMMARY: - The remarkable activity of donor T cells
against malignant cells in the context of an allogeneic haematopoietic
stem-cell transplantation (HSCT) is arguably, at present, the most potent
clinical immunotherapy for cancer. However, alloreactive donor T cells are also
important effector cells in the development of graft-versus-host disease
(GVHD), which is a potentially lethal complication for recipients of an
allogeneic HSCT. Therefore, the separation of the GVHD and graft-versus-tumour
(GVT) activity of donor T cells has become a topic of great interest for many
investigators. Recent studies have shown that donor T cells make differential
use of their cytolytic pathways in mediating GVHD and GVT effects. Therefore,
the selective blockade or enhancement of cytolytic pathways provides an
intriguing therapeutic opportunity to separate the desired GVT effect from the
potentially devastating GVHD. N.
Ref:: 96
----------------------------------------------------
[25]
TÍTULO / TITLE: - Preliminary guidelines
for diagnosing and treating tuberculosis in patients with rheumatoid arthritis
in immunosuppressive trials or being treated with biological agents.
REVISTA
/ JOURNAL: - Ann Rheum Dis 2002 Nov;61 Suppl 2:ii62-3.
AUTORES
/ AUTHORS: - Furst DE; Cush J; Kaufmann S; Siegel J;
Kurth R
INSTITUCIÓN
/ INSTITUTION: - UCLA Medical School, Los Angeles, USA
Presbyterian Hospital, Dallas, USA.
----------------------------------------------------
[26]
TÍTULO / TITLE: - Clinical consequences
of iron overload in hemochromatosis homozygotes.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2003 May 1;101(9):3351-3; discussion 3354-8.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-11-3453
AUTORES
/ AUTHORS: - Ajioka RS; Kushner JP
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology, Department of
Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
84132, USA. N. Ref:: 58
----------------------------------------------------
[27]
TÍTULO / TITLE: - The influence of
environment and experience on neural grafts.
REVISTA
/ JOURNAL: - Nat Rev Neurosci 2001 Dec;2(12):871-9.
●●
Enlace al texto completo (gratuito o de pago) 1038/35104055
AUTORES
/ AUTHORS: - Dobrossy MD; Dunnett SB
INSTITUCIÓN
/ INSTITUTION: - School of Biosciences, Cardiff University,
Museum Avenue Box 911, Cardiff CF10 3US, Wales, UK. dobrossymd@cardiff.ac.uk N. Ref:: 106
----------------------------------------------------
[28]
TÍTULO / TITLE: - Glucocorticoids and
invasive fungal infections.
REVISTA
/ JOURNAL: - Lancet 2003 Nov 29;362(9398):1828-38.
AUTORES
/ AUTHORS: - Lionakis MS; Kontoyiannis DP
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases,
Infection Control and Employee Health, University of Texas MD Anderson Cancer
Center, Houston, TX 77030, USA.
RESUMEN
/ SUMMARY: - Since the 1990s, opportunistic fungal
infections have emerged as a substantial cause of morbidity and mortality in
profoundly immunocompromised patients. Hypercortisolaemic patients, both those
with endogenous Cushing’s syndrome and, much more frequently, those receiving
exogenous glucocorticoid therapy, are especially at risk of such infections.
This vulnerability is attributed to the complex dysregulation of immunity
caused by glucocorticoids. We critically review the spectrum and presentation
of invasive fungal infections that arise in the setting of hypercortisolism,
and the ways in which glucocorticoids contribute to their pathogenesis. A
better knowledge of the interplay between glucocorticoid-induced immunosuppression
and invasive fungal infections should assist in earlier recognition and
treatment of such infections. Efforts to decrease the intensity of
glucocorticoid therapy should help to improve outcomes of opportunistic fungal
infections. N. Ref:: 135
----------------------------------------------------
[29]
TÍTULO / TITLE: - Hemophagocytic syndrome
in renal transplant recipients: report of 17 cases and review of literature.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):238-43.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107285.86939.37
AUTORES
/ AUTHORS: - Karras A; Thervet E; Legendre C
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie et Transplantation
Renale, Hopital Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - BACKGROUND: Hemophagocytic syndrome (HPS)
combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and liver
dysfunction. It is defined by bone marrow and organ infiltration by activated,
nonmalignant macrophages phagocytizing blood cells. HPS is often caused by an
infectious or neoplastic disease and has rarely been described in renal
transplant recipients. METHODS: We retrospectively analyzed 17 cases of HPS
after cadaveric renal transplantation (13 men and 4 women, age 41+/-8 years).
The median time between transplantation and hemophagocytosis was 52 days.
Eleven patients (64%) had received antilymphocyte globulins during the 3 months
before presentation. RESULTS: Fever was present in all patients, and
hepatosplenomegaly was present in 9 of 17 patients. Other nonspecific clinical
findings included abdominal, neurologic, and respiratory symptoms. Laboratory
tests showed anemia (hemoglobin 6.1+/-1.3 g/dL), thrombocytopenia (34,000+/-32,000/mm3),
and leukopenia (1,700+/-1,400/mm3). Elevated liver enzymes were present in 12
of 17 patients, and cholestasis was present in 10 of 17 patients. Elevated
triglycerides and ferritin were noted in 75% and 86% of cases, respectively.
HPS was related to viral infection in nine patients (cytomegalovirus,
Epstein-Barr virus, human herpesvirus 6, and human herpesvirus 8), bacterial
infection in three patients (tuberculosis and Bartonella henselae), and other
infections in two patients (toxoplasmosis and Pneumocystis carinii pneumoniae).
Posttransplant lymphoproliferative disease was present in two patients. Despite
large-spectrum anti-infectious treatment and dramatic tapering of
immunosuppression, death occurred in eight patients (47%). Graft nephrectomy
was performed in four of the nine surviving patients. CONCLUSIONS: We report
here the largest series of HPS after renal transplantation. This rare disease
is usually secondary to herpes viridae infections, mostly cytomegalovirus and
Epstein-Barr virus in severely immunocompromised patients. Despite aggressive
treatment, the prognosis remains poor. N.
Ref:: 22
----------------------------------------------------
[30]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma,
antiviral treatment with acyclovir, valacyclovir or ganciclovir may be initiated
for at least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[31]
TÍTULO / TITLE: - Regulatory (suppressor)
T cells in peripheral allograft tolerance and graft-versus-host reaction.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107184.18562.FC
AUTORES
/ AUTHORS: - Rifle G; Herve P
INSTITUCIÓN
/ INSTITUTION: - UPRES EA563, Faculte de Medecine, Universite
de Bourgogne and Department of Nephrology-Intensive Care-Transplantation,
Hopital du Bocage, Dijon, France. gerard.rifle@chu-dijon.fr.
RESUMEN
/ SUMMARY: - Among the mechanisms capable of inducing peripheral
tolerance, regulatory (suppressor) T cells (Treg) probably play a key role in
the control of both reactivity to self-antigens and alloimmune response.
Augmentation or manipulation of Treg could improve organ allograft survival or
control graft-versus-host disease, thus resulting in operational tolerance. The
role of this immunomanipulation as one method of inducing tolerance has yet to
be clearly defined. N.
Ref:: 14
----------------------------------------------------
[32]
TÍTULO / TITLE: - Organ transplantation:
what is the state of the art?
REVISTA
/ JOURNAL: - Ann Surg 2003 Dec;238(6 Suppl):S72-89.
AUTORES
/ AUTHORS: - Collins BH
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Duke University Medical Center, Durham, NC 27710, USA. colli005@mc.duke.edu N. Ref:: 130
----------------------------------------------------
[33]
TÍTULO / TITLE: - Syngeneic hematopoietic
stem-cell transplantation for non-Hodgkin’s lymphoma: a comparison with
allogeneic and autologous transplantation—The Lymphoma Working Committee of the
International Bone Marrow Transplant Registry and the European Group for Blood
and Marrow Transplantation.
REVISTA
/ JOURNAL: - J Clin Oncol 2003 Oct 15;21(20):3744-53.
Epub 2003 Sep 8.
●●
Enlace al texto completo (gratuito o de pago) 1200/JCO.2003.08.054
AUTORES
/ AUTHORS: - Bierman PJ; Sweetenham JW; Loberiza FR Jr;
Taghipour G; Lazarus HM; Rizzo JD; Schmitz N; van Besien K; Vose JM; Horowitz
M; Goldstone A
INSTITUCIÓN
/ INSTITUTION: - University of Nebraska Medical Center,
Omaha, NE 68198-7680, USA. pjbierman@unmc.edu
RESUMEN
/ SUMMARY: - PURPOSE: To compare results of syngeneic,
allogeneic, and autologous hematopoietic stem-cell transplantation for
non-Hodgkin’s lymphoma (NHL). PATIENTS AND METHODS: The databases of the
International Bone Marrow Transplant Registry (IBMTR) and the European Group for
Blood and Marrow Transplantation were used to identify 89 NHL patients who
received syngeneic transplants. These patients were compared with NHL patients
identified from the IBMTR and the Autologous Blood and Marrow Transplant
Registry who received allogeneic (T-cell depleted and T-cell replete) and
autologous (purged and unpurged) transplants. RESULTS: No significant
differences in relapse rates were observed when results of allogeneic
transplantation were compared with syngeneic transplantation for any histology.
T-cell depletion of allografts was not associated with a higher relapse risk,
but was associated with improved overall survival for patients with low-grade
and intermediate-grade histology. Patients who received unpurged autografts for
low-grade NHL had a five-fold (P =.008) greater risk of relapse than recipients
of syngeneic transplants, and recipients of unpurged autografts had a two-fold
(P =.0009) greater relapse risk than patients who received purged autografts.
Among low-grade NHL patients, the use of purging was associated with
significantly better disease-free survival (P =.003) and overall survival (P
=.04) when compared with patients who received unpurged autografts. CONCLUSION:
These analyses failed to find evidence of a graft-versus-lymphoma effect, but
do provide indirect evidence to support the hypothesis that tumor contamination
may contribute to lymphoma relapse, and that purging may be beneficial for
patients undergoing autologous hematopoietic stem-cell transplantation for low-grade
NHL.
----------------------------------------------------
[34]
TÍTULO / TITLE: - Current directions in
hemochromatosis research: towards an understanding of the role of iron overload
and the HFE gene mutations in the development of clinical disease.
REVISTA
/ JOURNAL: - Nutr Rev 2003 Jan;61(1):38-42.
AUTORES
/ AUTHORS: - Neff LM
INSTITUCIÓN
/ INSTITUTION: - Jean Mayer USDA Human Nutrition Research
Center on Aging, Tufts University, New England Medical Center, Boston, MA, USA.
RESUMEN
/ SUMMARY: - Since the discovery of a candidate gene
(HFE) thought to be involved in the development of hereditary hemochromatosis,
there has been much interest in the potential use of genetic testing as a
screening tool for the disease in the general population. However, a recent
study suggests that less than 1% of subjects who are homozygous for the gene
mutations will go on to develop the full-blown disease of hereditary
hemochromatosis, historically termed “bronzed diabetes.” The study also
suggests that homozygotes have no higher risk of mortality or of any clinically
significant morbidity than normal control subjects. This conclusion contradicts
earlier findings that linked iron overload and HFE mutations to a number of
devastating diseases, including cardiovascular disease, diabetes, and
cancer. N. Ref:: 15
----------------------------------------------------
[35]
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.
----------------------------------------------------
[36]
TÍTULO / TITLE: - Penicillin-resistant
Streptococcus pneumoniae septic shock and meningitis complicating chronic graft
versus host disease: a case report and review of the literature.
REVISTA
/ JOURNAL: - Am J Med 2002 Aug 1;113(2):152-5.
AUTORES
/ AUTHORS: - Haddad PA; Repka TL; Weisdorf DJ
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology, Oncology and
Transplantation, Department of Medicine, University of Minnesota, Minneapolis,
USA. N. Ref:: 34
----------------------------------------------------
[37]
TÍTULO / TITLE: - How I treat chronic
graft-versus-host disease.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2001 Mar 1;97(5):1196-201.
AUTORES
/ AUTHORS: - Vogelsang GB
INSTITUCIÓN
/ INSTITUTION: - Oncology Center, Johns Hopkins University
School of Medicine, Baltimore, MD 21231-1000, USA. vogelge@jhmi.edu
RESUMEN
/ SUMMARY: - Allogeneic stem cell transplantation (SCT)
is now a commonplace procedure. Clinicians who care for patients with
hematologic malignancies and aplastic anemia are almost certain to follow up
patients after SCT. This review is intended to help clinicians observe patients
for probably the most important late complication of SCT, chronic
graft-versus-host disease (GVHD). It reviews the pathophysiology, risk factors,
clinical manifestations, evaluation, treatment, and supportive care of chronic
GVHD. N. Ref:: 34
----------------------------------------------------
[38]
TÍTULO / TITLE: - Risk for myopathy with
statin therapy in high-risk patients.
REVISTA
/ JOURNAL: - Arch Intern Med 2003 Mar 10;163(5):553-64.
AUTORES
/ AUTHORS: - Ballantyne CM; Corsini A; Davidson MH;
Holdaas H; Jacobson TA; Leitersdorf E; Marz W; Reckless JP; Stein EA
INSTITUCIÓN
/ INSTITUTION: - Center for Cardiovascular Disease
Prevention, Baylor College of Medicine, 6565 Fannin, Mail Station A601, Suite
A656, Houston, TX 77030, USA. cmb@bcm.tmc.edu
RESUMEN
/ SUMMARY: - Emerging data suggest that the 3-hydroxy-3-methylglutaryl
coenzyme A (HMG-CoA) reductase inhibitors (statins) offer important benefits
for the large population of individuals at high risk for coronary heart
disease. This population encompasses a sizable portion of individuals who are
also at high risk for drug-drug interactions due to their need for multiple
medications. In general, statins are associated with a very small risk for
myopathy (which may progress to fatal or nonfatal rhabdomyolysis); however, the
potential for drug-drug interactions is known to increase this risk in specific
high-risk groups. The incidence of myopathy associated with statin therapy is
dose related and is increased when statins are used in combination with agents
that share common metabolic pathways. Of particular concern is the potential
for interactions with other lipid-lowering agents such as fibrates and niacin
(nicotinic acid), which may be used in patients with mixed lipidemia, and with
immunosuppressive agents, such as cyclosporine, which are commonly used in patients
after transplantation. Clinicians should be alert to the potential for
drug-drug interactions to minimize the risk of myopathy during long-term statin
therapy in patients at high risk for coronary heart disease. N. Ref:: 128
----------------------------------------------------
[39]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[40]
TÍTULO / TITLE: - Longstanding
obliterative panarteritis in Kawasaki disease: lack of cyclosporin A effect.
REVISTA
/ JOURNAL: - Pediatrics 2003 Oct;112(4):986-92.
AUTORES
/ AUTHORS: - Kuijpers TW; Biezeveld M; Achterhuis A;
Kuipers I; Lam J; Hack CE; Becker AE; van der Wal AC
INSTITUCIÓN
/ INSTITUTION: - Emma Children’s Hospital, Academic Medical
Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. t.w.kuijpers@amc.uva.nl
RESUMEN
/ SUMMARY: - Kawasaki disease is a childhood vasculitis
of medium-sized vessels, affecting the coronary arteries in particular. We have
treated a therapy-resistant child who met all diagnostic criteria for Kawasaki
disease. After the boy was given intravenous immunoglobulins and salicylates,
as well as several courses of pulsed methylprednisolone, disease recurred and
coronary artery lesions became progressively detectable. Cyclosporin A was
started and seemed clinically effective. In contrast to the positive effect on
inflammatory parameters, ie, C-reactive protein and white blood cell counts, a
novel plasma marker for cytotoxicity (granzyme B) remained elevated. Coronary
disease progressed to fatal obstruction and myocardial infarction.
Echocardiography, electrocardiograms, and myocardial creatine phosphokinase did
not predict impending death. At autopsy an obliterative panarteritis was
observed resulting from massive fibrointimal proliferation, affecting the aorta
and several large and medium-sized arteries. Immunophenotypic analysis of the
inflammatory infiltrates in arteries revealed mainly granzyme-positive
cytotoxic T cells and macrophages in the intima and media, as well as nodular
aggregates of T cells, B cells, and plasma cells in the adventitia of affected
arteries. These findings further endorse the role of specific cellular and
humoral immunity in Kawasaki disease. Unremitting coronary arteritis and
excessive smooth muscle hyperplasia resulted in coronary occlusion despite the
use of cyclosporin A. N.
Ref:: 37
----------------------------------------------------
[41]
TÍTULO / TITLE: - The history and future
of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic
hematopoietic stem cell transplantation.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2001 Dec 1;98(12):3192-204.
AUTORES
/ AUTHORS: - Ho VT; Soiffer RJ
INSTITUCIÓN
/ INSTITUTION: - Department of Adult Oncology, Dana-Farber
Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA, USA. N. Ref:: 244
----------------------------------------------------
[42]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular
mammography, according to national recommendations where available. N. All
renal transplant recipients should undergo a faecal occult-blood testing as a
screening for colorectal cancer and other (pre-malignant) lesions, according to
national recommendations where available. O. In all these conditions, it is
recommended to reduce immunosuppression whenever possible.
----------------------------------------------------
[43]
TÍTULO / TITLE: - Severe Ehrlichia
chaffeensis infection in a lung transplant recipient: a review of ehrlichiosis
in the immunocompromised patient.
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: <> 2002 Mar;8(3):320-3.
AUTORES
/ AUTHORS: - Safdar N; Love RB; Maki DG
INSTITUCIÓN
/ INSTITUTION: - Section of Infectious Diseases, University
of Wisconsin Medical School, 600 Highland Avenue, Madison, WI 53792, USA.
RESUMEN
/ SUMMARY: - We describe a case of human ehrlichiosis
in a lung transplant recipient and review published reports on ehrlichiosis in
immunocompromised patients. Despite early therapy with doxycycline, our patient
had unusually severe illness with features of thrombotic thrombocytopenic
purpura. Of 23 reported cases of ehrlichiosis in immunocompromised patients,
organ failure occurred in all patients and 6 (25%) died. N. Ref:: 32
----------------------------------------------------
[44]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease
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: <> 2002;17 Suppl 4:24-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant
cardiovascular disease is very common, an important cause of morbidity and the
first cause of mortality in renal transplant recipients. Therefore, detection
and early treatment of post-transplant cardiovascular disease are mandatory. B.
Specific risk factors for developing post-transplant cardiovascular disease
include pre-transplant cardiovascular disease, arterial hypertension, uraemia
(graft dysfunction), hyperlipidaemia, diabetes mellitus, smoking and
immunosuppressive treatment. These factors should be targeted for intervention.
C. Pre-transplant cardiovascular disease is a major risk factor for
post-transplant cardiovascular disease. Therefore, prior to transplantation, it
is mandatory to detect and treat symptomatic coronary artery disease, heart
failure due to valvular failure or cardiomyopathy, and pericardial
constriction. This policy should also be followed in asymptomatic diabetic
patients.
----------------------------------------------------
[45]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[46]
TÍTULO / TITLE: - Imiquimod 5% cream for
the treatment of cutaneous lesions in immunocompromised patients.
REVISTA
/ JOURNAL: - Acta Derm Venereol Suppl (Stockh) 2003
Sep;(214):23-7.
AUTORES
/ AUTHORS: - Johnson R; Stockfleth E
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Massachusetts
General Hospital, 55 Fruit Street, Bartlett Hall, Boston, MA 02114, USA. RAJOHNSON@PARTNERS.ORG N. Ref:: 43
----------------------------------------------------
[47]
TÍTULO / TITLE: - Donor chimerism and
stem cell function in a murine congenic transplantation model after low-dose
radiation conditioning: effects of a retroviral-mediated gene transfer protocol
and implications for gene therapy.
REVISTA
/ JOURNAL: - Exp Hematol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medicinedirect.com/journal
●●
Cita: Experimental Hematology: <> 2002 Nov;30(11):1324-32.
AUTORES
/ AUTHORS: - Goebel WS; Yoder MC; Pech NK; Dinauer MC
INSTITUCIÓN
/ INSTITUTION: - Herman B. Wells Center for Pediatric
Research and Department of Pediatrics, Hematology/Oncology, James Whitcomb
Riley Hospital for Children, Indiana University School of Medicine,
Indianapolis, IN, USA.
RESUMEN
/ SUMMARY: - OBJECTIVE: We investigated low-dose
radiation conditioning for the transplantation of retrovirus-transduced cells
in a C57Bl6/J murine model. MATERIALS AND METHODS: The effect of low-dose
radiation on stem cell function was investigated using a competitive
repopulation assay. Stem cell function of marrow cells that underwent a
retroviral-mediated gene transfer (RMGT) protocol was examined by this assay,
and donor chimerism of these cells when transplanted into 160-cGy conditioned
syngeneic hosts was compared to fresh marrow. RESULTS: Irradiation with 300 or
160 cGy substantially decreased stem cell function as measured by competitive
repopulation. Animals conditioned with 160 cGy and transplanted with 20 x 10(6)
fresh marrow cells permitted donor cell engraftment of 53.6% +/- 11.4% 6 months
after transplant compared to 100% donor cell engraftment after 1100 cGy
irradiation. Lymphoid and myeloid engraftment did not significantly differ from
total engraftment in submyeloablated hosts. When transplanted into lethally
irradiated hosts, the competitive repopulating activity of marrow treated with
a single dose of 5-fluorouracil followed by ex vivo culture according to a
standard RMGT protocol was equal to 5-fluorouracil-only treated marrow.
However, cells treated with 5-fluorouracil or 5-fluorouracil plus ex vivo
culture for RMGT repopulated less well than fresh marrow cells in 160 cGy
conditioned hosts. CONCLUSIONS: Low-dose irradiation decreases host stem cell
function, allowing engraftment of both fresh and RMGT protocol-treated marrow,
although the engraftment of 5-fluorouracil-treated cells was reduced at least
two-fold, and 5-fluorouracil plus RMGT protocol-treated cells at least
three-fold, compared to fresh marrow. Modification of current RMGT protocols
may be important for optimizing engraftment under these conditions.
----------------------------------------------------
[48]
TÍTULO / TITLE: - Evaluation of
thalidomide for treatment or prevention of chronic graft-versus-host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Jul;44(7):1141-6.
AUTORES
/ AUTHORS: - Flowers ME; Martin PJ
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Research, Fred
Hutchinson Cancer Research Center, 1100 Fairview Avenue N., DS-290, PO Box
19024, Seattle, WA 98109-1024, USA. mflowers@fhcrc.org
RESUMEN
/ SUMMARY: - During the past 5 years, better
understanding of immunomodulatory and anti-angiogenesis properties of
thalidomide has increased interest in the use of this agent for a wider variety
of clinical applications. This article reviews the clinical evaluation of
thalidomide for treatment or prevention of chronic
graft-versus-host-disease. N.
Ref:: 38
----------------------------------------------------
[49]
TÍTULO / TITLE: - Dry eye as a major
complication associated with chronic graft-versus-host disease after
hematopoietic stem cell transplantation.
REVISTA
/ JOURNAL: - Cornea 2003 Oct;22(7 Suppl):S19-27.
AUTORES
/ AUTHORS: - Ogawa Y; Kuwana M
INSTITUCIÓN
/ INSTITUTION: - Institute for Advanced Medical Research,
and Department of Ophthalmology, Keio University School of Medicine, Tokyo,
Japan. yoko@sc.itc.keio.ac.jp
RESUMEN
/ SUMMARY: - PURPOSE: To review the condition of dry
eye associated with chronic graft-versus-host disease (GVHD). METHODS: The
immunopathogenic processes and therapeutic options for lacrimal gland chronic
GVHD are discussed. RESULTS: Dry eye is the most frequent ocular complication
after hematopoietic stem cell transplantation. The condition typically occurs
around 6 months post-operation and is recognized as a complication of chronic
GVHD. Lacrimal gland specimens from patients with dry eye show prominent
fibrosis and an increase in CD34+ stromal fibroblasts in the glandular
interstitium in addition to infiltration of T cells into the periductal areas.
In periductal areas, CD4+ and CD8+ T cells colocalize with stromal fibroblasts
that express the full component of surface molecules necessary for antigen
presentation. These findings strongly suggest that periductal fibroblasts are
involved in fibrogenic and immune processes by interacting with T cells in the
lacrimal gland of patients with chronic GVHD, resulting in rapidly progressive
dry eye. Current therapies for dry eye related to chronic GVHD include tear
supplements and nonspecific immunosuppressants. CONCLUSION: We report a
significant role for stromal fibroblasts in the pathogenic processes of dry eye
related to chronic GVHD. Although several supportive therapies can reduce the
symptoms, specific therapies that suppress fibrotic and immune processes in the
lacrimal glands are necessary to control dry eye associated with chronic
GVHD. N. Ref:: 49
----------------------------------------------------
[50]
TÍTULO / TITLE: - HLA-DPB1 and chronic
beryllium disease: a HuGE review.
REVISTA
/ JOURNAL: - Am J Epidemiol 2003 Mar 1;157(5):388-98.
AUTORES
/ AUTHORS: - McCanlies EC; Kreiss K; Andrew M; Weston A
INSTITUCIÓN
/ INSTITUTION: - Biostatistics and Epidemiology Branch,
Health Effects Laboratory Division, National Institute for Occupational Safety
and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505,
USA. eim4@cdc.gov
RESUMEN
/ SUMMARY: - The human leukocyte antigen (HLA) complex
is a series of genes located on chromosome 6 that are important in normal
immune function. Susceptibility to chronic beryllium disease, a granulomatous
lung disease that appears in workers exposed to beryllium, is modified by
genetic variants of the HLA-DP subregion. Evaluation of HLA-DPB1 sequence
motifs in current and former beryllium workers implicated a glutamic acid
residue at position 69 (HLA-DPB1(Glu69)) in chronic beryllium disease. This
finding has since been extended to specific HLA-DPB1(Glu69) alleles. Specific
job tasks have also been implicated in degree of risk, and in this paper the
authors explore gene-environment interaction. The utility of this genetic
information for prospective, current, and former beryllium workers must be
weighed against the potential for employment and insurance discrimination.
Continued research in the beryllium-exposed population will be important for
improving personal risk assessment and identifying high-risk genes associated
with disease progression. N.
Ref:: 79
----------------------------------------------------
[51]
TÍTULO / TITLE: - Donor-specific
tolerance in fully major histocompatibility major histocompatibility
complex-mismatched limb allograft transplants under an anti-alphabeta T-cell
receptor monoclonal antibody and cyclosporine A protocol.
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 27;76(12):1662-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000105343.49626.6F
AUTORES
/ AUTHORS: - Siemionow MZ; Izycki DM; Zielinski M
INSTITUCIÓN
/ INSTITUTION: - Department of Plastic Surgery, Cleveland
Clinic Foundation, A60, 9500 Euclid Avenue, Cleveland, OH 44195, USA. siemiom@ccf.org
RESUMEN
/ SUMMARY: - BACKGROUND: Recent studies have
demonstrated that treatment with alphabeta-T-cell receptor (TCR) monoclonal
antibody and cyclosporine A (CsA) can extend survival in composite tissue
allografts (CTA). The purpose of this study was to induce tolerance in fully
major histocompatibility complex (MHC)-mismatched rat limb allografts under 7 days
of a combined alphabeta-TCR-CsA protocol. METHODS: The authors performed 30
hind-limb allotransplantations across the MHC barrier between Brown Norway
donors (BN; RT1n) and Lewis recipients (LEW; RT1l). Isograft and allograft
controls received no treatment. The experimental groups received monotherapy of
alphabeta-TCR and CsA or a combination of alphabeta-TCR and CsA for 7 days
only. Donor-specific tolerance and immunocompetence were determined by standard
skin grafting in vivo and mixed lymphocyte reaction (MLR) in vitro. The
efficacy of immunosuppressive therapy and the level of donor-specific chimerism
were determined by flow cytometry. RESULTS: Long-term survival (>350 days)
was achieved in allograft recipients (n=6) under the 7-day protocol of combined
alphabeta-TCR-CsA. Donor-specific tolerance and immunocompetence of long-term
chimeras were confirmed by acceptance of skin grafts from the donors and
rejection of the third-party alloantigens (AxC Irish). At day 120, MLR
demonstrated unresponsiveness to the host and donor antigens but strong
reactivity against third-party alloantigens. Flow cytometry confirmed the high
efficacy of immunosuppressive treatment and the development of donor-specific
chimerism (7.6% of CD4+-RT1n+ cells, 1.3% of CD8+-RT1n+ cells, and 16.5% of
CD45RA+-RT1n+ cells) in the periphery of tolerated recipients. CONCLUSIONS:
Combined therapy of alphabeta-TCR-CsA for 7 days resulted in tolerance
induction in fully MHC-mismatched rat hind-limb allografts. Tolerance was
directly associated with stable, donor-specific chimerism.
----------------------------------------------------
[52]
TÍTULO / TITLE: - Perioperative
single-dose glucocorticoid administration: pathophysiologic effects and
clinical implications.
REVISTA
/ JOURNAL: - J Am Coll Surg 2002 Nov;195(5):694-712.
AUTORES
/ AUTHORS: - Holte K; Kehlet H
INSTITUCIÓN
/ INSTITUTION: - Department of Surgical Gastroenterology,
Hvidovre University Hospital, Denmark. N.
Ref:: 138
----------------------------------------------------
[53]
TÍTULO / TITLE: - Vascular disease in
mixed connective tissue disease (MCTD).
REVISTA
/ JOURNAL: - Intern Med 2001 Dec;40(12):1176.
AUTORES
/ AUTHORS: - Kondo H
N. Ref:: 13
----------------------------------------------------
[54]
TÍTULO / TITLE: - Subcutaneous black
fungus (phaeohyphomycosis) infection in renal transplant recipients:three
cases.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1):140-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107287.70512.E7
AUTORES
/ AUTHORS: - Yehia M; Thomas M; Pilmore H; Van Der
Merwe W; Dittmer I
INSTITUCIÓN
/ INSTITUTION: - Auckland Renal Transplant Group, Auckland
Hospital, Auckland, New Zealand. mahay@adhb.govt.nz
RESUMEN
/ SUMMARY: - We describe three cases of subcutaneous
phaeohyphomycosis developing in the lower limbs of renal transplant recipients
shortly after transplantation. Each case presented with dark-colored nodules
that subsequently ulcerated. Histopathologic examination revealed dematiaceous
fungal hyphae with a surrounding granulomatous reaction. The fungi were subsequently
identified as Alternaria alternatum in two cases and Phialophora richardsiae in
one case. In one case, the lesions resolved during a prolonged (6-month) course
of itraconazole without the requirement for surgical excision. In the other two
cases, combined medical and surgical treatment resulted in cure. A review of
the literature on phaeohyphomycosis is presented. N. Ref:: 11
----------------------------------------------------
[55]
TÍTULO / TITLE: - Prevention of
transfusion-associated graft-versus-host disease by inactivation of T cells in
platelet components.
REVISTA
/ JOURNAL: - Semin Hematol 2001 Oct;38(4 Suppl
11):34-45.
AUTORES
/ AUTHORS: - Luban NL
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine and
Pathology and the Transfusion Medicine/Donor Center, Children’s National
Medical Center, Washington, DC 20010, USA.
RESUMEN
/ SUMMARY: - Patients with hematological malignancies
and infants with congenital immunodeficiencies who received blood are two of
many populations at risk for transfusion-associated graft-versus-host disease
(TA-GVHD). Of the methodologies (eg, photoinactivation, peglyation, ultraviolet
light, and irradiation) that can be used to prevent TA-GVHD, only irradiation
of whole blood and cellular components is currently accepted practice of the US
Food and Drug Administration (FDA). Among the newer methods that have been
developed to reduce the risks of bacterial and viral contaminants of platelet
transfusions, photochemical treatment (PCT) using psoralens and long-wavelength
ultraviolet (UVA) irradiation modifies bacterial and viral genomes sufficiently
to inhibit replication. Among a broad group of compounds, the synthetic
psoralen compound amotosalen hydrochloride (HCl) (S-59) has been shown to be
particularly effective in inactivating bacteria and viruses, without adversely
affecting in vitro and in vivo platelet function. N. Ref:: 92
----------------------------------------------------
[56]
TÍTULO / TITLE: - Unrelated donor
hematopoietic cell transplantation: marrow or umbilical cord blood?
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2003 Jun 1;101(11):4233-44. Epub 2003 Jan 9.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-08-2510
AUTORES
/ AUTHORS: - Grewal SS; Barker JN; Davies SM; Wagner JE
INSTITUCIÓN
/ INSTITUTION: - University of Minnesota, 420 Delaware St
SE, MMC 477, Minneapolis, MN 55455, USA. grewa002@umn.edu N. Ref:: 165
----------------------------------------------------
[57]
TÍTULO / TITLE: - Vascular thrombosis and
acute cytomegalovirus infection in immunocompetent patients: report of 2 cases
and literature review.
REVISTA
/ JOURNAL: - Clin Infect Dis 2003 Jun 1;36(11):E134-9.
Epub 2003 May 19.
AUTORES
/ AUTHORS: - Abgueguen P; Delbos V; Chennebault JM;
Payan C; Pichard E
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases, Centre
Hospitalo-Universitaire, Angers, France. piabgueguen@chu-angers.fr
RESUMEN
/ SUMMARY: - Acute cytomegalovirus (CMV) infection in
immunocompetent patients is common worldwide, with seroprevalence rates of
40%-100%, depending on the country, socioeconomic conditions, and the patient’s
age. Infection is most often asymptomatic, but acute cytomegalovirus infection
is occasionally revealed by prolonged fever, cervical lymphadenitis, and
arthralgia, and it is more rarely revealed by pneumonia, myocarditis,
pericarditis, colitis, and hemolytic anemia. Here, we report 2 cases of acute
CMV infection in nonimmunocompromised adults that were complicated by venous
thrombosis with pulmonary embolism. We also review previously reported cases of
vascular thrombosis and discuss the propensity of CMV to induce vascular damage
with associated thrombosis. N.
Ref:: 55
----------------------------------------------------
[58]
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.
----------------------------------------------------
[59]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.4. Chronic graft dysfunction. De novo renal disease
after 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: <> 2002;17 Suppl 4:15-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Acute pyelonephritis is
relatively frequent in the transplanted kidney and carries a risk of
septicaemia. The condition should be recognized and the patient should be
treated promptly in the hospital. B. After initiation of any drugs known to
induce the development of interstitial nephritis in the transplant patient, it
is recommended to monitor renal function and abnormalities in order to detect
any side effects rapidly. If interstitial nephritis is observed, it is
recommended to stop the offending drug, and to initiate appropriate treatment.
C. De novo membranous nephropathy should be considered in cases of proteinuria
and nephrotic syndrome after transplantation. Viral infection, such as HCV,
should be excluded. D. In the case of the development of graft dysfunction in a
transplant patient with Alport’s syndrome, one should consider additionally the
possibility of de novo anti-glomerular basement membrane (anti-GBM)
glomerulonephritis.
----------------------------------------------------
[60]
TÍTULO / TITLE: - Alicaforsen. Isis
Pharmaceuticals.
REVISTA
/ JOURNAL: - Curr Opin Investig Drugs 2001
Oct;2(10):1401-6.
AUTORES
/ AUTHORS: - Gewirtz AT; Sitaraman S
INSTITUCIÓN
/ INSTITUTION: - Emory University School of Medicine,
Department of Pathology and Laboratory Medicine, Atlanta, GA 30322, USA. agewirt@emory.edu
RESUMEN
/ SUMMARY: - Alicaforsen (ISIS-2302) is an RNase
H-dependent antisense inhibitor of the intercellular adhesion molecule ICAM-1
under development by Isis Pharmaceuticals, for the potential treatment of a
variety of inflammatory disorders [175741]. As of April 1997 it was in phase
III trials for Crohn’s disease (CD); however, the trial failed and, in December
1999, the company suspended development for this indication [352801]. In October
2000, the company re-initiated development in CD [384820] and new phase III
trials had begin by May 2001 [409704]. In August 2000, phase II studies of
alicaforsen in an enema formulation for ulcerative colitis and a topical
formulation for psoriasis were ongoing [378715]. Development of the compound
for the potential treatment of rheumatoid arthritis (RA) was discontinued in
1999 [347579]. By the end of 1998, alicaforsen was in phase II trials for
kidney transplant rejection. At this time, these trials were expected to finish
in mid-1999 [343460]. However, they were ongoing in September 1999, although no
further development has been reported for this indication since that time
[338672]. In February 1995, Isis Pharmaceuticals and Boehringer Ingelheim (BI)
signed a collaborative agreement on cell adhesion inhibitors, including
alicaforsen [174111]. By early 1999, Isis and BI were to decide on the next
developmental step for alicaforsen following further analyses of its
performance against CD [292915], [315439]. Their joint development agreement
was terminated in 1999; Isis regained rights to the product and by September
1999 was in talks to license alicaforsen to another partner for CD [338672]. In
June 2000, Cytogenix entered into a sponsored research agreement with Baylor
College of Medicine at the Texas Medical Center Houston for the use of its
ssDNA expression system for the development of antisense strategies directed
against intercellular adhesion molecules for the purpose of reducing lung
inflammation and injury in disease states and conditions [369677]. US-05514788,
and other patents, cover antisense cell adhesion molecule inhibitors [212289],
[234792]. N. Ref:: 45
----------------------------------------------------
[61]
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.
----------------------------------------------------
[62]
TÍTULO / TITLE: - Posttransplantation
diabetes: a systematic review of the literature.
REVISTA
/ JOURNAL: - Diabetes Care. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://care.diabetesjournals.org/
●●
Cita: Diabetes Care: <> 2002 Mar;25(3):583-92.
AUTORES
/ AUTHORS: - Montori VM; Basu A; Erwin PJ; Velosa JA;
Gabriel SE; Kudva YC
INSTITUCIÓN
/ INSTITUTION: - Division of Endocrinology, Diabetes,
Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota
55905, USA.
RESUMEN
/ SUMMARY: - OBJECTIVES: To systematically review the
incidence of posttransplantation diabetes (PTD), risk factors for its
development, prognostic implications, and optimal management. RESEARCH DESIGN
AND METHODS: We searched databases (MEDLINE, EMBASE, the Cochrane Library, and
others) from inception to September 2000, reviewed bibliographies in reports
retrieved, contacted transplantation experts, and reviewed specialty journals.
Two reviewers independently determined report inclusion (original studies, in
all languages, of PTD in adults with no history of diabetes before
transplantation), assessed study methods, and extracted data using a
standardized form. Meta-regression was used to explain between-study
differences in incidence. RESULTS: Nineteen studies with 3,611 patients were
included. The 12-month cumulative incidence of PTD is lower (<10% in most
studies) than it was 3 decades ago. The type of immunosuppression explained 74%
of the variability in incidence (P = 0.0004). Risk factors were patient age,
nonwhite ethnicity, glucocorticoid treatment for rejection, and
immunosuppression with high-dose cyclosporine and tacrolimus. PTD was
associated with decreased graft and patient survival in earlier studies; later
studies showed improved outcomes. Randomized trials of treatment regimens have
not been conducted. CONCLUSIONS: Physicians should consider modification of
immunosuppressive regimens to decrease the risk of PTD in high-risk transplant
recipients. Randomized trials are needed to evaluate the use of oral
glucose-lowering agents in transplant recipients, paying particular attention
to interactions with immunosuppressive drugs.
N. Ref:: 79
----------------------------------------------------
[63]
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
----------------------------------------------------
[64]
TÍTULO / TITLE: - Mycophenolate mofetil
for the prevention and treatment of graft-versus-host disease following stem
cell transplantation: preliminary findings.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2001 Jun;27(12):1255-62.
AUTORES
/ AUTHORS: - Vogelsang GB; Arai S
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, Johns Hopkins
Oncology Center, Baltimore, MD 21287-8943, USA.
RESUMEN
/ SUMMARY: - The therapeutic benefits of allogeneic
stem cell transplantation in patients with hematologic disorders are limited by
the significant morbidity and mortality of graft-versus-host disease (GVHD).
Current agents for the prevention and treatment of GVHD have limited efficacy
and often result in toxic side-effects. Mycophenolate mofetil (MMF) is a new
immunosuppressant with a selective mechanism of action. When employed following
solid organ transplantation, MMF reduces the incidence and severity of acute
rejection episodes. By selectively targeting activated lymphocytes, the active
metabolite of MMF, mycophenolic acid (MPA), appears to augment the actions of
standard immunosuppressant agents without adding overlapping toxicities.
Studies of combination regimens that include MMF report that this agent permits
a dose reduction of cyclosporine, tacrolimus, or corticosteroid, without
increasing the incidence of acute rejection in solid organ transplants. Reports
on the efficacy of MMF following stem cell transplantation in animal studies
were mixed. However, the use of a non-myeloablative conditioning regimen with a
post-graft immunosuppressive regimen of MMF and cyclosporine was able to
sustain stable mixed chimeras in 60% to 80% of dogs who received hematopoietic
grafts from DLA-identical littermates. MMF has demonstrated activity in
preliminary clinical trials for GVHD prophylaxis, and treatment of acute or
chronic GVHD. Larger clinical trials are warranted to determine the optimum
dose and route of MMF administration for GVHD, as well as the comparative
safety and efficacy of MMF-containing regimens. N. Ref:: 36
----------------------------------------------------
[65]
TÍTULO / TITLE: - Postmenopausal
tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant
patient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 15;72(7):1241-4.
AUTORES
/ AUTHORS: - El Khoury J; Stikkelbroeck MM; Goodman A;
Rubin RH; Cosimi AB; Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division, GRJ 504,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Pseudomonas aeruginosa is an
uncommon cause of infection in the female genital tract. We report a case of
postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal
transplant recipient. The presentation included mild abdominal symptoms with
rapid progression of peritonitis and surgical abscess drainage. This is the
first such case in an organ transplant recipient described in the English
literature. METHODS AND RESULTS: Published reports of 1040 cases of TOA were
reviewed. The most common features were a history of sexually transmitted
disease or pelvic inflammatory disease, and symptoms including abdominal pain
and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were
the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia
trachomatis, which are frequently isolated from cervical cultures, are
uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were
treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with
surgery and antimicrobial therapy. CONCLUSION: This report illustrates the
muted presentation and atypical microbiology of gynecologic infection in an
organ transplant recipient. N.
Ref:: 59
----------------------------------------------------
[66]
TÍTULO / TITLE: - Cardiac allograft
vasculopathy: central role of endothelial injury leading to transplant
“atheroma”.
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 27;76(6):891-9.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000080981.90718.EB
AUTORES
/ AUTHORS: - Valantine HA
INSTITUCIÓN
/ INSTITUTION: - Falk Cardiovascular Research Center, Stanford
University, California 94305-5406, USA. hvalantine@stanford.edu
RESUMEN
/ SUMMARY: - Endothelial injury plays a central role in
the pathophysiologic mechanisms underlying cardiac allograft vasculopathy
(CAV). Although the accelerated course of CAV and its localization to the
allograft support an important role for the alloimmune response, there is
considerable evidence implicating lipoprotein abnormalities, metabolic
disturbances, viral infections, and systemic inflammation in the process. This
multifactorial basis for CAV may be put into a pathophysiologic context in
which endothelial cell injury is the triggering event that initiates and drives
the proliferative and fibrotic processes characteristic of CAV. In the
transplant setting, endothelial cell injury is induced by multiple factors,
including brain death, ischemia-reperfusion, alloimmune responses, and viral
infections. Once initiated, propagation of the proliferative processes that
ultimately lead to vascular occlusion is enhanced by the abnormal metabolic
environment of elevated lipoproteins and insulin resistance encountered in most
patients. This review examines the evidence for the role of potential triggers
of endothelial injury in the pathophysiology of CAV and discusses the central
role of the nitric oxide pathway in the disease process. N. Ref:: 89
----------------------------------------------------
[67]
TÍTULO / TITLE: - Treatment of myelopathy
in Sjogren syndrome with a combination of prednisone and cyclophosphamide.
REVISTA
/ JOURNAL: - Arch Neurol 2001 May;58(5):815-9.
AUTORES
/ AUTHORS: - Williams CS; Butler E; Roman GC
INSTITUCIÓN
/ INSTITUTION: - Department of Neurology, Wilford Hall
Medical Center, Lackland Air Force Base, Texas, USA. christopher.williams@59MDW.WHMC.af.mil
RESUMEN
/ SUMMARY: - BACKGROUND: Peripheral neuropathy is a
common complication of primary Sjogren syndrome, but central nervous system
involvement also occurs and may be the only extraglandular manifestation. Sicca
symptoms may also be minimal. Combinations of lesions along with relapses and
remissions can suggest multiple sclerosis in the proper clinical setting,
making the correct diagnosis elusive. OBJECTIVES: To report a case of
progressive transverse myelopathy with previous optic neuropathy in primary
central nervous system Sjogren syndrome (CNS-SS), and to review 17 previously
reported cases and the patient’s responses to various therapies. DESIGN: Case
report and literature review. SETTING: University hospital. PATIENT: A
63-year-old Hispanic woman with a 10-month history of progressive spastic
paraparesis associated with optic neuropathy and a T10 sensory level. Magnetic
resonance imaging demonstrated multifocal, contrast-enhancing lesions in the
spinal cord. The patient was diagnosed as having CNS-SS because of the presence
of sicca symptoms, abnormal serological test results, and salivary gland biopsy
results, which fulfilled San Diego criteria for “definite” Sjogren syndrome.
She responded to treatment with a combination of prednisone and
cyclophosphamide. CONCLUSIONS: Diagnosis of primary CNS-SS requires a high
index of suspicion and specialized clinical testing. Treatment with pulse doses
of corticosteroids alone may be suboptimal, but results of treatment with a
combination of corticosteroids and either cyclophosphamide or chlorambucil have
been encouraging. N.
Ref:: 24
----------------------------------------------------
[68]
TÍTULO / TITLE: - ‘GVHD’:
graft-versus-host disease or graft-versus-Hodgkin’s disease? An old acronym
with new meaning.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
May;31(9):739-46.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703895
AUTORES
/ AUTHORS: - Porter DL; Stadtmauer EA; Lazarus HM
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow and Stem Cell Transplant
Program, Division of Hematology-Oncology, University of Pennsylvania Medical
Center, Philadelphia 19104, USA.
RESUMEN
/ SUMMARY: - The majority of patients with relapsed or
refractory Hodgkin’s lymphoma (HL) will not be cured with standard therapy.
Relapse rates remain high even after autologous stem cell transplantation
(SCT), particularly for patients with high-risk disease. Allogeneic SCT offers
several potential advantages for patients with HL. It is feasible when
autologous stem cells are not available and stem cell grafts will be tumor
free. Perhaps a more important advantage is the potential to generate a
graft-versus-Hodgkin’s lymphoma (GVHL) effect. Unfortunately, although
allogeneic SCT may cure some HL patients, treatment-related mortality has been
unusually high, and superior survival, when compared to autologous SCT, has not
been demonstrated. Nonmyeloablative conditioning and allogeneic SCT may induce
a direct GVHL reaction with less conditioning regimen-related toxicity and
ultimately may have the potential to improve cure rates and survival for
advanced HL patients. N.
Ref:: 81
----------------------------------------------------
[69]
TÍTULO / TITLE: - Alternative concepts of
suicide gene therapy for graft-versus-host disease after adoptive
immunotherapy.
REVISTA
/ JOURNAL: - Acta Haematol 2003;110(2-3):132-8.
●●
Enlace al texto completo (gratuito o de pago) 1159/000072462
AUTORES
/ AUTHORS: - Kramm CM
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Hematology,
Oncology, and Immunology, University Hospital Dusseldorf, Dusseldorf, Germany. kramm@uni-duesseldorf.de
RESUMEN
/ SUMMARY: - T-cell suicide gene therapy represents a
promising novel treatment strategy for graft-versus-host disease following
adoptive immunotherapy after allogeneic hematopoietic stem cell
transplantation. The clinical efficiency of this approach is still hampered by
several obstacles including induction of alloresponses due to the use of
immunogenic suicide and selection genes, genetic inactivation of suicide genes,
and functional immunological impairment after retroviral transduction with
extensive in vitro stimulation. New concepts as possible solutions to these
limitations are discussed. N.
Ref:: 36
----------------------------------------------------
[70]
TÍTULO / TITLE: - Post-transplant
Burkitt’s leukemia or lymphoma. Study of five cases treated with specific
intensive therapy (PETHEMA ALL-3/97 trial).
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Sep;44(9):1541-3.
AUTORES
/ AUTHORS: - Xicoy B; Ribera JM; Esteve J; Brunet S;
Sanz MA; Fernandez-Abellan P; Feliu E
INSTITUCIÓN
/ INSTITUTION: - Services of Hematology, Hospital
Universitari Germans Trias i Pujol, Badalona, España.
RESUMEN
/ SUMMARY: - Burkitt’s lymphoma (BL) and Burkitt-like
acute lymphoblastic leukemia (ALL) are uncommon lymphoproliferative disorders
after solid organ or stem cell transplantation. Although their prognosis is
considered to be poor, there are scarce data on the clinical characteristics
and the response to specific therapies. We report the main clinical
characteristics and the results of a specific intensive chemotherapy in 5 adult
patients with postransplant BL/ALL3 included in the PETHEMA ALL3/97 protocol.
Two patients died in induction, another died in consolidation phase and the
remaining 2 patients are in continuous complete remission 6 and 18 months from
the diagnosis. N.
Ref:: 6
----------------------------------------------------
[71]
TÍTULO / TITLE: - CD30+ T-cell lymphoma
in a patient with psoriasis treated with ciclosporin and infliximab.
REVISTA
/ JOURNAL: - Br J Dermatol 2003 Jul;149(1):170-3.
AUTORES
/ AUTHORS: - Mahe E; Descamps V; Grossin M; Fraitag S;
Crickx B
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Bichat-Claude
Bernard Hospital, 46 Rue Henri-Huchard, Paris Cedex 18, France. emmanuel.mahe@bch.ap-hop-paris.fr
RESUMEN
/ SUMMARY: - There is a known relationship between the
use of immunosuppressive therapies and the development of lymphoproliferative
malignancies. These lymphomas are mainly B-cell nonHodgkin’s lymphomas
associated with Epstein-Barr virus. Most cases concern classical
immunosuppressive treatments including ciclosporin and methotrexate. A
relationship between the new antitumour necrosis factor (TNF)-alpha agents and
lymphoproliferative malignancies is debated. Patients with psoriasis on
immunosuppressive therapies, mainly ciclosporin, are considered to have a low
risk of developing lymphoid proliferation. We report a patient with
erythrodermic psoriasis treated with ciclosporin and infliximab who developed a
CD30+ T-cell lymphoma. This lymphoma regressed after stopping these treatments.
In this case, the anti-TNF-alpha agent may have played a role in association
with ciclosporin in the development of the lymphoproliferative disorder.
Whereas the combination of anti-TNF-alpha therapies with methotrexate has been
well studied, their combination with ciclosporin has been evaluated only in a
few patients. Psoriatic patients who may require anti-TNF-alpha treatment have
often been or will be treated with ciclosporin. The combination of ciclosporin
and anti-TNF-alpha warrants further investigation. N. Ref:: 17
----------------------------------------------------
[72]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.8. Cardiovascular risks. Immunosuppressive therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:30-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Immunosuppressive therapies,
especially corticosteroids and anticalcineurin inhibitors; contribute to the
prevalence of cardiovascular risk factors, such as arterial hypertension,
hyperlipidaemia and hyperglycaemia, and this effect is dose dependent.
Reduction of the dose, withdrawal and/or switching to another drug could be
useful to control these risk factors.
----------------------------------------------------
[73]
TÍTULO / TITLE: - Introduction to the Immunocompromised
Host Society consensus conference on epidemiology, prevention, diagnosis, and
management of infections in solid-organ transplant patients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Jul 1;33 Suppl
1:S1-4.
AUTORES
/ AUTHORS: - Rubin RH; Schaffner A; Speich R
INSTITUCIÓN
/ INSTITUTION: - Center for Experimental Pharmacology and
Therapeutics, Harvard-MIT Division of Health Sciences and Technology,
Cambridge, MA 02142-1308, USA. rhrubin@mit.edu
RESUMEN
/ SUMMARY: - Infectious complications are still a
significant cause of morbidity and death in solid-organ transplant patients,
with significant infection being found in up to two-thirds of these
individuals. The risk of infection in the organ transplant patient,
particularly of opportunistic infection, is largely determined by 3 factors:
the net state of immunosuppression, the epidemiologic exposures the patient
encounters, and the consequences of the invasive procedures to which the
patient is subjected. The most important principles of patient treatment are
prevention, early diagnosis, and specific therapy. This issue is designed as a
position paper by a group of experts on epidemiology, prevention, diagnosis,
and management of infections in solid-organ transplant patients. We feel that
our efforts may serve as an important first step in the development of
guidelines in this area. N.
Ref:: 25
----------------------------------------------------
[74]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.6. Chronic graft dysfunction. Late recurrence of
other diseases.
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 4:18-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the rare case of
recurrent lupus nephritis, no particular treatment is recommended. Only in the
few patients with clinically evident flare up is a reinforcement of
immunosuppression recommended. B. Recurrence of Henoch-Schonlein purpura may
occur even in the absence of clinical signs and symptoms. The prognosis for the
graft may be severe, particularly in adults. C. In the case of recurrent
ANCA-associated renal or systemic vasculitis, it is recommended to reinforce
the immunosuppression with appropriate agents. D. Since diabetic nephropathy
recurs almost invariably after transplantation, strict control of diabetes and
hypertension, and the use of ACE inhibitors and/or angiotensin II receptor
antagonists are recommended in order to prevent or slow the risk of recurrence.
----------------------------------------------------
[75]
TÍTULO / TITLE: - Graft-versus-host
disease in lung transplantation: 4 case reports and literature review.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
Jun;22(6):691-7.
AUTORES
/ AUTHORS: - Luckraz H; Zagolin M; McNeil K; Wallwork J
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, Papworth Hospital,
Cambridge, UK. heyman.luckraz@papworth-tr.anglox.nhs.uk
RESUMEN
/ SUMMARY: - Graft-versus-host disease (GVHD) is
uncommon in lung transplant recipients despite the transfer of a significant
amount of donor-derived lymphoid tissue and cells. It is associated with
significant morbidity and a high mortality rate. We describe 4 cases of GVHD
encountered over a 17-year period and review the literature about this peculiar
pathology. N. Ref:: 35
----------------------------------------------------
[76]
TÍTULO / TITLE: - Multidrug resistance
reversal agents.
REVISTA
/ JOURNAL: - J Med Chem 2003 Nov 6;46(23):4805-17.
●●
Enlace al texto completo (gratuito o de pago) 1021/jm030183a
AUTORES
/ AUTHORS: - Robert J; Jarry C
INSTITUCIÓN
/ INSTITUTION: - Institut Bergonie, 229, Cours de
l’Argonne, 33076 Bordeaux Cedex, France. robert@bergonie.org N. Ref:: 151
----------------------------------------------------
[77]
TÍTULO / TITLE: - Oxidized LDL
autoantibodies, endothelial dysfunction, and transplant-associated
arteriosclerosis.
REVISTA
/ JOURNAL: - Arterioscler Thromb Vasc Biol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://atvb.ahajournals.org/
●●
Cita: Arteriosclerosis & Thrombosis :
A J. Vasc Biol: <> 2002 Dec 1;22(12):1950-1.
AUTORES
/ AUTHORS: - Alexander RW N. Ref:: 19
----------------------------------------------------
[78]
TÍTULO / TITLE: - Review article: the
risk of lymphoma associated with inflammatory bowel disease and
immunosuppressive treatment.
REVISTA
/ JOURNAL: - Aliment Pharmacol Ther 2001
Aug;15(8):1101-8.
AUTORES
/ AUTHORS: - Aithal GP; Mansfield JC
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology, University
of Newcastle, Newcastle upon Tyne, UK.
RESUMEN
/ SUMMARY: - Lymphoma complicating inflammatory bowel
disease is well described. Whether the risk of lymphoma is increased by
immunosuppressive treatment with azathioprine, 6-mercaptopurine or infliximab
is a common concern among patients and physicians considering using these
agents. This review aims to quantify the lymphoma risk in inflammatory bowel
disease and the added risk attributable to these treatments. The evidence from
published cases is that lymphomas occur at sites of active inflammatory bowel
disease more often than expected for this to be a chance association. Studies
on inflammatory bowel disease populations are conflicting, with some follow-up
studies from large inflammatory bowel disease clinics showing an increase in
lymphoma incidence, while other population-based studies show little or no
increase in risk of lymphoma. A small increase in lymphoma risk in inflammatory
bowel disease, perhaps 2-3-fold, may be compatible with both sets of data.
Studies of the risks associated with immuno- suppression are less satisfactory,
with smaller numbers of patients and relatively short follow-up. The available
evidence would support a further increase in lymphoma risk associated with
immunosuppressive treatment in inflammatory bowel disease of around fivefold
compared to no immunosuppressive use, and tenfold compared to the general
population. The risks appear to be less than that associated with renal and
hepatic transplant-related immunosuppression. Infliximab treatment is still too
new to make a full assessment of its long-term safety, but post-marketing
surveillance currently suggests that lymphoma risk may not be any greater than
that associated with azathioprine and 6-mercaptopurine. Population-wide
surveillance for lymphoma in inflammatory bowel disease would be required to
narrow the confidence intervals on these estimates of lymphoma risk in
inflammatory bowel disease and immunosuppressive treatment. N. Ref:: 54
----------------------------------------------------
[79]
TÍTULO / TITLE: - The current status of
T-cell depleted allogeneic stem-cell transplants in adult patients with AML.
REVISTA
/ JOURNAL: - Cytotherapy 2001;3(3):175-88.
●●
Enlace al texto completo (gratuito o de pago) 1080/146532401753174007
AUTORES
/ AUTHORS: - Bunjes D
INSTITUCIÓN
/ INSTITUTION: - Stem Cell Transplantation Programme,
Department of Haematology/Oncology, Ulm University Hospital, FRG. N. Ref:: 186
----------------------------------------------------
[80]
TÍTULO / TITLE: - Heat shock proteins,
anti-heat shock protein reactivity and allograft rejection.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11):1503-7.
AUTORES
/ AUTHORS: - Pockley AG
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Sciences (NGH),
Clinical Sciences Centre, Northern General Hospital, Herries Road, Sheffield S5
7AU, UK.
RESUMEN
/ SUMMARY: - Heat shock proteins are families of highly
conserved immunodominant molecules, reactivity to which has been implicated in
the pathogenesis of a number of autoimmune and vascular disease states.
However, heat shock proteins are cytoprotective, and in clinical and
experimental arthritis, anti-heat shock protein reactivity can down modulate
immune responses via a self-Hsp reactive, Th2-type mechanism. Despite a number
of studies associating heat shock protein expression and anti-heat shock
protein reactivity with allograft rejection, the balance between protective and
damaging effects and the precise influence of these responses on graft outcome
is unclear. This article reviews current knowledge surrounding heat shock
proteins, autoimmunity, and allograft rejection and presents a perspective on
the potential influence of these proteins and the stress response on allograft
outcome. N. Ref:: 90
----------------------------------------------------
[81]
TÍTULO / TITLE: - Treatment of severe
life-threatening graft-versus-host disease by autologous peripheral blood stem
cell transplantation using a nonmyeloablative preconditioning regimen.
REVISTA
/ JOURNAL: - Haematologica. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Haematologica: <> 2003 Mar;88(3):ELT06.
AUTORES
/ AUTHORS: - Taniguchi Y; Ikegame K; Yoshihara S;
Sugiyama H; Kawase I; Ogawa H N.
Ref:: 9
----------------------------------------------------
[82]
TÍTULO / TITLE: - Ganciclovir: an update
of its use in the prevention of cytomegalovirus infection and disease in
transplant recipients.
REVISTA
/ JOURNAL: - Drugs 2001;61(8):1153-83.
AUTORES
/ AUTHORS: - McGavin JK; Goa KL
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Mairangi Bay,
Auckland, New Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Ganciclovir is a nucleoside guanosine
analogue which incorporates ganciclovir triphosphate (the active moiety) into
DNA during elongation, thereby inhibiting viral replication. Comparative
studies of pre-emptive and prophylactic ganciclovir therapies in bone marrow
transplant (BMT) recipients have shown similar rates of cytomegalovirus (CMV)
infection, disease and patient mortality. Long term prophylaxis with either
oral, or sequential intravenous/oral, ganciclovir has shown efficacy in renal
allograft recipients, including high risk patients or those receiving
antilymphocyte antibody therapy. A preliminary study indicates that ganciclovir
is more efficacious than aciclovir in paediatric patients. Both oral and
intravenous prophylactic ganciclovir regimens have shown efficacy compared with
no antiviral treatment in lung transplant recipients; initial reports have
shown similar efficacy between pre-emptive and prophylactic ganciclovir. Oral
ganciclovir monotherapy is as efficacious as sequential intravenous/oral
ganciclovir therapy in liver transplant recipients. Pre-emptive treatment was
equally as effective as long term ganciclovir prophylaxis in high risk
patients. Ganciclovir prophylaxis for 4 weeks appears ineffective in heart
allograft recipients treated with antithymocyte globulin. Long term sequential
intravenous/ oral ganciclovir therapy has shown greater efficacy in preventing
CMV disease than sequential ganciclovir/aciclovir therapy. in these patients.
Initial reports indicate that pre-emptive therapy may be beneficial in this
patient group. although this remains to be determined. Ganciclovir in
therapeutic dosage regimens generally has acceptable tolerability with adverse
effects usually of a haematological or neurological nature. Neutropenia,
thrombocytopenia and anaemia are the primary dose-limiting toxicities
associated with ganciclovir therapy. Overall, neutropenia occurs less
frequently with administration of oral ganciclovir than with intravenous
ganciclovir. Monitoring of renal function is recommended as serum creatinine
levels may rise during ganciclovir therapy. In addition, ganciclovir
prophylaxis appears more cost effective than the majority of other currently
available therapies for CMV with oral ganciclovir more cost effective than
intravenous ganciclovir. In conclusion, it is unlikely that a single strategy
will be able to be applied to all transplant patients for the prevention of CMV
disease. An optimal strategy will probably be arisk-adapted approach.
Prophylactic treatment with ganciclovir appears the best strategy to implement
in high risk patients: oral ganciclovir formulations may be best employed where
lower toxicity is required. Pre-emptive treatment with ganciclovir appears most
efficacious in patients identified as lower risk or, in the case of BMT
recipients, where lower toxicity may be desirable. Ganciclovir remains an
important therapeutic option for the prevention and treatment of CMV disease in
transplant recipients. N.
Ref:: 105
----------------------------------------------------
[83]
TÍTULO / TITLE: - Prevention of and
treatment for hepatitis B virus infection after liver transplantation in the
nucleoside analogues era.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Mar;3(3):250-8.
AUTORES
/ AUTHORS: - Papatheodoridis GV; Sevastianos V;
Burroughs AK
INSTITUCIÓN
/ INSTITUTION: - 2nd Academic Department of
Medicine, Hippokration General Hospital, Athens, Greece. gpapath@cc.uoa.gr
RESUMEN
/ SUMMARY: - Post-transplant prophylaxis with hepatitis
B immune globulin (HBIG) has significantly reduced hepatitis B virus (HBV)
recurrence rates, but it is rather ineffective in patients with pretransplant
viremia. Moreover, long-term HBIG administration is very expensive and may be
associated with emergence of escape HBV mutants. Lamivudine has been widely
used in the management of HBV transplant patients. Pretransplant lamivudine
lowers HBV viremia, decreasing the risk of post-transplant HBV recurrence, but
to try and minimize development of resistant HBV strains, it should start
within the last 6 months of the anticipated transplantation timing. Preemptive
post-transplant lamivudine monotherapy is associated with progressively
increasing HBV recurrence rates, but combined therapy with lamivudine and HBIG
at relatively low dosage is currently the most effective approach in this
setting, even in HBV-DNA-positive patients, who also receive lamivudine in the
pretransplant period. The most frequent therapy for post-transplant HBV
recurrence is lamivudine, but the increasing resistance rates represent a
rather challenging problem. Adefovir dipivoxil and entecavir are currently the
most promising agents for lamivudine-resistant HBV strains. All these advances
in anti-HBV therapy have made HBV liver disease an indication for liver
transplantation irrespective of viral replication status, a complete turn
around from 10 years ago. N.
Ref:: 93
----------------------------------------------------
[84]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.8. Bone disease.
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 4:43-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All kidney-transplanted
patients should undergo a systematic evaluation of their skeletal status,
including pre-transplant history of renal osteodystrophy, history of fractures
and plasma concentrations of calciotropic hormones and other parameters, and if
possible measurement of bone mineral density (BMD). B. Glucocorticoid therapy
should be given at the lowest possible dosage. As long as patients are
receiving steroids, vitamin D treatment (ergocalciferol or
1,25-dihydroxyvitamin D) is highly recommended. C. Optimal prevention of bone
disease by vitamin D treatment, sufficient calcium intake, sex hormone
substitution and appropriate use of thiazide diuretics should be considered in
all transplant patients. D. In established osteopenia, bisphosphonate treatment
should be considered despite limited information in transplant recipients. E.
Persistent tertiary hyperparathyroidism should be observed for 1 year after
transplantation whenever possible to allow for a spontaneous involution. F. In
patients with GFR <50 ml/min after transplantation, uraemic osteodystrophy
should be prevented.
----------------------------------------------------
[85]
TÍTULO / TITLE: - The role of monoclonal
antibodies in stem cell transplantation.
REVISTA
/ JOURNAL: - Semin Oncol 2004 Feb;31(1):83-9.
AUTORES
/ AUTHORS: - Wasil T; Rai KR; Mehrotra B
INSTITUCIÓN
/ INSTITUTION: - Long Island Jewish Medical Center, Division
of Hematology-Oncology, New Hyde Park, NY 11040, USA.
RESUMEN
/ SUMMARY: - Monoclonal antibodies directed at the
lymphoid antigens have become established treatments for hematological
malignancies either alone or in combination with chemotherapy. However, their
incorporation in the transplant setting remains investigational. This review
focuses on the currently available data for in vitro and in vivo purging with
these antibodies as well as their role in modulating graft-versus-host disease
(GVHD). N. Ref:: 44
----------------------------------------------------
[86]
TÍTULO / TITLE: - Reactivation of chronic
hepatitis B infection following intensive chemotherapy and successful treatment
with lamivudine: a case report and review of the literature.
REVISTA
/ JOURNAL: - Ann Oncol 2001 Jan;12(1):123-9.
AUTORES
/ AUTHORS: - Saif MW; Little RF; Hamilton JM; Allegra
CJ; Wilson WH
INSTITUCIÓN
/ INSTITUTION: - Medicine Branch, National Cancer
Institute, National Naval Medical Center, Bethesda, Maryland 20889, USA. saifw@mail.nih.gov
RESUMEN
/ SUMMARY: - BACKGROUND: Hepatitis B virus reactivation
has been reported in cancer patients following administration of chemotherapy
or immunosuppressive therapy and may result in liver damage of varying degrees
of severity. Although treatment is supportive in nature, lamivudine, a
nucleoside analogue has been found to suppress HBV replication as evidenced by
reports of 13 cases in the medical literature. PATIENTS AND METHODS: We report
a patient who achieved a successful outcome with lamivudine following
reactivation of HBV during combination chemotherapy for non-Hodgkin’s lymphoma,
and provide a brief overview of the literature including the 13 published case
reports. RESULTS: Lamivudine therapy resulted in clinical improvement as well
as in normalization of liver function tests and coagulation profile.
CONCLUSIONS: Lamivudine has been found to suppress HBV replication manifested
both by histology and serum HBV-DNA levels in chronic carriers of HBV who
developed reactivation of hepatic disease following chemotherapy. Physicians
caring for such patients should be able to recognize this clinical challenge,
and lamivudine should be considered. N.
Ref:: 33
----------------------------------------------------
[87]
TÍTULO / TITLE: - Weakness of respiratory
and skeletal muscles after a short course of steroids in patients with acute
lung rejection.
REVISTA
/ JOURNAL: - Eur Respir J 2002 Aug;20(2):497-9.
AUTORES
/ AUTHORS: - Nava S; Fracchia C; Callegari G; Ambrosino
N; Barbarito N; Felicetti G
INSTITUCIÓN
/ INSTITUTION: - Respiratory Unit, Istituto Scientifico di
Montescano, Pavia, Italy. snava@fsm.it
RESUMEN
/ SUMMARY: - There have been occasional reports of
acute respiratory and skeletal muscle weakness in intensive care unit patients
treated with massive doses of corticosteroids. However, in this setting the
concomitant use of other drugs may have influenced the finding. In this study
the effects of 5 days of treatment with high doses of steroids in consecutive
patients with acute lung rejection after transplantation were systematically
evaluated. Maximal inspiratory pressure during phrenic nerve stimulation and
peak torque of isokinetic contraction of the quadriceps and hamstring muscles
were measured objectively. Compared to the pretreatment condition,
approximately 45% of patients showed acute generalised muscle weakness that
recovered after approximately 2 months. This demonstrates muscle weakness
induced by steroids within patients. N.
Ref:: 6
----------------------------------------------------
[88]
- Castellano -
TÍTULO / TITLE:Linfoma Ki-1 cutaneo en paciente
con enfermedad de crohn en tratamiento con azatioprina. Ki-1 lymphoma of the
skin in a patient with Crohn’s disease undergoing treatment with azathioprine.
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: <> 2001 May;24(5):271-2.
AUTORES
/ AUTHORS: - Martinez Tirado P; Redondo Cerezo E;
Gonzalez Aranda Y; J Cabello Tapia M;
Nogueras Lopez F; Gomez Garcia M N.
Ref:: 6
----------------------------------------------------
[89]
TÍTULO / TITLE: - Beta-herpesvirus
challenges in the transplant recipient.
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:S99-S109.
AUTORES
/ AUTHORS: - Ljungman P
INSTITUCIÓN
/ INSTITUTION: - Karolinska Institutet, SE-14186 Stockholm,
Sweden. per.ljungman@medhs.ki.se
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) has major
consequences after allogeneic stem cell and solid organ transplantation. CMV
may cause significant morbidity and mortality, and monitoring to detect
reactivation to reduce disease or management of end organ disease is associated
with increased resource utilization. Two other members of the beta-herpesvirus
family, human herpesvirus (HHV) type 6 and HHV-7, are increasingly recognized
as important pathogens in transplant recipients, either by direct infection
(e.g., encephalitis, hepatitis, or pneumonitis) or via interaction with CMV. In
addition to direct effects of CMV infection, such indirect effects as an
increased risk for bacterial and fungal infections or impaired graft acceptance
and function are important research topics. Diagnosis and treatment of CMV
infection is currently more advanced than for HHV-6 and HHV-7. N. Ref:: 109
----------------------------------------------------
[90]
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
----------------------------------------------------
[91]
TÍTULO / TITLE: - Cardiac allograft
vasculopathy and dysregulation of the NO synthase pathway.
REVISTA
/ JOURNAL: - Arterioscler Thromb Vasc Biol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://atvb.ahajournals.org/
●●
Cita: Arteriosclerosis & Thrombosis :
A J. Vasc Biol: <> 2003 Apr 1;23(4):567-75. Epub 2003 Mar 20.
●●
Enlace al texto completo (gratuito o de pago) 1161/01.ATV.0000067060.31369.F9
AUTORES
/ AUTHORS: - Weis M; Cooke JP
INSTITUCIÓN
/ INSTITUTION: - Division of Cardiovascular Medicine,
Stanford University School of Medicine, Stanford, Calif 94305-5406, USA.
RESUMEN
/ SUMMARY: - Cardiac allograft vasculopathy is the most
aggressive form of atherosclerosis in humans and is the leading cause of death
after the first year of heart transplantation. Endothelial dysfunction is a
major contributing factor to the acceleration of coronary vascular disease in
these individuals. A reflection of this endothelial dysfunction is the severe
impairment in endothelium-dependent vasodilation that occurs early after
transplantation. The etiology of this allograft endothelial alteration is
multifactorial and may include preexisting atherosclerosis of the graft
vessels, reperfusion injury during transplantation, denervation, disruption of
the lymphatic system, and acute and chronic immune injury, as well as
traditional risk factors for coronary artery disease (hyperlipidemia, diabetes,
hypertension, or hyperhomocysteinemia) and pathogens, such as cytomegalovirus.
The alteration in endothelial function affects vasomotor tone of the coronary arteries.
Evidence indicates that there may be an impairment of endothelial production
and/or activity of NO. Because NO is a potent vasodilator, its deficiency would
explain the abnormal vasomotor tone in these individuals. In addition, because
NO inhibits key processes in vascular inflammation and atherosclerosis, its
absence may contribute to the acceleration of transplant vascular disease.
Recent studies from our group and others have shed light on the mechanisms of
endothelial dysfunction and its importance in cardiac allograft vasculopathy.
In addition, the alteration in endothelial function contributes to vascular
inflammation and progression of the disease.
N. Ref:: 148
----------------------------------------------------
[92]
TÍTULO / TITLE: - New immunosuppressive
agent: expectations and controversies.
REVISTA
/ JOURNAL: - Transplantation 2003 Mar 27;75(6):741-2.
AUTORES
/ AUTHORS: - Alsina J; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Bellvitge
Hospital, Barcelona, España. N.
Ref:: 5
----------------------------------------------------
[93]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:36-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Approximately 5% of
patients develop Pneumocystis carinii pneumonia (PCP) after renal
transplantation if they do not receive prophylaxis. PCP is a severe disease,
with a very high fatality rate. Therefore, all renal transplant recipients
should receive PCP prophylaxis. The treatment of choice is
trimethoprim-sulfamethoxazole (TMP-SMX), at a dose of 80/400 mg/day or 160/800
mg every other day, for at least 4 months. Patients who are treated for
rejection should receive TMP-SMX prophylaxis for 3-4 months. B. In the case of
TMP-SMX intolerance, aerosolized pentamidine (300 mg once or twice per month)
is an alternative for prophylaxis. C. The first-line treatment of PCP is
high-dose TMP-SMX. Patients with a PaO2 of <70 mmHg initially should be
treated parenterally, and the administration of additional steroids should be
considered.
----------------------------------------------------
[94]
TÍTULO / TITLE: - Cellular engineering of
HSV-tk transduced, expanded T lymphocytes for graft-versus-host disease
management.
REVISTA
/ JOURNAL: - Acta Haematol 2003;110(2-3):121-31.
●●
Enlace al texto completo (gratuito o de pago) 1159/000072461
AUTORES
/ AUTHORS: - Burger SR; Kadidlo DM; Basso L; Bostrom N;
Orchard PJ
INSTITUCIÓN
/ INSTITUTION: - Advanced Cell and Gene Therapy, Chapel
Hill, NC 27516, USA. sburger@ac-gt.com
RESUMEN
/ SUMMARY: - Engineering donor T lymphocytes with
inducible ‘suicide genes’, such as herpes simplex virus thymidine kinase, has
potential to improve safety and efficacy in allogeneic transplantation by
facilitating management of graft-versus-host disease. Elective administration
of a relatively nontoxic pro-drug would induce in vivo negative selection of
engineered lymphocytes specifically, sparing other donor hematopoietic cells.
The engineered cells must retain immunologic function, and undergo negative
selection in response to clinically attainable plasma concentrations of
pro-drug. The cell engineering process itself, typically involving activation,
transduction, ex vivo expansion, and selection, must produce clinically useful
numbers of genetically modified cells at high purity. We discuss development of
a cellular engineering manufacturing process that yields transduced, expanded T
lymphocytes meeting these requirements.
N. Ref:: 37
----------------------------------------------------
[95]
TÍTULO / TITLE: - B-cell activation and
lymphoma in patients with HIV.
REVISTA
/ JOURNAL: - Curr Opin Oncol 2002 Sep;14(5):528-32.
AUTORES
/ AUTHORS: - Martinez-Maza O; Breen EC
INSTITUCIÓN
/ INSTITUTION: - Department of Microbiology, David Geffen
School of Medicine, University of California-Los Angeles, 90095, USA. omartinez@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The risk of developing non-Hodgkin
lymphoma (AIDS lymphoma) is greatly increased in HIV infection. Disruption of
immune function by HIV infection may contribute to lymphomagenesis by inducing
(1) loss of immunoregulation of Epstein-Barr virus-infected B cells [immunoblastic
and central nervous system (CNS) lymphoma] caused by loss of T-cell function,
and (2) chronic B-cell hyperactivation enhancing the generation of genetic
lesions (c- :immunoglobulin gene translocation, -6 overexpression) associated
with some forms of AIDS lymphoma (Burkitt lymphoma-like small noncleaved cell
lymphoma and large noncleaved cell lymphoma). Also, the overproduction of
B-cell-stimulatory cytokines (interleukin 10 and 6) has the potential to
contribute to tumor development by supporting the growth and viability of
nascent lymphoma cell clones. Therefore, HIV infection-associated B-cell
hyperactivation, including direct activation of B cells by various mechanisms,
and chronic overproduction of B-cell-stimulatory cytokines have the potential
to contribute to the development and growth of AIDS lymphoma. Several recent
reports are discussed in this review, including recent work relevant to
understanding the potential of a virus-encoded cytokine-like molecule, HHV8
vIL6, to induce B-cell hyperactivation in HIV-infected people, work pointing to
the potential role of a chemokine (stromal cell-derived factor 1) in
lymphomagenesis, and studies on phenotypic changes in circulating B cells in
HIV infection. N.
Ref:: 38
----------------------------------------------------
[96]
TÍTULO / TITLE: - Signal transduction via
MHC class I molecules in endothelial and smooth muscle cells.
REVISTA
/ JOURNAL: - Crit Rev Immunol 2003;23(1-2):109-28.
AUTORES
/ AUTHORS: - Reed EF
INSTITUCIÓN
/ INSTITUTION: - UCLA Immunogenetics Center, Department of
Pathology and Laboratory Medicine, David Geffen School of Medicine, University
of California, Los Angeles, CA 90095, USA. ereed@mednet.ucla.edu
RESUMEN
/ SUMMARY: - MHC class I molecules have long been
recognized for their ability to stimulate intracellular signals in T and B
lymphocytes. More recently, it has become clear that MHC class I molecules can
also initiate intracellular signals in endothelial and smooth muscle cells,
which synergize with growth factor receptors to elicit cell proliferation. This
review describes our current knowledge of class I-mediated signaling pathways
in human endothelial and smooth muscle cells. The role of the class I signaling
pathway in modulating cell growth and the clinical significance of this pathway
in chronic allograft rejection are discussed.
N. Ref:: 190
----------------------------------------------------
[97]
TÍTULO / TITLE: - Monoclonal antibodies
for the prevention and treatment of graft-versus-host disease.
REVISTA
/ JOURNAL: - Semin Oncol 2003 Aug;30(4):509-19.
AUTORES
/ AUTHORS: - Bruner RJ; Farag SS
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow Transplantation Program, The
Ohio State University Comprehensive Cancer Center, Columbus, USA.
RESUMEN
/ SUMMARY: - Acute and chronic graft-versus-host
disease (GvHD) remain major obstacles to successful allogeneic hematopoietic
stem cell transplantation, contributing substantially to morbidity and
non-relapse mortality. Better understanding of the immunopathophysiology of
GvHD has identified a number of targets for intervention. Among newly developed
agents suitable for the prevention and treatment of GvHD, monoclonal antibodies
hold much promise. Monoclonal antibodies currently available, such as
infliximab and anti-interferon-gamma (anti-IFN-gamma), are capable of blocking
of the action of initiating and effector cytokines. Antibodies directed against
activated T cells, including daclizumab, visilizumab and ABX-CBL, may offer more
specificity than the more broadly acting pan-T-cell-depleting agents. Finally,
the clinical investigation of antibodies to adhesion molecules (such as LFA-1),
or distal effector mechanisms (such as FasL) may offer another level of
specificity. Many of these monoclonal antibodies have already undergone
clinical testing. Campath-1H has been used for the prevention of acute GvHD
with success. Daclizumab, infliximab, visilizumab, and ABX-CBL have shown
promising activity in steroid-resistant acute GvHD in early clinical testing.
This review summarizes current experience with monoclonal antibodies in the
management of acute and chronic GvHD. Over the next decade, however, the
challenge will be to define the relative place of these antibodies in the
therapeutic armamentarium for GvHD and their impact on long-term survival. N. Ref:: 101
----------------------------------------------------
[98]
TÍTULO / TITLE: - Preventing saphenous
vein graft failure: does gene therapy have a role?
REVISTA
/ JOURNAL: - Ann Thorac Surg 2003 Sep;76(3):959-66.
AUTORES
/ AUTHORS: - Akowuah EF; Sheridan PJ; Cooper GJ; Newman
C
INSTITUCIÓN
/ INSTITUTION: - Cardiovascular Research Group, The
University of Sheffield, Sheffield, United Kingdom. akowuah@yahoo.com
RESUMEN
/ SUMMARY: - Gene therapy potentially allows local
delivery and expression of cytokines, growth factors, and other mediators. In
spite of increasing knowledge of the human genome, applications in clinical
practice are only just beginning. The main limitations of effective clinical
gene therapy are safety and low transfection efficiency. Saphenous vein grafts
permit the transfection of the conduit ex vivo. This allows a variety of
transfection techniques to be used, enhancing the transfection efficiency while
limiting the risk of systemic complications. This review examines the potential
mechanisms of gene delivery and genetic targets that may be applied to
saphenous vein graft failure. N.
Ref:: 68
----------------------------------------------------
[99]
TÍTULO / TITLE: - Cost advantages of oral
drug therapy for managing cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S9-12.
AUTORES
/ AUTHORS: - Somerville KT
INSTITUCIÓN
/ INSTITUTION: - University of Utah Health Sciences Center,
Department of Pharmacy Services, Salt Lake City, UT, USA. troy.somerville@hsc.utah.edu
RESUMEN
/ SUMMARY: - Cost advantages of the oral route of drug
therapy administration over the intravenous route for managing cytomegalovirus
(CMV) disease are described. The overall costs usually are lower for the oral
route of administration than for the intravenous route, although the cost to
the patient depends on insurance coverage. Other advantages of the oral route
include greater safety and convenience, which may improve patient adherence and
quality of life. In patients with acquired immunodeficiency syndrome (AIDS),
the use of oral ganciclovir instead of intravenous ganciclovir to treat the
maintenance phase of CMV retinitis reduced the incidence of neutropenia and
sepsis, outpatient and inpatient resource use, and costs. Oral therapy also
improved patient quality of life. A cost-effectiveness model for liver
transplant recipients found that CMV prophylaxis is warranted for all patients,
ganciclovir is preferred over CMV immune globulin i.v. and oral acyclovir for
prophylaxis, and the oral route of administration is more cost-effective than
the intravenous route for ganciclovir. Valganciclovir, the oral prodrug of
ganciclovir, was not included in this model. Oral maintenance therapy is
usually cost-effective, safer, and more convenient than intravenous therapy in
the management of CMV. N.
Ref:: 8
----------------------------------------------------
[100]
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
----------------------------------------------------
[101]
TÍTULO / TITLE: - Successful management
of disseminated Nocardia transvalensis infection in a heart transplant
recipient after development of sulfonamide resistance: case report and review.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
Apr;22(4):492-7.
AUTORES
/ AUTHORS: - Lopez FA; Johnson F; Novosad DM; Beaman
BL; Holodniy M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Louisiana State
University Health Sciences Center, New Orleans, Louisiana, USA.
RESUMEN
/ SUMMARY: - Nocardia transvalensis is a rarely
reported cause of clinically significant disease, and, to our knowledge, has
not been reported previously as a cause of infection in the cardiac transplant
population. We report a case of N transvalensis new taxon-2 pulmonary infection
that disseminated to the brain and skin in a cardiac transplant recipient
despite adequate sulfonamide serum levels. Subsequent isolates were resistant
to sulfonamides, and molecular ribotyping of the primary and subsequent
isolates confirmed that these were the same N transvalensis new taxon-2 strain.
The taxonomic and diagnostic considerations, as well as the clinical
significance of anti-microbial-resistant nocardia, are reviewed and discussed
herein. N. Ref:: 37
----------------------------------------------------
[102]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.2. Cardiovascular risks. Arterial hypertension.
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 4:25-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Arterial hypertension is
often present after renal transplantation and is of multifactorial origin.
Pre-transplant arterial hypertension, chronic allograft nephropathy and
immunosuppressive therapy are the most frequent causes of post-transplant
arterial hypertension. Careful monitoring and treatment of high blood pressure
are recommended following transplantation. B. Post-transplant arterial
hypertension is associated with an increased incidence of cardiovascular
disease in renal transplant patients and is an independent risk factor for graft
failure. Therefore, blood pressure control (<130/85 mmHg for renal
transplant recipients without proteinuria, and <125/75 mmHg for proteinuric
patients) is mandatory in these patients. General measures and pharmacological
intervention are necessary in many cases. In proteinuric patients,
anti-hypertensive and anti-proteinuric agents could be used, and stricter blood
pressure control is recommended. C. In patients with uncontrolled arterial
hypertension and/or renal function deterioration, underlying causes should be
excluded, especially transplant renal artery stenosis.
----------------------------------------------------
[103]
TÍTULO / TITLE: - Deleterious clinical
effects of transfusion-associated immunomodulation: fact or fiction?
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2001 Mar 1;97(5):1180-95.
AUTORES
/ AUTHORS: - Vamvakas EC; Blajchman MA
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, New York
University Medical Center, New York, NY 10016, USA. stephen.vamvakas@med.nyu.edu N. Ref:: 114
----------------------------------------------------
[104]
TÍTULO / TITLE: - Hepatitis B core
antibody-positive grafts: recipient’s risk.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3
Suppl):S49-53.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000047006.96782.64
AUTORES
/ AUTHORS: - de Villa VH; Chen YS; Chen CL
INSTITUCIÓN
/ INSTITUTION: - Liver Transplant Program, Department of
Surgery, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical
Center, Kaohsiung, Taiwan.
RESUMEN
/ SUMMARY: - The transmission of hepatitis B virus
infection through hepatitis B core antibody (anti-HBc)-positive liver grafts in
hepatitis B surface antigen (HBsAg)-negative recipients has been established.
The mandatory use of immunosuppression in transplant patients favors
reactivation of latent virus that may be present in grafts from HBsAg-negative
anti-HBc-positive donors. With the persistent organ donor scarcity, the use of
these grafts cannot be avoided, especially in urgent cases and in areas where
the prevalence of the hepatitis B virus is high, as in Asia. The recognition of
posttransplant de novo hepatitis B from core antibody-positive liver donors
has, therefore, led to modifications in graft allocation policies and the
introduction of strategies for prophylaxis. The risk of developing this type of
new-onset hepatitis B virus infection in liver transplant recipients and the
various approaches to minimize this risk are reviewed. The peculiar
implications of using core antibody-positive grafts in the context of living
donor liver transplantation in Asia are discussed. N. Ref:: 30
----------------------------------------------------
[105]
TÍTULO / TITLE: - Clinicopathological
evaluation of renal allografts of four patients by 20-year protocol biopsies.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:20-4.
AUTORES
/ AUTHORS: - Okamoto M; Nobori S; Higuchi A; Kadotani
Y; Ushigome H; Nakamura K; Akioka K; Omori Y; Yoshimura N
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation and
Endocrine Surgery, Kyoto Prefectural University of Medicine, Kyoto 602, Japan. amoto@koto.kpu-m.ac.jp
RESUMEN
/ SUMMARY: - Twenty-year protocol biopsies were
performed in four cases of renal transplant recipients with grafts that had
survived 20 years or more. All four recipients received transplants from their
parents, and never had episodes of acute rejection. They were maintained with
the conventional immunosuppressive protocol including azathioprine, mizoribine,
and prednisolone. Three of them had past history of malignant diseases such as
breast cancer and tongue cancer. In spite of fair graft function, the
microscopic findings of 20-year protocol biopsy showed various degrees of
histological damage; e.g. obsolescence of the glomeruli, glomerulosclerosis,
arteriole wall thickening, interstitial fibrosis and tubular atrophy. Although
two of the four grafts were functioning with low serum creatinine levels
(1.3-1.4 mg dL-1) at 24 years and 26 years following transplantation,
respectively, the function of the other two grafts had decreased more than 20
years after transplantation. In the two grafts with decreased function,
glomerulosclerosis and arteriole wall thickening tended to be more severe
(Banff classification of chronic allograft nephropathy [CAN] grade II and III)
at the 20-year protocol biopsy compared with the two well-functioning grafts
(CAN grade I and II). We conclude that the protocol biopsies even at 20 years
can contribute to predict the fate of renal allografts.
----------------------------------------------------
[106]
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
----------------------------------------------------
[107]
TÍTULO / TITLE: - Filgrastim treatment of
acute myelogenous leukemia (M7) relapse after allogeneic peripheral stem cell
transplantation resulting in both graft-versus-leukemia effect with cytogenetic
remission and chronic graft-versus-host disease manifesting as polyserositis
and subsequent bronchiolitis obliterans with organizing pneumonia.
REVISTA
/ JOURNAL: - Int J Hematol 2002 Nov;76(4):360-4.
AUTORES
/ AUTHORS: - Law L; Tuscano J; Wun T; Ahlberg K;
Richman C
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology/Oncology,
Department of Internal Medicine, University of California, Davis, California,
USA.
RESUMEN
/ SUMMARY: - Filgrastim (granulocyte colony-stimulating
factor) has recently been reported to successfully treat patients with leukemic
relapse after allogeneic peripheral stem cell transplantation (PSCT). However,
the majority of the patients who responded also developed graft-versus-host
disease (GVHD). Polyserositis as a manifestation of GVHD is a rare phenomenon.
We report the first case of polyserositis following the use of filgrastim to
treat a patient with acute myelogenous leukemia (M7), who had relapsed after an
initially successful allogeneic PSCT. The polyserositis manifested with
effusions and was initially controlled with high doses of steroids and
pericardial stripping; however, after a quiescent period the patient eventually
developed bronchiolitis obliterans with organizing pneumonia that required
additional immunosuppressive therapy. We review the literature on
GVHD-associated polyserositis and offer potential explanations for its
pathogenesis. N.
Ref:: 20
----------------------------------------------------
[108]
TÍTULO / TITLE: - Prevention of
cytomegalovirus disease in recipients of solid-organ transplants.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Feb 15;32(4):596-603.
Epub 2001 Feb 6.
AUTORES
/ AUTHORS: - Paya CV
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases and
Transplant Center, Mayo Clinic, Rochester, MN 55905. USA. paya@mayo.edu
RESUMEN
/ SUMMARY: - The introduction and combination of
more-potent immunosuppressive regimens, and the increased transplantation of
organs into more severely ill patients, have again placed cytomegalovirus (CMV)
disease in the spotlight of posttransplantation complications. Both direct and
associated complications related to CMV need to be considered in understanding
the pathogenesis of CMV infection after solid-organ transplantation. New
diagnostic methods with higher sensitivity for the detection of CMV and the
ability to quantify CMV indicate that low levels of CMV replication are present
in many patients who don’t have clinical symptoms ascribed to CMV infection.
How these low levels of CMV replication impact the outcome of the transplanted
graft remains unknown. In addition, there needs to be further study regarding
whether only patients at high risk for developing CMV disease or, also, those
with clinically asymptomatic levels of CMV replication should be the target of
effective preventive regimens. This review summarizes our current knowledge of
the pathogenesis of CMV infection after solid-organ transplantation, and it
outlines different effective preventive regimens and approaches. N. Ref:: 47
----------------------------------------------------
[109]
TÍTULO / TITLE: - Common community
respiratory viruses in patients with cancer: more than just “common colds”.
REVISTA
/ JOURNAL: - Cancer 2003 May 15;97(10):2576-87.
●●
Enlace al texto completo (gratuito o de pago) 1002/cncr.11353
AUTORES
/ AUTHORS: - Hicks KL; Chemaly RF; Kontoyiannis DP
INSTITUCIÓN
/ INSTITUTION: - Department of Bone Marrow Transplantation,
The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030,
USA.
RESUMEN
/ SUMMARY: - Community respiratory viruses long have
been recognized as primary respiratory pathogens among infants and young
children. More recently, it has become clear that these viruses cause a
considerable disease burden throughout life. The consequences of repeated
infections are most evident in elderly and immunocompromised persons. Even in
otherwise healthy persons, reinfections often require medical attention but
generally are undiagnosed and unrecognized. These reinfections may spread from
healthy persons to those at highest risk. Control requires a multifaceted
approach combining vaccination, chemoprophylaxis, and aggressive early
antiviral treatment of high-risk individuals, as well as education of all
populations affected by these viruses. N.
Ref:: 90
----------------------------------------------------
[110]
TÍTULO / TITLE: - Pharmacologically
regulated cell therapy.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2001 May 1;97(9):2535-40.
AUTORES
/ AUTHORS: - Neff T; Blau CA
INSTITUCIÓN
/ INSTITUTION: - Division of Hematology, Department of
Medicine, University of Washington, Seattle, WA 98195, USA. N. Ref:: 67
----------------------------------------------------
[111]
TÍTULO / TITLE: - Kaposi’s sarcoma in
rheumatic diseases.
REVISTA
/ JOURNAL: - Semin Arthritis Rheum 2003
Apr;32(5):326-33.
●●
Enlace al texto completo (gratuito o de pago) 1053/sarh.2002.50000
AUTORES
/ AUTHORS: - Louthrenoo W; Kasitanon N; Mahanuphab P;
Bhoopat L; Thongprasert S
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology, Department of
Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. wlouthre@mail.med.cmu.ac.th
RESUMEN
/ SUMMARY: - OBJECTIVE: To review the clinical features
and outcome of all reported cases of Kaposi’s sarcoma in patients with
rheumatic diseases. METHODS: In addition to our patient, we identified cases
from a Medline search between the years 1966 and 2002. Cases associated with
human immunodeficiency virus infection were excluded. RESULTS: Including our
patient, there were a total of 25 cases reported (11 men and 14 women).
Rheumatoid arthritis was present in 8 cases, polymyositis/dermatomyositis in 5,
vasculitis syndromes in 5, systemic lupus erythematosus in 3, polymyalgia
rheumatica in 2, and 1 each of undifferentiated connective tissue disease and
Behcet disease. All but 1 patient had been given systemic corticosteroids for a
duration that ranged from 6 weeks to 22 years, and immunosuppressive drugs from
25 days to 3.5 years. The Kaposi’s lesions usually involved the skin on the
extremities; internal organ involvement occurred in 7 cases. Most lesions
responded to a decreasing dosage of corticosteroids and immunosuppressive
drugs, or to the administration of radiation or cytotoxic therapy. Six patients
died, 4 of which were related to the progression of Kaposi’s sarcoma.
CONCLUSION: Kaposi’s sarcoma in patients with rheumatologic conditions is rare.
The clinical features are similar to those with classical Kaposi’s sarcoma.
Tumor regression usually occurs with decreasing corticosteroids and/or
immunosuppressive drugs, local irradiation, or cytotoxic therapy. N. Ref:: 36
----------------------------------------------------
[112]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[113]
TÍTULO / TITLE: - Electrostatic potential
on human leukocyte antigen: implications for putative mechanism of chronic
beryllium disease.
REVISTA
/ JOURNAL: - Environ Health Perspect. Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://ehpnet1.niehs.nih.gov/docs/montharch.html
●●
Cita: Environmental Health Perspectives: <> 2003 Nov;111(15):1827-34.
AUTORES
/ AUTHORS: - Snyder JA; Weston A; Tinkle SS; Demchuk E
INSTITUCIÓN
/ INSTITUTION: - Health Effects Laboratory Division,
National Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, 1095 Willowdale Road, Morgantown, WV 26505, USA.
RESUMEN
/ SUMMARY: - The pathobiology of chronic beryllium
disease (CBD) involves the major histocompatibility complex class II human
leukocyte antigen (HLA). Although occupational exposure to beryllium is the
cause of CBD, molecular epidemiologic studies suggest that specific
(Italic)HLA-DPB1(/Italic) alleles may be genetic susceptibility factors. We
have studied three-dimensional structural models of HLA-DP proteins encoded by
these genes. The extracellular domains of HLA-DPA1*0103/B1*1701, *1901, *0201,
and *0401, and HLA-DPA1*0201/B1*1701, *1901, *0201, and *0401 were modeled from
the X-ray coordinates of an HLA-DR template. Using these models, the
electrostatic potential at the molecular surface of each HLA-DP was calculated
and compared. These comparisons identify specific characteristics in the
vicinity of the antigen-binding pocket that distinguish the different HLA-DP
allotypes. Differences in electrostatics originate from the shape, specific
disposition, and variation in the negatively charged groups around the pocket.
The more negative the pocket potential, the greater the odds of developing CBD
estimated from reported epidemiologic studies. Adverse impact is caused by
charged substitutions in positions 55, 56,
69, 84, and 85, namely, the exact same loci identified
as genetic markers of CBD susceptibility as well as cobalt-lung hard metal
disease. These findings suggest that certain substitutions may promote an
involuntary cation-binding site within a putatively metal-free peptide-binding
pocket and therefore change the innate specificity of antigen recognition. N. Ref:: 31
----------------------------------------------------
[114]
TÍTULO / TITLE: - New strategies for
prevention and treatment of graft-versus-host disease and for induction of
graft-versus-leukemia effects.
REVISTA
/ JOURNAL: - Int J Hematol 2003 Jan;77(1):15-21.
AUTORES
/ AUTHORS: - Deeg HJ
INSTITUCIÓN
/ INSTITUTION: - Fred Hutchinson Cancer Research Center and
University of Washington, Seattle, Washington 98109-1024, USA. jdeeg@fhcrc.org
RESUMEN
/ SUMMARY: - Graft-versus-host disease (GVHD) continues
to be a problem in allogeneic hemopoietic stem cell transplantation; however,
our understanding of the basic pathophysiology of GVHD has improved. Although
not all data obtained from murine or other animal models can be extrapolated to
the clinic, there are leads that deserve to be pursued. The skin, intestinal
tract, and liver are the 3 major target organs of GVHD and share the feature of
presenting a barrier to the “environment” of the host. There is evidence that
the damage inflicted to these organs, the epithelial and endothelial cells in
particular, by the conditioning regimen causes a release of various cytokines
and a penetration of endotoxin into the systemic circulation. According to
these observations, the nonimmunologic aspects of GVHD have been likened to an
inflammatory process. If this characterization is valid, blocking these
nonspecific inflammatory changes would ameliorate GVHD without interfering with
the graft-versus-leukemia (GVL) reaction. In fact, one study has shown a
substantial amelioration of GVHD with a molecule that directly blocks
endotoxin. Clinical data also suggest that patients with organ dysfunction
early after transplantation that is presumed to be treatment related may
benefit from preemptive interventions aimed at controlling GVHD. Furthermore,
there is growing evidence that the mechanisms involved in GVHD may differ from
organ to organ (for example, Fas/Fas-ligand interactions in the liver versus
tumor necrosis factor alpha/receptor interactions in the intestinal tract), and
from a therapeutic point of view, the time of onset of clinical GVHD may be
important in choosing the appropriate therapy. Thus, combinations of
interventions chosen and timed appropriately may be more effective in
preventing and managing GVHD than are the standard across-the-board approaches
that have been used so far. Such a strategy may also be successful in
maintaining a GVL effect and possibly in incorporating direct antileukemic
therapy, such as the use of cytotoxic T-cells directed at minor
histocompatibility antigens, without increasing the risk of GVHD. The
development of nonmyeloablative conditioning regimens and the observations on GVHD
kinetics and the progression or eradication of leukemia with that strategy are
likely to add new insights into how one can optimally combine various
modalities to achieve engraftment, prevent GVHD, and at the same time maintain
a GVL effect. N.
Ref:: 75
----------------------------------------------------
[115]
TÍTULO / TITLE: - Implications of the
advent of homozygous alpha l, 3-galactosyltransferase gene-deficient pigs on
transmission of infectious agents.
REVISTA
/ JOURNAL: - Xenotransplantation 2003 Jul;10(4):287-8.
AUTORES
/ AUTHORS: - Chapman LE; Wilson CA
INSTITUCIÓN
/ INSTITUTION: - National Center for Infectious Diseases,
Centers for Disease Control and Prevention, Atlanta, Georgia, USA. lec3@cdc.gov
N. Ref:: 16
----------------------------------------------------
[116]
TÍTULO / TITLE: - Prevention of acute
graft-versus-host-disease by selective depletion of T cells reactive with minor
histocompatibility antigens on epithelial cells.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2001 Jan;40(3-4):385-91.
AUTORES
/ AUTHORS: - Otten HG; Van Dyk AM; Verdonck LF
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology, University
Hospital Utrecht, The Netherlands. H.G.Otten@lab.azu.nl
RESUMEN
/ SUMMARY: - Graft-versus-host disease (GVHD) is a
major obstacle in allogeneic hematopoietic stem cell transplantation (HSCT).
Mature donor T-cells present in the graft play a pivotal role in the
development of acute GVHD. On the other hand, mature donor T-cells in the graft
are also crucial for the elimination of residual tumor cells still present in
the patient after HSCT. Whether donor T cells act non-specifically against the
patient, including an overlapping GVHD/GVL reactivity, or some donor T cells
have GVHD reactivity while other donor T cells have GVL reactivity is still
unclear. Some in-vitro data are suggestive that selective T cell depletion
techniques are possible by which GVHD-reactive T cells can be eliminated while
GVL-reactive T cells are preserved. Here we update some approaches of selective
T cell depletion that have been developed in our laboratory. N. Ref:: 50
----------------------------------------------------
[117]
TÍTULO / TITLE: - Contrasting
alloreactive CD4+ and CD8+ T cells: there’s more to it than MHC restriction.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Feb;3(2):107-15.
AUTORES
/ AUTHORS: - Csencsits KL; Bishop DK
INSTITUCIÓN
/ INSTITUTION: - Depajtment of Surgery University of
Michigan School of Medicine, Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - Surface expression of CD4 or CD8 is
commonly used to identify T-cell subsets that recognize antigen presented by
class II MHC or class I MHC, respectively. This holds true for T cells that
respond to allogeneic MHC molecules that are directly recognized as foreign, as
well as peptides from allogeneic MHC molecules that are indirectly presented by
self MHC molecules. CD4 or CD8 expression was initially believed to define
cytokine secreting helper T cells or cytotoxic cells, respectively. However,
this association of phenotype and function is not absolute, in that CD4+ cells
may possess lytic activity and CD8+ cells secrete cytokines, notably IFNgamma.
Recently, additional fundamental differences in the immunobiology of these
T-cell subsets have been identified. These include differences in costimulatory
requirements, cytokine responsiveness, cytokine production, cell survival, and
the maintenance of memory. This review will survey these differences, emphasizing
alloreactive T-cell responses as well as relevant observations that have been
made in other systems. N.
Ref:: 134
----------------------------------------------------
[118]
TÍTULO / TITLE: - Formulary
considerations for drugs used to prevent cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S17-21.
AUTORES
/ AUTHORS: - Pescovitz MD
INSTITUCIÓN
/ INSTITUTION: - Organ Transplant Program, Indiana
University Medical Center, Indianapolis, IN, USA. mpescov@iupui.edu
RESUMEN
/ SUMMARY: - Four types of therapeutic strategies for
managing cytomegalovirus (CMV) in solid organ transplant recipients, the
mechanisms of action and efficacy of drugs used for prophylaxis, and the
criteria for evaluating drugs for inclusion in a formulary are described.
Universal and selective prophylaxis are simple to implement and effective for
CMV prophylaxis, but they are costly and patient nonadherence and viral
resistance can develop. Preemptive therapy may cause less resistance and cost
less, but it is more complex and associated with a higher incidence of
infection, which may have no effect on secondary effects from CMV infection,
and higher recurrence of disease than prophylactic therapy. Treatment of active
disease may be less costly for the drug than other approaches, but intravenous
access is required and the rates of infection recurrence and mortality are
higher compared with prophylaxis and preemptive therapy. Criteria for deciding
which CMV prophylactic drugs to include in a formulary include efficacy,
safety, convenience, and cost. CMV immune globulin i.v. is costly and exhibits
reduced efficacy when used alone in patients at high risk for CMV disease.
Intravenous ganciclovir is effective, but it is costly because of infusion
costs. Intravenous drug therapies are inconvenient and associated with a risk
of bacterial and fungal infection. Oral acyclovir is safe to use and
inexpensive (since a genetic exists), but it has poor efficacy and is
inconvenient because of the need for four large daily doses. Valacyclovir is
more convenient and with similar safety and probably better efficacy than
acyclovir, but it is more costly. Oral ganciclovir and oral valganciclovir have
similar safety and costs, with greater efficacy than acyclovir. The single
daily dose and lack of resistance to valganciclovir are advantages over oral
ganciclovir, which requires three daily doses and can result in the development
of resistance. N.
Ref:: 20
----------------------------------------------------
[119]
TÍTULO / TITLE: -
Ischemia-reperfusion-induced lung injury.
REVISTA
/ JOURNAL: - Am J Respir Crit Care Med. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajrccm.atsjournals.org/
●●
Cita: Am J. of Respir & Crit Care Med: <> 2003 Feb 15;167(4):490-511.
●●
Enlace al texto completo (gratuito o de pago) 1164/rccm.200207-670SO
AUTORES
/ AUTHORS: - de Perrot M; Liu M; Waddell TK; Keshavjee
S
INSTITUCIÓN
/ INSTITUTION: - Toronto Lung Transplant Program, Toronto
General Hospital, University Health Network, University of Toronto, Toronto,
Ontario, Canada.
RESUMEN
/ SUMMARY: - Ischemia-reperfusion-induced lung injury
is characterized by nonspecific alveolar damage, lung edema, and hypoxemia
occurring within 72 hours after lung transplantation. The most severe form may
lead to primary graft failure and remains a significant cause of morbidity and
mortality after lung transplantation. Over the past decade, better
understanding of the mechanisms of ischemia-reperfusion injury, improvements in
the technique of lung preservation, and the development of a new preservation
solution specifically for the lung have been associated with a reduction in the
incidence of primary graft failure from approximately 30 to 15% or less.
Several strategies have also been introduced into clinical practice for the
prevention and treatment of ischemia-reperfusion-induced lung injury with
various degrees of success. However, only three randomized, double-blinded,
placebo-controlled trials on ischemia-reperfusion-induced lung injury have been
reported in the literature. In the future, the development of new agents and
their application in prospective clinical trials are to be expected to prevent
the occurrence of this potentially devastating complication and to further
improve the success of lung transplantation.
N. Ref:: 340
----------------------------------------------------
[120]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.7. Cardiovascular risks. Obesity and weight gain.
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 4:29-30.
RESUMEN
/ SUMMARY: - GUIDELINE: Obesity (BMI >30 kg/m2) and
weight gain are associated with increased prevalence of cardiovascular disease
after transplantation. Appropriate dietary and lifestyle measures should be
recommended to these patients.
----------------------------------------------------
[121]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV
disease in kidney and liver transplant recipients. It is more effective for
recipients who are seronegative before the transplant and receive organs from
seronegative (D-/R-) donors than in seronegative recipients of organs from
seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV
disease increases the risk of graft failure, which decreases the likelihood of
patient survival. The extent of matching of the DR subregion of the human
leukocyte antigen complex in the donor and recipient may affect graft survival
in patients with CMV disease. Graft failure is costly and should be considered
in economic analyses of CMV prophylaxis regimens because of the potential
impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV prophylaxis
has reduced the incidence of CMV disease in kidney and liver transplant
recipients. N. Ref:: 10
----------------------------------------------------
[122]
TÍTULO / TITLE: - Present results and
perspectives of allogeneic non-myeloablative hematopoietic stem cell
transplantation for treatment of human solid tumors.
REVISTA
/ JOURNAL: - Ann Oncol 2003 Aug;14(8):1177-84.
AUTORES
/ AUTHORS: - Renga M; Pedrazzoli P; Siena S
INSTITUCIÓN
/ INSTITUTION: - Divisione Oncologia Medica Falck,
Dipartimento di Oncologia ed Ematologia, Ospedale Niguarda Ca’ Granda, Milan,
Italy. oncologia@ospedaleniguarda.it
RESUMEN
/ SUMMARY: - Several clinical observations have
confirmed that a donor immune-mediated anti-malignancy effect, called
graft-versus-leukemia or graft-versus-tumor, occurs following allogeneic
hematopoietic stem cell transplantation. While the potential antitumor effect
mediated by donor lymphocytes has been established in many hematological malignancies,
its efficacy in inducing clinically meaningful responses in solid tumors has
been largely unexplored despite evidence of its potential benefit in
experimental animal models. Only in recent years has the investigational
application of non-myeloablative stem cell transplantation in patients with
refractory non-hematological cancers proved that a graft-versus-tumor effect
can be generated in patients with metastatic renal cell cancer and possibly
with other solid tumors. In the present article we review the biological basis,
development and early clinical results of this novel immunotherapeutic approach
for solid tumors. N.
Ref:: 64
----------------------------------------------------
[123]
TÍTULO / TITLE: - Cutaneous lymphoma
associated with Epstein-Barr virus infection in 2 patients treated with
methotrexate.
REVISTA
/ JOURNAL: - Mayo Clin Proc. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.mayo.edu/proceedings/
●●
Cita: Mayo Clinic Proceedings: <> 2001 Aug;76(8):845-8.
AUTORES
/ AUTHORS: - Tournadre A; D’Incan M; Dubost JJ; Franck
F; Dechelotte P; Souteyrand P; Soubrier M
INSTITUCIÓN
/ INSTITUTION: - Department of Rheumatology, Hjpital
Gabriel Montpied, Clermont-Ferrand, France.
RESUMEN
/ SUMMARY: - Whether patients with rheumatoid arthritis
(RA) have an increased risk of developing non-Hodgkin lymphoma is
controversial, and opinions differ on the possible role of methotrexate in the
occurrence of lymphomas in patients with RA. We report 1 T-cell lymphoma and 1
B-cell lymphoma restricted to the skin associated with Epstein-Barr virus
infection that healed completely and spontaneously after discontinuation of
methotrexate in a man with RA and a woman with dermatomyositis. Cutaneous
infiltrating cells were infected by a replicative form of Epstein-Barr virus.
After discontinuation of methotrexate, the cutaneous lesions disappeared
completely in 15 days without recurrence. Discontinuation of methotrexate is necessary
in patients with RA or dermatomyositis who have a lymphoproliferative disorder,
and a follow-up period of several weeks should be observed before specific
therapy is initiated. N.
Ref:: 18
----------------------------------------------------
[124]
TÍTULO / TITLE: - Chronic
graft-versus-host disease: clinical manifestation and therapy.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2001
Jul;28(2):121-9.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj/bmt/1703111
AUTORES
/ AUTHORS: - Ratanatharathorn V; Ayash L; Lazarus HM;
Fu J; Uberti JP
INSTITUCIÓN
/ INSTITUTION: - Blood and Marrow Stem Cell Transplantation
Program at University of Michigan Medical Center, Ann Arbor, MI, USA.
RESUMEN
/ SUMMARY: - Chronic graft-versus-host disease (GVHD)
is a major cause of morbidity and mortality in long-term survivors of
allogeneic stem cell transplantation. The immunopathogenesis of chronic GVHD
is, in part, TH-2 mediated, resulting in a syndrome of immunodeficiency and an
autoimmune disorder. The most important risk factor for chronic GVHD is prior
history of acute GVHD and strategies that prevent acute GVHD also decrease the
risk of chronic GVHD. Other important risk factors are the use of a non-T
cell-depleted graft, and older age of donor and recipient. Whether recipients
of peripheral blood stem cells are at increased risk of chronic GVHD remains
unsettled. There are no known pharmacologic agents which can specifically
prevent development of chronic GVHD. Agents which have efficacy in the
treatment of autoimmune disorders have been utilized as therapy for established
chronic GVHD and are associated with response rates of 20% to 80%. Most
responses are confined to skin, soft tissue, oral mucosa and occasionally
liver. Bronchiolitis obliterans responds infrequently to therapy and is
associated with a dismal prognosis. Newer, promising therapeutic strategies
under investigation include thalidomide, photopheresis therapy, anti-tumor
necrosis factor and B cell depletion with anti-CD20 monoclonal antibody. N. Ref:: 126
----------------------------------------------------
[125]
TÍTULO / TITLE: - Role of dendritic cells
in graft-versus-host disease.
REVISTA
/ JOURNAL: - J Hematother Stem Cell Res 2002
Aug;11(4):601-16.
●●
Enlace al texto completo (gratuito o de pago) 1089/15258160260194758
AUTORES
/ AUTHORS: - Clark FJ; Chakraverty R
INSTITUCIÓN
/ INSTITUTION: - Department of Haematology, Institute of
Cancer Studies, University of Birmingham, Birmingham, UK.
RESUMEN
/ SUMMARY: - A major barrier to successful allogeneic
hematopoietic stem cell transplantation is graft-versus-host disease (GVHD).
Until recently, the role of antigen presentation in the development of this
disorder was unknown. The experimental finding that recipient
antigen-presenting cells (APCs) were required for the development of CD8(+) T
cell-dependent GVHD has led to a fundamental reappraisal of our ideas
concerning the pathogenesis of this disease. Following transplantation, the
origin (donor or recipient), number, lineage, and function of APCs within the
recipient are altered significantly. Studies that test the influence of each of
these factors upon graft-versus-host responses, including graft-versus-tumor
responses, are beginning to emerge and suggest that APCs, such as dendritic
cells, constitute a potential target for therapeutic manipulation. N. Ref:: 149
----------------------------------------------------
[126]
TÍTULO / TITLE: - Graft vascular function
after transplantation of pancreatic islets.
REVISTA
/ JOURNAL: - Diabetologia 2002 Jun;45(6):749-63. Epub
2002 May 15.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00125-002-0827-4
AUTORES
/ AUTHORS: - Jansson L; Carlsson PO
INSTITUCIÓN
/ INSTITUTION: - Department of Medical Cell Biology,
Biomedical Center, Uppsala University, Box 571, 751 23 Uppsala, Sweden. Leif.Jansson@medcellbiol.uu.se
RESUMEN
/ SUMMARY: - Endogenous pancreatic islets have a dense
glomerular-like angioarchitecture, which ensures an optimal delivery of oxygen
and nutrients to the islet cells, provides signals from other cells in the body
and disposes secreted hormones. Transplantation of isolated islets means that
their vascular connection is interrupted. The islet grafts therefore depend
upon endothelial cells and microvessels originating in the implantation organ
for derivation of a new vascular system. A re-establishment of islet blood-flow
occurs within 7-14 days after transplantation, mainly through vascular
sprouting. The newly formed blood vessels acquire the morphological
characteristics of those in endogenous islets. In intraportally transplanted
islets to the liver, the islets become revascularized almost exclusively from
tributaries to the hepatic artery. Exocrine contamination of the transplanted
islets could hamper the revascularization process, whereas neither cryopreservation
nor immunosuppressive drugs like cyclosporin, prednisolon and RS-61443 have any
essential effects on the angiogenesis. Investigators have noticed improvements
in islet graft survival and function by means of basic fibroblast growth factor
(bFGF), acidic FGF and endothelial cell growth factor exposure of the grafts.
The functional properties of transplanted islets are largely unknown, but
evidence from experimental islet transplantation suggests that both the blood
perfusion and the tissue oxygen tension of the grafted islets are chronically
decreased, indicating an insufficient vascular system. In order to achieve
optimal condition for survival and function of transplanted beta cells, it is
important to ascertain whether impairments in vascular function are present
also after clinical islet transplantations as well. N. Ref:: 181
----------------------------------------------------
[127]
TÍTULO / TITLE: - Is there still a role
for cyclosporine in the treatment of inflammatory bowel disease? Pro argument.
REVISTA
/ JOURNAL: - Inflamm Bowel Dis 2003 May;9(3):194-7;
discussion 202-4.
AUTORES
/ AUTHORS: - Kornbluth A
INSTITUCIÓN
/ INSTITUTION: - The Mount Sinai Medical Center, New York,
New York, USA. akornbluth@aol.com N. Ref:: 32
----------------------------------------------------
[128]
TÍTULO / TITLE: - Is there still a role
for cyclosporine in the treatment of inflammatory bowel disease? Con argument.
REVISTA
/ JOURNAL: - Inflamm Bowel Dis 2003 May;9(3):198-201;
discussion 202-4.
AUTORES
/ AUTHORS: - Fellermann K; Luhmann D; Stange EF
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine I,
Robert-Bosch-Krankenhaus, Stuttgart, Germany. klaus.fellermann@rbk.de N. Ref:: 21
----------------------------------------------------
[129]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.4. Cardiovascular risks. Post-transplant diabetes
mellitus.
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 4:28.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant diabetes
mellitus (PTDM) should be identified by regular (every 3 months) fasting blood
glucose and/or glycated haemoglobin (HbA1c) measurements. PTDM should be
treated as appropriate to achieve normoglycaemia. B. Immunosuppressive therapy
should be adjusted to reverse or ameliorate PTDM.
----------------------------------------------------
[130]
TÍTULO / TITLE: - TOR inhibitors and
cardiac allograft vasculopathy: is inhibition of intimal thickening an adequate
surrogate of benefit?
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
May;22(5):501-4.
AUTORES
/ AUTHORS: - Mehra MR; Uber PA
INSTITUCIÓN
/ INSTITUTION: - Cardiomyopathy and Heart Transplantation
Center, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA. mmehra@ochsner.org N. Ref:: 30
----------------------------------------------------
[131]
TÍTULO / TITLE: - Role of resident
corneal leukocytes and draining cervical lymph nodes in corneal allograft
rejection.
REVISTA
/ JOURNAL: - Cornea 2003 Oct;22(7 Suppl):S61-5.
AUTORES
/ AUTHORS: - Yamagami S; Amano S
INSTITUCIÓN
/ INSTITUTION: - Department of Corneal Tissue Regeneration,
Graduate School of Medicine, University of Tokyo, Tokyo, Japan. syamagami-tky@umin.ac.jp
RESUMEN
/ SUMMARY: - We review recently published experimental
evidence on corneal transplant immunology involving cornea and draining
cervical lymph nodes (CLNs) in the mouse. In the cornea, major
histocompatibility complex (MHC) class II- dendritic cells (DCs) are present in
the corneal epithelium. These DCs can express MHC class II antigen in vivo and
in vitro. In the corneal stroma, there are many leukocytes of monocyte or
macrophage lineage. Normal cornea has been reported to contain a significant
number of bone marrow-derived resident cells, which may be able to act as
antigen-presenting cells. Allograft rejection does not occur if draining CLNs
are removed before corneal transplantation, indicative of an essential role of
CLNs in promoting corneal allorejection. Moreover, donor cornea-derived DCs
were detected in host draining CLNs in a mouse corneal transplantation model.
These findings provide direct evidence that MHC class II- bone marrow-derived
antigen-presenting leukocytes exist in the part of cornea used for
transplantation and that direct allorecognition of antigen is, at least in
part, relevant to the occurrence of corneal allograft rejection in which
draining CLNs play a central role. N.
Ref:: 34
----------------------------------------------------
[132]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.3. Cardiovascular risks. Hyperlipidaemia.
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 4:26-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Hyperlipidaemia risk
profiles should be identified by regular screening (at least once a year) for
cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride blood levels in
renal transplant patients. B. In renal transplant patients, hyperlipidaemia
must be treated in order to keep the cholesterol/lipid levels within
recommended limits according to the number of risk factors. C. Management of
hyperlipidaemia after renal transplantation should be the same as for the
dialysis population, with, in addition, modification of the immunosuppressive
protocol when appropriate. D. Patients should be carefully monitored for
adverse effects of lipid-lowering agents or interactions with immunosuppressive
drugs.
----------------------------------------------------
[133]
TÍTULO / TITLE: - Antigen presentation in
graft-vs-host disease.
REVISTA
/ JOURNAL: - Exp Hematol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medicinedirect.com/journal
●●
Cita: Experimental Hematology: <> 2003 Dec;31(12):1187-97.
AUTORES
/ AUTHORS: - Shlomchik WD
INSTITUCIÓN
/ INSTITUTION: - Section of Medical Oncology, Yale
University School of Medicine, PO Box 208032, 333 Cedar Street, New Haven, CT
06520, USA. warren.shlomchik@yale.edu N. Ref:: 137
----------------------------------------------------
[134]
TÍTULO / TITLE: - Improving immune
reconstitution while preventing graft-versus-host disease in allogeneic stem
cell transplantation.
REVISTA
/ JOURNAL: - Semin Hematol 2002 Jan;39(1):32-40.
AUTORES
/ AUTHORS: - Cavazzana-Calvo M; Andre-Schmutz I;
Hacein-Bey-Abina S; Bensoussan D; Le Deist F; Fischer A
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Therapie Cellulaire et
Genique, INSERM U429, Hopital Necker-Enfants Malades, Paris, France.
RESUMEN
/ SUMMARY: - Allogeneic hematopoietic stem cell
transplantation (HSCT) is the treatment of choice for many hematologic
malignancies or inherited disorders. Ex vivo T-cell depletion (TCD) of the
graft and post-transplantation immunosuppression efficiently prevent the
development of graft-versus-host disease (GVHD). However, the consequence of
these nonspecific approaches is a long-lasting immunodeficiency associated with
increased disease relapse, graft rejection, and reactivation of viral
infections. Donor lymphocyte infusion, to treat leukemic relapse after
allogeneic HSCT, can cause severe GVHD. Several strategies are being optimized
to specifically inactivate anti-host T cells while preserving antileukemic or
antimicrobial immunocompetence, based on ex vivo or in vivo elimination of
anti-host T cells or on the modulation of their anti-host activity. N. Ref:: 80
----------------------------------------------------
[135]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.1 Long-term immunosuppression. Late steroid or
cyclosporine withdrawal.
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 4:19-20.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In order to reduce or avoid
long-term serious adverse effects of corticosteroids, such as bone fractures,
diabetes mellitus, arterial hypertension, osteoporosis and eye complications,
steroid withdrawal should be considered. B. Steroid withdrawal is safe only in
a proportion of graft recipients and is recommended only in low-risk patients.
The efficacy of the remaining immunosuppression should be considered. C. After
steroid withdrawal, graft function has to be monitored very carefully because
of the risk of a delayed but continuous loss of function due to chronic graft
dysfunction. In the case of functional deterioration or dysfunction, steroids
should be re-administered. D. Cyclosporine withdrawal might be considered in
order to ameliorate nephrotoxicity, arterial hypertension, lipid disorders and
hypertrichosis. This can be carried out with no significant long-term risk of
progressive graft loss. The efficacy of the remaining immunosuppression should
be considered. After cyclosporine withdrawal, careful monitoring for acute
rejection is recommended.
----------------------------------------------------
[136]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[137]
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
----------------------------------------------------
[138]
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
----------------------------------------------------
[139]
TÍTULO / TITLE: - ATP-binding cassette
transporters and calcineurin inhibitors: potential clinical implications.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2420-1.
AUTORES
/ AUTHORS: - van Gelder T; Klupp J; Sawamoto T;
Christians U; Morris RE
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine (T.vG.),
University Hospital Rotterdam, Rotterdam, The Netherlands. vangelder@INW1.AZR.NL N. Ref:: 17
----------------------------------------------------
[140]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.6. Cardiovascular risks. Smoking.
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 4:29.
RESUMEN
/ SUMMARY: - GUIDELINE: Cigarette smoking is associated
with a high frequency of post-transplant cardiovascular disease and may
adversely influence patient and graft survival. Active measures against tobacco
smoking are recommended.
----------------------------------------------------
[141]
TÍTULO / TITLE: - Pneumocystis carinii
pneumonia in patients without HIV infection.
REVISTA
/ JOURNAL: - Am J Med Sci 2001 Jan;321(1):56-65.
AUTORES
/ AUTHORS: - Russian DA; Levine SJ
INSTITUCIÓN
/ INSTITUTION: - Critical Care Medicine Department, Warren
Grant Magnuson Clinical Center and the Pulmonary-Critical Care Branch, National
Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda,
Maryland 20892-1590, USA.
RESUMEN
/ SUMMARY: - Pneumocystis carinii is an important, but
sporadic, opportunistic pulmonary pathogen in immunosuppressed HIV seronegative
persons. Historically, patients at highest risk for P. carinii pneumonia are
included infants with severe malnutrition, children with primary
immunodeficiencies, patients with hematological malignancies, and recipients of
solid organ or bone marrow transplants. Recently, solid tumor patients, in
particular those receiving high-dose corticosteroids for brain neoplasms, and
patients with inflammatory or collagen-vascular disorders, especially patients
with Wegener granulomatosis receiving immunosuppressive therapy, have been
identified as subgroups at increased risk for P. carinii pneumonia. Other
factors associated with P. carinii pneumonia include the intensity of the
immunosuppressive regimen and tapering doses of corticosteroids. Because P.
carinii pneumonia is associated with significant morbidity and mortality, it is
important to identify high-risk patient populations to administer effective
chemoprophylactic agents, such as trimethoprim-sulfamethoxazole. N. Ref:: 55
----------------------------------------------------
[142]
TÍTULO / TITLE: - Interaction of
immunophilin-binding immunosuppressives with the glucocorticoid receptor
signaling pathway: implications for transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2417-9.
AUTORES
/ AUTHORS: - Brogan IJ; Geraghty PJ; Hutchinson IV
INSTITUCIÓN
/ INSTITUTION: - Transplant Immunology Research Group,
School of Biological Sciences, University of Manchester, Manchester, UK. ibrogan@fs1.scg.man.ac.uk N. Ref:: 11
----------------------------------------------------
[143]
TÍTULO / TITLE: - Prevention and
treatment of cytomegalovirus infections in solid organ transplant recipients.
REVISTA
/ JOURNAL: - Pediatr Infect Dis J 2002 May;21(5):432-4.
AUTORES
/ AUTHORS: - Danziger-Isakov LA; Storch GA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Washington
University School of Medicine, St. Louis, MO, USA. N. Ref:: 17
----------------------------------------------------
[144]
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.
----------------------------------------------------
[145]
TÍTULO / TITLE: - Posttransplantation
lymphoproliferative disorders.
REVISTA
/ JOURNAL: - Arch Intern Med 2003 Sep 22;163(17):1997-2004.
●●
Enlace al texto completo (gratuito o de pago) 1001/archinte.163.17.1997
AUTORES
/ AUTHORS: - Andreone P; Gramenzi A; Lorenzini S;
Biselli M; Cursaro C; Pileri S; Bernardi M
INSTITUCIÓN
/ INSTITUTION: - Dipartimento di Medicina Interna,
CardioAngiologia ed Epatologia, Policlinico S Orsola-Malpighi, Bologna, Italy. andreone@med.unibo.it
RESUMEN
/ SUMMARY: - Posttransplantation lymphoproliferative
disorders include a wide spectrum of diseases ranging from
hyperplastic-appearing lesions to frank non-Hodgkin lymphoma. More than 90% of
these disorders are Epstein-Barr virus-associated lesions of B-cell origin that
arise in the setting of pharmacologic immunosuppression after transplantation.
With the increased use of organ transplantation and intensive
immunosuppression, posttransplantation lymphoproliferative disorders are
becoming more common. The prognosis is often poor, with most patients dying
despite receiving treatment. The aim of this review is to report the most
recent knowledge about the clinical features, diagnosis, prophylaxis, and
treatment of posttransplantation lymphoproliferative disorders, which can be
useful to physicians and health assistants dealing with these life-threatening,
posttransplantation clinical entities in clinical practice. N. Ref:: 76
----------------------------------------------------
[146]
- 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
----------------------------------------------------
[147]
TÍTULO / TITLE: - Molecular pathways of
regeneration and repair after liver transplantation.
REVISTA
/ JOURNAL: - World J Surg 2002 Jul;26(7):831-7. Epub
2002 Apr 15.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00268-002-4060-6
AUTORES
/ AUTHORS: - Olthoff KM
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Pennsylvania, 4 Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania
19104, USA.
RESUMEN
/ SUMMARY: - Injury to liver grafts due to cold
ischemia, preservation, and reperfusion continues to be an important factor in
patient outcome after liver transplantation. The development of therapeutic
interventions that can limit ischemic injury, enhance recovery, and improve
early graft function can have a major impact on patient morbidity. The
mechanisms of hepatic preservation and reperfusion injury, the molecular
pathways of graft recovery, and the cells involved remain poorly understood. With
significant damage to parenchymal tissue following cold ischemic injury comes
the need for replacement or repair of injured cells. In a rat liver transplant
model, expression of cytokines and activation of transcription factors
associated with the cell cycle resulting in cellular replication correlates
with the length of cold ischemia and the degree of damage. The resident liver
macrophage, the Kupffer cell, has been implicated as the primary source of
inflammatory factors but may also be the source of important growth factors and
cytokines that initiate cellular recovery and regeneration. Determining the
source of the initiating signal is important, as manipulation of this signal
can be used for therapeutic interventions in such fields as transplantation,
tumor immunology, and inflammatory disease. These studies demonstrate the
critical interrelation between parenchymal cells and cells of the immune system
during signaling and recovery from preservation and reperfusion injury in the
liver. Further defining the role of these immune cells and their products
during the initiation of cellular recovery is essential for developing
strategies to improve hepatocellular function after injury. N. Ref:: 37
----------------------------------------------------
[148]
TÍTULO / TITLE: - Role of interleukin-18
in acute graft-vs-host disease.
REVISTA
/ JOURNAL: - J Lab Clin Med 2003 Jun;141(6):365-71.
●●
Enlace al texto completo (gratuito o de pago) 1016/S0022-2143(03)00028-3
AUTORES
/ AUTHORS: - Reddy P; Ferrara JL
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Division
of Hematology/Oncology, Blood and Marrow Transplantation Program, University of
Michigan Cancer Center, Ann Arbor, Michigan 48109, USA. reddypr@umich.edu
RESUMEN
/ SUMMARY: - Allogeneic hematopoietic cell
transplantation (HCT) has emerged as an important therapeutic option for
several malignant and nonmalignant diseases. In addition to delivering systemic
chemoradiotherapy, the therapeutic potential of allogeneic HCT relies on the
graft-vs-leukemia (GVL) effect, which eradicates residual malignant cells by
way of immunologic mechanisms. Unfortunately, GVL effects are closely associated
with graft-vs-host disease (GVHD), the major complication of allogeneic HCT.
Separation of the toxicity of acute GVHD from the beneficial GVL effects
remains a major challenge to expanding the utility of this effective treatment
modality. The pathophysiology of acute GVHD involves dysregulation of
inflammatory cytokine cascades and donor T-cell responses to host alloantigens.
Interleukin 18 (IL-18) is a recently discovered cytokine with potent
immunomodulatory effects. This unique cytokine has the capacity to induce Th1
or Th2 polarization, depending on the immunologic context. The level of IL-18
is increased in acute GVHD, but this cytokine’s role in the pathophysiology of
acute GVHD is complex. It reduces the severity of acute GVHD as a T helper 1
(Th1)-inducing cytokine when administered early after bone-marrow transplant to
the lethally irradiated recipients. When administered to the donor, it can also
reduce the severity of acute GVHD, as a T helper 2 (Th2)-inducing cytokine.
Despite reducing the severity of acute GVHD, IL-18 preserves the GVL effect
after bone-marrow transplant. Thus IL-18 has the remarkable capacity to
modulate acute GVHD when administered either to the donor or the recipient
through distinct mechanisms. N.
Ref:: 57
----------------------------------------------------
[149]
TÍTULO / TITLE: - Immunosuppression and
transplant vascular disease: benefits and adverse effects.
REVISTA
/ JOURNAL: - Pharmacol Ther 2003 Nov;100(2):141-56.
AUTORES
/ AUTHORS: - Moien-Afshari F; McManus BM; Laher I
INSTITUCIÓN
/ INSTITUTION: - Department of Pharmacology and
Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health
Sciences Mall, Vancouver, BC Canada V6T 1Z3.
RESUMEN
/ SUMMARY: - Cardiac allograft vasculopathy (CAV) occurs
within 5 years of transplantation surgery and represents the main cause of
death in long-term heart transplant survivors. The detailed pathogenesis of CAV
is unknown, but there are strong indications that immunologic mechanisms, which
are regulated by nonimmunologic factors, are the major cause of this
phenomenon. Cyclosporine A (CsA) is a frequently used immunosuppressive agent
in transplant medicine to prevent rejection. The mechanism of action of CsA
involves initial binding to cyclophilin to form a complex that then inhibits
calcineurin (CN), leading to reduced interleukin (IL)-2 production as part of
the signal transduction pathway for the activation of B-lymphocytes and
T-lymphocytes. Based on this proposed mechanism, it was expected that CsA should
be an effective strategy in attenuating the host immune response against
transplanted allograft tissue; however, CsA has not changed the outcome of CAV.
Several mechanisms have been suggested for the ineffectiveness of CsA in
long-term prevention of CAV. For example, routine therapeutic doses of CsA may
block CN incompletely (50%), whereas complete blockade requires doses that are
not clinically tolerable. Another explanation is the possible activation of
T-cell receptors directly (CN independent) by the immune response, which
induces protein kinase C theta (PKCtheta) and leads to IL-2 production and
immune rejection. Moreover, there may be a role for nonimmunologic mechanisms,
such as complement, which cannot be controlled by CsA, or CsA may cause hypercholesterolemia
or induce overexpression of transforming growth factor-beta (TGF-beta). This
review also compares the effect of CsA with other immunosuppressants in
allograft artery preservation and their clinical efficacy. N. Ref:: 192
----------------------------------------------------
[150]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.2. Late infections. Tuberculosis.
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 4:39-43.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Tuberculosis (TB) is not
rare after renal transplantation, and can be life-threatening. Treatment of
active TB in renal transplant recipients should be the same as in the general
population, i.e. 2 months of quadruple therapy combining rifampin, isoniazid,
ethambutol and pyrazinamide, followed by a 4-months double therapy with
isoniazid and rifampin. The drug ethambutol should not be used initially if the
rate of resistance to isoniazid is less than 4% in the community. B. As
rifampin will reduce the plasma concentration of calcineurin antagonists and
rapamycin, the blood levels of these agents must be monitored closely.
Rifabutin may be used as an alternative to rifampin, as this drug is a less potent
inducer of the microsomal P450 enzymes. C. Renal transplant candidates and
renal transplant recipients should be screened for latent TB infection.
Patients considered to have latent TB infection are defined as: (i) those who
display a 5 mm (renal transplant recipients) or a 10 mm (dialysis patients)
induration after tuberculin skin testing; (ii) those with chest X-ray images
suggestive of past TB infection; (iii) those with a history of past TB
infection that was not treated adequately; and (iv) those who have been in
close contact with infectious patients. The preferred treatment of latent TB
infection is isoniazid 300 mg/day for 9 months.
----------------------------------------------------
[151]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.5. Cardiovascular risks. Hyperhomocysteinaemia.
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 4:28-9.
RESUMEN
/ SUMMARY: - GUIDELINE: Based on the present data, it
is not recommended to measure homocysteine levels.
----------------------------------------------------
[152]
TÍTULO / TITLE: - Genetic polymorphisms
influencing therapy and susceptibility to rejection in organ allograft
recipients.
REVISTA
/ JOURNAL: - BioDrugs 2002;16(1):11-7.
AUTORES
/ AUTHORS: - Poli F; Piccolo G; Scalamogna M
INSTITUCIÓN
/ INSTITUTION: - Centro Trasfusionale e di Immunologia dei
Trapianti, Ospedale Maggiore Policlinico, IRCCS, Milan, Italy.
RESUMEN
/ SUMMARY: - Solid organ transplantation during the
past 30 years has developed from an experimental procedure into routine
clinical practice. The current repertoire of immunosuppressive agents has made
a major contribution to transplant survival; however, problems in different
areas still need to be overcome. Several gene polymorphisms are supposed to
influence immunosuppressive therapy and susceptibility to rejection. Therefore,
a priority of transplant biologists is to estimate individual patient risk and
to characterise the genetic profile of patients in need of a transplant in
order to optimise the use of a scarce resource such as organs from cadaver
donors, and to avoid serious drug-induced adverse effects. Polymorphisms in
genes encoding tumour necrosis factor-alpha (TNFalpha), interleukin (IL)-6,
IL-10, interferon-gamma (IFNgamma), transforming growth factor-beta (TGFbeta)
and thiopurine S-methyltransferase (TPMT) can have significant effects on an
individual’s risk of rejection, as well as their ability to tolerate
immunosuppressive therapy. Genotyping of known polymorphisms in these genes may
in the future contribute to our ability to individualise immunosuppressive
therapy in organ transplant recipients.
N. Ref:: 72
----------------------------------------------------
[153]
- Castellano -
TÍTULO / TITLE:Leucoencefalopatia posterior
reversible en un paciente con linfoma no-Hodgkin tras tratamiento con CHOP.
Reversible posterior leukoencephalopathy in a patient with non-Hodgkin’s
lymphoma after treatment with CHOP.
REVISTA
/ JOURNAL: - An Med Interna 2001 Nov;18(11):591-3.
AUTORES
/ AUTHORS: - Gimenez-Mesa E; Martinez-Salio A;
Porta-Etessam J; Berbel Garcia A; Cedena Romero T; Salama Bendoyan P
INSTITUCIÓN
/ INSTITUTION: - Servicio de Neurologia, Hospital
Universitario Doce de Octubre, Ctra de Andalucia km 5,400, 28041 Madrid.
RESUMEN
/ SUMMARY: - Reversible posterior leukoencephalopathy
syndrome is a newly characterised and increasingly recognized
clinico-radiologic syndrome. Underlying conditions that reportedly trigger this
syndrome include hypertensive encephalopathy, eclampsia, renal failure, and
immunosuppressive drug therapy with cyclosporine, tacrolimus and interferon
alpha. We describe a 51-year-old woman with non-Hodgkin’s lymphoma treated with
conventional CHOP chemotherapy. Eight days after this treatment she developed
severe headache, bilateral visual loss and focal seizures with secondary
generalization. Neurologic examination showed confusion, cortical blindness,
and left hemiparesis with hyperreflexia and sensory loss. A cranial T2-weighted
magnetic resonance imaging revealed increased signal intensity in the occipital
and frontal lobes in both hemispheres and right parietal lobe. A diagnosis of
reversible posterior leukoencephalopathy was made. She presented a favourable outcome
with conservative treatment with mannitol and phenytoin. A new cranial scanning
showed nearly complete resolution of the abnormalities. To the best of our
knowledge, this is the first case of reversible posterior leukoencephalopathy
in a patient treated with standard-dose CHOP. In this patient, we confirm the
theoretical pathophysiologic mechanisms suggested explaining how these drugs
can cause the syndrome. N.
Ref:: 7
----------------------------------------------------
[154]
TÍTULO / TITLE: - FTY720: altered
lymphocyte traffic results in allograft protection.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 15;72(5):764-9.
AUTORES
/ AUTHORS: - Brinkmann V; Pinschewer DD; Feng L; Chen S
INSTITUCIÓN
/ INSTITUTION: - Novartis Pharma AG, Transplantation
Research, WSJ-386.1.01, CH-4002 Basel, Switzerland. N. Ref:: 52
----------------------------------------------------
[155]
TÍTULO / TITLE: - Transplant Mac attack:
humor the macrophages.
REVISTA
/ JOURNAL: - Kidney Int 2003 May;63(5):1953-4.
AUTORES
/ AUTHORS: - Colvin RB
N. Ref:: 10
----------------------------------------------------
[156]
TÍTULO / TITLE: - Insulin resistance as
putative cause of chronic renal transplant dysfunction.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Apr;41(4):859-67.
AUTORES
/ AUTHORS: - de Vries AP; Bakker SJ; van Son WJ; Homan
van der Heide JJ; The TH; de Jong PE; Gans RO
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology Department of
Medicine, Groningen University Medical Center, Groningen, The Netherlands. a.p.j.de.vries@int.azg.nl
RESUMEN
/ SUMMARY: - Transplantation is the preferred organ
replacement therapy for most patients with end-stage renal disease. Despite
impressive improvements over recent years in the treatment of acute rejection,
approximately half of all grafts will loose function within 10 years after
transplantation. Chronic renal transplant dysfunction, also known as transplant
atherosclerosis, is a leading cause of late allograft loss. To date, no
specific treatment for chronic renal transplant dysfunction is available.
Although its precise pathophysiology remains unknown, it is believed that it
involves a multifactorial process of alloantigen-dependent and
alloantigen-independent risk factors. Obesity, posttransplant diabetes
mellitus, dyslipidemia, hypertension, and proteinuria have all been identified
as alloantigen-independent risk factors. Notably, these recipient-related risk
factors are well-known risk factors for cardiovascular disease, which cluster
within the insulin resistance syndrome in the general population. Insulin
resistance is considered the central pathophysiologic feature of this syndrome.
It is therefore tempting to speculate that it is insulin resistance that
underlies the recipient-related risk factors for chronic renal transplant
dysfunction. Recognition of insulin resistance as a central feature underlying
many, if not all, recipient-related risk factors would not only improve our
understanding of the pathophysiology of chronic renal transplant dysfunction,
but also stimulate development of new treatment and prevention strategies. N. Ref:: 99
----------------------------------------------------
[157]
TÍTULO / TITLE: - Fulminant mixed humoral
and cellular rejection in a cardiac transplant recipient: a review of the
histologic findings and literature.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
May;22(5):604-7.
AUTORES
/ AUTHORS: - Book WM; Kelley L; Gravanis MB
INSTITUCIÓN
/ INSTITUTION: - Internal Medicine, Emory University School
of Medicine, Atlanta, Georgia 30322, USA. wendy_book@emoryhealthcare.org
RESUMEN
/ SUMMARY: - Mixed acute cellular and humoral rejection
is diagnosed uncommonly among heart transplant recipients and usually occurs
within the first post-transplant month. We report a case of fatal, fulminant,
mixed, acute cellular and humoral rejection in a 33-year-old woman 6 weeks
after orthotopic heart transplantation. She had been treated with intravenous
methylprednisolone for International Society for Heart and Lung Transplantation
(ISHLT) Grade 2 rejection at post-operative Day 28. Despite intensification of
immunosuppression therapy, she developed fever and progressive hemodynamic
instability. Autopsy results revealed ISHLT Grade 4 mixed cellular and humoral
rejection. Cellular rejection is a well-described mechanism of graft failure
early after heart transplantation. Although humoral rejection also is
recognized as contributing to early graft failure, its characteristics and
clinical implications are not as well characterized. We describe a patient with
fulminant mixed rejection, despite intensified immunosuppression therapy, early
after orthotopic heart transplantation who presented with high-grade fever. We
include a review of the literature on humoral and mixed rejections. N. Ref:: 13
----------------------------------------------------
[158]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.3. Long-term immunosuppression. Toxicity of
immunosuppression.
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 4:21-3.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Careful long-term
monitoring of graft recipients is mandatory to discover signs of
immunosuppressive drug toxicity, in particular nephrotoxicity. B. In the case
of a discrepancy between the drug dose and signs of toxicity, then a thorough
pharmacokinetic analysis should be performed. C. Cardiovascular, renal and
metabolic risks and the risk of de novo malignancy must be considered in a
long-term monitoring programme.
----------------------------------------------------
[159]
TÍTULO / TITLE: - Defining opportunistic
invasive fungal infections in immunocompromised patients with cancer and
hematopoietic stem cell transplants: an international consensus.
REVISTA
/ JOURNAL: - Clin Infect Dis 2002 Jan 1;34(1):7-14.
Epub 2001 Nov 26.
AUTORES
/ AUTHORS: - Ascioglu S; Rex JH; de Pauw B; Bennett JE;
Bille J; Crokaert F; Denning DW; Donnelly JP; Edwards JE; Erjavec Z; Fiere D;
Lortholary O; Maertens J; Meis JF; Patterson TF; Ritter J; Selleslag D; Shah
PM; Stevens DA; Walsh TJ
RESUMEN
/ SUMMARY: - During the past several decades, there has
been a steady increase in the frequency of opportunistic invasive fungal
infections (IFIs) in immunocompromised patients. However, there is substantial
controversy concerning optimal diagnostic criteria for these IFIs. Therefore,
members of the European Organization for Research and Treatment of
Cancer/Invasive Fungal Infections Cooperative Group and the National Institute
of Allergy and Infectious Diseases Mycoses Study Group formed a consensus
committee to develop standard definitions for IFIs for clinical research. On
the basis of a review of literature and an international consensus, a set of
research-oriented definitions for the IFIs most often seen and studied in
immunocompromised patients with cancer is proposed. Three levels of probability
are proposed: “proven,” “probable,” and “possible.” The definitions are
intended for use in the context of clinical and/or epidemiological research,
not for clinical decision making.
----------------------------------------------------
[160]
TÍTULO / TITLE: - Solitary embolic
cutaneous aspergillosis in the immunocompromised patient with acute myelogenous
leukemia - a propos another case caused by Aspergillus flavus.
REVISTA
/ JOURNAL: - Int J Dermatol 2003 Dec;42(12):946-50.
AUTORES
/ AUTHORS: - Krunic AL; Medenica M; Busbey S
INSTITUCIÓN
/ INSTITUTION: - Section of Dermatology, University of
Chicago Hospitals, Chicago, IL, USA. N.
Ref:: 27
----------------------------------------------------
[161]
TÍTULO / TITLE: - Alloimmunity and
nonimmunologic risk factors in cardiac allograft vasculopathy.
REVISTA
/ JOURNAL: - Eur Heart J 2003 Jul;24(13):1180-8.
AUTORES
/ AUTHORS: - Vassalli G; Gallino A; Weis M; von Scheidt
W; Kappenberger L; von Segesser LK; Goy JJ
INSTITUCIÓN
/ INSTITUTION: - Division of Cardiology, University
Hospital, Lausanne, Switzerland. gvassall@hospvd.ch
RESUMEN
/ SUMMARY: - Graft vasculopathy is an accelerated form
of coronary artery disease that occurs in transplanted hearts. Despite major
advances in immunosuppression, the prevalence of the disease has remained
substantially unchanged during the last two decades. According to the ‘response
to injury’ paradigm, graft vasculopathy is the result of a continuous
inflammatory response to tissue injury initiated by both alloantigen-dependent
and independent stress responses. Experimental evidence suggests that these
responses may become self-sustaining, as allograft re-transplantation into the
donor strain at a later stage fails to prevent disease progression. Histological
evidence of endothelitis and arteritis, in association with intima fibrosis and
atherosclerosis, reflects the central role of alloimmunity and inflammation in
the development of arterial lesions. Experimental results in gene-targeted
mouse models indicate that cellular and humoral immune responses are both
involved in the pathogenesis of graft vasculopathy. Circulating antibodies
against donor endothelium are found in a significant number of patients, but
their pathogenic role is still controversial. Alloantigen-independent factors
include donor-transmitted coronary artery disease, surgical trauma,
ischaemia-reperfusion injury, viral infections, hyperlipidaemia, hypertension,
and glucose intolerance. Recent therapeutic advances include the use of novel
immunosuppressive agents such as sirolimus (rapamycin), HMG-CoA reductase
inhibitors, calcium channel blockers, and angiotensin converting enzyme
inhibitors. Optimal treatment of cardiovascular risk factors remains of
paramount importance. N.
Ref:: 100
----------------------------------------------------
[162]
TÍTULO / TITLE: - Basiliximab: a review
of its use as induction therapy in renal transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(24):2803-35.
AUTORES
/ AUTHORS: - Chapman TM; Keating GM
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Basiliximab (Simulect), a chimeric
(human/murine) monoclonal antibody, is indicated for the prevention of acute
organ rejection in adult and paediatric renal transplant recipients in
combination with other immunosuppressive agents.Basiliximab significantly
reduced acute rejection compared with placebo in renal transplant recipients
receiving dual- (cyclosporin microemulsion and corticosteroids) or
triple-immunotherapy (azathioprine- or mycophenolate mofetil-based); graft and
patient survival rates at 12 months were similar. Significantly more
basiliximab than placebo recipients were free from the combined endpoint of
death, graft loss or acute rejection 3 years, but not 5 years, after
transplantation.The incidence of adverse events was similar in basiliximab and
placebo recipients, with no increase in the incidence of infection, including
cytomegalovirus (CMV) infection. Malignancies or post-transplant
lymphoproliferative disorders after treatment with basiliximab were rare, with
a similar incidence to that seen with placebo at 12 months or 5 years
post-transplantation. Rare cases of hypersensitivity reactions to basiliximab
have been reported.The efficacy of basiliximab was similar to that of equine
antithymocyte globulin (ATG) and daclizumab, and similar to or greater than
that of muromonab CD3. Basiliximab was as effective as rabbit antithymocyte globulin
(RATG) in patients at relatively low risk of acute rejection, but less
effective in high-risk patients. Numerically or significantly fewer patients
receiving basiliximab experienced adverse events considered to be related to
the study drug than ATG or RATG recipients. The incidence of infection,
including CMV infection, was similar with basiliximab and ATG or
RATG.Basiliximab plus baseline immunosuppression resulted in no significant
differences in acute rejection rates compared with baseline immunosuppression
with or without ATG or antilymphocyte globulin in retrospective analyses
conducted for small numbers of paediatric patients. Limited data from
paediatric renal transplant recipients suggest a similar tolerability profile
to that in adults. Basiliximab appears to allow the withdrawal of
corticosteroids or the use of corticosteroid-free or calcineurin
inhibitor-sparing regimens in renal transplant recipients.Basiliximab did not
increase the overall costs of therapy in pharmacoeconomic studies.CONCLUSION:
Basiliximab reduces acute rejection without increasing the incidence of adverse
events, including infection and malignancy, in renal transplant recipients when
combined with standard dual- or triple-immunotherapy. The overall incidence of
death, graft loss or acute rejection was significantly reduced at 3 years;
there was no significant difference for this endpoint 5 years after
transplantation. Malignancy was not increased at 5 years. The overall efficacy,
tolerability, ease of administration and cost effectiveness of basiliximab make
it an attractive option for the prophylaxis of acute renal transplant
rejection. N. Ref:: 85
----------------------------------------------------
[163]
TÍTULO / TITLE: - Cyclosporine-associated
hyperkalemia: report of four allogeneic blood stem-cell transplant cases.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 15;75(7):1069-72.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000057241.69355.59
AUTORES
/ AUTHORS: - Caliskan Y; Kalayoglu-Besisik S; Sargin D;
Ecder T
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow Transplantation Unit,
Department of Internal Medicine, Division of Hematology, Istanbul School of
Medicine, CAPA 34 390, Istanbul, Turkey.
RESUMEN
/ SUMMARY: - BACKGROUND: Nephrotoxicity is a well-known
effect of cyclosporine (CsA) that causes a reduction in glomerular filtration
rate through vasoconstriction of the afferent glomerular arterioles and may
result in acute renal failure. Isolated CsA-induced hyperkalemia occurring
through different mechanisms is also common. However, there are only a few
“case reports” addressing this phenomenon in allogeneic bone marrow
transplantation patients. In this report, we propose mechanisms and methods of
managing CsA-associated hyperkalemia in allogeneic transplantation. METHODS: We
report on four allogeneic blood stem- cell transplant cases and a review of the
literature. RESULTS: Four adult leukemia patients underwent allogeneic
peripheral blood stem cell transplantation and received CsA as a part of their
graft-versus-host disease prophylaxis. The patients developed hyperkalemia,
despite adequate kidney function. CsA seemed to be the only pharmaceutical
agent to which this electrolyte abnormality could be attributed. Renal tubule
dysfunction and secondary hypoaldosteronism seemed to be the reasons for
CsA-associated hyperkalemia. CONCLUSION: This report of four cases demonstrates
that CsA should be considered among the possible causes of hyperkalemia in bone
marrow transplantation. There may be a need for urgent intervention depending
on the severity of hyperkalemia. Monitoring of blood CsA level and dose
adjustment are important for the prevention of this complication. N. Ref:: 22
----------------------------------------------------
[164]
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
----------------------------------------------------
[165]
TÍTULO / TITLE: - A refined understanding
of immunosuppressives and cancer risk.
REVISTA
/ JOURNAL: - Kidney Int 2003 Mar;63(3):1160-1.
AUTORES
/ AUTHORS: - Strom TB; Sukhatme VP N. Ref:: 16
----------------------------------------------------
[166]
TÍTULO / TITLE: - Gene transfer of
cytoprotective and immunomodulatory molecules for prevention of cardiac
allograft rejection.
REVISTA
/ JOURNAL: - Eur J Cardiothorac Surg 2003
Nov;24(5):794-806.
AUTORES
/ AUTHORS: - Vassalli G; Fleury S; Li J; Goy JJ;
Kappenberger L; von Segesser LK
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiology, BH-10, CHUV,
University of Lausanne Medical School, Rue du Bugnon 46, 1011 Lausanne,
Switzerland. guiseppe.vassalli@chuv.hospvd.ch
RESUMEN
/ SUMMARY: - Current treatments of heart
transplantation are limited by incomplete effectiveness, significant toxicity,
and failure to prevent chronic rejection. Genetic manipulation of the donor
heart at the time of removal offers the unique opportunity to produce a
therapeutic molecule within the graft itself, while minimizing systemic
effects. Cytoprotective approaches including gene transfer of heme oxygenase
(HO)-1, endothelial nitric oxide synthase, and antisense oligodeoxynucleotides
specific for nuclear factor (NF)-kappa B or intercellular adhesion molecule
(ICAM)-1 reduced ischaemia-reperfusion injury and delayed cardiac allograft
rejection in small animals. Exogenous overexpression of immunomodulatory
cytokines such as interleukin (IL)-4, IL-10 and transforming growth
factor-beta, as well as gene transfer of inhibitors of pro-inflammatory
cytokines also delayed graft rejection. Gene transfer-based blockade of T-cell
costimulatory activation with CTLA4-Ig or CD40-Ig resulted in long-lasting
graft survival and donor-specific unresponsiveness, as manifested by acceptance
of a second graft from the original donor strain but rejection of third-party
grafts. Similar results were obtained with donor major histocompatibility
complex class I gene transfer into bone marrow cells. Gene therapy approaches
to chronic rejection included gene transfer of HO-1, soluble Fas, tissue
plasminogen activator and antisense oligodeoxynucleotides specific for the
anti-apoptotic mediator Bcl-x or the E2F transcription factor. Despite major
experimental advances, however, gene therapy for heart transplantation has not
entered the clinical arena yet. Fundamental questions regarding the most
suitable vector, the best gene, and safety issues remain unanswered.
Well-controlled studies that compare gene therapy with established treatments
in non-human primates are needed before clinical trials can be started. N. Ref:: 105
----------------------------------------------------
[167]
TÍTULO / TITLE: - More on the regulation
of tobacco smoke: how we got here and where next.
REVISTA
/ JOURNAL: - Ann Oncol 2003 Mar;14(3):353-7.
AUTORES
/ AUTHORS: - Gray N; Kozlowski LT
INSTITUCIÓN
/ INSTITUTION: - Division of Epidemiology and
Biostatistics, European Institute of Oncology, Milan, Italy. nigel@uicc.ch
RESUMEN
/ SUMMARY: - The modern cigarette is unnecessarily
dangerous. Despite being lower in tar yield, and consequently in
squamo-carcinogenic polyaromatic hydrocarbons such as benzo[a]pyrene, the
nitrosamine yields are often higher than they need to be. Also, reductions in
tar levels have not led to the consequential reductions in mortality that were
anticipated several decades ago. The modern cigarette is also smoother, easier
to smoke and to learn how to smoke, highly addictive and facilitates
compensatory smoking. Compensatory smoking leads to excess inhalation of
carcinogens and toxins in the hunt for nicotine. Its labelling is misleading in
that supposedly low-yielding cigarettes may, due to compensation occurring as a
result of cigarette design, lead to inhalation of much higher amounts of
nicotine, carcinogens and toxins than the smoker is led to expect. Regulation
of the product is needed to provide the persistent smoker with a cigarette
lower in risk, accurately labelled, providing a relatively consistent and known
dose of nicotine, and less likely to facilitate compensatory smoking. This will
not produce a safe cigarette but should result in a reduction in harm if
seriously implemented. N.
Ref:: 41
----------------------------------------------------
[168]
TÍTULO / TITLE: - Effectiveness of
sirolimus-eluting stent implantation for recurrent in-stent restenosis after
brachytherapy.
REVISTA
/ JOURNAL: - Am J Cardiol 2003 Jul 15;92(2):200-3.
AUTORES
/ AUTHORS: - Saia F; Lemos PA; Sianos G; Degertekin M;
Lee CH; Arampatzis CA; Hoye A; Tanabe K; Regar E; van der Giessen WJ; Smits PC;
de Feyter P; Ligthart J; van Domburg RT; Serruys PW
INSTITUCIÓN
/ INSTITUTION: - Erasmus MC, Thoraxcenter, Dr
Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. N. Ref:: 13
----------------------------------------------------
[169]
TÍTULO / TITLE: - Primary lymphoma of the
esophagus in a chronically immunosuppressed patient with hepatitis C infection:
case report and review of the literature.
REVISTA
/ JOURNAL: - Am J Med Sci 2001 Mar;321(3):203-5.
AUTORES
/ AUTHORS: - Golioto M; McGrath K
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology, Duke
University Medical Center, Durham, North Carolina, USA. golio001@mc.duke.edu
RESUMEN
/ SUMMARY: - Adenocarcinoma and squamous cell carcinoma
account for the vast majority of esophageal malignancies. Other malignancies
that can involve the esophagus include melanoma, sarcoma, and lymphoma.
Gastrointestinal involvement with lymphoma has a variable incidence, as
reported in the literature. However, primary involvement, as defined by Dawson,
is extremely rare. Lymphoma has been linked to immunosuppressive conditions
(such as AIDS), medications, and transplantation. We present what we believe to
be the first case of primary esophageal lymphoma in a patient on long-term
immunosuppression with azathioprine who was also infected with the hepatitis C
virus (HCV). HCV has been postulated to have a relationship with B cell
lymphomas. N. Ref:: 20
----------------------------------------------------
[170]
TÍTULO / TITLE: - De novo thrombotic
microangiopathy in renal transplant recipients: a comparison of hemolytic
uremic syndrome with localized renal thrombotic microangiopathy.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Feb;41(2):471-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/ajkd.2003.50058
AUTORES
/ AUTHORS: - Schwimmer J; Nadasdy TA; Spitalnik PF;
Kaplan KL; Zand MS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Nephrology Unit,
University of Rochester Medical Center, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Thrombotic microangiopathy
(TMA) is a well-recognized and serious complication of renal transplantation,
affecting 3% to 14% of patients administered calcineurin-inhibitor-based
immunosuppression. METHODS: We reviewed 1,219 biopsy reports of 742 kidney and
kidney-pancreas transplants performed during 15 years at our center and found
21 biopsy-confirmed cases of TMA. RESULTS: On presentation, the majority (62%)
had systemic TMA with manifest hemolysis and thrombocytopenia, whereas a subset
had TMA localized only to the graft (38%). There were no statistically
significant differences in sex, type of transplant, age, race, or type of
immunosuppression. Patients with systemic TMA were more likely to be treated
with plasma exchange (38% versus 13%; P < 0.05), more often required
dialysis therapy (54% versus 0%; P = 0.01), and had a greater rate of graft
loss (38% versus 0%; P < 0.05). No patient with the localized variant had
TMA-related graft loss. Patients with localized TMA often responded to reduction,
conversion, or temporary discontinuation of calcineurin-inhibitor-based
immunosuppression therapy and did not routinely require plasma exchange for
graft salvage. We compare our findings with the literature regarding the
prognosis of TMA. CONCLUSION: Classifying patients with post-renal
transplantation TMA into those with localized and systemic disease is
clinically useful because each group has distinct characteristics and clinical
courses. N. Ref:: 37
----------------------------------------------------
[171]
TÍTULO / TITLE: - Hypertension after
kidney transplantation: impact, pathogenesis and therapy.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):202-8.
AUTORES
/ AUTHORS: - Zhang R; Leslie B; Boudreaux JP; Frey D;
Reisin E
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, Department of
Medicine, Louisianna State University Health Sciences Center, New Orleans
70112-2822, USA.
RESUMEN
/ SUMMARY: - Hypertension (HTN) contributes to the high
incidence of cardiovascular disease mortality as well as chronic allograft
nephropathy (CAN) and late graft failure in renal transplant recipients. The
mechanisms are complex and may involve pathogenic factors attributable to the
host, allograft, and immunosuppressive drugs. Calcium channel blockers should
be used to ameliorate the nephrotoxicity of calcineurin inhibitors in the early
years after transplantation. Angiotensin-converting enzyme inhibitors and
angiotensin-2 type-1 receptor blockers are safe and effective, have
antiproteinuric effects, slow the progression of CAN, and may provide survival
benefits. Diuretics and/or beta-adrenergic receptor blockers are frequently
added in combination regimen. Appropriate adjustment of the immunosuppressive
drugs should also be considered for the long-term care of kidney recipients
with HTN. N. Ref:: 53
----------------------------------------------------
[172]
TÍTULO / TITLE: - Influence of tumor
vaccines on graft versus tumor activity and graft versus host disease in
allogeneic bone marrow transplantation.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2002 Mar;43(3):503-10.
AUTORES
/ AUTHORS: - Mullen CA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Texas M.D. Anderson Cancer Center, Houston 77030, USA. cmullen@mail.mdanderson.org
RESUMEN
/ SUMMARY: - Powerful immunologically-mediated
antitumor efforts can be observed in allogeneic hematopoietic stem cell
transplantation. In the absence of specific immune interventions, this graft
versus tumor effect is closely associated with graft versus host disease. In
the work summarized here, the influence of cellular tumor vaccines on graft
versus tumor activity and graft versus host disease is examined in a murine
model of MHC-matched, minor histocompatibility antigen-mismatched bone marrow
transplantation. The experiments have generated the following conclusions.
First, complex cellular vaccines, which include recipient minor
histocompatibility antigens, when administered to allogeneic donors generate
powerful graft versus tumor effects but also induce unacceptable exacerbations
of graft versus host disease. Second, cellular tumor vaccines, which contain
recipient minor histocompatibility antigens, can be administered to transplant
recipients after transplant without significant exacerbation of GVHD and with
retention of clinically significant graft versus tumor effects. Third,
immunization of donors with molecularly defined tumor-associated antigens,
which are not recipient minor histocompatibility antigens, can be coupled with
post-transplant immunization of recipients with cellular vaccines without
exacerbation of GVHD. N.
Ref:: 35
----------------------------------------------------
[173]
TÍTULO / TITLE: - Topical treatment of
sclerodermoid chronic graft vs. host disease.
REVISTA
/ JOURNAL: - Am J Phys Med Rehabil 2002
Feb;81(2):143-9.
AUTORES
/ AUTHORS: - Currie DM; Ludvigsdottir GK; Diaz CA;
Kamani N
INSTITUCIÓN
/ INSTITUTION: - Department of Rehabilitation Medicine,
University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA.
RESUMEN
/ SUMMARY: - Sclerodermoid chronic graft vs. host
disease is a severe adverse immunologic reaction following allogeneic bone
marrow transplantation, with deposition of collagen in the skin and possibly other
soft tissues, resulting in loss of range of motion and functional capabilities.
We present a case of a 14-yr-old girl who received a matched, unrelated donor
bone marrow transplant for myelodysplastic syndrome complicated by
sclerodermoid chronic graft vs. host disease, causing severe contractures of
the shoulders, elbows, wrists, fingers, hips and knees. This case report and
review of the literature regarding chronic graft vs. host disease suggest that
a controlled trial of a multimodality therapeutic approach, including topical
treatment, is warranted to determine whether this approach improves function in
these patients. N.
Ref:: 16
----------------------------------------------------
[174]
TÍTULO / TITLE: - Editorial on “Diagnosis
and treatment of arterial steal syndromes in liver transplantation recipients”.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Jun;9(6):603-4.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50127
AUTORES
/ AUTHORS: - Farges O; Belghiti J N. Ref:: 8
----------------------------------------------------
[175]
TÍTULO / TITLE: - Prevention of
cytomegalovirus disease in recipients of allogeneic stem cell transplants.
REVISTA
/ JOURNAL: - Clin Microbiol Rev. Acceso gratuito al
texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://cmr.asm.org/
●●
Cita: Clinical Microbiology Reviews: <> 2003 Oct;16(4):647-57.
AUTORES
/ AUTHORS: - Meijer E; Boland GJ; Verdonck LF
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology, University
Medical Center, Utrecht, The Netherlands. emeijer@digd.azu.nl
RESUMEN
/ SUMMARY: - The main risk factors for cytomegalovirus
(CMV) disease in recipients of allogeneic stem cell transplants (SCT) are
recipient CMV seropositivity and acute graft-versus-host disease. Currently,
two antiviral strategies, prophylactic or preemptive antiviral treatment, are
used for prevention of CMV disease. Preemptive treatment is most favorable when
short-term (14-day) treatment is applied. Several methods are available for
monitoring of CMV reactivation. PCR-based CMV DNA detection assays are the most
sensitive methods; however, the clinical benefit of this high sensitivity is
unclear. Even more, there is lack of clarity whether PCR tests can better be
performed with plasma, whole blood, or peripheral blood leukocyte samples.
Recovery of a CMV-specific CD8(+) cytotoxic-T-lymphocyte (CTL) response is
necessary for preventing CMV reactivation and disease. Reconstitution of
absolute CMV-specific CTL counts to values above 10 x 10(6) to 20 x 10(6)
CTLs/liter is associated with protection from CMV disease. In the near future,
preemptive therapy might be withheld in patients with CMV reactivation who are
shown to have adequate CMV-specific cytotoxic T-cell levels. Antiviral therapy
with (val)acyclovir has been studied only as prophylactic treatment for
prevention of CMV infection. High-dose oral valacyclovir is more effective than
acyclovir when used in addition to preemptive treatment of CMV reactivation
with ganciclovir or foscarnet. Three antiviral drugs have been tested for
preemptive therapy of CMV reactivation and/or treatment of CMV disease.
Although intravenous ganciclovir is considered the drug of choice, foscarnet
has similar efficacy and less toxicity, especially hematologic toxicity.
Cidofovir has not been tested extensively, but so far the results are
disappointing. Oral valganciclovir for preemptive treatment of SCT recipients
is currently being studied. In addition to antiviral therapy, adoptive
immunotherapy with CMV-specific cytotoxic T cells as prophylactic or preemptive
therapy is a very elegant strategy; however, generation of these cells is
expensive and time-consuming, and therefore the therapy is not available at
every transplantation center. Magnetic selection of CMV-specific CD8(+) T cells
from peripheral blood by using HLA class I-peptide tetramers may be very
promising, making this strategy more accessible. N. Ref:: 102
----------------------------------------------------
[176]
TÍTULO / TITLE: - West Nile encephalitis
in 2 hematopoietic stem cell transplant recipients: case series and literature
review.
REVISTA
/ JOURNAL: - Clin Infect Dis 2003 Oct 15;37(8):1044-9.
Epub 2003 Sep 18.
AUTORES
/ AUTHORS: - Hong DS; Jacobson KL; Raad II; de Lima M;
Anderlini P; Fuller GN; Ippoliti C; Cool RM; Leeds NE; Narvios A; Han XY;
Padula A; Champlin RE; Hosing C
INSTITUCIÓN
/ INSTITUTION: - Department of Blood and Marrow
Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston,
Texas 77030, USA.
RESUMEN
/ SUMMARY: - Most human cases of West Nile virus
infection are acquired via bites from an infected mosquito. In some cases,
infection may also be transmitted by infected blood products or transplanted
organs. There have been recent publications suggesting that chemotherapy and
immunosuppression may increase a person’s risks of developing central nervous
system disease if the person is infected with the West Nile virus. Because
patients undergoing hematopoietic stem cell transplantation not only are
immunocompromised, but also receive multiple blood products, they are at a
particularly high risk for acquiring symptomatic disease if exposed to the West
Nile Virus. We describe here 2 patients who underwent hematopoietic transplantation
at our institution and subsequently developed fatal West Nile virus
infections. N. Ref:: 24
----------------------------------------------------
[177]
- Castellano -
TÍTULO / TITLE:La enfermedad linfoproliferativa
difusa postrasplante renal y su relacion con el virus Epstein-Barr. Experiencia
de un centro. Diffuse lymphoproliferative disease after renal transplantation
and its relation with Epstein-Barr virus. Experience at one center.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22(5):463-9.
AUTORES
/ AUTHORS: - Franco A; Jimenez L; Aranda I; Alvarez L;
Gonzalez M; Rocamora N; Olivares J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital General
Alicante Maestro Alonso, 109 03010 Alicante. franco_ant@gva.es
RESUMEN
/ SUMMARY: - Post-transplant lymphoproliferative disorders
(PTLD) are a group of heterogeneous lymphoid proliferations in chronic
immunosuppressed recipients which appear to be related to Epstein Barr Virus
(EBV). Receptor EBV seronegativity, use of antilymphocyte antibodies and CMV
disease have been identified as risk factors that may tigger development of
PTLD. We have studied the incidence of PTLD and its relationship with EBV in
588 adult renal transplant recipients who were transplanted in our hospital
from 1988 to 2001. We have also evaluated the diagnostic and therapeutic
methods used, the risk factors and outcome of the patients who developed PTLD.
We identified 8 recipients (4 males and 4 females), range from 18 to 67 years
(mean age 45.6 years) with a median time between grafting and PTLD of 4.1 years
(0.1-7 years), who developed PTLD (1.3%). Only 1 patient received OKT3 and had
CMV disease, two of them (25%) had been treated with hight doses of
prednisolone, another was EBV seronegative, but the rest of them (50%) had no
risk factors. Two patients were diagnosed at autopsy, the diagnosis of 5 was
based on the histology of biopsy and the last one by CT scans of chest-abdomen
and cytology. The presence of EBV in the lymphoproliferative cells was assessed
in 5 out of the 7 studied patients (71.4%). The outcome of our recipients was
poor. Five out of 8 patients died shortly after diagnosis as a direct
consecuence of PTLD and another of an infectious complication of the treatment
(75%). The 2 patients alive started dialysis and 1 of them died 2 years later of
a non-related cause. In conclusion, PTLD is a relatively frequent disease with
a poor prognosis in renal transplant patients. It seems to have a close
relationship with EBV and can develop in the absence of the classical risk
factors. N. Ref:: 18
----------------------------------------------------
[178]
TÍTULO / TITLE: - Impaired gut function
as risk factor for invasive candidiasis in neutropenic patients.
REVISTA
/ JOURNAL: - Br J Haematol 2002 May;117(2):259-64.
AUTORES
/ AUTHORS: - Blijlevens NM; Donnelly JP; de Pauw BE
INSTITUCIÓN
/ INSTITUTION: - Department of Haematology, University
Medical Centre, St. Radboud Nijmegen, NL-6500 HB Nijmegen, the Netherlands. N.Blijlevens@hemat.azn.nl N. Ref:: 53
----------------------------------------------------
[179]
- Castellano -
TÍTULO / TITLE:Tratamiento de los sindromes
linfoproliferativos postrasplante. Management of lymphoproliferative disorders
associated to organ transplantation.
REVISTA
/ JOURNAL: - Med Clin (Barc). Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Medicina Clínica: <> 2003 May 31;120(20):780-5.
AUTORES
/ AUTHORS: - Segura Huerta A; Gomez Codina J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Oncologia Medica. Hospital
Universitario La Fe. Valencia. España. segura_ang@gva.es N. Ref:: 76
----------------------------------------------------
[180]
TÍTULO / TITLE: - Rush Hymenoptera venom
immunotherapy: a safe and practical protocol for high-risk patients.
REVISTA
/ JOURNAL: - J Allergy Clin Immunol 2002
Dec;110(6):928-33.
AUTORES
/ AUTHORS: - Sturm G; Kranke B; Rudolph C; Aberer W
INSTITUCIÓN
/ INSTITUTION: - Department of Environmental Dermatology
and Allergy, University of Graz, Graz, Austria.
RESUMEN
/ SUMMARY: - BACKGROUND: Hymenoptera venom
immunotherapy in allergic patients is a well-established treatment modality for
the prevention of systemic anaphylactic reactions caused by insect stings. A
variety of therapy regimens exists, from conventional to rush and ultrarush
modalities that operate on continuous or intermittent schedules. OBJECTIVE: The
aim of this study was to report the 8-year experience with our rush venom
immunotherapy regimen in predominantly high-risk patients and to compare data
on safety and convenience with the results of 26 studies published from 1978 to
2001. METHODS: One hundred one patients allergic to bee, yellow jacket, or
hornet venom were treated with rush Hymenoptera venom immunotherapy. Diagnosis
and selection of patients for venom immunotherapy were carried out according to
the recommendations of the European Academy of Allergology and Clinical
Immunology. We used a 4-day regimen, and the incidence and nature of systemic reactions
(SRs) were documented. Fifty-two patients were treated with honeybee venom, and
49 were treated with yellow jacket venom. RESULTS: One hundred (99%) patients
reached the maintenance dose. We observed 8 injection-related SRs (0.47% of all
injections given) in 7 (6.9%) patients. The number of SRs was higher in
patients treated with bee venom extract (12%) compared with in patients
receiving yellow jacket venom extract (2%). There was no significant difference
in the risk of SRs between female and male patients. The incidence of SRs was
considerably lower than the average of 17.8% reported in the literature.
CONCLUSION: With a rush immunotherapy regimen over a time period of 8 years in
predominantly high-risk patients, the incidence of SRs was low, despite the
high number of patients with bee venom allergy, who are more likely to have
side effects. Epinephrine as rescue medication was never necessary, and the
regimen proved to be safe and convenient for both the patients and the medical
staff.
----------------------------------------------------
[181]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.2 Chronic graft dysfunction. Immunological factors
(alloimmunity).
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 4:8-11.
RESUMEN
/ SUMMARY: - GUIDELINE: All recipients of an allogeneic
kidney graft should take life-long maintenance immunosuppressive medication.
Whereas there is no immunological test to diagnose chronic allograft
dysfunction, circumstantial evidence suggests that immunological factors play
an important role in its pathogenesis. This evidence is based on experimental
data, the beneficial effect of sharing HLA antigens between donor and recipient
and post-transplantation immunological monitoring studies.
----------------------------------------------------
[182]
TÍTULO / TITLE: - Capillary C4d
deposition as a marker of humoral immunity in renal allograft rejection.
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
Sep;13(9):2420-3.
AUTORES
/ AUTHORS: - Watschinger B; Pascual M N. Ref:: 38
----------------------------------------------------
[183]
TÍTULO / TITLE: - Current
immunosuppressive agents: efficacy, side effects, and utilization.
REVISTA
/ JOURNAL: - Pediatr Clin North Am 2003
Dec;50(6):1283-300.
AUTORES
/ AUTHORS: - Smith JM; Nemeth TL; McDonald RA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s
Hospital and Regional Medical Center, 4800 Sand Point Way, NE 5G-1, Seattle, WA
98105-0371, USA. jodi.smith@seattlechildrens.org
RESUMEN
/ SUMMARY: - Advances in immunosuppressive therapy over
the past decade have led to dramatic improvements in graft survival. With the
development of new agents, the focus of the transplant community is to
establish regimens that maintain excellent graft survival rates but with fewer
toxicities including infection, nephrotoxicity, malignancy, and cosmetic
effects. Examples include the use of steroid-free protocols and calcineurin
avoidance regimens, which are currently being studied by NAPRTCS. The ultimate
goal of transplant immunosuppressive therapy is the induction of tolerance. As
we learn more about immune function from basic and clinical research, tolerance
to allografts seems a more reachable goal.
N. Ref:: 89
----------------------------------------------------
[184]
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.
----------------------------------------------------
[185]
TÍTULO / TITLE: - Summary of the
Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem
Cell Transplant Recipients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Jul 15;33(2):139-44.
Epub 2001 Jun 14.
AUTORES
/ AUTHORS: - Dykewicz CA
INSTITUCIÓN
/ INSTITUTION: - Centers for Disease Control and
Prevention, National Center for Infectious Diseases, Division of AIDS, STD, and
TB Laboratory Research, Atlanta, GA 30333, USA. cad3@cdc.gov
RESUMEN
/ SUMMARY: - This article contains highlights of
“Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem
Cell Transplant Recipients: Recommendations of the CDC, the Infectious Diseases
Society of America, and the American Society of Blood and Marrow
Transplantation,” which was published in the Morbidity and Mortality Weekly
Report. There are sections on the prevention of bacterial, viral, fungal,
protozoal, and helminth infections and on hospital infection control,
strategies for safe living following transplantation, immunizations, and
hematopoietic stem cell safety. The guidelines are evidence-based, and
prevention strategies are rated by both the strength of the recommendation and
the quality of evidence that supports it. Recommendations are given for
preventing cytomegalovirus disease with prophylactic or preemptive gancyclovir,
herpes simplex virus disease with prophylactic acyclovir, candidiasis with
fluconazole, and Pneumocystis carinii pneumonia with
trimethoprim-sulfamethoxazole. Hopefully, following the recommendations made in
the guidelines will reduce morbidity and mortality from opportunistic
infections in hematopoietic stem cell transplant recipients.
----------------------------------------------------
[186]
TÍTULO / TITLE: - The natural history of
acute histologic rejection without biochemical graft dysfunction in orthotopic
liver transplantation: a systematic review.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Dec;8(12):1147-53.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.36240
AUTORES
/ AUTHORS: - Bartlett AS; Ramadas R; Furness S; Gane E;
McCall JL
INSTITUCIÓN
/ INSTITUTION: - Division of Surgery, University of
Auckland, Auckland, New Zealand.
RESUMEN
/ SUMMARY: - Protocol biopsy results in the first few
weeks after liver transplantation sometimes display histologic features of
acute cellular rejection (ACR), even in the absence of significant clinical or
biochemical dysfunction. At present there is no clear consensus about the need
to treat such cases with adjuvant immunosuppression. This systematic review
describes, from the available evidence, the natural history of untreated
histologic ACR in the absence of biochemical graft dysfunction. An electronic
search of the Medline, Embase, and Cochrane Library databases was performed to
select studies that reported protocol liver biopsies in the early
posttransplant period from 1983 to 2000. Studies that identified patients with
ACR on protocol biopsy who were not treated with adjuvant immunosuppression
formed the basis of the study group. Data from individual studies were
extracted using standardized pro forma and pooled for descriptive analysis. The
search identified 3431 studies, of which 516 were cited in full. Of these, 15
studies met all of the inclusion criteria. These 15 studies reported on 1566
patients who had protocol biopsies performed in the early posttransplant
period, of which 1048 (67%) had histologic evidence of ACR. Three hundred and
thirty one (32%) patients with histologic ACR on protocol biopsy had no
associated biochemical graft dysfunction. Without treatment, only 14% of these
patients subsequently developed biochemical graft dysfunction requiring
adjuvant immunosuppression. Steroid-resistant rejection and chronic rejection
both had a prevalence of 4% in patients with untreated histologic ACR and no
biochemical graft dysfunction. Withholding adjuvant immunosuppression from
patients with histologic ACR and no biochemical graft dysfunction seems to be
safe, as long as graft function is carefully monitored. The rationale for
performing protocol biopsies in the absence of biochemical graft dysfunction is
questionable. N.
Ref:: 41
----------------------------------------------------
[187]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[188]
TÍTULO / TITLE: - Human herpesvirus 6
meningoencephalitis successfully treated with ganciclovir in a patient who
underwent allogeneic bone marrow transplantation from an HLA-identical sibling.
REVISTA
/ JOURNAL: - Int J Hematol 2002 May;75(4):421-5.
AUTORES
/ AUTHORS: - Yoshida H; Matsunaga K; Ueda T; Yasumi M;
Ishikawa J; Tomiyama Y; Matsuzawa Y
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine and
Molecular Science, Graduate School of Medicine, Osaka University, Suita, Japan.
hyoshida@imed2.med.osaka-u.ac.jp
RESUMEN
/ SUMMARY: - Human herpesvirus 6 (HHV-6) has recently
been recognized as an important pathogen in immunocompromised hosts, such as
patients who have undergone allogeneic bone marrow transplantation (allo-BMT).
Here we report a case of HHV-6 meningoencephalitis in a patient who underwent
allo-BMT from an HLA-identical sibling. The patient suffered from headache,
high fever, tremor, and disorientation on day 35 after allo-BMT. Findings at
magnetic resonance imaging, electroencephalography, and routine cerebrospinal
fluid (CSF) examination suggested the presence of viral meningoencephalitis. We
diagnosed HHV-6 meningoencephalitis by means of polymerase chain reaction (PCR)
analysis of a CSF specimen. Successful treatment was achieved with ganciclovir.
Because HHV-6 encephalitis has a potentially fatal and fulminant course, it is
necessary that HHV-6 encephalitis be recognized as one of the central nervous
system complications that can follow allo-BMT. PCR analysis for HHV-6 in the
CSF specimen is necessary for appropriate diagnosis and treatment. N. Ref:: 18
----------------------------------------------------
[189]
TÍTULO / TITLE: - Primary intestinal
posttransplant T-cell lymphoma.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 27;75(12):2131-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000060253.54333.F3
AUTORES
/ AUTHORS: - Michael J; Greenstein S; Schechner R;
Tellis V; Vasovic LV; Ratech H; Glicklich D
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Albert Einstein
College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
RESUMEN
/ SUMMARY: - There have been only five reported cases
of primary posttransplant T-cell lymphoma. We report the first case associated
with the use of sirolimus (Rapamycin, Wyeth-Ayerst, Philadelphia, PA). The
patient, receiving prednisone, cyclosporine, and sirolimus treatment, developed
ascites, diarrhea, and weight loss 7 months after his second renal transplant.
Tissue obtained at laparotomy established the diagnosis of primary T-cell
lymphoma. Latent membrane protein-1 for Epstein-Barr virus was negative, but
in-site hybridization test for Epstein-Barr-encoded RNA was positive. Despite
aggressive chemotherapy, the patient died 8 months posttransplant. This is the
sixth reported case of primary intestinal posttransplant T-cell lymphoma, but
it is the first case associated with the use of sirolimus. The incidence of
posttransplant lymphoproliferative disease in patients receiving sirolimus
should be studied. N.
Ref:: 6
----------------------------------------------------
[190]
- Castellano -
TÍTULO / TITLE:Alteraciones del metabolismo oseo
tras el trasplante renal. Bone metabolism alterations after kidney
transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23 Suppl 2:122-6.
AUTORES
/ AUTHORS: - Torres A; Garcia S; Barrios Y; Hernandez
D; Lorenzo V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Investigacion, Hospital Universitario de Canarias, Instituto Reina Sofia de
Investigacion. atorres@ull.es
RESUMEN
/ SUMMARY: - Early after renal transplantation (RT) a
rapid decrease in bone mineral density at the lumbar spine, femoral neck, and
femoral shaft has been documented. In addition, an appreciable proportion of
patients still remain losing bone late after RT. As a consequence, RT patients
are at a high risk of bone fractures as compared to general population. Most
fractures involve appendicular skeleton, particularly the feet and ankles, and
the diabetic patient is at increased risk of fractures. Thus, early institution
of preventive measures and treatment of established osteoporosis are central.
The major cause of post-transplantation bone loss is corticosteroid treatment,
and this should be used at the lower dose compatible with graft survival.
Preexisting hyperparathyroidism also affects the early cancellous bone loss at
the spine, and post-transplantation bone loss reflects variable individual
susceptibility, resembling the polygenic determination of bone mineral density
in general. Clinical trials have demonstrated that bisphosphonates or vitamin D
plus calcium supplementation, prevent post-transplantation bone loss during the
first 6-12 months. However, their role in preventing bone fractures has not
been proven. Finally, recommendations for management, prevention and treatment,
are summarized. N.
Ref:: 24
----------------------------------------------------
[191]
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
----------------------------------------------------
[192]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.10. Pregnancy in renal transplant recipients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:50-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Renal transplantation
restores fertility, and successful pregnancies have been reported in renal
transplant women. In women with normal graft function, pregnancy usually has no
adverse effect on graft function and survival. Therefore, women of childbearing
age who consider pregnancy should receive complete information and support from
the transplant team. B. Pregnancy could be considered safe about 2 years after
transplantation in women with good renal function, without proteinuria, without
arterial hypertension, with no evidence of ongoing rejection and with normal
allograft ultrasound. C. Pregnancy after transplantation should be considered a
high-risk pregnancy and should be monitored by both an obstetrician and the
transplant physician. Pregnancy should be diagnosed as early as possible. The
principal risks are infection, proteinuria, anaemia, arterial hypertension and
acute rejection for the mother, and prematurity and low birth weight for the
foetus. D. Pregnant women and transplanted patients are at increased risk of
infections, especially bacterial urinary tract infections and acute
pyelonephritis of the graft. Urine cultures should be performed monthly and all
asymptomatic infections should be treated. Monitoring of viral infections is
also recommended. (Evidence level B) E. Acute rejection episodes are uncommon
but may occur after delivery. Therefore, immunosuppression should be
re-adjusted immediately after delivery. F. Because pre-eclampsia develops in
30% of pregnant patients, especially those with prior arterial transplant hypertension,
blood pressure, renal function, proteinuria and weight should be monitored
every 2-4 weeks, with more attention during the third trimester.
Anti-hypertensive agents should be changed to those tolerated during pregnancy.
ACE inhibitors and angiotensin II receptor antagonists are absolutely
contra-indicated. G. Immunosuppressive therapy based on cyclosporine or
tacrolimus with or without steroids and azathioprine may be continued in renal
transplant women during pregnancy. Other drugs, such as mycophenolate mofetil
and sirolimus, are not recommended based on current information available.
Because of drug transfer into maternal milk, breastfeeding is not recommended.
H. Vaginal delivery is recommended, but caesarean section is required in at
least 50% of cases. Delivery should occur in a specialized centre. In the
puerperium, renal function, proteinuria, blood pressure,
cyclosporine/tacrolimus blood levels and fluid balance should be closely
monitored.
----------------------------------------------------
[193]
TÍTULO / TITLE: - Efficacy and toxicity
of a protocol using sirolimus, tacrolimus and daclizumab in a nonhuman primate
renal allotransplant model.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Apr;2(4):381-5.
AUTORES
/ AUTHORS: - Montgomery SP; Mog SR; Xu H; Tadaki DK;
Hirshberg B; Berning JD; Leconte J; Harlan DM; Hale D; Kirk AD
INSTITUCIÓN
/ INSTITUTION: - NIDDK/Navy Transplantation and
Autoimmunity Branch, Naval Medical Research Center, Bethesda, Maryland 20892,
USA.
RESUMEN
/ SUMMARY: - A regimen combining sirolimus, tacrolimus,
and daclizumab has recently been shown to provide adequate immunosuppression
for allogeneic islet transplantation in humans, but remains unproven for
primarily vascularized allografts. We evaluated this regimen for renal
allograft transplantation in mismatched nonhuman primates. Dosages of sirolimus
and tacrolimus were adjusted for trough levels of 10-15 ng/mL and 4-6 ng/mL,
respectively. Treated monkeys (n = 5) had significantly prolonged allograft
survival, with a mean survival of 36 days vs. 7 days in untreated controls (n =
6, p = 0.008). Four of five treated animals, but none of the controls,
developed fibrinoid vascular necrosis of the small intestine. A review of gut
histology from animals on other immunosuppressive protocols performed by our
laboratory suggested that these lesions were a result of sirolimus exposure. In
summary, this regimen prolongs the survival of vascularized renal allografts,
but is limited by profound GI toxicity in rhesus macaques.
----------------------------------------------------
[194]
TÍTULO / TITLE: - Definitions of
cytomegalovirus infection and disease in transplant recipients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2002 Apr 15;34(8):1094-7.
Epub 2002 Mar 11.
AUTORES
/ AUTHORS: - Ljungman P; Griffiths P; Paya C
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology, Huddinge
University Hospital, Karolinska Institutet, SE-14186 Stockholm, Sweden. Per.Ljungman@medhs.ki.se
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) infection and
disease are important causes of morbidity and mortality among transplant
recipients. For the purpose of developing consistent reporting of CMV in
clinical trials, definitions of CMV infection and disease were developed and
published. This study seeks to update the definitions of CMV on the basis of
recent developments in diagnostic techniques, as well as to add to these
definitions the concept of indirect effects caused by CMV. N. Ref:: 19
----------------------------------------------------
[195]
TÍTULO / TITLE: - Acute necrotizing
gastritis by Escherichia coli in a severely neutropenic patient.
REVISTA
/ JOURNAL: - Haematologica. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Haematologica: <> 2002 Jan;87(1):ELT01.
AUTORES
/ AUTHORS: - Martinez-Chamorro C; Martinez E;
Gil-Fernandez JJ; Escudero A; Acevedo A; Fernandez-Ranada JM
INSTITUCIÓN
/ INSTITUTION: - Hematology Department, Clinica Ruber,
C/Juan Bravo, 49 28006-Madrid, España. m-chamorro@navegalia.com N. Ref:: 6
----------------------------------------------------
[196]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.3. Haematological complications. Erythrocytosis.
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 4:49-50.
RESUMEN
/ SUMMARY: - GUIDELINE: In the case of erythrocytosis,
the first-line treatment should be administration of ACE inhibitors or
angiotensin II receptor antagonists.
----------------------------------------------------
[197]
TÍTULO / TITLE: - Calcium channel
blockers as the treatment of choice for hypertension in renal transplant
recipients: fact or fiction.
REVISTA
/ JOURNAL: - Pharmacotherapy 2003 Jun;23(6):788-801.
AUTORES
/ AUTHORS: - Baroletti SA; Gabardi S; Magee CC; Milford
EL
INSTITUCIÓN
/ INSTITUTION: - Department of Pharmacy Services, Brigham
and Women’s Hospital, Boston, Massachusetts 02115, USA. Sbaroletti@partners.org
RESUMEN
/ SUMMARY: - Posttransplantation hypertension has been
identified as an independent risk factor for chronic allograft dysfunction and
loss. Based on available morbidity and mortality data, posttransplantation
hypertension must be identified and managed appropriately. During the past
decade, calcium channel blockers have been recommended by some as the antihypertensive
agents of choice in this population, because it was theorized that their
vasodilatory effects would counteract the vasoconstrictive effects of the
calcineurin inhibitors. With increasing data becoming available, reexamining
the use of traditional antihypertensive agents, including diuretics and
beta-blockers, or the newer agents, angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor blockers, may be beneficial. Transplant
clinicians must choose antihypertensive agents that will provide their patients
with maximum benefit, from both a renal and a cardiovascular perspective.
Beta-blockers, diuretics, and ACE inhibitors have all demonstrated significant
benefit on morbidity and mortality in patients with cardiovascular disease. Calcium
channel blockers have been shown to possess the ability to counteract
cyclosporine-induced nephrotoxicity. When compared with beta-blockers,
diuretics, and ACE inhibitors, however, the relative risk of cardiovascular
events is increased with calcium channel blockers. With the long-term benefits
of calcium channel blockers on the kidney unknown and a negative cardiovascular
profile, these agents are best reserved as adjunctive therapy to beta-blockers,
diuretics, and ACE inhibitors. N.
Ref:: 68
----------------------------------------------------
[198]
TÍTULO / TITLE: - Why study kidney
transplant risk factors?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):266-7.
AUTORES
/ AUTHORS: - Matas AJ; Humar A
INSTITUCIÓN
/ INSTITUTION: - Medical School, University of Minnesota,
Minneapolis, MN, USA. N.
Ref:: 10
----------------------------------------------------
[199]
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
----------------------------------------------------
[200]
TÍTULO / TITLE: - The impact of
cytomegalovirus infections and acute rejection episodes on the development of
vascular changes in 6-month protocol biopsy specimens of cadaveric kidney
allograft recipients.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun
15;75(11):1858-64.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000064709.20841.E1
AUTORES
/ AUTHORS: - Helantera I; Koskinen P; Tornroth T;
Loginov R; Gronhagen-Riska C; Lautenschlager I
INSTITUCIÓN
/ INSTITUTION: - Department of Virology, Helsinki
University Central Hospital and University of Helsinki, Helsinki, Finland.
RESUMEN
/ SUMMARY: - BACKGROUND: The role of cytomegalovirus
(CMV) in chronic kidney allograft rejection remains controversial. The purpose
of this study was to examine the impact of CMV infection on histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts. METHODS:
Altogether, 52 renal allograft recipients were studied. CMV infection was
diagnosed by CMV antigenemia test, viral cultures from blood and urine, or
both. CMV was demonstrated in the biopsy specimens by antigen detection and
hybridization in situ. Acute rejections were diagnosed by biopsy histology, and
biopsy specimens were graded according to the Banff ‘97 classification.
RESULTS: CMV infection was diagnosed in 41 patients. The 11 patients in whom
CMV infection was not detected were used as controls. Acute rejection was
diagnosed in 22 of 41 CMV patients and in 6 of 11 control patients. CMV was
demonstrated in the biopsy specimens of 19 of 41 CMV patients. CMV was not
associated with increased glomerular, tubular, or interstitial changes.
However, the arteriosclerotic changes in small arterioles were significantly
increased in the subgroup of patients where CMV was demonstrated in the graft
as compared with controls (P<0.01). Analysis of the impact of acute
rejection on arteriolar thickening showed that only a positive history of both
acute rejection and CMV found in the graft was associated with significantly
increased vascular changes compared with CMV-free recipients (P<0.05).
CONCLUSIONS: Neither CMV nor acute rejection alone was associated with
increased vascular or other histopathologic changes in 6-month protocol biopsy
specimens of kidney allografts, but a previous history of both acute rejection
and the presence of CMV in the graft was associated with increased vascular
changes.
----------------------------------------------------