#14#
Revisiones-Ciencias
Sociales (todas) *** Reviews-Social Sciences (all)
INMUNOSUPRESIÓN
*** IMMUNOSUPPRESSION
(Conceptos
/ Keywords: Immunosuppression; Immunosuppressive ag.; Transpl. immunol.; GVH;
Antirejection therapy; Lymphocyte depletion; Transpl. conditioning; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Fulminant hepatic
failure secondary to acetaminophen poisoning: a systematic review and
meta-analysis of prognostic criteria determining the need for liver
transplantation.
REVISTA
/ JOURNAL: - Crit Care Med 2003 Jan;31(1):299-305.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.CCM.0000034674.51554.4C
AUTORES
/ AUTHORS: - Bailey B; Amre DK; Gaudreault P
INSTITUCIÓN
/ INSTITUTION: - Division of Emergency Medicine, Department
of Pediatrics, Hopital Ste-Justine, Universite de Montreal, Quebec, Canada. baileyb@med.umontreal.ca
RESUMEN
/ SUMMARY: - OBJECTIVES: To summarize and compare
different prognostic criteria used to determine need for liver transplantation
in patients with fulminant hepatic failure secondary to acetaminophen
poisoning. DATA SOURCES: Studies published in the literature that investigated
criteria for hepatic transplantation secondary to acetaminophen-induced liver
failure as identified by a preestablished MEDLINE strategy (1966 through
October 2001). STUDY SELECTION: Studies were included if 2 x 2 tables could be
reconstructed and if they did not assume that patients undergoing
transplantation would have eventually died had they not received the
transplant. DATA EXTRACTION: Relevant articles were reviewed by two authors
independently. Discrepancies or disagreements, if any, on the inclusion or
exclusion of studies were resolved by consulting the third author. DATA
SYNTHESIS: King’s criteria (pH < 7.30 or prothrombin time of >100 secs
plus creatinine of >300 micromol/L plus encephalopathy grade of > or =3)
were evaluated in nine studies, pH < 7.30 in four, prothrombin time of
>100 secs in three, prothrombin time of >100 secs plus creatinine of
>300 micromol/L plus encephalopathy grade of > or =3 in three, creatinine
of >300 micromol/L in two, and one each for increase in prothrombin time day
4, factor V of <10%, Acute Physiology and Chronic Health Evaluation (APACHE)
II score of >15, and Gc-globulin of <100 mg/L. King’s criteria were more
sensitive than pH: 69% (95% confidence interval, 63-75) vs. 57% (95% confidence
interval, 44-68). Their specificities were, however, comparable: 92% (95%
confidence interval, 81-97) vs. 89% (95% confidence interval, 62-97). APACHE II
score of >15 had the highest positive likelihood ratio (16.4) and the lowest
negative likelihood ratio (0.19) but was evaluated in only one study. The
accuracy measures of all other criteria were lower than that of King’s criteria
or pH < 7.30. CONCLUSIONS: Presently, available criteria are not very
sensitive and may miss patients requiring transplantation. Future studies
should further evaluate the efficacy of the APACHE II criteria. N. Ref:: 33
----------------------------------------------------
[2]
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
----------------------------------------------------
[3]
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
----------------------------------------------------
[4]
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
----------------------------------------------------
[5]
TÍTULO / TITLE: - Dialysis, kidney
transplantation, or pancreas transplantation for patients with diabetes
mellitus and renal failure: a decision analysis of treatment options.
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
Feb;14(2):500-15.
AUTORES
/ AUTHORS: - Knoll GA; Nichol G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, University of Ottawa, Canada. gknoll@ottawahospital.on.ca
RESUMEN
/ SUMMARY: - Patients with type 1 diabetes mellitus and
end-stage renal disease may remain on dialysis or undergo cadaveric kidney
transplantation, living kidney transplantation, sequential pancreas after
living kidney transplantation, or simultaneous pancreas-kidney transplantation.
It is unclear which of these options is most effective. The objective of this
study was to determine the optimal treatment strategy for type 1 diabetic
patients with renal failure using a decision analytic Markov model. Input data
were obtained from the published medical literature, the United Network for
Organ Sharing registry, and patient interviews. The outcome measures were life
expectancy (in life-years [LY]) and quality-adjusted life expectancy (in
quality-adjusted life-years [QALY]). Living kidney transplantation was
associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation,
17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY
and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY;
dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of
several key variables. Simultaneous pancreas-kidney transplantation had the
greatest life expectancy and quality-adjusted life expectancy when living
kidney transplantation was excluded from the analysis. These data indicate that
living kidney transplantation is associated with the greatest life expectancy
and quality-adjusted life expectancy for type 1 diabetic patients with renal
failure. Treatment strategies involving pancreas transplantation should be
considered for patients with frequent metabolic complications of diabetes and
for those patients who favor kidney-pancreas transplantation over kidney
transplantation alone. For patients without a living donor, simultaneous
pancreas-kidney transplantation is associated with the greatest life
expectancy.
----------------------------------------------------
[6]
TÍTULO / TITLE: - The future of
antigen-specific immunotherapy of allergy.
REVISTA
/ JOURNAL: - Nat Rev Immunol 2002 Jun;2(6):446-53.
●●
Enlace al texto completo (gratuito o de pago) 1038/nri824
AUTORES
/ AUTHORS: - Valenta R
INSTITUCIÓN
/ INSTITUTION: - Department of Pathophysiology, University
of Vienna Medical School, Vienna General Hospital-AKH, Australia. Rudolf.valenta@akh-wein.ac.at
RESUMEN
/ SUMMARY: - More than 25% of the population in
industrialized countries suffers from immunoglobulin-E-mediated allergies. The
antigen-specific immunotherapy that is in use at present involves the
administration of allergen extracts to patients with the aim to cure allergic
symptoms. However, the risk of therapy-induced side effects limits its broad
application. Recent work indicates that the epitope complexity of natural
allergen extracts can be recreated using recombinant allergens, and
hypoallergenic derivatives of these can be engineered to increase treatment
safety. It is proposed that these modified molecules will improve the current practice
of specific immunotherapy and form a basis for prophylactic vaccination. N. Ref:: 120
----------------------------------------------------
[7]
TÍTULO / TITLE: - Ultraviolet
light-induced regulatory (suppressor) T cells: an approach for promoting
induction of operational allograft tolerance?
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S29-31.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000112969.24120.64
AUTORES
/ AUTHORS: - Aubin F; Mousson C
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology and EA3181,
University Hospital, Besancon, France. francois.aubin@ufc-chu.univ-fcomte.fr.
RESUMEN
/ SUMMARY: - Ultraviolet (UV) light is known to induce
skin cancers by causing DNA gene mutations and inducing immunosuppression.
Taking advantage of these immunosuppressive capacities, UV light has been used,
with different modalities, as an immunosuppressive therapy in a variety of
diseases including allograft rejection and graft-versus-host disease.
Phototherapy includes UVB irradiation, UVA irradiation, oral psoralen (+)UVA
irradiation (PUVA), photodynamic therapy, and extracorporeal photopheresis,
which consists of infusion of UVA-irradiated autologous leukocytes collected by
apheresis and incubated with 8-methoxypsoralen. According to numerous
experimental models and human data, there is increasing evidence that UVB
irradiation and extracorporeal photopheresis can induce regulatory T cells and
anticlonotypic activity. These therapies induce apoptosis of activated T cells
or of extracorporally treated mononuclear cells, and up-regulate the expression
of costimulary molecules and adhesion molecules on antigen presenting cells.
UVB- or UVA-induced apoptotic cells could secrete immune suppressive cytokines
(interleukin (IL)-4, IL-10). The processing and presentation of apoptotic T
cell antigens from clones of pathogenic T cells by activated antigen presenting
cells might explain the induction of systemic anticlonotypic activity by
photopheresis. This induction of cell-mediated suppressive activity opens up
future prospects with the aim of expanding regulatory T cells and/or
anticlonotypic activity, especially by photopheresis in organ and cell
transplantation. N.
Ref:: 40
----------------------------------------------------
[8]
TÍTULO / TITLE: - Guidelines for
preventing opportunistic infections among hematopoietic stem cell transplant
recipients. Recommendations of CDC, the Infectious Disease Society of America,
and the American Society of Blood and Marrow Transplantation.
REVISTA
/ JOURNAL: - Cytotherapy 2001;3(1):41-54.
●●
Enlace al texto completo (gratuito o de pago) 1080/146532401753156403
----------------------------------------------------
[9]
TÍTULO / TITLE: - The treatment of
glomerular disease—a compromise between the standard and the individual
approach.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v31-3.
AUTORES
/ AUTHORS: - Kiperova B
INSTITUCIÓN
/ INSTITUTION: - Medical University of Sofia, University
Hospital Alexandrovska, Clinic of Nephrology, Sofia, Bulgaria. bkiperova@yahoo.com
RESUMEN
/ SUMMARY: - Chronic glomerulonephritis (GN) is one of
the leading causes of end-stage renal disease (ESRD). The possibilities for
successful treatment in the earliest stages are still limited.
Immunosuppressive treatment leads to complete or partial remission only in some
patients. Even then, a non-immunological evolution to chronic renal
insufficiency often enters a progressive course. By applying a consistent
strategy for their individual evaluation and management, it is possible to
improve the outcome of patients with GN. The early referral to a nephrologist
and an early histomorphological diagnosis; the precise assessment of the type
of injury, i.e. proliferative or non-proliferative; the indices of activity and
chronicity; and the prognostic indicators are helpful for the therapeutic
approach. The goal of the management of GN has to be to suppress the disease
with minimum side effects of the treatment. Many unanswered questions and
controversies remain concerning the immunosuppressive therapy. A precise
distinction is needed between the problematic assertions and evidence-based
protocols. A common task for the treatment of all types of chronic GN should be
the protection of renal structure and function: control of blood pressure,
action on renal haemodynamics and proteinuria via pharmacological inhibition of
the renin-angiotensin system, control of hyperlipidaemia and limitation of
fibrosis. Some novel and promising pharmacological approaches to extracellular
matrix accumulation and chronic interstitial fibrosis are in progress. N. Ref:: 15
----------------------------------------------------
[10]
TÍTULO / TITLE: - Administration of donor
apoptotic cells: an alternative cell-based therapy to induce tolerance?
REVISTA
/ JOURNAL: - Transplantation 2003 May 15;75(9
Suppl):43S-45S.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000067951.90241.54
AUTORES
/ AUTHORS: - Kleinclauss F; Perruche S; Cahn JY;
Tiberghien P; Saas P
INSTITUCIÓN
/ INSTITUTION: - INSERM E0119/UPRES EA2284, Etablissement
Francais du Sang Bourgogne Franche-Comte, Universite de Franche-Comte,
Besancon, France.
RESUMEN
/ SUMMARY: - Apoptotic cells are endowed with
immunomodulatory properties. The authors propose infusing apoptotic cells as a
cell-based therapy product to facilitate allogeneic hematopoietic engraftment
after a nonmyeloablative conditioning regimen. Such an approach may be used to
obtain macrochimerism in combined hematopoietic cells and solid organ
transplantation. In this article, the authors describe the mechanisms of
combined hematopoietic and organ allograft transplantation and the potential
difficulties. The authors discuss how intravenous apoptotic cell infusion may
influence the outcome of combined transplantation. This may prove to be an
interesting approach for future development in cell therapy. N. Ref:: 29
----------------------------------------------------
[11]
TÍTULO / TITLE: - Hematopoietic cell
transplantation for inherited metabolic diseases: an overview of outcomes and
practice guidelines.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Feb;31(4):229-39.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703839
AUTORES
/ AUTHORS: - Peters C; Steward CG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Minnesota School of Medicine, Minneapolis, 55455, USA.
RESUMEN
/ SUMMARY: - For the past two decades, hematopoietic
cell transplantation (HCT) has been used as effective therapy for selected
inherited metabolic diseases (IMD) including Hurler (MPS IH) and Maroteaux-Lamy
(MPS VI) syndromes, childhood-onset cerebral X-linked adrenoleukodystrophy
(X-ALD), globoid-cell leukodystrophy (GLD), metachromatic leukodystrophy (MLD),
alpha-mannosidosis, osteopetrosis, and others. Careful pre-HCT evaluation is
critical and coordinated, multidisciplinary follow-up is essential in this
field of transplantation. The primary goals of HCT for these disorders have
been to promote long-term survival with donor-derived engraftment and to
optimize the quality of life. Guidelines for HCT and monitoring are provided; a
brief overview of long-term results is also presented. N. Ref:: 131
----------------------------------------------------
[12]
TÍTULO / TITLE: - Choosing treatment for
proliferative lupus nephritis.
REVISTA
/ JOURNAL: - Arthritis Rheum 2002 Aug;46(8):1981-3.
●●
Enlace al texto completo (gratuito o de pago) 1002/art.10466
AUTORES
/ AUTHORS: - Balow JE
N. Ref:: 31
----------------------------------------------------
[13]
TÍTULO / TITLE: - Mechanisms of tolerance
induction through the transplantation of donor hematopoietic stem cells:
central versus peripheral tolerance.
REVISTA
/ JOURNAL: - Transplantation 2003 May 15;75(9
Suppl):21S-25S.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000067947.90241.66
AUTORES
/ AUTHORS: - Wekerle T; Blaha P; Koporc Z; Bigenzahn S;
Pusch M; Muehlbacher F
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Vienna General
Hospital, Waehringer Guertel 18, A 1090 Vienna, Austria. thomas.wekerle@akh-wien.ac.at
RESUMEN
/ SUMMARY: - The transplantation of donor hematopoietic
stem cells has been used successfully in numerous experimental settings to
induce donor-specific tolerance. After appropriate host conditioning,
hematopoietic stem-cell transplantation leads to a lasting state of donor
macrochimerism that is associated with a robust form of tolerance. One of the
key factors in the success of this approach is its reliance on intrathymic
clonal deletion to ensure lifelong tolerization of newly developing T cells.
Evidence for ongoing central deletion comes from studies following
superantigen-reactive T cells and from experiments using mice transgenic for an
alloreactive T-cell receptor. In protocols inducing tolerance through
macrochimerism, the preexisting mature T-cell repertoire is controlled by
either globally destroying all T cells before the hematopoietic cell
transplantation or, in more recent models, by tolerizing it through
co-stimulation blockade. The peripheral mechanisms induced by hematopoietic
stem-cell transplantation and co-stimulation blockade include both extrathymic
clonal deletion and the nondeletional mechanisms anergy, suppression, or both.
In addition to these immunologic hurdles, a physiologic engraftment barrier has
to be surmounted for the successful induction of mixed chimerism. This can be
achieved by cytoreductive host treatment or by the infusion of high numbers of
donor hematopoietic cells. A detailed delineation of the mechanisms responsible
for tolerance induction after hematopoietic stem-cell transplantation is
expected to help in the translation of these experimental protocols to clinical
organ transplantation. N.
Ref:: 31
----------------------------------------------------
[14]
TÍTULO / TITLE: - Low recurrence rate of
hepatocellular carcinoma after liver transplantation: better patient selection
or lower immunosuppression?
REVISTA
/ JOURNAL: - Transplantation 2002 Dec 27;74(12):1664-5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000039802.85634.9C
AUTORES
/ AUTHORS: - Weber M; Kadry Z; Clavien PA N. Ref:: 11
----------------------------------------------------
[15]
TÍTULO / TITLE: - Hereditary
hemochromatosis: perspectives of public health, medical genetics, and primary
care.
REVISTA
/ JOURNAL: - Genet Med 2003 Jan-Feb;5(1):1-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.GIM.0000047946.94270.34
AUTORES
/ AUTHORS: - Imperatore G; Pinsky LE; Motulsky A; Reyes
M; Bradley LA; Burke W
INSTITUCIÓN
/ INSTITUTION: - National Canter for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, Georgia 30341, USA.
RESUMEN
/ SUMMARY: - Hereditary hemochromatosis (HHC) is a
condition characterized by excess iron in body tissues, resulting in
complications such as cirrhosis, cardiomyopathy, diabetes, and arthritis. These
complications usually manifest during adulthood. Two methods of screening for
the detection of early stage of HHC are available: serum iron measures and
molecular testing to detect mutations in the gene. These phenotypic and
genotypic screening tests are of particular interest because a simple
treatment-periodic phlebotomy-can be used to prevent iron accumulation and
clinical complications. HHC might represent the first adult-onset genetic
disorder for which universal population-based screening would be appropriate.
Therefore, HHC has been proposed as a paradigm for the introduction of adult
genetic diseases into clinical and public health practice. However, universal
screening for HHC has not been recommended because of the uncertainty about the
natural history of the iron overload or HHC and, in particular, uncertainty
about the prevalence of asymptomatic iron overload and the likelihood that it
will progress to clinical complications. If universal screening is not
appropriate based on current data, what other measures might reduce the disease
burden of iron overload? New studies provide more systematic information about
the penetrance of the C282Y mutation and shed further light on the natural
history of the disorder. The authors review these data and consider their
implications for public health, medical genetics, and primary care. N. Ref:: 64
----------------------------------------------------
[16]
TÍTULO / TITLE: - Donor-derived
hematopoietic stem cells in organ transplantation: technical aspects and
hurdles yet to be cleared.
REVISTA
/ JOURNAL: - Transplantation 2003 May 15;75(9
Suppl):55S-57S.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000067954.60639.9C
AUTORES
/ AUTHORS: - Herve P
INSTITUCIÓN
/ INSTITUTION: - Establissement Francais du Sang Borgogne
Franche-Comte, Besancon, France. patrick.herve@efs.sante.fr
RESUMEN
/ SUMMARY: - The use of hematopoietic stem-cell (HSC)
therapy in organ transplantation is a challenge to promote chimerism with the
aim of enhancing organ tolerance. Several HSC sources are available, including
bone marrow (most of the time), peripheral blood after stem-cell mobilization,
and placental blood. HSC collection techniques from vertebral bodies or iliac
crests require a number of complex manipulations. The best yield of HSC is
obtained from vertebral bodies. HSC harvesting by cytapheresis after cell
mobilization with a cytokine such as granulocyte colony-stimulating factor
should be preferred with a live donor. The number of CD3+ T cells is more than
10-fold higher in peripheral blood than in bone marrow. Cell separation by the
immunoselection technique (positive selection of the CD34+ cell population)
eliminates erythrocytes, granulocytes, and T cells, thus preventing the
possible occurrence of acute graft-versus-host disease. In the future, an
accreditation will be required for HSC collection and processing. In Europe,
the reference tool is the Joint Accreditation Committee of Ishage-Europe or the
Foundation for the Accreditation of Haematopoietic Cell Therapy manual, which
provides standards for every technical step of these procedures. N. Ref:: 26
----------------------------------------------------
[17]
TÍTULO / TITLE: - Ethical considerations
on preimplantation genetic diagnosis for HLA typing to match a future child as
a donor of haematopoietic stem cells to a sibling.
REVISTA
/ JOURNAL: - Hum Reprod 2002 Mar;17(3):534-8.
AUTORES
/ AUTHORS: - Pennings G; Schots R; Liebaers I
INSTITUCIÓN
/ INSTITUTION: - Department of Philosophy, Lok. 5 C 442,
Academic Hospital, Free University Brussels, Pleinlaan 2, B-1050 Brussels,
Belgium. gpenning@vub.ac.be
RESUMEN
/ SUMMARY: - Recently, several requests were made by
couples with an affected child who wanted preimplantation genetic diagnosis
(PGD) to select embryos in the hope of conceiving an HLA identical donor
sibling. This article considers the ethical arguments for and against the
application of PGD for this goal. Only embryos HLA matched with an existing
sibling in need of a compatible donor of haematopoietic stem cells would be
transferred. The main arguments are the instrumentalization of the child, the
best-interests standard, the postnatal test for acceptability and the
experience of the donor child. It is argued that conceiving a child to save a
child is a morally defensible decision on the condition that the operation that
will be performed on the future child is acceptable to perform on an existing
child. The instrumentalization of the donor child does not demonstrate
disrespect for its autonomy or its intrinsic worth. N. Ref:: 29
----------------------------------------------------
[18]
TÍTULO / TITLE: - Donor-derived
hematopoietic cells in organ transplantation: a major step toward allograft
tolerance?
REVISTA
/ JOURNAL: - Transplantation 2003 May 15;75(9
Suppl):3S-7S.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000067943.90241.73
AUTORES
/ AUTHORS: - Rifle G; Mousson C
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology-Intensive
Care-Transplantation, Hopital du Bocage, 2 boulevard de Lattre de Tassigny,
21034 Dijon, France. gerard.rifle@chu-dijon.fr
RESUMEN
/ SUMMARY: - Infusion of donor-derived cells can
improve organ allograft survival in animal models. Under certain conditions, it
can even induce tolerance (i.e., unlimited organ survival without any
maintenance immunosuppressive therapy). Use of nonmyeloablative regimens allows
engraftment of donor-derived bone marrow cells, induction of mixed chimerism,
and tolerance in rodents. High doses of bone marrow cells together with
anti-T-cell antibodies can even result in mixed chimerism without cytoablative
host conditioning. Cultured donor-derived CD34+ cells or donor-derived immature
(or even mature) dendritic cells associated with monoclonal antibodies directed
against co-stimulatory molecules might also induce tolerance. Among the
numerous experimental protocols leading to tolerance of solid organs in animal
models, how can we find our bearings in human transplantation? Numerous
problems have yet to be solved: the type and amount of donor-derived cells
(including stromal cells) to be used, the timing for infusion of donor cells in
keeping with organ transplantation, the route of infusion (should it be
intravenous, into the portal vein?), and the conditioning regimen. The first
clinical trials would appear to indicate that tolerance induction in humans
using donor-derived cells is a relatively safe solution that is both promising
and realistic. N.
Ref:: 42
----------------------------------------------------
[19]
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
----------------------------------------------------
[20]
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
----------------------------------------------------
[21]
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
----------------------------------------------------
[22]
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
----------------------------------------------------
[23]
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
----------------------------------------------------
[24]
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
----------------------------------------------------
[25]
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
----------------------------------------------------
[26]
TÍTULO / TITLE: - IMGT databases, web
resources and tools for immunoglobulin and T cell receptor sequence analysis, http://imgt.cines.fr.
REVISTA
/ JOURNAL: - Leukemia 2003 Jan;17(1):260-6.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.leu.2402637
AUTORES
/ AUTHORS: - Lefranc MP
INSTITUCIÓN
/ INSTITUTION: - Laboratoire d’ImmunoGenetique Moleculaire,
LIGM, Universite Montpellier II, UPR CNRS 1142, Institut de Genetique Humaine,
IGH, Montpellier, France.
RESUMEN
/ SUMMARY: - IMGT, the international ImMunoGeneTics database(®)
(http://imgt.cines.fr), is a high-quality
integrated information system specializing in immunoglobulins (IG), T cell
receptors (TR) and major histocompatibility complex (MHC) of human and other
vertebrates, created in 1989, by LIGM, at the Universite Montpellier II, CNRS,
Montpellier, France. IMGT provides a common access to standardized data which
include nucleotide and protein sequences, oligonucleotide primers, gene maps,
genetic polymorphisms, specificities, 2D and 3D structures. IMGT includes
several databases (IMGT/LIGM-DB, IMGT/3Dstructure-DB, IMGT/HLA-DB), Web
resources (‘IMGT Marie-Paule page’) and interactive tools (IMGT/V-QUEST,
IMGT/JunctionAnalysis). IMGT expertly annotated data and tools described in
this paper are particularly useful for the analysis of the IG and TR
rearrangements in leukemia, lymphoma and myeloma, and in translocations
involving the antigen receptor loci. IMGT is freely available at http://imgt.cines.fr. N. Ref:: 51
----------------------------------------------------
[27]
TÍTULO / TITLE: - Complexities of
CD28/B7: CTLA-4 costimulatory pathways in autoimmunity and transplantation.
REVISTA
/ JOURNAL: - Annu Rev Immunol 2001;19:225-52.
●●
Enlace al texto completo (gratuito o de pago) 1146/annurev.immunol.19.1.225
AUTORES
/ AUTHORS: - Salomon B; Bluestone JA
INSTITUCIÓN
/ INSTITUTION: - The Committee on Immunology, Ben May
Institute for Cancer Research and Department of Pathology, University of
Chicago, Chicago, Illinois 60637, USA.
RESUMEN
/ SUMMARY: - Recent advances in the understanding of T
cell activation have led to new therapeutic approaches in the treatment of immunological
disorders. One attractive target of intervention has been the blockade of T
cell costimulatory pathways, which result in more selective effects on only
those T cells that have encountered specific antigen. In fact, in some
instances, costimulatory pathway antagonists can induce antigen-specific
tolerance that prevents the progression of autoimmune diseases and organ graft
rejection. In this review, we summarize the current understanding of these
complex costimulatory pathways including the individual roles of the CD28,
CTLA-4, B7-1 (CD80), and B7-2 (CD86) molecules. We present evidence that
suggests that multiple mechanisms contribute to CD28/B7-mediated T cell
costimulation in disease settings that include expansion of activated
pathogenic T cells, differentiation of Th1/Th2 cells, and the migration of T
cells into target tissues. Additionally, the negative regulatory role of CTLA-4
in autoimmune diseases and graft rejection supports a dynamic but complex
process of immune regulation that is prominent in the control of
self-reactivity. This is most apparent in regulation of the
CD4(+)CD25(+)CTLA-4(+) immunoregulatory T cells that control multiple
autoimmune diseases. The implications of these complexities and the potential
for use of these therapies in clinical immune intervention are discussed. N. Ref:: 163
----------------------------------------------------
[28]
TÍTULO / TITLE: - Advanced medical
therapy does not render heart transplantation obsolete for ambulatory end-stage
heart failure patients: a debate.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2001
Jul;20(7):725-8.
AUTORES
/ AUTHORS: - Copeland JG
INSTITUCIÓN
/ INSTITUTION: - University of Arizona Sarver Heart Center,
Tucson, Arizona 85724-5071, USA. jgc@u.arizona.edu N. Ref:: 8
----------------------------------------------------
[29]
TÍTULO / TITLE: - A systematic review of
psychosocial factors affecting survival after bone marrow transplantation.
REVISTA
/ JOURNAL: - Psychosomatics 2003 May-Jun;44(3):181-95.
AUTORES
/ AUTHORS: - Hoodin F; Weber S
INSTITUCIÓN
/ INSTITUTION: - Department of Psychology, Eastern Michigan
University, Ypsilani, MI 48197, USA. flora.hoodin@emich.edu
RESUMEN
/ SUMMARY: - An electronic database search identified
15 studies of psychosocial factors affecting survival after bone marrow
transplantation. The studies were assessed for methodological quality by two
reviewers using the procedures of Bland and colleagues. Although some studies
found that psychological variables affect survival after bone marrow
transplantation, the reviewers’ analysis of the methodologically sound studies
suggested that survival after bone marrow transplantation is not substantively
affected by depressed mood or other psychopathology in adults or by social
support in adults or children. Longer survival may be related to lower “anxious
preoccupation,” higher “fighting spirit,” and better quality of life ratings
before and soon after transplant in adults. Overall, however, the literature is
insufficiently developed to provide definitive evidence for a relationship
between psychological variables and survival after bone marrow transplantation.
Future primary studies in this area should be designed to maximize
replicability and generalizability. N.
Ref:: 50
----------------------------------------------------
[30]
TÍTULO / TITLE: - 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.
----------------------------------------------------
[31]
TÍTULO / TITLE: - Evidence-based
recommendations for immunosuppression in IgA nephropathy: handle with caution.
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 Feb;18(2):241-5.
AUTORES
/ AUTHORS: - Floege J
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Immunology,
University of Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany. juergen.floege@post.rwth-aachen.de N. Ref:: 27
----------------------------------------------------
[32]
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
----------------------------------------------------
[33]
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
----------------------------------------------------
[34]
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
----------------------------------------------------
[35]
TÍTULO / TITLE: - Treatment of
periodontal disease in the immunodeficient patient.
REVISTA
/ JOURNAL: - Periodontol 2000 2002;28:190-205.
AUTORES
/ AUTHORS: - Holmstrup P; Glick M
INSTITUCIÓN
/ INSTITUTION: - Department of Periodontology, School of
Dentistry, University of Copenhagen, Denmark.
N. Ref:: 170
----------------------------------------------------
[36]
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.
----------------------------------------------------
[37]
TÍTULO / TITLE: - Epidemiology of Candida
species infections in critically ill non-immunosuppressed patients.
REVISTA
/ JOURNAL: - Lancet Infect Dis 2003 Nov;3(11):685-702.
AUTORES
/ AUTHORS: - Eggimann P; Garbino J; Pittet D
INSTITUCIÓN
/ INSTITUTION: - Medical Clinic II, the Medical Intensive
Care Unit and the Infection Control Programme, Department of Internal Medicine,
University of Geneva Hospitals, Geneva, Switzerland.
RESUMEN
/ SUMMARY: - A substantial proportion of patients
become colonised with Candida spp during hospital stay, but only few
subsequently develop severe infection. Clinical signs of severe infection
manifest early but lack specificity until late in the course of the disease,
thus representing a particular challenge for diagnosis. Mostly nosocomial,
invasive candidiasis occurs in only 1-8% of patients admitted to hospitals, but
in around 10% of patients housed in intensive care units where it can represent
up to 15% of all nosocomial infections. We review the epidemiology of invasive
candidiasis in non-immunocompromised, critically ill patients with special
emphasis on disease trends over time, pathophysiology, diagnostic approach,
risk factors, and impact. Recent epidemiological data suggesting that the
emergence of non-albicans candida strains with reduced susceptibility to
azoles, previously linked to the use of new antifungals for empiric and
prophylactic therapy in immunocompromised patients, may not have occurred in
the critically ill. Management of invasive candidiasis in these patients will
be addressed in the December issue of The Lancet Infectious Diseases. N. Ref:: 177
----------------------------------------------------
[38]
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
----------------------------------------------------
[39]
TÍTULO / TITLE: - “Least incompatible”
units for transfusion in autoimmune hemolytic anemia: should we eliminate this
meaningless term? A commentary for clinicians and transfusion medicine
professionals.
REVISTA
/ JOURNAL: - Transfusion 2003 Nov;43(11):1503-7.
AUTORES
/ AUTHORS: - Petz LD
N. Ref:: 22
----------------------------------------------------
[40]
TÍTULO / TITLE: - The impact of the model
for end-stage liver disease on recipient selection for adult living liver
donation.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Oct;9(10 Suppl
2):S54-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50223
AUTORES
/ AUTHORS: - Freeman RB
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, Tufts-New
England Medical Center, Boston, MA 02111, USA. rfreeman@tufts-nemc.org N. Ref:: 11
----------------------------------------------------
[41]
TÍTULO / TITLE: - International
Federation of Clinical Chemistry/International Association of Therapeutic Drug
Monitoring and Clinical Toxicology working group on immunosuppressive drug
monitoring.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):59-67.
AUTORES
/ AUTHORS: - Holt DW; Armstrong VW; Griesmacher A;
Morris RG; Napoli KL; Shaw LM
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - Issues surrounding the measurement and
interpretation of immunosuppressive drug concentrations have been summarized in
a number of consensus documents. The Scientific Division of the International
Federation of Clinical Chemistry has formed a working group in collaboration
with the International Association of Therapeutic Drug Monitoring and Clinical
Toxicology. This paper sets out the goals of the working group in light of the
developments that have occurred in the field of immunosuppressive drug
monitoring since the publication of the last consensus documents.
----------------------------------------------------
[42]
TÍTULO / TITLE: - Transplant center
characteristics and clinical outcomes after hematopoietic stem cell
transplantation: what do we know?
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Mar;31(6):417-21.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703873
AUTORES
/ AUTHORS: - Loberiza FR Jr; Serna DS; Horowitz MM;
Rizzo JD
INSTITUCIÓN
/ INSTITUTION: - International Bone Marrow Transplant
Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI
53226, USA.
RESUMEN
/ SUMMARY: - Center effects are differences in outcome
among treatment centers that cannot be explained by identifiable differences in
patients treated or specific treatments applied and are presumed to result from
differences in the ways health care is delivered. This paper will briefly
review studies of association between treatment center factors and clinical
outcomes in general medicine and surgery and look more closely at studies
involving hematopoietic stem cell transplantation. We will also attempt to
identify conceptual domains to study further the processes and mechanisms that
may be associated with better outcomes.
N. Ref:: 26
----------------------------------------------------
[43]
TÍTULO / TITLE: - ICOS costimulation in
inflammatory bowel disease.
REVISTA
/ JOURNAL: - J Gastroenterol 2002 Nov;37 Suppl
14:78-81.
AUTORES
/ AUTHORS: - Kanai T; Totsuka T; Tezuka K; Watanabe M
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology and
Hepatology, Graduate School, Tokyo Medical and Dental University, 1-5-45
Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
RESUMEN
/ SUMMARY: - For years, medical researchers have
striven to develop selective immunotherapies that could specifically ameliorate
pathogenic immune responses without immunocompromising the patient. Blockade of
many known receptors on T cells can inhibit the initiation of immune responses.
However, this approach is problematic in that it is not possible to predict the
onset of disease in patients. Current immunotherapies are unsatisfactory for
the sporadic exacerbating type of diseases such as multiple sclerosis and
inflammatory bowel disease (IBD), because they require either long-term
treatment or acute treatment with high-dose immunosuppressants. With regard to
this issue, the inducible and inflammatory site-specific molecule, inducible
costimulator (ICOS), may be particularly useful as an ideal targeting molecule
for the strategy of treatment of human IBD patients. N. Ref:: 31
----------------------------------------------------
[44]
TÍTULO / TITLE: - Genetically
haploidentical stem cell transplantation for acute leukemia.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2001
Apr;27(7):669-76.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj/bmt/1702856
AUTORES
/ AUTHORS: - Rowe JM; Lazarus HM
INSTITUCIÓN
/ INSTITUTION: - Department of Hematology and Bone Marrow
Transplantation, Rambam Medical Center, Technion, Haifa 31096, Israel.
RESUMEN
/ SUMMARY: - Genetically haploidentical stem cell
transplants have been performed for several decades, mostly for patients with
advanced acute leukemia. Such transplants are an option for those patients who
do not have a histocompatible sibling donor. The historical data have been
disappointing due to graft-versus-host disease, engraftment failure and delayed
immune reconstitution. Recent modifications and new technological developments
have led to more encouraging clinical results. Haploidentical transplantation
is immediately available to the majority of patients with acute leukemia and is
an acceptable alternative to matched unrelated donor transplantation. N. Ref:: 74
----------------------------------------------------
[45]
TÍTULO / TITLE: - The CD154-CD40
costimulatory pathway in transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Jan 15;73(1
Suppl):S36-9.
AUTORES
/ AUTHORS: - Yamada And A; Sayegh MH
INSTITUCIÓN
/ INSTITUTION: - Laboratory of Immunogenetics and
Transplantation, Brigham and Women’s Hospital, Transplantation Unit,
Massachusetts General Hospital, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - The CD154-CD40 pathway is one of the
critical costimulatory pathways that are required for full activation of T
cells during alloimmune responses. Blockade of this pathway with anti-CD154
antibodies has been reported to prolong allograft survival in experimental
transplantation models and to induce tolerance in some instances. However,
anti-CD154 monotherapy cannot induce tolerance in “stringent” models such as
skin and islet transplantation and is not sufficient to prevent chronic graft
vasculopathy in vascularized organ transplantation. Therefore, combined
therapies of anti-CD154 antibodies plus donor-specific transfusion, bone marrow
infusion, or B7 blockade by CTLA4-Ig have been tried, and synergistic effects
for tolerance induction have been reported. Furthermore, the efficacy of CD154
blockade in primate models has been confirmed for islet and kidney
transplantation. The mechanisms of CD154 blockade in vivo include
CTLA4-dependent anergy or regulation, T-cell apoptosis, and induction of
regulatory cells. Finally, anti-CD154 antibody therapy has been reported to
result in unexpected thromboembolic complications in both primates and humans,
although the etiology of these conditions remains unclear. In addition, not all
antibodies cause this side effect. Clinical trials with humanized anti-CD154
monoclonal antibodies are underway in severe autoimmune diseases, but its
development in transplantation is unclear at this time. N. Ref:: 50
----------------------------------------------------
[46]
TÍTULO / TITLE: - Immunization of
children after solid organ transplantation.
REVISTA
/ JOURNAL: - Pediatr Clin North Am 2003
Dec;50(6):1435-49, ix-x.
AUTORES
/ AUTHORS: - Lopez MJ; Thomas S
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0718, USA. jamlopez@umich.edu
RESUMEN
/ SUMMARY: - The array of immunizations commonly used
in childhood has risen in an attempt to prevent many of the potentially serious
infections of infancy and childhood. In this article, the authors provide
rational guidelines for vaccination of these children. The authors briefly
review the susceptibilities caused by immunosuppression in these patients,
discuss the problems with various immunizations, and make individual
recommendations regarding the use of each vaccine. Most recommendations are
based on inferences from populations that may not be directly comparable to the
transplantation population (patients with HIV or cancer or patients who have
undergone bone marrow transplant), from case reports, and from small series of
patients. The best recommendations ultimately must await the results of
controlled trials of immunization. N.
Ref:: 87
----------------------------------------------------
[47]
TÍTULO / TITLE: - Selected populations at
increased risk from respiratory syncytial virus infection.
REVISTA
/ JOURNAL: - Pediatr Infect Dis J 2003 Feb;22(2
Suppl):S40-4; discussion S44-5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.inf.0000053884.21238.13
AUTORES
/ AUTHORS: - Meissner HC
INSTITUCIÓN
/ INSTITUTION: - New England Medical Center, Tufts
University School of Medicine, Boston, MA, USA.
RESUMEN
/ SUMMARY: - Respiratory syncytial virus (RSV) is the
principal cause of bronchiolitis and pneumonia in infants and young children
worldwide. Deficits in cellular immunity appear to promote severe RSV disease
in children with malignancies, those undergoing chemotherapy and bone marrow
transplant recipients. Respiratory syncytial virus infection appears to
exacerbate pulmonary symptoms of cystic fibrosis. In such patients RSV disease
may result in a prolonged hospital course, which is often complicated by the
need for mechanical ventilation. Retrospective analyses of hospital admissions
for RSV bronchiolitis among Native American and Alaskan Native children younger
than 1 year of age have demonstrated rates of 62 per 1000 or higher, compared
with the national average of 34 per 1000. Among these ethnic groups, specific
host factors as well as environmental factors appear to contribute to these
comparatively high rates of hospitalization for RSV infection. Respiratory
syncytial virus has the potential to cause disease in all age groups. A 3-year
observational study found that individuals who lived in a community setting, or
who cared for young children on a consistent basis, experienced acute
respiratory infections more commonly than those living independently or whose
interaction with children was limited. N.
Ref:: 31
----------------------------------------------------
[48]
TÍTULO / TITLE: - Donor morbidity
associated with right lobectomy for living donor liver transplantation to adult
recipients: a systematic review.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Feb;8(2):110-7.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.31315
AUTORES
/ AUTHORS: - Beavers KL; Sandler RS; Shrestha R
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Division
of Digestive Diseases and Nutrition, University of North Carolina School of
Medicine, Chapel Hill, NC 27599-7080, USA.
RESUMEN
/ SUMMARY: - The aim if this study is to determine
donor morbidity associated with right lobectomy for living donor liver transplantation
(LDLT) to adult recipients through a systematic review of the published
literature. Data sources were English-language reports on donor outcome after
LDLT. MEDLINE (1995 to June 2001) was searched using the MeSH terms “living
donors” and “liver transplantation.” Limits were set for human only and English
language only. Bibliographies of retrieved references were cross-checked to
identify additional reports; 211 reports were obtained. Population studies and
consecutive and nonconsecutive series were included. All studies reported at
least one of the following outcomes specific to living donors (LDs) of right
hepatic lobes to adult recipients: surgical and hospital complications, length
of hospital stay, readmissions, recovery time, return to predonation
occupation, health-related quality of life, or mortality. Abstracts of relevant
articles were reviewed independently using predetermined criteria, and
appropriate articles were retrieved. Study design and results were summarized
in evidence tables. Summary statistics of combined data were performed when
possible. Twelve studies met the inclusion criteria. Data on donor morbidity
associated with right lobectomy are limited. On the basis of reported data,
morbidity associated with LD right lobectomy ranges from 0% to 67%. In
conclusion, reported morbidity associated with right lobe donation for LDLT
varies widely. Standardized definitions of morbidity and better methods for
observing and measuring outcomes are necessary to understand and potentially improve
morbidity. Future studies assessing LD outcomes should report donor outcome
more explicitly. N.
Ref:: 26
----------------------------------------------------
[49]
TÍTULO / TITLE: - Vaccines for persons at
high risk due to medical conditions, occupation, environment, or lifestyle,
2003.
REVISTA
/ JOURNAL: - J Fam Pract 2003 Jan;52(1 Suppl):S22-35.
AUTORES
/ AUTHORS: - Zimmerman RK; Middleton DB; Smith NJ
INSTITUCIÓN
/ INSTITUTION: - Department of Family Medicine and Clinical
Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
15621, USA. zimmer@pitt.edu
RESUMEN
/ SUMMARY: - The safety and efficacy of current
vaccines are reviewed for high-risk populations, such as those with underlying
medical conditions or occupational or lifestyle circumstances. The morbidity
and mortality from vaccine-preventable diseases are high among persons with
underlying medical conditions; thus, influenza and pneumococcal polysaccharide
vaccines are recommended for those with cardiac disease, diabetes mellitus, or
chronic obstructive pulmonary disease. For the same reasons, influenza vaccine
is recommended for pregnant women and for persons with asthma. Health-care
workers are at risk for acquiring and transmitting hepatitis B, measles, and
influenza; hence, vaccination against these diseases is recommended. N. Ref:: 75
----------------------------------------------------
[50]
TÍTULO / TITLE: - Treatment of atopic
dermatitis and impact on quality of life: a review with emphasis on topical
non-corticosteroids.
REVISTA
/ JOURNAL: - Pharmacoeconomics 2003;21(3):159-79.
AUTORES
/ AUTHORS: - Schiffner R; Schiffner-Rohe J; Landthaler
M; Stolz W
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
Regensburg, Regensburg, Germany. jr.schiffner@t-online.de
RESUMEN
/ SUMMARY: - Atopic dermatitis (AD) is a chronic skin
disease with increasing prevalence and rising costs. Stigmatisation and
pruritus are only some aspects of potential quality-of-life (QOL) impairments.
AD is not curable and repeated treatments are often necessary. At present,
treatment with topically-applied corticosteroids is state-of-the-art for mild
to moderate flare-ups. However, many patients are worried about the use of
corticosteroids due to the widespread fear of adverse effects. In this review
the present literature is analysed concerning impact on quality of life for
topically-applicable alternatives to the state-of-the-art treatment. For
comparison reasons, data from other treatment modalities are additionally
given. Characteristics of studies were analysed using ‘general’ (year and mode
of publication, type and aim of study, number of patients, and clinical
measurement) and ‘QOL specific’ criteria (type and number of QOL measurements
including relevance for study aim and age group, validation in used language,
sensitivity to change, and improvement at end of study). QOL data are published
only in the minority of studies evaluating treatment efficacy and do not cover
the variety of possible therapies. Data are available for tacrolimus,
pimecrolimus, UVA/UVB combination and UVB narrowband (topical
non-corticosteroidal treatments), as well as for topical corticosteroids,
cyclosporin, and inpatient treatment. All studies provided a marked improvement
in quality of life after therapy. One study assessed quality of life after a
treatment-free follow-up period obtaining a clear increase in impact on quality
of life. Since studies used different QOL measurements and vary in inclusion
criteria, treatment schedules and presentation of results, a comparison of QOL
improvement is not recommended. A single randomised study compared topically
applied non-corticosteroidal treatment (UVA/UVB combination) with another
treatment modality (cyclosporin) and found no difference in QOL improvement. At
present, there is a clear lack of controlled randomised studies evaluating
different active treatment modalities and their impact on quality of life.
Consensus meetings are desirable to formulate guidelines for the selection and
correct use of QOL measurements. Patients’ fear of side effects (e.g.
concerning corticosteroids) should be integrated in QOL questionnaires for
evaluation of possible compliance problems and real costs. Since relapse after
treatment is frequent in AD, QOL measurements should also be performed after a
treatment-free follow-up period. At present, we can not answer the question
‘which treatment best improves quality of life in AD?’. N. Ref:: 128
----------------------------------------------------
[51]
TÍTULO / TITLE: - Assessment of
functional outcome in hand transplantation patients.
REVISTA
/ JOURNAL: - Hand Clin 2003 Aug;19(3):505-9, x.
AUTORES
/ AUTHORS: - Herzberg G; Parmentier H; Erhard L
INSTITUCIÓN
/ INSTITUTION: - Orthopaedic Hand and Upper Extremity Unit,
Edouard Herriot Hospital, 5 Place d’Arsonval-Pavillon M, 69437, Lyon Cedex 03,
France. guillaume.herzberg@chu-lyon.fr
RESUMEN
/ SUMMARY: - The purpose of this article is to report
the criteria used for functional evaluation of hand transplant patients in a
one-page clinical examination chart. A satisfactory immunologic status is
mandatory for a functional evaluation to take place. N. Ref:: 17
----------------------------------------------------
[52]
TÍTULO / TITLE: - Clinical audit and
long-term evaluation of renal transplant recipients.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S94-8.
AUTORES
/ AUTHORS: - Short CD; Russell S; Valentine A
RESUMEN
/ SUMMARY: - Renal transplant recipients now have an
increased life expectancy, and this has highlighted the need for increased
concern about the long-term complications associated with transplantation. To
better manage renal transplant recipients over the long term, it is essential
to schedule periodic clinic visits to detect problems and intervene in a timely
fashion. Besides enabling early detection and possible treatment, periodic
visits permit continuing patient education. Unfortunately, there is no
scientifically based consensus that indicates what the optimal frequency and
timing of such visits should be, although the AST has recently issued some
guidelines. At the MINT, an Annual Review Clinic has been implemented to
provide better service to renal transplant recipients over the long term. The
clinic offers a comprehensive medical assessment, identifies and quantifies
risk factors for CVD, and initiates referrals to appropriate specialists. The Annual
Review Clinic increases patient awareness in a number of areas specific to
transplantation, promotes a positive approach to healthcare, enables collection
of structured data for analysis, and, with hope, engenders a significant degree
of patient well-being and satisfaction. The medical community needs to continue
long-term patient evaluation and clinical audit as means to improve long-term
patient and graft survival, as well as patient quality of life. N. Ref:: 31
----------------------------------------------------
[53]
TÍTULO / TITLE: - The testicular-derived
Sertoli cell: cellular immunoscience to enable transplantation.
REVISTA
/ JOURNAL: - Cell Transplant 2003;12(4):335-49.
AUTORES
/ AUTHORS: - Emerich DF; Hemendinger R; Halberstadt CR
INSTITUCIÓN
/ INSTITUTION: - Sertoli Technologies, Inc, Cranston RI
02921, USA. ED3FJM@aol.com
RESUMEN
/ SUMMARY: - There is a renewed enthusiasm for the
potential of cellular transplantation as a therapy for numerous clinical
disorders. The revived interest is largely due to the unprecedented success of
the “Edmonton protocol,” which produced a 100% cure rate for type I diabetics
following the transplantation of human islet allografts together with a
modified immunosuppressive regimen. While these data provide a clear and
unequivocal demonstration that transplantation is a viable treatment strategy,
the shortage of suitable donor tissue together with the debilitating
consequences of lifelong immunosuppression necessitate a concerted effort to
develop novel means to enable transplantation on a widespread basis. This
review outlines the use of Sertoli cells to provide local immunoprotection to
cografted discordant cells, including those from xenogeneic sources. Sertoli
cells are normally found in the testes where one of their functions is to
provide local immunologic protection to developing germ cells. Isolated Sertoli
cells 1) engraft and self-protect when transplanted into allogeneic and
xenogeneic environments, 2) protect cografted allogeneic and xenogeneic cells
from immune destruction, 3) protect islet grafts to reverse diabetes in animal
models, 4) enable survival and function of cografted foreign dopaminergic
neurons in rodent models of Parkinson’s disease (PD), and 5) promote
regeneration of damaged striatal dopaminergic circuitry in those same PD
models. These benefits are discussed in the context of several potential
underlying biological mechanisms. While the majority of work to date has
focused on Sertoli cells to facilitate transplantation for diabetes and PD, the
generalized ability of these unique cells to potently suppress the local immune
environment opens additional clinical possibilities. N. Ref:: 134
----------------------------------------------------
[54]
TÍTULO / TITLE: - Kidney transplantation
from living-unrelated donors: comparison of outcome with living-related and
cadaveric transplants under current immunosuppressive protocols.
REVISTA
/ JOURNAL: - Urology 2003 Dec;62(6):1002-6.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai E; Yussim A;
Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Centre of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - OBJECTIVES: Living-unrelated donors may
become an additional organ source for patients on the kidney waiting list. We
studied the impact of a combination of calcineurin inhibitors and
mycophenolate-mofetil together with steroids on the outcomes of living-related
(LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September
1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49)
kidney transplantation, and another 173 patients received a cadaveric kidney.
Immunosuppressive protocols consisted of mycophenolate-mofetil with
cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the
patient and graft survival data, rejection rate, and graft functional
parameters. RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8
years) and cadaver (43.7 years) donor recipients (P <0.001). HLA matching
was higher in LRD patients (P <0.001). Acute rejection developed in 28.6% of
LUR versus 27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P =
not significant). The creatinine level at 1, 2, and 3 years after transplant
was 1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR
patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not
significant), respectively. No difference in patient survival rates was found
among the groups. The 1, 2, and 3-year graft survival rates were significantly
better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR
transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney
recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS:
Despite HLA disparity, the rejection and survival rates of LUR transplants
under current immunosuppressive protocols are comparable to those of LRD and
better than those of cadaveric transplants.
----------------------------------------------------
[55]
TÍTULO / TITLE: - Hospital infection
control in hematopoietic stem cell transplant recipients.
REVISTA
/ JOURNAL: - Emerg Infect Dis. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.cdc.gov/
●●
Cita: Emerging Infectious Diseases: <> 2001 Mar-Apr;7(2):263-7.
AUTORES
/ AUTHORS: - Dykewicz CA
INSTITUCIÓN
/ INSTITUTION: - Centers for Disease Control and
Prevention, Atlanta, Georgia 30333, USA. cad3@cdc.gov
RESUMEN
/ SUMMARY: - Guidelines for Preventing Opportunistic
Infections Among Hematopoietic Stem Cell Transplant Recipients contains a
section on hospital infection control including evidence-based recommendations
regarding ventilation, construction, equipment, plants, play areas and toys,
health-care workers, visitors, patient skin and oral care, catheter-related
infections, drug-resistant organisms, and specific nosocomial infections. These
guidelines are intended to reduce the number and severity of hospital
infections in hematopoietic stem cell transplant recipients. N. Ref:: 37
----------------------------------------------------
[56]
TÍTULO / TITLE: - SCAI statement on
drug-eluting stents: practice and health care delivery implications.
REVISTA
/ JOURNAL: - Catheter Cardiovasc Interv 2003
Mar;58(3):397-9.
●●
Enlace al texto completo (gratuito o de pago) 1002/ccd.10513
AUTORES
/ AUTHORS: - Hodgson JM; King SB 3rd;
Feldman T; Cowley MJ; Klein LW; Babb JD
INSTITUCIÓN
/ INSTITUTION: - Heart and Vascular Center, MetroHealth
Medical Center, Cleveland, Ohio 44109, USA. jhodgson@metrohealth.org
----------------------------------------------------
[57]
TÍTULO / TITLE: - Current status of lung
transplantation.
REVISTA
/ JOURNAL: - Eur Respir J Suppl 2003 Nov;47:57s-64s.
AUTORES
/ AUTHORS: - Lau CL; Patterson GA
INSTITUCIÓN
/ INSTITUTION: - Division of Cardiothoracic Surgery,
Washington University School of Medicine, St Louis, MO, USA. lauch@msnotes.wustl.edu
RESUMEN
/ SUMMARY: - Two decades have passed since the first
successful clinical lung transplant was performed in 1983, and, in the interim,
lung transplantation has become the preferred treatment option for a variety of
end-stage pulmonary diseases. Remarkable progress has been made in the field
through refinement of technique and improved understanding of transplant
immunology and microbiology. Unfortunately, donor shortages continue to limit
the more widespread application of lung transplantation. In order to address
this issue, marginal donors, living lobar and split lung donor techniques, and
nonheartbeating donors have been used clinically to increase the number of
donor lungs available. Chronic rejection of the lung allograft is currently the
major hurdle limiting longterm survival. To date, prevention of known risk
factors and treatment strategies have not lessened the devastating toll this
process has on lung transplant survival. Better understanding of the cause of
chronic rejection is needed in order to develop novel strategies for its
treatment. Promotion of immune tolerance is a promising area that could
potentially eliminate chronic rejection. The present article discusses recent
advances in lung transplantation. It also details the major issues facing the
field today. Only through continued clinical and experimental investigation
will lung transplantation eventually reach its full potential. N. Ref:: 95
----------------------------------------------------
[58]
TÍTULO / TITLE: - General health
management and long-term care of the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S10-24.
AUTORES
/ AUTHORS: - Cohen D; Galbraith C
INSTITUCIÓN
/ INSTITUTION: - Columbia Presbyterian Hospital, New York,
NY 10032, USA. djc5@columbia.edu
RESUMEN
/ SUMMARY: - The steady improvement in short-term
success rates in renal transplant patients has translated into better long-term
success rates and a large number of patients with long-functioning renal
transplants. The necessity for the lifelong administration of immunosuppressive
medications to prevent rejection, coupled with the presence in many patients of
a variety of other medical problems dating from the period of renal
insufficiency prior to the time of renal transplantation, has created a large
group of patients with a unique and complex set of long-term medical care
needs. Due to the constraints of managed care, considerations of geography, or
patient preference, the long-term care of an increasing number of renal
transplant recipients has shifted away from the transplant center to the
community-based nephrologist or internist. For optimal care to be delivered, it
is important that the physicians managing these patients be cognizant of the
complex and interacting medical issues involved in their care. Appropriate
management can significantly prolong the life of the allograft as well as that
of the patient. Guidelines for understanding and managing some of the more
important and common general medical problems facing the long-term renal
transplant recipient (eg, infectious complications, cardiovascular disease,
hypertension, diabetes, hyperlipidemia, malignancy, pregnancy, bone disease,
dental care, preventive care) are addressed in this section. N. Ref:: 47
----------------------------------------------------
[59]
TÍTULO / TITLE: - Mechanisms involved in
ultraviolet light-induced immunosuppression.
REVISTA
/ JOURNAL: - Eur J Dermatol 2003 Nov-Dec;13(6):515-23.
AUTORES
/ AUTHORS: - Aubin F
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology and Cell
Biology, University Hospital, 2 Place Saint Jacques, 25030 Besancon, France. francois.aubin@ufc-chu.univ-fcomte.fr
RESUMEN
/ SUMMARY: - Ultraviolet radiation (UV) represents one
of the most important environmental factors affecting human health, especially
with regard to its hazardous effects on the generation of skin cancer,
suppression of the immune system and premature skin aging. At molecular level,
various chromophores have been identified, and DNA remains the major
chromophore in the skin. Epidermal Langerhans cells (LC) are considered as the
main targets of UV, as UV inhibits their antigen-presenting activity and their
capacity to stimulate allogeneic type 1 T cells. Keratinocytes are also a
target of UV light and they produce and release numerous soluble and
immunosuppressive mediators. In human skin, IL-10 is mainly produced by dermis
CD11b + macrophages and neutrophils that infiltrate epidermis after intense UV.
UV-induced immunosuppression is transferable with suppressor T cells whose
phenotype is still debated (Natural Killer T cells and T regulatory type 1 cells).
Although the mechanisms by which immune regulatory suppressor T cells act still
remain unclear, there is increasing evidence that apoptosis of epidermal LC or
reactive T cells may play an important role through the Fas/FasL system. N. Ref:: 101
----------------------------------------------------
[60]
TÍTULO / TITLE: - Expanding the donor
pool: effect on graft outcome.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Oct;13(10):2590-9.
AUTORES
/ AUTHORS: - Ramos E; Aoun S; Harmon WE
INSTITUCIÓN
/ INSTITUTION: - Nephrology Division, University of
Maryland Medical System, Baltimore, Maryland 21201, USA. eramos@medicine.umaryland.edu N. Ref:: 106
----------------------------------------------------
[61]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[62]
TÍTULO / TITLE: - Clinical trials,
immunosuppression and renal transplantation: new trends in design and analysis.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Aug;17(8):573-84.
Epub 2002 Jun 13.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0909-z
AUTORES
/ AUTHORS: - Landais P; Daures JP
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Biostatistique et
d’Informatique Medicale, Hopital Necker Enfants Malades, Faculte Paris 5, 149
rue de Sevres, 75743 Paris Cedex 15, France. landais@necker.fr
RESUMEN
/ SUMMARY: - Clinical trials provide a framework to
search for more effective and less toxic immunosuppressive agents to control
renal transplant rejection. Some methodological aspects are presented. Patient
selection and the choice of study endpoints are discussed with emphasis on
standardized definitions and classification of histopathology, and on
qualification and quantification of chronic rejection. Choosing a Bayesian or a
frequentist approach and the afferent hypotheses is discussed together with the
interpretation of a P-value and a confidence interval. Strategies for limiting the
number of patients, increasing power and feasibility are reviewed, including
discussion of surrogate endpoints. New approaches to statistical analysis are
then presented, including intention-to-treat versus per-protocol analysis,
analysis of correlated data, dependent censoring, and meta-analysis applied to
renal transplantation. Pharmacoeconomics are finally introduced as necessary
for implementation of decision making regarding therapeutic strategies.
Reporting research increases its standards, and the CONSORT (Consolidated
Standards of Reporting Trials) and QOROM (Quality of Reporting of
Meta-analyses) criteria are to be integrated in the process of clinical trial
procedures. In conclusion, observational studies are presented as part of an
evidence-based approach in the hierarchy of evidence, keeping in mind that high
quality, randomized, controlled trials are still necessary to decrease
uncertainty in the field of renal transplantation. N. Ref:: 100
----------------------------------------------------
[63]
TÍTULO / TITLE: - Bronchiolitis
obliterans syndrome: utility of the new guidelines in single lung transplant
recipients.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2003
Apr;22(4):427-32.
AUTORES
/ AUTHORS: - Nathan SD; Barnett SD; Wohlrab J; Burton N
INSTITUCIÓN
/ INSTITUTION: - Inova Transplant Center, Inova Fairfax
Hospital, Falls Church, Virginia 22042, USA. steven.nathan@inova.com
RESUMEN
/ SUMMARY: - BACKGROUND: Bronchiolitis obliterans syndrome
is defined by a >20% decrease from baseline in the forced expiratory volume
in 1 second (FEV(1)). Recently, a consensus panel under the auspices of the
International Society for Heart and Lung Transplantation proposed a new stage,
designated “potential BOS” or BOS 0-p. This study sought to validate
retrospectively this new stage in a cohort of single-lung transplant
recipients. METHODS: A retrospective analysis of serial pulmonary function
tests in 43 single-lung transplant recipients was performed. Baseline FEV(1)
and midflow rate (FEF(25-75%)) were determined and compared with the most
recent set of pulmonary function tests in clinically stable patients. RESULTS:
The sensitivity of the FEF(25-75%) at <or=75% of baseline for subsequently
detecting BOS Stage 1 was 80%, with a specificity of 82.6%. For the patients
with idiopathic pulmonary fibrosis, the sensitivity was 62.5% and the
specificity was 100.0%, whereas in the patients with chronic obstructive lung
disease, the sensitivity was 91.7% and the specificity was 69.2%. Different
cutoff points for the FEF(25-75%) also were tested and are shown in receiver
operator curves. Likelihood ratios for the different cutoff points also were
calculated. Five of 9 (55.6%) patients qualified for BOS 0-p using the FEV(1)
parameter (FEV(1) of 81-90% of baseline) alone. CONCLUSION: The FEF(25-75%)
seems to be a useful criterion for predicting BOS development in single-lung
transplant recipients. The FEF(25-75%) might best be used with likelihood
ratios for different values rather than for 1 defined cutoff point of or=75% of
baseline. The value of the second criterion that constitutes BOS 0-p (FEV(1),
81-90%of baseline) remains uncertain.
----------------------------------------------------
[64]
TÍTULO / TITLE: - Utility of intravenous
immune globulin in kidney transplantation: efficacy, safety, and cost
implications.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jun;3(6):653-64.
AUTORES
/ AUTHORS: - Jordan S; Cunningham-Rundles C; McEwan R
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology &
Transplant Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. sjordan@cshs.org
RESUMEN
/ SUMMARY: - Intravenous immunoglobulin preparations
(IVIG) are known to be effective in the treatment of various autoimmune and
inflammatory disorders into their immunomodulatory, immunoregulatory, and
anti-inflammatory properties. Recently, IVIG has been utilized in the
management of highly sensitized patients awaiting renal transplantation. The
mechanisms of suppression of panel reactive antibodies (PRA) in patients
awaiting transplantation are currently under investigation and appear to be
related to anti-idiotypic antibodies present in IVIG preparations. In this
review, the various immunomodulatory mechanisms attributable to IVIG and their
efficacy in reducing PRAs will be described. In addition, the use of IVIG in
solid organ transplant recipients will be reviewed. The adverse events, safety
considerations, and economic impact of IVIG protocols for patients awaiting
solid organ transplantation will be discussed.
N. Ref:: 67
----------------------------------------------------
[65]
TÍTULO / TITLE: - Loss of living donor
renal allograft survival advantage in children with focal segmental
glomerulosclerosis.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):328-33.
AUTORES
/ AUTHORS: - Baum MA; Stablein DM; Panzarino VM; Tejani
A; Harmon WE; Alexander SR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Because of concerns of
increased risk of graft loss with recurrent disease, living donor (LD)
transplantation in children with focal segmental glomerulosclerosis (FSGS) has
been controversial. METHODS: The North American Pediatric Renal Transplant
Cooperative Study (NAPRTCS) database from January 1987 to January 2000 was
examined to determine differences in demographics, treatment, and outcomes in
children with FSGS compared with other renal diseases. RESULTS: Data on 6484
children, 752 (11.6%) with FSGS, demonstrated that FSGS patients were more
likely to be older and black, and were less likely to receive either
pre-emptive or LD transplant (P < 0.001). No differences existed in human
lymphocyte antigen (HLA) matching or immunosuppression regimens. Acute tubular
necrosis occurred in more FSGS patients following LD (11.8 vs. 4.6%) or
cadaveric (CD; 27.9 vs. 16.3%) transplants (P < 0.001). Graft survival was
worse for LD FSGS patients (5 years 69%) compared with no FSGS (82%, P <
0.001) and was not significantly different than CD graft survival in the FSGS
(60%) and No FSGS groups (67%). The LD to CD ratios of relative risk of graft
failure were higher in FSGS patients (test for interaction, P = 0.01).
Recurrence of original disease was the only cause of graft failure that
differed between groups (P < 0.001). A greater percentage of LD FSGS graft
failures was attributed to recurrence (P = 0.06). CONCLUSIONS: The impact of FSGS
on graft survival in children is greatest in LD transplants, resulting in loss
of expected LD graft survival advantage. The rationale for LD grafts in
children with FSGS should be based on factors other than better outcomes
typically associated with LD transplantation.
----------------------------------------------------
[66]
TÍTULO / TITLE: - Sunlight,
immunosuppression and skin cancer: role of histamine and mast cells.
REVISTA
/ JOURNAL: - Clin Exp Pharmacol Physiol 2001
Jan-Feb;28(1-2):1-8.
AUTORES
/ AUTHORS: - Hart PH; Grimbaldeston MA; Finlay-Jones JJ
INSTITUCIÓN
/ INSTITUTION: - Department of Microbiology and Infectious
Diseases, School of Medicine, Flinders University, Adelaide, South Australia,
Australia. prue.hart@flinders.edu.au
RESUMEN
/ SUMMARY: - 1. The development into tumours of skin
cells transformed by ultraviolet (UV) B radiation of wavelengths 290-320 nm is
enhanced by the ability of UVB to suppress an immune response that would
otherwise destroy them. Ultraviolet B-induced immunomodulation may be by
multiple mechanisms, but generally manifests in an antigen-presenting cell
defect and an altered cytokine environment in the draining lymph nodes. 2.
Immune responses to microbial or self-antigens may be dysfunctional by similar
mechanisms following UVB exposure. 3. Earliest-acting intermediates in the
initiation of UVB-induced immunosuppression are the UVB absorbers
(photoreceptors) of the skin, notably DNA resulting in immunoregulatory cytokine
production, and trans-urocanic acid (UCA), which, upon isomerization to its cis
isomer, signals downstream immunosuppressive events. 4. In mice, dermal mast
cells are critical to UVB-induced systemic immunomodulation. In mice, there is
a functional link as well as a linear relationship between the prevalence of
histamine-staining dermal mast cells and the log of the dose of UVB required
for 50% immunosuppression. Studies with histamine receptor antagonists support
histamine as the main’ product of mast cells involved. Histamine acts in large
part via a prostanoid-dependent pathway. 5. Approximately 50% of humans and
greater than 90% of patients with non-melanoma skin cancer are UVB susceptible
for suppression of a contact hypersensitivity response. Neither cytokine
polymorphisms nor UVB-induced levels of cis-UCA in irradiated skin have been
linked to UVB susceptibility. Patients with basal cell carcinomas (BCC) have an
increased dermal mast cell prevalence in non-sun-exposed buttock skin. We
propose that mast cells function in humans, as in mice, by initiating
immunosuppression and, thereby, allowing a permissive environment for BCC
development. N.
Ref:: 71
----------------------------------------------------
[67]
TÍTULO / TITLE: - Inflammatory bowel disease,
azathioprine and skin cancer: case report and literature review.
REVISTA
/ JOURNAL: - Eur J Gastroenterol Hepatol 2001
Feb;13(2):193-4.
AUTORES
/ AUTHORS: - Austin AS; Spiller RC
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology, University
Hospital NHS Trust, Queen’s Medical Centre, Nottingham, UK.
RESUMEN
/ SUMMARY: - A 42-year-old blond Caucasian woman taking
azathioprine for 8 years developed an intra-epidermal carcinoma of the shin.
She regularly used a sun bed to maintain a tan. Although the increased risk of
non-melanoma skin cancer in immunosuppressed transplant recipients is well
recognized, patients with Crohn’s disease are not currently warned of the risk
of exposure to ultraviolet light. Individuals with inflammatory bowel disease
who take azathioprine, especially those with a fair complexion, should be
informed of the potential dangers of sun bathing and should be advised to limit
sun exposure.
----------------------------------------------------
[68]
TÍTULO / TITLE: - Donor and recipient
outcomes after adult living donor liver transplantation.
REVISTA
/ JOURNAL: - Liver Transpl 2003 Oct;9(10 Suppl
2):S42-4.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50219
AUTORES
/ AUTHORS: - Humar A
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Minnesota, Minneapolis, MN 55455, USA. humar001@umn.edu N. Ref:: 11
----------------------------------------------------
[69]
TÍTULO / TITLE: - Pulmonary
considerations in the immunocompromised patient.
REVISTA
/ JOURNAL: - Emerg Med Clin North Am 2003
May;21(2):499-531, x-xi.
AUTORES
/ AUTHORS: - Belleza WG; Browne B
INSTITUCIÓN
/ INSTITUTION: - Division of Emergency Medicine, University
of Maryland Medical System, 419 West Redwood Street, Suite 208, Baltimore, MD
21201, USA.
RESUMEN
/ SUMMARY: - The compromised patient who presents to
the emergency department with pulmonary complaints is becoming a common
occurrence. An immunocompromised state can result from a disease process such
as HIV or from medications used to prevent graft rejection in solid organ
recipients or to treat conditions such as collagen vascular disease. The
emergency department physician should be familiar with the more common
complications that can afflict this unique patient group. This article
addresses the presentation, evaluation, and treatment of the more common
pulmonary complications that can occur in solid organ transplant recipients,
cancer patients, patients suffering from collagen vascular disease, and
patients with HIV disease. N.
Ref:: 79
----------------------------------------------------
[70]
TÍTULO / TITLE: - Preimplantation renal
biopsy: structure does predict function.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):264-6.
AUTORES
/ AUTHORS: - D’Agati VD; Cohen DJ
INSTITUCIÓN
/ INSTITUTION: - Columbia University College of Physicians
and Surgeons, New York, NY, USA. N.
Ref:: 11
----------------------------------------------------
[71]
TÍTULO / TITLE: - The FDA guidelines for
the treatment of psoriasis using cyclosporine A: are they adequate?
REVISTA
/ JOURNAL: - Cutis 2002 Nov;70(5):288-90.
AUTORES
/ AUTHORS: - Zackheim HS
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
California, San Francisco, USA. hszackheim@orca.ucsf.edu
RESUMEN
/ SUMMARY: - I present a review of the current US Food
and Drug Administration (FDA) guidelines for using cyclosporine A (CSA) to
treat psoriasis, with particular emphasis on the period for which CSA may be
administered. My concern is that, without violating the guidelines, CSA could
be given for a prolonged period with only very brief time-outs. I also review
the risks for renal toxicity, malignancy, and other side effects from prolonged
administration. N.
Ref:: 18
----------------------------------------------------
[72]
TÍTULO / TITLE: - Blocking the CD80 and
CD86 costimulation molecules: lessons to be learned from animal models.
REVISTA
/ JOURNAL: - Transplantation 2002 Jan 15;73(1
Suppl):S23-6.
AUTORES
/ AUTHORS: - Jonker M; Ossevoort And MA; Vierboom M
INSTITUCIÓN
/ INSTITUTION: - Department of Immunobiology, Biomedical
Primate Research Centre (BPRC), Rijswijk, The Netherlands.
RESUMEN
/ SUMMARY: - The induction of tolerance for allografts,
obviating the need for immunosuppression, is the ultimate goal in
transplantation. Immunoregulatory antibodies preventing graft rejection are
promising candidates for the induction of tolerance. Costimulation blockade
could be a useful approach to inducing donor-specific nonresponsiveness in
organ transplantation. Rodent studies and in vitro studies using human or
nonhuman primate peripheral blood mononuclear cells indicated that this
approach might indeed lead to specific T-cell anergy. Nonhuman primate studies,
in which the B7 costimulation pathway was blocked, have so far not led to
permanent drug-free graft acceptance. The results are promising, however,
because during the treatment period with B7 costimulation blockade alone or
combined with anti-CD40 or cyclosporine, no graft loss was observed and
donor-specific antibody formation was prevented. Based on these findings, new
approaches to inducing drug-free graft acceptance should be investigated. N. Ref:: 15
----------------------------------------------------
[73]
TÍTULO / TITLE: - Allogeneic and
autologous transplantation for haematological diseases, solid tumours and
immune disorders: definitions and current practice in Europe.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2002
Apr;29(8):639-46.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703535
AUTORES
/ AUTHORS: - Urbano-Ispizua A; Schmitz N; de Witte T;
Frassoni F; Rosti G; Schrezenmeier H; Gluckman E; Friedrich W; Cordonnier C;
Socie G; Tyndall A; Niethammer D; Ljungman P; Gratwohl A; Apperley J;
Niederwieser D; Bacigalupo A
INSTITUCIÓN
/ INSTITUTION: - Dept of Hematology, Hospital Clinic,
Barcelona, España.
RESUMEN
/ SUMMARY: - The Accreditation Sub-Committee of the
EBMT regularly publishes special reports on current practice of haemopoietic
stem cell transplantation for haematological diseases, solid tumours and immune
disorders. Major changes have occurred since the last report in 1998.
Haemopoietic stem cell transplantation today includes allogeneic and autologous
stem cells derived from bone marrow, peripheral blood and cord blood. With
reduced intensity conditioning regimens in allogeneic transplantation, the age
limit has increased, permitting the inclusion of older patients. New
indications have emerged, such as autoimmune disorders and AL amyloidosis for
autologous, and solid tumours for allogeneic transplants. Other indications,
such as autologous transplantation for breast cancer have been challenged. An updated
report with revised tables and operating definitions is presented here.
----------------------------------------------------
[74]
TÍTULO / TITLE: - Diabetes mellitus in
transplantation: 2002 consensus guidelines.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1265-70.
AUTORES
/ AUTHORS: - Moore R; Boucher A; Carter J; Kim SJ;
Kiberd B; Loertscher R; Mongeau JG; Prasad GV; Vautour L
INSTITUCIÓN
/ INSTITUTION: - University Hospital of Wales, Cardiff,
Wales, UK.
RESUMEN
/ SUMMARY: - Diabetes mellitus is a serious
complication following organ transplantation that is underdiagnosed, possibly
due to the inadequate definitions used in published literature and the lack of
standardized screening. Diabetes in transplantation amplifies the already increased
risk of cardiovascular disease among transplant patients, and increases the
risk of graft loss and death. Patients at risk of developing diabetes in
transplantation should therefore be prospectively identified and given
individualized immunosuppressive therapy to minimize the risk of developing
this disease. These guidelines are intended to: (1) help identify patients at
risk for diabetes after transplantation; (2) set down a standard definition of
posttransplant diabetes mellitus (PTDM); (3) create a standard monitoring
protocol for the diagnosis of PTDM; and (4) optimize the management of patients
at risk of developing or who develop diabetes after transplantation. With
improved diagnosis, individualization of therapy, and proper early management,
the incidence of diabetes in transplantation, and the accompanying additional
burden of illness the disease carries, may be diminished. In turn, this will
help achieve the therapeutic goals of reducing the risk of graft complications,
improving quality of life, and reducing postoperative morbidity and mortality
in transplant patients.
----------------------------------------------------
[75]
TÍTULO / TITLE: - Psychological stress
and antibody response to immunization: a critical review of the human literature.
REVISTA
/ JOURNAL: - Psychosom Med. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.psychosomaticmedicine.org/
●●
Cita: Psychosomatic Medicine: <> 2001 Jan-Feb;63(1):7-18.
AUTORES
/ AUTHORS: - Cohen S; Miller GE; Rabin BS
INSTITUCIÓN
/ INSTITUTION: - Department of Psychology, Carnegie Mellon
University, Pittsburgh, PA 15213, USA. scohen@andrew.cmu.edu
RESUMEN
/ SUMMARY: - OBJECTIVE: The objective of this review
was to evaluate the evidence for the hypothesis that psychological stress
influences antibody response to immunization in humans. METHODS: A critical
review of the literature was conducted. RESULTS: The evidence supports an
association between psychological stress and suppression of humoral immune
(antibody) response to immunization. This association is convincing in the case
of secondary immune response but weak for primary response. The lack of
consistent evidence for a relation with primary response may be attributed to a
failure to consider the critical points when stress needs to be elevated in the
course of the production of antibody. Lower secondary antibody responses were
found among patients with chronically high levels of stress (severe enduring
problems or high levels of trait negative affect). These responses were found
most consistently among older adults. Lower secondary responses were also found
for those reporting acute stress or negative affect, but only in studies of
secretory immunoglobulin A antibody in which psychological and antibody
measures were linked very closely in time. Health practices did not mediate
relations between stress and antibody responses; however, there were
indications that elevated cortisol levels among stressed patients could play a
role. Evidence also suggests the possible influences of dispositional
stress-reactivity and low positive affect in the inhibition of antibody
production. CONCLUSIONS: The literature supports a relationship between
psychological stress and antibody responses to immunizations. The data are
convincing in the case of secondary response but weak for primary response.
More attention to the kinetics of stress and antibody response and their
interrelations is needed in future research.
N. Ref:: 51
----------------------------------------------------
[76]
TÍTULO / TITLE: - Role of chiral
chromatography in therapeutic drug monitoring and in clinical and forensic
toxicology.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Apr;24(2):290-6.
AUTORES
/ AUTHORS: - Williams ML; Wainer IW
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, Leicester
University, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - Advances in chiral chromatographic
separations have given pharmacologists and toxicologists the tools to examine
unexpected clinical results involving chiral drugs. The ability to unravel
complex phenomena associated with drug transport and drug metabolism is
presented in this manuscript. The relation between the chirality of the drug
mefloquine and the intracellular concentrations of the drug cyclosporine is
illustrated by examining the effect of the enantiomers of mefloquine on the
transport activity of P-glycoprotein (Pgp). These studies were conducted using
a liquid chromatographic column containing immobilized Pgp. The results
demonstrated that (+)-mefloquine competitively displaced the Pgp substrate
cyclosporine whereas (-)-mefloquine had no effect on cyclosporine-Pgp binding.
The data suggest that cyclosporine cellular and CNS concentrations can be
increased through the concomitant administration of (+)-mefloquine. The use of
chirality in clinical and forensic situations is also illustrated by the metabolism
of the enantiomers of ketamine (KET). The plasma concentrations of (+)-KET and
(-)-KET and the norketamine metabolites (+)-NK and (-)-NK were measured in rat
plasma using enantioselective gas chromatography. The separations were
accomplished using a gas chromatography chiral stationary phase based on
beta-cyclodextrin. The pharmacokinetic profiles of (+)-, (-)-KET and (+)-,
(-)-NK were determined in control and protein-calorie malnourished (PCM) rats
to determine the effect of PCM on ketamine metabolism and clearance. The
results indicate that PCM produced a significant and stereoselective decrease
in KET and NK metabolism. The data suggest that the effects of environmental
factors (smoking, alcohol use, diet) and drug interactions (coadministered agents)
can be measured using the changes in stereochemical metabolic and
pharmacokinetic patterns of KET and similar drugs. N. Ref:: 33
----------------------------------------------------
[77]
TÍTULO / TITLE: - Suggested guidelines
for the use of tacrolimus in cardiac transplant recipients.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2001
Jul;20(7):734-8.
AUTORES
/ AUTHORS: - Taylor DO; Barr ML; Meiser BM; Pham SM;
Mentzer RM; Gass AL
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of Cardiology,
University of Utah, Salt Lake City, Utah 84132, USA. N. Ref:: 11
----------------------------------------------------
[78]
TÍTULO / TITLE: - Kidney transplantation:
graft monitoring and immunosuppression.
REVISTA
/ JOURNAL: - World J Surg 2002 Feb;26(2):185-93. Epub
2001 Dec 17.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00268-001-0206-1
AUTORES
/ AUTHORS: - Fisher JS; Woodle ES; Thistlethwaite JR Jr
INSTITUCIÓN
/ INSTITUTION: - Section of Transplantation, Department of
Surgery, University of Tennessee, Room A-202, Memphis,Tennessee 38103, USA.
RESUMEN
/ SUMMARY: - Renal transplantation has become the
preferred means of treating end-stage renal disease. Episodes of allograft
rejection have become the exception rather than the rule. The development of
real-time ultrasound-guided allograft biopsy and adoption of the Banff criteria
for histologic evaluation permit safe,accurate monitoring of graft histology.
New immunosuppressive agents have drastically reduced the number of episodes of
both primary and refractory rejection. Novel biologic agents in the form of
monoclonal antibodies and soluble receptor hybrid molecules may serve to reduce
the required doses of toxic chemical immunosuppressants and provide more
specific immune suppression directed at those elements of the immune system
involved in rejection of a given allograft. Development of assays to identify
patients who demonstrate donor antigen-specific hyporeactivity is now feasible.
Hopefully, these assays will serve as a guide for the reduction and possible
removal of immunosuppressive agents from stable renal allograft
recipients. N. Ref:: 81
----------------------------------------------------
[79]
TÍTULO / TITLE: - Successful kidney
transplantation using organs from a donor with disseminated intravascular
coagulation and impaired renal function: case report and review of the
literature.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Feb;16(2):412-5.
AUTORES
/ AUTHORS: - Pastural M; Barrou B; Delcourt A; Bitker
MO; Ourahma S; Richard F
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Hopital La
Pitie-Salpetriere, Paris, France. N.
Ref:: 9
----------------------------------------------------
[80]
TÍTULO / TITLE: - Histochemical
properties of intrastriatal mesencephalic grafts.
REVISTA
/ JOURNAL: - Adv Exp Med Biol 2002;517:43-61.
AUTORES
/ AUTHORS: - Triarhou LC
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, Division of Neuropathology, Medical Science Building A142, Indiana
University Medical Center, 635 Barnhill Drive, Indianapolis, Indiana
46202-5120, USA. N.
Ref:: 96
----------------------------------------------------
[81]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy based on donor and recipient risk factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2207-11.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati Medical Center,
Cincinnati, Ohio 45267-0585, USA. N.
Ref:: 35
----------------------------------------------------
[82]
TÍTULO / TITLE: - Tolerance through bone
marrow transplantation with costimulation blockade.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):125-33.
AUTORES
/ AUTHORS: - Wekerle T; Blaha P; Langer F; Schmid M;
Muehlbacher F
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Vienna General
Hospital, Austria. thomas.wekerle@akh-wien.ac.at
RESUMEN
/ SUMMARY: - The routine induction of tolerance in
organ transplant recipients remains an unattained goal. The creation of a state
of mixed chimerism through allogeneic bone marrow transplantation leads to
robust donor-specific tolerance in several experimental models and this
approach has several features making it attractive for clinical development.
One of its major drawbacks, however, has been the toxicity of the required host
conditioning. The use of costimulation blocking reagents (anti-CD 154
monoclonal antibodies and the fusion protein CTLA4Ig) has led to much less
toxic models of mixed chimerism in which global T cell depletion of the host is
no longer necessary and which has even allowed the elimination of all
cytoreductive treatment when combined with the injection of very high doses of
bone marrow cells. In this overview we will briefly discuss general features of
tolerance induction through bone marrow transplantation, will then describe
recent models using costimulation blockade to induce mixed chimerism and will
review the mechanisms of tolerance found with these regimens. Finally we will
attempt to identify issues related to the clinical introduction of bone marrow
transplantation with costimulation blockade which remain unresolved. N. Ref:: 84
----------------------------------------------------
[83]
TÍTULO / TITLE: - Maintenance
immunosuppression in the renal transplant recipient: an overview.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S25-35.
AUTORES
/ AUTHORS: - Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Alabama at Birmingham, Birmingham, AL 35294, USA. rgaston@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Managing maintenance immunosuppressive
regimens after kidney transplantation is often challenging and confusing,
requiring careful attention to efficacy, dosing, adverse effects, and costs of
multiple medications. Most protocols combine a primary immunosuppressant
(cyclosporine or tacrolimus) with one or two adjunctive agents (azathioprine,
mycophenolate mofetil, sirolimus, corticosteroids). Avoiding drug-drug
interactions is a major part of effective immunosuppressant management, and
special situations (eg, pregnancy, intravenous dosing, caring for minority
patients) can prove especially daunting. This review summarizes available data
regarding current practices in maintenance immunosuppression, emphasizing
issues that arise in day-to-day management of renal transplant recipients. N. Ref:: 69
----------------------------------------------------
[84]
TÍTULO / TITLE: - Ten years’ experience
with liposomal amphotericin B in transplant recipients at Huddinge University
Hospital.
REVISTA
/ JOURNAL: - J Antimicrob Chemother. Acceso gratuito al
texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://jac.oupjournals.org/
●●
Cita: Journal of Antimicrobial Chemotherapy: <> 2002 Feb;49 Suppl 1:51-5.
AUTORES
/ AUTHORS: - Ringden O
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Immunology, Centre
for Allogeneic Stem Cell Transplantation, Karolinska Institute, Huddinge
University Hospital, Huddinge S-14186, Sweden. olle.ringden@impi.ki.se
RESUMEN
/ SUMMARY: - Our substantial experience in several
trials with AmBisome in adult and paediatric patients undergoing
transplantation has shown this formulation of amphotericin B to be safe and
effective in therapeutic and prophylactic use. AmBisome has shown a significant
reduction in fungal colonization and invasive Candida infections compared with
placebo in a prospective, double-blind study in bone marrow transplantation,
and eradication of invasive fungal infections in 86% of 14 children undergoing
bone marrow transplantation. The main side effects of AmBisome use are
elevations in serum potassium and creatinine, but these lead to very few
withdrawals from treatment. Compared with conventional amphotericin B, AmBisome
is very expensive, but its much improved safety profile and proven efficacy make
it an excellent agent for management of invasive fungal disease in transplant
recipients. N. Ref:: 14
----------------------------------------------------
[85]
TÍTULO / TITLE: - Structural correlates
of process outgrowth and circuit reconstruction.
REVISTA
/ JOURNAL: - Adv Exp Med Biol 2002;517:63-88.
AUTORES
/ AUTHORS: - Triarhou LC
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, Division of Neuropathology, Medical Science Building A142, Indiana
University Medical Center, 635 Barnhill Drive, Indianapolis, Indiana
46202-5120, USA. N.
Ref:: 105
----------------------------------------------------
[86]
TÍTULO / TITLE: - The immune tolerance
network: a new paradigm for developing tolerance-inducing therapies.
REVISTA
/ JOURNAL: - J Allergy Clin Immunol 2002
Jul;110(1):17-23.
AUTORES
/ AUTHORS: - Rotrosen D; Matthews JB; Bluestone JA
INSTITUCIÓN
/ INSTITUTION: - National Institute of Allergy and
Infectious Diseases, Bethesda, MD 20817,USA.
RESUMEN
/ SUMMARY: - Immune tolerance therapies are designed to
reprogram immune cells in a highly specific fashion to eliminate pathogenic
responses while preserving protective immunity. A concept that has tantalized
immunologists for decades, the development of tolerance-inducing therapies,
would revolutionize the management of a wide range of chronic and often
debilitating diseases by obviating the need for lifelong immunosuppressive
regimens. The advances of the past decade have provided a more detailed
understanding of the molecular events associated with T-cell recognition and
activation. Building on these advances, immunologists have demonstrated the
feasibility of various tolerance-inducing approaches in small- and large-animal
models of autoimmunity, allergy, and transplant graft rejection. Unprecedented
opportunities to test these approaches in a variety of human diseases have now
emerged. To capitalize on these advances, the National Institutes of Health
recently established the Immune Tolerance Network (ITN), an international consortium
of more than 70 basic and clinical immunologists dedicated to the evaluation of
novel tolerance-inducing therapies and associated studies of immunologic
mechanisms. By using a unique interactive approach to accelerate the
development of clinical tolerance therapies, the ITN is partnering with the
biotechnology and pharmaceutical industries to examine innovative tolerogenic
approaches in a range of allergic and autoimmune diseases and to prevent graft
rejection after transplantation. Two years since its inception, the ITN now has
approximately 2 dozen clinical trials or tolerance assays studies ongoing or in
later stages of protocol development. This report summarizes the rationale for
emphasizing clinical research on immune tolerance and highlights the progress
of the ITN. N. Ref:: 29
----------------------------------------------------
[87]
TÍTULO / TITLE: - Directions for future
research.
REVISTA
/ JOURNAL: - Adv Exp Med Biol 2002;517:127-42.
AUTORES
/ AUTHORS: - Triarhou LC
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, Division of Neuropathology, Medical Science Building A142, Indiana
University Medical Center, 635 Barnhill Drive, Indianapolis, Indiana
46202-5120, USA. N.
Ref:: 102
----------------------------------------------------
[88]
TÍTULO / TITLE: - The current state of,
and future prospects for, cardiac transplantation in children.
REVISTA
/ JOURNAL: - Cardiol Young 2003 Feb;13(1):64-83.
AUTORES
/ AUTHORS: - Webber SA
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatric Cardiology,
Department of Pediatrics, University of Pittsburgh School of Medicine and
Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. steve.webber@chp.edu
RESUMEN
/ SUMMARY: - During the last two decades, several
advances have resulted in marked improvement in medium-term survival, with
excellent quality of life, in children undergoing cardiac transplantation.
Improved outcomes reflect better selection of donors and recipients, increased
surgical experience in transplantation for complex congenital heart disease,
development of effective surveillance for rejection, and wider choice of
immunosuppressive medications. Despite all of these advances, recipients
continue to suffer from the adverse effects of non-specific immunosupression,
including infections, induction of lymphoproliferative disorders and other
malignancies, renal dysfunction, and other important end-organ toxicities.
Furthermore, newer immunosuppressive regimes, thus far, appear to have had
relatively little impact on the incidence of chronic rejection. Progress in our
understanding of the immunologic mechanisms of rejection and graft acceptance
should lead to more targeted immunosuppressive therapy and avoidance of
non-specific immunosupression. The ultimate goal is to induce a state of
tolerance, wherein the recipient will accept the allograft indefinitely,
without the need for long-term immunusupression, and yet remain
immuno-competent to all non-donor antigens. This quest is currently being
realized in many animal models of solid organ transplantation, and offers great
hope for the future. N.
Ref:: 129
----------------------------------------------------
[89]
TÍTULO / TITLE: - Mechanisms of
transplant tolerance induction using costimulatory blockade.
REVISTA
/ JOURNAL: - Curr Opin Immunol 2002 Oct;14(5):592-600.
AUTORES
/ AUTHORS: - Wekerle T; Kurtz J; Bigenzahn S; Takeuchi
Y; Sykes M
INSTITUCIÓN
/ INSTITUTION: - The Division of Transplantation,
Department of Surgery, Vienna General Hospital, University of Vienna,
Waehringer Guertel 18, A 1090 Vienna, Austria. Thomas.Wekerle@akh-wien.ac.at
RESUMEN
/ SUMMARY: - The potential use of
costimulation-blocking reagents to induce transplantation tolerance has
recently created considerable excitement. Recent evidence has begun to
delineate the mechanisms by which these powerful effects occur. It has become
increasingly clear, firstly, that T cell costimulation is mediated by a
delicate network of signaling pathways and, secondly, that interference with
these systems can lead to numerous different tolerance mechanisms, including
immune regulation, anergy and deletion.
N. Ref:: 90
----------------------------------------------------
[90]
TÍTULO / TITLE: - Allergen immunotherapy:
a practice parameter. American Academy of Allergy, Asthma and Immunology.
American College of Allergy, Asthma and Immunology.
REVISTA
/ JOURNAL: - Ann Allergy Asthma Immunol 2003 Jan;90(1
Suppl 1):1-40.
----------------------------------------------------
[91]
TÍTULO / TITLE: - Recipient selection in
cardiac transplantation: contraindications and risk factors for mortality.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2002
Nov;21(11):1161-73.
AUTORES
/ AUTHORS: - Cimato TR; Jessup M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania, USA.
RESUMEN
/ SUMMARY: - Currently the only acknowledged,
definitive treatment for refractory heart failure is heart transplantation
(HTx). During the past 10 years, selection criteria for heart transplant
recipients have been developed that use an analysis of risk factors associated
with mortality, which were identified by consensus opinion and by single-center
and multi-center database review. A number of other studies also have been
designed to evaluate specific risk factors for transplant such as advanced age,
diabetes, and sex. This review identifies variables that continue to provoke
controversy during the candidate selection process or variables that have
changed from absolute to relative contraindications for HTx. Clinicians may use
the data summarized in this review as a guide to making decisions about patient
candidacy for HTx. One could conclude from this analysis that a more formalized
and objective scale to select patients and to assess risk of death after HTx is
necessary. Moreover, as alternative therapies to HTx become reality, a better
instrument for triaging patients to one form of therapy or another may be
necessary. N. Ref:: 61
----------------------------------------------------
[92]
TÍTULO / TITLE: - Small-for-size graft in
living donor liver transplantation: how far should we go?
REVISTA
/ JOURNAL: - Liver Transpl 2003 Sep;9(9):S29-35.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50198
AUTORES
/ AUTHORS: - Kiuchi T; Tanaka K; Ito T; Oike F; Ogura
Y; Fujimoto Y; Ogawa K
INSTITUCIÓN
/ INSTITUTION: - Department of Transplant Surgery, Kyoto
University Hospital, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. kiuchi@kuhp-u.ac.jp
RESUMEN
/ SUMMARY: - With the extensive use of living donor
liver grafts in adult patients, controversy over small-for-size syndrome has
escalated in recent years. Although several symptoms have been suggested as
manifestations of the syndrome, small-for-size syndrome remains difficult to
diagnose because these symptoms are neither specific nor inevitable. The
occurrence of small-for-size syndrome also seems to depend on a number of
recipient and graft factors. Potential pathogenic mechanisms include persistent
portal hypertension and portal overperfusion. At present, several techniques are
being explored in an attempt to ameliorate the impact of small-for-size
syndrome. Recent experience suggests that the occurrence of small-for-size
syndrome is multifactorial and that complications relating to small-for-size
grafts should be examined in relation to a variety of graft, recipient, and
technical factors. N.
Ref:: 17
----------------------------------------------------
[93]
TÍTULO / TITLE: - Donor specific
transfusion in kidney transplantation: effect of different immunosuppressive
protocols on graft outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2787-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Joubran N;
Dagher O; Kamel G
INSTITUCIÓN
/ INSTITUTION: - Department ofNephrology and
Transplantation, Rizk Hospital, Beirut, Lebanon.
----------------------------------------------------
[94]
TÍTULO / TITLE: - Plasmodium vivax
malaria complicated by hemophagocytic syndrome in an immunocompetent
serviceman.
REVISTA
/ JOURNAL: - Am J Hematol 2003 Oct;74(2):127-30.
●●
Enlace al texto completo (gratuito o de pago) 1002/ajh.10390
AUTORES
/ AUTHORS: - Park TS; Oh SH; Choi JC; Kim HH; Chang CL;
Son HC; Lee EY
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine, College
of Medicine, Pusan National University, Busan, Korea.
RESUMEN
/ SUMMARY: - We describe a 23-year-old retired military
officer who was immunocompetent but diagnosed with hemophagocytic syndrome
(HPS) by Plasmodium vivax infection. Initially, the patient was suspected to
have toxic hepatitis related to heavy drinking. But abnormal hematologic
findings required a further bone marrow examination and the diagnosis of HPS
was made. Antimalarial chemotherapy then brought complete remission. Plasmodium
falciparum, a species causing more severe malarial infection, was listed as one
of the major causes of HPS. However, P. vivax was not mentioned, and only one
case was reported in the literature. In this study, we suggest that P. vivax
malaria should be included in the differential diagnosis of HPS, even in an
immunocompetent person. N.
Ref:: 9
----------------------------------------------------
[95]
- Castellano -
TÍTULO / TITLE:Presente y futuro del trasplante
renal. Present and future of kidney transplantation.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Nov-Dec;26(10):731-58.
AUTORES
/ AUTHORS: - Burgos FJ; Alcaraz A; Castillon I;
Gonzalez Martin M; Lledo E; Matesanz R; Marcen R; Montanes P; Pascual J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital Ramon y
Cajal, Universidad Alcala, Madrid.
RESUMEN
/ SUMMARY: - Renal transplant is the treatment of
choice for the patient with end stage renal disease. España is the country with
the highest donation rate (33 ppm). However, at present this figure is
stabilized. The development of non-beating heart programmes, living-donor
nephrectomy (specially laparoscopic nephrectomy) programmes, and may be xenotransplantation
in a non-immediate future could increase the transplantation activity. The
knowledge of preservation mechanisms, specially with the use of perfusion
machines allows to rescue for transplantation kidneys with a long warm-ischemia
time. Furthermore, these machines are useful for analyzing viability markers.
The new immunosuppressive drugs: Tacrolimus, Mycophenolate-Mophetil, Rapamycin
and monoclonal antibodies against alpha chain of the interleukine-2 receptor
(Basoliximab and Dazcizumab) have reduced the incidence of acute rejection in
the immediate renal transplant period. However, its effect in the long-term
follow-up period is still a matter of controversy. The incidence of tumour in
the renal transplant recipient is increased, specially those of lymphoma, skin
cancer and Kaposi sarcoma. Periodical exams for detecting the development of
tumours are mandatory in this population. Finally, xenotransplantation is an
attractive alternative, although immunological, infective and ethical barriers should
previously be resolved. N.
Ref:: 92
----------------------------------------------------
[96]
TÍTULO / TITLE: - Pharmacokinetic aspects
of treating infections in the intensive care unit: focus on drug interactions.
REVISTA
/ JOURNAL: - Clin Pharmacokinet 2001;40(11):833-68.
AUTORES
/ AUTHORS: - Pea F; Furlanut M
INSTITUCIÓN
/ INSTITUTION: - Institute of Clinical Pharmacology and
Toxicology, Department of Experimental and Clinical Pathology and Medicine,
Medical School, University of Udine, Italy. federico.pea@med.uniud.it
RESUMEN
/ SUMMARY: - Pharmacokinetic interactions involving
anti-infective drugs may be important in the intensive care unit (ICU).
Although some interactions involve absorption or distribution, the most
clinically relevant interactions during anti-infective treatment involve the
elimination phase. Cytochrome P450 (CYP) 1A2, 2C9, 2C19, 2D6 and 3A4 are the
major isoforms responsible for oxidative metabolism of drugs. Macrolides (especially
troleandomycin and erythromycin versus CYP3A4), fluoroquinolones (especially
enoxacin, ciprofloxacin and norfloxacin versus CYP1A2) and azole antifungals
(especially fluconazole versus CYP2C9 and CYP2C19, and ketoconazole and
itraconazole versus CYP3A4) are all inhibitors of CYP-mediated metabolism and
may therefore be responsible for toxicity of other coadministered drugs by
decreasing their clearance. On the other hand, rifampicin is a nonspecific
inducer of CYP-mediated metabolism (especially of CYP2C9, CYP2C19 and CYP3A4)
and may therefore cause therapeutic failure of other coadministered drugs by
increasing their clearance. Drugs frequently used in the ICU that are at risk
of clinically relevant pharrmacokinetic interactions with anti-infective agents
include some benzodiazepines (especially midazolam and triazolam),
immunosuppressive agents (cyclosporin, tacrolimus), antiasthmatic agents
(theophylline), opioid analgesics (alfentanil), anticonvulsants (phenytoin,
carbamazepine), calcium antagonists (verapamil, nifedipine, felodipine) and
anticoagulants (warfarin). Some lipophilic anti-infective agents inhibit
(clarithromycin, itraconazole) or induce (rifampicin) the transmembrane
transporter P-glycoprotein, which promotes excretion from renal tubular and
intestinal cells. This results in a decrease or increase, respectively, in the
clearance of P-glycoprotein substrates at the renal level and an increase or
decrease, respectively, of their oral bioavailability at the intestinal level.
Hydrophilic anti-infective agents are often eliminated unchanged by renal
glomerular filtration and tubular secretion, and are therefore involved in
competition for excretion. Beta-lactams are known to compete with other drugs
for renal tubular secretion mediated by the organic anion transport system, but
this is frequently not of major concern, given their wide therapeutic index.
However, there is a risk of nephrotoxicity and neurotoxicity with some
cephalosporins and carbapenems. Therapeutic failure with these hydrophilic
compounds may be due to haemodynamically active coadministered drugs, such as
dopamine, dobutamine and furosemide, which increase their renal clearance by
means of enhanced cardiac output and/or renal blood flow. Therefore,
coadministration of some drugs should be avoided, or at least careful
therapeutic drug monitoring should be performed when available. Monitoring may
be especially helpful when there is some coexisting pathophysiological
condition affecting drug disposition, for example malabsorption or marked
instability of the systemic circulation or of renal or hepatic function. N. Ref:: 397
----------------------------------------------------
[97]
TÍTULO / TITLE: - Immunosuppression:
practice and trends.
REVISTA
/ JOURNAL: - Am J Transplant 2003;3 Suppl 4:41-52.
AUTORES
/ AUTHORS: - Helderman JH; Bennett WM; Cibrik DM;
Kaufman DB; Klein A; Takemoto SK
INSTITUCIÓN
/ INSTITUTION: - Vanderbilt University, Nashville, TN, USA.
hal.helderman@Vanderbilt.edu N. Ref:: 11
----------------------------------------------------
[98]
TÍTULO / TITLE: - Characteristics of
poliovirus strains from long-term excretors with primary immunodeficiencies.
REVISTA
/ JOURNAL: - Dev Biol (Basel) 2001;105:75-80.
AUTORES
/ AUTHORS: - Minor P
INSTITUCIÓN
/ INSTITUTION: - National Institute for Biological
Standards and Control, Potters Bar, UK.
RESUMEN
/ SUMMARY: - Individuals who are deficient in humoral
immunity are particularly at risk from infection with enteroviruses, and
poliovirus in particular, where antibodies are the main source of protection
from disease. Long-term excretion of vaccine strains of poliovirus has been
documented for many years and instances of paralytic poliomyelitis in
hypogammaglobulinaemic patients who were subsequently found to have been
excreting virus for prolonged periods have been reported in the U.S.A., Germany
and Japan. The identification of a healthy immunodeficient patient in the U.K.
who has probably been excreting type 2 poliovirus for 15 years will be
described, with the characteristics of the virus and the results of attempts at
treatment so far. Such individuals pose a significant risk to the eradication
programme unless they can be identified and treated. N. Ref:: 12
----------------------------------------------------
[99]
TÍTULO / TITLE: - Maximizing optimal
hematopoietic stem cell donor selection from registries of unrelated adult
volunteers.
REVISTA
/ JOURNAL: - Tissue Antigens 2003 Jun;61(6):415-24.
AUTORES
/ AUTHORS: - Hurley CK; Fernandez Vina M; Setterholm M
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, CW Bill Young
Marrow Donor Recruitment and Research Program, Georgetown University Medical
Center, 3970 Reservoir Road NW, Washington, DC 20057, USA. hurleyc@georgetown.edu
RESUMEN
/ SUMMARY: - Today, more than 50 registries of
HLA-typed potential adult hematopoietic stem cell donors have been established
in 40 countries and include more than 7.5 million volunteers. HLA testing of
new volunteers includes HLA-A, -B and often -DR typing at low to intermediate
resolution. Searching patients are tested for these same loci, preferably at a
higher level of resolution. Over 95,000 patient searches are received by registries
annually resulting in approximately 4660 unrelated transplants. In 2001, nearly
one-third of transplants involved a patient in one country receiving stem cells
from a donor in another. The diversity of the HLA system complicates the search
process, requiring sophisticated registry algorithms for matching, and
expertise in allele and haplotype frequencies and associations to design search
strategies. Within registries, HLA frequency data have been used to evaluate
optimal registry size and composition. N.
Ref:: 76
----------------------------------------------------
[100]
TÍTULO / TITLE: - Idiopathic interstitial
pneumonias: a re-appraisal of idiopathic pulmonary fibrosis.
REVISTA
/ JOURNAL: - Int J Tuberc Lung Dis 2001
Dec;5(12):1086-98.
AUTORES
/ AUTHORS: - Taylor DA; du Bois RM
INSTITUCIÓN
/ INSTITUTION: - Royal Brompton Hospital, London, UK.
RESUMEN
/ SUMMARY: - Over the last 30 years the clinical and
histopathological definitions of the diffuse lung diseases have evolved
considerably. Initially pathological entities were defined in parallel with
clinico-radiological diagnoses, but these have more recently become
consolidated into a more meaningful combined classification. These refinements
have impacted on the diffuse lung diseases in particular, and have defined
individual diseases more precisely than in previous classifications in which a
number of distinct entities had been grouped together and mistaken for
idiopathic pulmonary fibrosis, resulting in much confusion. The American
Thoracic and European Respiratory Societies’ committees, charged with the task
of defining the idiopathic interstitial pneumonias, have recently published a
statement on idiopathic pulmonary fibrosis, and a statement on the other
idiopathic interstitial pneumonias should follow this year. Of these diseases,
idiopathic pulmonary fibrosis is the most lethal, and this review deals with
the impact that the changes in the nomenclature will have on our understanding
of this and the other diseases with which idiopathic pulmonary fibrosis was
previously confused and explores the implications of our new understanding on
clinical practice. It also attempts to highlight areas of previous dogma in the
literature that now need to be re-considered in the context of these more recent
statements. N. Ref:: 87
----------------------------------------------------
[101]
TÍTULO / TITLE: - DNA analysis to find
rare blood donors when antisera is not available.
REVISTA
/ JOURNAL: - Vox Sang 2002 Aug;83 Suppl 1:91-3.
AUTORES
/ AUTHORS: - Reid ME
INSTITUCIÓN
/ INSTITUTION: - Immunochemistry Laboratory, New York Blood
Center, New York, NY, USA. marion_reid@nybc.org
RESUMEN
/ SUMMARY: - In order to screen for antigen-negative
blood donors, it is necessary to have appropriate, potent antisera in
sufficient volume. Anti-Do(a) and anti-Do(b) are notoriously weakly reactive
antibodies, available only in small volumes, usually in sera containing other
alloantibodies, and often deteriorate on storage. Thus, it has not been
possible to test large numbers of blood samples to find Do (a-) or Do (b-)
blood donors. At the NYBC, we now type selected donors for DOA and DOB by DNA
analysis. Initially, we tested DNA prepared from donors who had been typed by
hemagglutination for one or both antigens. We found that four donors, whose
RBCs previously typed as Do (a+b-), had both DOA and DOB alleles, and when
retested, the RBCs were Do (a+b+w). We have now tested over 300 donors for DO
by PCR-RFLP using either Eam1105 I or BseRI restriction enzymes. Blood from
DOA/DOA donors has survived better than “crossmatch compatible” blood for
patients with anti-Do(b) and such results suggest that anti-Do(b) is a more
frequent cause of transfusion reactions than reported. Furthermore, we have
demonstrated that PCR-RFLP can be used to screen for antigen-negative donors in
other blood group systems when appropriate antisera are not available. When
interpreting the results, it is important to remember that the genotype may not
reflect the phenotype. Our strategy has been to perform DNA analysis for the DO
alleles on those donors who have been shown by hemagglutination to lack
antigens corresponding to multiple alloantibodies in patients’ plasma. In this
way, we have been able to supply rare blood to numerous patients, whose serum
contained at least 5 additional alloantibodies of clinical significance. N. Ref:: 19
----------------------------------------------------
[102]
TÍTULO / TITLE: - Protocol biopsies
should be part of the routine management of kidney transplant recipients. Pro.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Oct;40(4):671-3.
AUTORES
/ AUTHORS: - Rush D
INSTITUCIÓN
/ INSTITUTION: - Winnipeg Transplant Program Winnipeg,
Manitoba, Canada.
----------------------------------------------------
[103]
TÍTULO / TITLE: - Discovery: HLA and
disease.
REVISTA
/ JOURNAL: - Curr Opin Rheumatol 2003 Jul;15(4):369-73.
AUTORES
/ AUTHORS: - Brewerton DA
INSTITUCIÓN
/ INSTITUTION: - University of London, England. Derrick.Brewerton@btinternet.com
RESUMEN
/ SUMMARY: - This article is a personal account of the
author’s involvement in the discovery of HLA associations with ankylosing
spondylitis; Reiter disease; acute anterior uveitis; and the arthropathies
associated with psoriasis, chronic inflammatory bowel disease, and
sarcoidosis. N.
Ref:: 20
----------------------------------------------------
[104]
TÍTULO / TITLE: - Regulation of dopamine
cell type and transmitter function in fetal and stem cell transplantation for
Parkinson’s disease.
REVISTA
/ JOURNAL: - Prog Brain Res 2002;138:411-20.
AUTORES
/ AUTHORS: - Bjorklund LM; Isacson O
INSTITUCIÓN
/ INSTITUTION: - Udall Parkinson’s Disease Research Center
of Excellence, Neuroregeneration Laboratories, McLean Hospital/Harvard Medical
School, Belmont, MA 02478, USA. N.
Ref:: 74
----------------------------------------------------
[105]
TÍTULO / TITLE: - The mind of primitive
anthropologists: hemoglobin and HLA, patterns of molecular evolution.
REVISTA
/ JOURNAL: - Hum Biol 2003 Aug;75(4):577-84.
AUTORES
/ AUTHORS: - Williams RC
INSTITUCIÓN
/ INSTITUTION: - Department of Anthropology, Arizona State
University, Tempe, AZ 85257, USA.
RESUMEN
/ SUMMARY: - Frank Livingstone played a central role in
defining the population genetics of the sickle cell mutation at position 6 of
the human beta globin gene, the most famous amino acid substitution in
evolutionary biology. Its discovery occurred at a time when traditional, 19th-century
principles of natural selection were being joined with the newly discovered
mechanics of DNA structure and protein synthesis to produce Neo-Darwinian
theory. When combined with the epidemiology of malaria in Africa, differential
mortality for both homozygotes, and the resulting advantage of the
heterozygote, sickle cell became the classic balanced polymorphism. Human HLA-A
has 237 molecular alleles. The histocompatibility system has as its primary
function the presentation of peptides to T-cell receptors and plays an
essential role in the immune system. Nearly all of the alleles are codominant
and fully functional. Despite almost 30 years of disease-association studies
with HLA-A, no convincing evidence has been found for differential fertility or
mortality at this locus. Yet the dogma in the histocompatibility field is that
this extensive human polymorphism is maintained by “balancing selection.”
Explaining HLA-A polymorphism is what one might call the sickle-cell-effect.
This one mutation, coming as it did at the historical convergence of Darwinian
theory and modern genetics, and carrying with it the strong relationship
between mutation, disease, and allele frequency, has conditioned our discussion
of human genetic variation and population genetics. Has the strength of this
early idea made evolutionary biologists uncritical of systems like HLA-A and
retarded the search for new mechanisms of molecular evolution? Is it now time
to move away from a focus on mutation and polymorphism in evolutionary genetics
and toward a systems theory that would explain the origin and evolution of
hemoglobin and HLA-A and the biochemical pathways that surround them? N. Ref:: 22
----------------------------------------------------
[106]
TÍTULO / TITLE: - Outcomes in kidney
transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 May;23(3):306-16.
AUTORES
/ AUTHORS: - Djamali A; Premasathian N; Pirsch JD
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and Surgery,
University of Wisconsin Medical School, Madison, WI 53792, USA.
RESUMEN
/ SUMMARY: - It is estimated that there are greater
than 100000 kidney transplant recipients with a functioning graft in the United
States. Recent advances in immunosuppression have improved short-term graft
survival rates and decreased early mortality by decreasing the incidence and
therapy for acute rejection episodes. For those accepted on the waiting list,
transplant prolongs patient survival compared with remaining on dialysis.
During the 1990s, 3 new immunosuppressive drugs were introduced in clinical
kidney transplantation. All were approved for use by the Food and Drug
Administration after large, controlled, randomized trials. Mycophenolate
mofetil (MMF), when combined with cyclosporine (CSA) and prednisone, lowered
acute rejection rates by nearly 50% compared with control. Tacrolimus compared
with CSA also significantly reduced acute rejection rates in kidney transplant
recipients, but was associated with a significant increase in posttransplant
diabetes mellitus (PTDM) in the early trials. When evaluated in combination
with MMF, the incidence of PTDM was much lower. At the end of the decade,
sirolimus was shown in several randomized trials to lower acute rejection rates
and is believed to be less nephrotoxic compared with calcineurin inhibitors.
All of the randomized trials were not statistically powered to assess long-term
superiority. Registry analyses have been performed that appear to show some
long-term benefit of immunosuppressive therapy with MMF. Other outcome
assessments in kidney transplant recipients include risk factors for chronic
allograft nephropathy, hypertension, hyperlipidemia, and bone disease. Although
there are few randomized trials, understanding of the significance of these
common complications has progressed and strategies for therapy and intervention
have been developed. This article focuses on the randomized trials of
immunosuppressive therapy and complications associated with use of these drugs.
In addition, we review the current management and intervention for the
comorbidities associated with the long-term clinical management of the kidney
transplant recipient. N.
Ref:: 78
----------------------------------------------------
[107]
TÍTULO / TITLE: - Evolution of
immunosuppression and continued importance of acute rejection in renal
transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S2-9.
AUTORES
/ AUTHORS: - Chan L; Gaston R; Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, University
of Colorado Health Sciences Center, Denver, CO 80262, USA. Larry.Chan@uchsc.edu
RESUMEN
/ SUMMARY: - As steady improvement in short-term kidney
graft survival and long-term outcomes prolongs the lives of transplant
patients, responsibility for their care is shifting away from transplant
specialists and into the hands of community nephrologists. Therefore, community
nephrologists need to have a deeper understanding of immunosuppressive
therapies than ever before. Pharmacologic immunosuppression has been
continuously evolving over the past two decades. Azathioprine was introduced in
the early 1960s. Introduction of cyclosporine (CsA) in 1983 revolutionized
short-term outcomes after renal transplantation. The first monoclonal antibody
immunosuppressant, OKT3, was introduced in 1986. The 1990s saw the introduction
of a number of important new agents, including mycophenolate mofetil (MMF),
tacrolimus, and a microemulsion CsA, as well as two new monoclonal antibodies.
Combinations of these new agents, along with improving clinical care, have
produced 1-year patient survival approaching 100% and graft survival exceeding
90%. The newest class of agents, the first of which is sirolimus, is called
target of rapamycin (TOR) inhibitors and is used with CsA for maintenance
therapy. Immunosuppressive drug therapy after kidney transplantation continues
to evolve. There is a variety of pharmacologic combinations from which to
choose, based on immunologic risk and side effect profiles. As new regimens are
developed, ongoing communications between the transplant center and community
nephrologists will be required to implement therapeutic changes and optimize
patient care successfully. N.
Ref:: 59
----------------------------------------------------
[108]
- Castellano -
TÍTULO / TITLE:Los nuevos conocimientos sobre las
moleculas HLA de clase II y una mejor asignacion de los organos para
trasplante. New knowledge on HLA class II molecules and a better selection of
organs for transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22(1):4-8.
AUTORES
/ AUTHORS: - Torres MJ; Rodriguez Perez JC N. Ref:: 21
----------------------------------------------------
[109]
TÍTULO / TITLE: - Negative T cell
costimulation and islet tolerance.
REVISTA
/ JOURNAL: - Diabetes Metab Res Rev 2003
May-Jun;19(3):179-85.
●●
Enlace al texto completo (gratuito o de pago) 1002/dmrr.345
AUTORES
/ AUTHORS: - Gao W; Demirci G; Li XC
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Harvard Medical
School, Division of Immunology, Beth Israel Deaconess Medical Center, 99
Brookline Avenue, Boston, MA 02215, USA. wgao@caregroup.harvard.edu
RESUMEN
/ SUMMARY: - Activation of self-reactive T cells that
specifically destroy the pancreatic beta-cells is one of the hallmarks in the
development of type 1 diabetes. Thus, for prevention and treatment of this
autoimmune disease, approaches to induce and maintain T cell tolerance toward
the beta-cells, especially in islet transplantation, have been actively
pursued. Noticeably, many of the recent protocols for inducing transplant
tolerance involve blockade of positive T cell costimulation extrinsically.
Though highly effective in prolonging graft survival, these strategies alone
might not be universally sufficient to achieve true tolerance. As the mystery of
the suppressive and regulatory T cells unfolds, it is becoming appreciated that
exploiting the intrinsic molecular and cellular mechanisms that turn off an
immune response would perhaps facilitate the current protocols in establishing
T cell tolerance. In this perspective, here we summarize the recent findings on
the negative costimulation pathways, in particular, the newly identified PD-1 :
PD-L interactions. On the basis of these observations, we propose a new
principle of curtailing pathogenic T cell response in which blockade of
positive T cell costimulation is reinforced by concurrent engagement of the
negative costimulation machinery. Such a strategy may hold greater hope for
therapeutic intervention of transplant rejection and autoimmune diseases. N. Ref:: 85
----------------------------------------------------
[110]
TÍTULO / TITLE: - Mycophenolate mofetil:
a pharmacoeconomic review of its use in solid organ transplantation.
REVISTA
/ JOURNAL: - Pharmacoeconomics 2002;20(10):675-713.
AUTORES
/ AUTHORS: - Young M; Plosker GL
INSTITUCIÓN
/ INSTITUTION: - Adis International Ltd, Auckland, New
Zealand.
RESUMEN
/ SUMMARY: - Most pharmacoeconomic studies of
mycophenolate mofetil have focused on its use as part of maintenance
immunosuppression for renal transplantation, involving short-term (3 to 12
months) time frames. In general, mycophenolate mofetil reduced the treatment
costs for rejection episodes and graft failure which offset its higher drug
acquisition cost compared with azathioprine. Several cost analyses have been
modelled on the large multicentre trials of adult renal transplant recipients.
The use of mycophenolate mofetil was associated with either cost savings or no
additional costs after 6 or 12 months in French, US and Canadian analyses of
triple or quadruple immunosuppressant therapy. A further cost analysis
utilising a registry database of renal transplant recipients in the US found
mycophenolate mofetil to be cost saving compared with azathioprine after 6.4
years when evaluating costs due to graft loss only. Of the limited
cost-effectiveness analyses with the drug, one US study modelled the 1- and
10-year cost effectiveness of mycophenolate mofetil and various other
immunosuppressants used in combined regimens. Long-term use of mycophenolate
mofetil was less cost effective than other regimens, but the use of long-term
mycophenolate mofetil in high-risk patients was shown to be a relatively
cost-effective strategy. In another US analysis comparing mycophenolate mofetil
with azathioprine as part of quadruple therapy, mycophenolate mofetil was
associated with slightly lower costs during the first year after renal
transplantation as well as improved clinical outcomes. Conclusion:
Pharmacoeconomic studies support the use of mycophenolate mofetil as part of
immunosuppressant therapy in renal transplantation, at least in the short term.
Although the cost effectiveness of mycophenolate mofetil in the long term is
less clear, limited pharmacoeconomic data available appear promising. Among
issues to be examined in future economic analyses in renal transplantation are
the calcineurin-sparing potential of mycophenolate mofetil and the feasibility
of using more efficient mycophenolate mofetil dosage regimens when using the
drug on a long-term basis. Additional pharmacoeconomic analyses of
mycophenolate mofetil are also needed in other types of solid organ
transplantation. N.
Ref:: 155
----------------------------------------------------
[111]
TÍTULO / TITLE: - A standardized protocol
for the treatment of severe pneumonia in kidney transplant recipients.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Dec;16(6):450-4.
AUTORES
/ AUTHORS: - Sileri P; Pursell KJ; Coady NT; Giacomoni
A; Berliti S; Tzoracoleftherakis E; Testa G; Benedetti E
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, Infectious
Diseases, University of Illinois at Chicago Medical Center, USA.
RESUMEN
/ SUMMARY: - Although the incidence of pneumonia after
kidney transplantation is the lowest among all solid organ transplants, it is
associated with high mortality rate (40-50%). We evaluated the efficacy of a
protocol consisting of bronco-alveolar-lavage (BAL) for early microbiological
diagnosis, reduction of the immunosuppressive therapy, and prompt
administration of standardized antibiotic regimen in renal transplant
recipients with severe pneumonia. Between 6/1989 and 5/1999, 40 kidney
transplant recipients developed 46 episodes of severe pneumonia (hypoxia and/or
infiltrate on the chest X-ray). According to protocol, in all these cases, a
BAL was immediately performed and empirical antibiotic therapy was initiated
with erythromycin and trimethoprim-sulfamethoxazole i.v. Furthermore, the
immunosuppressive therapy was drastically reduced. Analyses of BAL fluid
included cell differential count, cytopathologic examination and cultures for
bacteria, fungi and viruses. Within 48 h, the therapy was switched to proper
i.v. antibiotics, if necessary, according to the results of sensitivity testing
of BAL specimens. The mortality rate was 12.5% (5 of 40). Mechanical
ventilation was required in 20 cases (34.5%) and four of the patients that
required intubation died. BAL alone established a diagnosis in 67.4% (31 of 46)
of the patients. Bacteria were responsible for 61% of the episodes, with fungi
responsible for 29% and viruses for 10%. Seven cases of Pneumocystis carinii
pneumonia were treated with the prolongation of the initial therapy. We
conclude that a combination of early detection of the responsible pathogen by
BAL, aggressive reduction of the immunosuppressive therapy and the immediate
empirical administration of erythromycin and trimethoprim-sulfamethoxazole is
an effective strategy to treat pneumonia kidney transplantation (KTX)
recipients.
----------------------------------------------------
[112]
TÍTULO / TITLE: - How to manage patients
with lupus nephritis.
REVISTA
/ JOURNAL: - Best Pract Res Clin Rheumatol 2002
Apr;16(2):195-210.
●●
Enlace al texto completo (gratuito o de pago) 1053/berh.2001.0221
AUTORES
/ AUTHORS: - Esdaile JM
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology, University of
British Columbia, Canada.
RESUMEN
/ SUMMARY: - The clinical and renal biopsy predictors
of assistance in determining therapy are reviewed. While pulse cyclophosphamide
remains the most effective treatment for proliferative nephritis, there is
increasing interest in other agents, such as azathioprine, particularly to
maintain remission. While lupus membranous nephropathy has attracted limited
study, preliminary work suggests a role for cyclophosphamide. Newer therapies,
including cyclosporine A, mycophenolate mofetil, immunoadsorption, intravenous
immune globulin, LJP-394, high-dose immunoablation and nucleoside analogues
require further study but offer hope for those failing conventional
treatments. N. Ref:: 60
----------------------------------------------------
[113]
TÍTULO / TITLE: - Cost-effectiveness
analysis of basixilimab induction and calcineurin-sparing protocols in “old to
old” programs using Markov models.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1324-5.
AUTORES
/ AUTHORS: - Emparan C; Wolters H; Laukotter M; Dame C;
Senninger N
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Uniklinikum, Munster, Germany. cemparan@teleline.es
RESUMEN
/ SUMMARY: - INTRODUCTION: Markov models are employed
in economic analyses to evaluate all possible expectations in a dilemna. The
introduction of a new clinical protocol (basiliximab induction with
calcineurin-sparing protocols) for a group of kidney transplant recipients
receiving organs from marginal donors was validated with a Markov simulation
model. HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2/antibody
induction (Simulect) show a beneficial effect on initial kidney function,
reducing transplantation costs reception based upon mean length of stay, mean
admission cost, and incidences of delayed graft function and complications
during the first month after transplant. PATIENTS AND METHODS: A Markov
simulation model was established following three different chains. A
calcineurin-free regimen with basiliximab induction (chain A), a
calcineurin-sparing protocol with basiliximab induction (chain B), and a
conventional immunosuppressive regimen (chain C). After designing the Markov
chain and cohorts, 31 patients from the “old to old” program were assigned to
each chain eight to chain A, (eight to chain B, and 15 to chain C). A month
after transplantation a cost-benefit study was performed guided by the three
branches of the Markov model. RESULTS: The Markov model showed a benefit of
induction therapies in elderly patients. A cost-benefit model showed that after
a month there was a clear benefit from Calcineurin=free plus basiliximab
induction therapies, with a slight benefit from calcineurin-sparing protocols.
CONCLUSIONS: Markov models are extremely useful when introducing new clinical
therapies. In our transplant program, a cost-effective analysis of outcomes in
old patients using the Markov model showed a clear benefit of
calcineurin-sparing protocols with basixilimab induction.
----------------------------------------------------
[114]
TÍTULO / TITLE: - Association between
nasal methicillin-resistant Staphylococcus aureus carriage and infection in
liver transplant recipients.
REVISTA
/ JOURNAL: - Liver Transpl 2001 Aug;7(8):752-4.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2001.0070752
AUTORES
/ AUTHORS: - Patel R
INSTITUCIÓN
/ INSTITUTION: - Mayo Clinic, 200 First St SW, Rochester,
MN 55905, USA. N.
Ref:: 18
----------------------------------------------------
[115]
TÍTULO / TITLE: - Protocol biopsies
should be part of the routine management of kidney transplant recipients. Con.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Oct;40(4):674-7.
AUTORES
/ AUTHORS: - Salomon DR
INSTITUCIÓN
/ INSTITUTION: - Department of Molecular and Experimental
Medicine, The Scripps Research Institute, and Center for Organ and Cell
Transplantation, Scripps Health, La Jolla, CA, USA.
----------------------------------------------------
[116]
TÍTULO / TITLE: - The screening,
identification and use of rare blood.
REVISTA
/ JOURNAL: - Vox Sang 2002 Aug;83 Suppl 1:99-100.
AUTORES
/ AUTHORS: - Poole J
INSTITUCIÓN
/ INSTITUTION: - International Blood Group Reference
Laboratory, Bristol UK. joyce.poole@nbs.nhs.uk N. Ref:: 3
----------------------------------------------------
[117]
TÍTULO / TITLE: - The major factors and
weak links that must be considered to achieve safety in compatability testing.
REVISTA
/ JOURNAL: - Vox Sang 2002 Aug;83 Suppl 1:327-32.
AUTORES
/ AUTHORS: - Voak D; Knowles SM; Milkins CE; Chapman
JS; Scott M
INSTITUCIÓN
/ INSTITUTION: - NBS Cambridge, UK. tracy.mumford@nbs.nhs.uk N. Ref:: 48
----------------------------------------------------
[118]
TÍTULO / TITLE: - Guidelines for
nomenclature usage in HLA reports: ambiguities and conversion to serotypes.
REVISTA
/ JOURNAL: - Eur J Immunogenet 2002 Jun;29(3):273-4.
AUTORES
/ AUTHORS: - Tiercy JM; Marsh SG; Schreuder GM; Albert
E; Fischer G; Wassmuth R
INSTITUCIÓN
/ INSTITUTION: - Transplantation Immunology Unit,
University Hospital, Geneva, Switzerland. jean-marie.tiercy@medecine.unige.ch
----------------------------------------------------
[119]
TÍTULO / TITLE: - Issues of adherence to
immunosuppressant therapy after solid-organ transplantation.
REVISTA
/ JOURNAL: - Drugs 2002;62(4):567-75.
AUTORES
/ AUTHORS: - Chisholm MA
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical and Administrative
Sciences, University of Georgia College of Pharmacy and Department of Medicine,
Medical College of Georgia, Augusta, Georgia, USA. mchishol@mail.mcg.edu
RESUMEN
/ SUMMARY: - Nonadherence to immunosuppressant therapy
constitutes a major barrier to post-transplant care. Failure of transplant
recipients to take prescribed drugs properly may not only be a significant obstacle
to optimal graft function but it may also result in decreased quality of life
and productivity, increased morbidity and healthcare cost, and death. Despite
the obvious importance of adherence to immunosuppressant therapy, nonadherence
is frequent among transplant recipients, with rates ranging from 2 to 68%. This
manuscript briefly discusses several issues concerning adherence to
immunosuppressant therapy of solid-organ transplant recipients; presents a
literature review concerning adherence to immunosuppressant therapy by
solid-organ transplant recipients; and suggests strategies that may be used to
enhance medication adherence. Although many of the studies have results that
conflict concerning factors associated with immunosuppressive nonadherence, most
of the investigators concluded that nonadherent behaviour is usually not
predictable. Because of possible adverse events, emphasis should be placed on
increasing medication adherence in all transplant recipients. N. Ref:: 28
----------------------------------------------------
[120]
TÍTULO / TITLE: - Molecular determinants
of UV-induced immunosuppression.
REVISTA
/ JOURNAL: - Exp Dermatol 2002;11 Suppl 1:9-12.
AUTORES
/ AUTHORS: - Schwarz A; Schwarz T
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
Munster, Von-Esmarch-Strasse 58, D-48149 Munster, Germany.
RESUMEN
/ SUMMARY: - It is almost three decades ago that it was
discovered that ultraviolet radiation (UV) can compromise the immune system. UV
suppresses immune responses in several ways. It inhibits the function of
antigen-presenting cells, induces T cells with suppressor activity and induces
the release of immunosuppressive cytokines. The latter phenomenon is mainly
responsible for systemic immunosuppression. Although UV can also target
cytoplasmic and cell membrane components, UV-induced DNA damage has been
recognized as the most important molecular structure in mediating UV-induced
immunosuppression. Recently, it was observed that interleukin-12 (IL-12), which
antagonizes UV-induced immunosuppression, can accelerate the removal of
UV-induced DNA lesions, probably via inducing DNA repair. Hence, it is tempting
to speculate that the activity of IL-12 to reduce UV-induced immunosuppression
may be due at least partially to this new biological activity of IL-12. N. Ref:: 27
----------------------------------------------------
[121]
TÍTULO / TITLE: - Recipient screening
prior to solid-organ transplantation.
REVISTA
/ JOURNAL: - Clin Infect Dis 2002 Dec 15;35(12):1513-9.
Epub 2002 Dec 3.
AUTORES
/ AUTHORS: - Avery RK
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases and
Transplant Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. averyr@ccf.org
RESUMEN
/ SUMMARY: - Screening a potential transplant recipient
for infectious diseases is an important component of the transplantation
process. Such screening may lead to the discovery and treatment of occult
active infection, may help determine posttransplant prophylactic strategies, or
may disqualify the recipient from receiving a transplant. The pretransplant
period also affords an opportunity for updating vaccination status and
providing education regarding the reduction of posttransplant infectious risks.
The present brief review will outline the investigation of preexisting active
infection, as well as latent bacterial, mycobacterial, fungal, parasitic, and
viral infections. Recommendations for pretransplant immunization and education
are provided. N.
Ref:: 45
----------------------------------------------------
[122]
TÍTULO / TITLE: - Tolerance protocols and
cell transplantation: prospects for the clinic.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3):1248-9.
AUTORES
/ AUTHORS: - Calne RY
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Cambridge (Addenbrooke’s Hospital), Douglas House Annexe, 18 Trumpington Rd,
Cambridge, CB2 2AH UK.
----------------------------------------------------
[123]
TÍTULO / TITLE: - An outbreak of
mediastinitis among heart transplant recipients apparently related to a change
in the united network for organ sharing guidelines.
REVISTA
/ JOURNAL: - Infect Control Hosp Epidemiol 2002
Jul;23(7):377-81.
AUTORES
/ AUTHORS: - Samuel R; Axelrod P; John KS; Fekete T;
Alexander S; McCarthy J; Truant A; Todd B; Furukawa S; Eisen H; Spotnitz W
INSTITUCIÓN
/ INSTITUTION: - Section of Infectious Diseases, Temple
University Hospital, Philadelphia, Pennsylvania, 19140, USA.
RESUMEN
/ SUMMARY: - OBJECTIVE: To describe an outbreak of
mediastinitis in heart transplant recipients. DESIGN: Retrospective and
contemporaneous cohort SETTING: Urban tertiary-care university hospital with a
large cardiac transplantation program. PATIENTS: Heart transplant recipients.
INTERVENTIONS: Modifications of donor harvest technique; procedures aimed at
decreasing skin and mucosal bacterial colonization; strict aseptic technique in
the intensive care unit; and aggressive policing of established infection
control practices. RESULTS: In April 1999, mediastinitis rates among heart
transplant recipients increased abruptly from a baseline of 6 cases per 100
procedures to sequential quarterly rates of 22, 31, and 50 cases per 100
procedures, whereas infection rates in other cardiac operations were unchanged.
Bacteria causing these infections were multidrug-resistant “nosocomial”
organisms. The epidemic occurred 2 months after a change in the United Network
for Organ Sharing organ allocation algorithm. This change resulted in an
increase in the duration of preoperative hospitalization from a median of 52 to
79 days (P = .008) and may have promoted prolonged hospitalization of patients
with high illness severity. Aggressive multidisciplinary interventions were
temporally associated with a return to preoperative mediastinitis rates without
changing length of hospitalization prior to transplantation. CONCLUSIONS:
Changes in organ allocation for transplant that prolong waiting time in the
hospital and alter illness acuity may lead to increased rates of postoperative
infection. Measures to limit bacterial colonization may be a helpful
countervailing strategy.
----------------------------------------------------
[124]
TÍTULO / TITLE: - Immunizations in adult
immunocompromised patients: which to use and which to avoid.
REVISTA
/ JOURNAL: - Cleve Clin J Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.ccjm.org/
●●
Cita: Cleveland Clinic J. of Medicine: <> 2001 Apr;68(4):337-48.
AUTORES
/ AUTHORS: - Avery RK
INSTITUCIÓN
/ INSTITUTION: - Department of Infectious Diseases and
Transplant Center, Cleveland Clinic, USA. averyr@ccf.org
RESUMEN
/ SUMMARY: - Immunization is important to protect
immunocompromised patients from preventable infectious disease but is often
underused. Although live vaccines are contraindicated for most
immunocompromised patients, many killed or component vaccines are safe and
recommended. Vaccines may sometimes induce suboptimal immunogenicity, but even
partial protection may benefit severely ill patients. KEY POINTS: Vaccines
against Streptococcus pneumoniae and influenza are strongly recommended for
most immunosuppressed patients. When possible, immunization series should be
completed before procedures that require or induce immunosuppression, such as
organ transplantation or chemotherapy. If this is not possible, the patient may
mount only a partial immune response, but even this partial response can be
beneficial. Patients who undergo allogeneic bone marrow’ transplantation lose
preexisting immunities against a variety of diseases and should be
revaccinated. In many situations, family members should be vaccinated to
protect the patient. However, oral live polio vaccine should be avoided because
it may carry the risk of infecting the patient. N. Ref:: 39
----------------------------------------------------
[125]
TÍTULO / TITLE: - The MHC haplotype
project: a resource for HLA-linked association studies.
REVISTA
/ JOURNAL: - Tissue Antigens 2002 Jun;59(6):520-1.
AUTORES
/ AUTHORS: - Allcock RJ; Atrazhev AM; Beck S; de Jong
PJ; Elliott JF; Forbes S; Halls K; Horton R; Osoegawa K; Rogers J; Sawcer S;
Todd JA; Trowsdale J; Wang Y; Williams S
INSTITUCIÓN
/ INSTITUTION: - University of Cambridge, UK. N. Ref:: 0
----------------------------------------------------
[126]
TÍTULO / TITLE: - Computerization in the
transfusion service.
REVISTA
/ JOURNAL: - Vox Sang 2002 Aug;83 Suppl 1:105-10.
AUTORES
/ AUTHORS: - Butch SH
INSTITUCIÓN
/ INSTITUTION: - Blood Bank & Transfusion Service, Ann
Arbor, MI, USA. butchs@med.umich.edu N. Ref:: 16
----------------------------------------------------
[127]
TÍTULO / TITLE: - Trends in transplantation
of hematopoietic stem cells from unrelated donors.
REVISTA
/ JOURNAL: - Curr Opin Hematol 2001 Nov;8(6):337-41.
AUTORES
/ AUTHORS: - Anasetti C; Petersdorf EW; Martin PJ;
Woolfrey A; Hansen JA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Oncology, University of Washington, Seattle, Washington, USA. canasett@fhcrc.org
RESUMEN
/ SUMMARY: - Transplants of hematopoietic stem cells
from unrelated donors have become feasible for patients with a growing variety
of hematologic disorders. The probability of finding a suitable donor has
increased because of the expansion of the network of registries containing more
than seven million HLA-typed donors worldwide. The selection of compatible
donors has become more effective, thanks to the discovery of new HLA alleles
and the development of precise and efficient HLA typing methods using DNA
technology. Improved methods for transplantation may provide the opportunity to
further decrease treatment-related toxicity and improve survival. N. Ref:: 54
----------------------------------------------------
[128]
TÍTULO / TITLE: - Immunotherapy of
multiple sclerosis—current practice and future directions.
REVISTA
/ JOURNAL: - J Rehabil Res Dev. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://www.vard.org/
●●
Cita: J. of Rehabilitation Research & Development: <> 2002
Mar-Apr;39(2):273-85.
AUTORES
/ AUTHORS: - Tullman MJ; Lublin FD; Miller AE
INSTITUCIÓN
/ INSTITUTION: - The Corinne Goldsmith Dickinson Center for
Multiple Sclerosis, Mount Sinai Medical Center, New York, NY 10029, USA. gmtullman@aol.com
RESUMEN
/ SUMMARY: - Over the past decade, multiple sclerosis
(MS) has become a treatable neurological disease. This paper reviews the
therapies that have been studied to treat MS and discusses various treatment
approaches on the horizon. Immunosuppressive and immunomodulatory therapies
have been shown to alter the long-term course of MS. Therapies are currently
available for relapsing-remitting, secondary progressive, and progressive
relapsing disease. Although effective, these therapies have a modest impact on
reduction in relapse rate and slowing of disease progression. Much work is
needed to improve upon this modest effect and hopefully obtain a cure. N. Ref:: 81
----------------------------------------------------
[129]
TÍTULO / TITLE: - Nomenclature for
factors of the dog major histocompatibility system (DLA), 2000: Second report
of the ISAG DLA Nomenclature Committee.
REVISTA
/ JOURNAL: - Tissue Antigens 2001 Jul;58(1):55-70.
AUTORES
/ AUTHORS: - Kennedy LJ; Angles JM; Barnes A; Carter
SD; Francino O; Gerlach JA; Happ GM; Ollier WE; Thomson W; Wagner JL
INSTITUCIÓN
/ INSTITUTION: - Mammalian Immunogenetics Research Group,
Veterinary Clinical Sciences, University of Liverpool, United Kingdom. Lorna.Kennedy@man.ac.uk
RESUMEN
/ SUMMARY: - The ISAG DLA Nomenclature Committee met
during the “Comparative Evolution of the Mammalian MHC” meeting in Manchester,
England on 10th September 2000. The main points discussed were the
naming of class I genes and alleles, and the inclusion of alleles from other canidae.
----------------------------------------------------
[130]
TÍTULO / TITLE: - Selection of unrelated
bone marrow donors by serology, molecular typing and cellular assays.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 Aug;10(2-3):215-21.
AUTORES
/ AUTHORS: - Tiercy JM; Villard J; Roosnek E
INSTITUCIÓN
/ INSTITUTION: - National Reference Laboratory for
Histocompatibility, University Hospital, Geneva, Switzerland. jean-marie.tiercy@medecine.unige.ch
RESUMEN
/ SUMMARY: - As compared to hematopoietic stem cell
transplantation (HSCT) with HLA genotypically identical donors, phenotypically
matched unrelated HSCT is associated with lower survival. Serologically
undisclosed HLA disparities account for the increased rate of post-transplant
complications. With more than 1300 alleles currently identified,
high-resolution molecular typing techniques have to be applied to distinguish
the extensive degree of allelic polymorphism of the HLA system. Whereas a
HLA-ABDR-serologically identical donor can be identified in the International
Registry for >90% of the patients, only half of them can benefit of a highly
compatible donor if donor selection is based on allele level matching for
HLA-A/B/Cw/DRB1/B3/B5/DQB1 loci. During the last 10 years, we identified only
approximately 20% of all known HLA alleles in the searches for our mainly
Caucasoid patients. Rare alleles (i.e. alleles that represent <1% of a given
serotype) do not have a major impact in patient/donor matching. Most of the
incompatibilities are clustered in a limited number of serotypes that can be
targeted first during the searches. However, due to linkage disequilibrium
(e.g. B-Cw or DRB1-DQB1), incompatibilities at a given locus are often associated
with disparities at adjacent loci. In vitro cellular assays such as the
cytotoxic T-lymphocyte precursor frequency (CTLpf) analysis may contribute in
discriminating functionally relevant HLA class I disparities, as well as minor
antigen mismatches in case of sensitized donors. When a rare variant or an
uncommon association in the patient’s HLA haplotype has been found, the tissue
typing laboratory may recommend considering a mismatched donor early in the
search procedure instead of continuing a search with a low probability of
success. N. Ref:: 32
----------------------------------------------------
[131]
TÍTULO / TITLE: - Sirolimus eluting
stent: a new era in interventional cardiology?
REVISTA
/ JOURNAL: - Curr Pharm Des 2003;9(13):1077-94.
AUTORES
/ AUTHORS: - Windecker S; Roffi M; Meier B
INSTITUCIÓN
/ INSTITUTION: - Swiss Cardiovascular Center Bern,
University Hospital, Bern, Switzerland. Bernhard.Meier@insel.ch
RESUMEN
/ SUMMARY: - Coronary artery stents have emerged as the
preferred tool for percutaneous coronary interventions during the past decade
by eliminating abrupt vessel closure and reducing restenosis compared with
balloon angioplasty. While coronary artery stents prevent constrictive arterial
remodeling and elastic recoil, the implantation is associated with more severe
arterial vascular injury than balloon angioplasty alone. The arterial injury
initiates a vasculoproliferative response with smooth muscle cell proliferation
and migration as well as extracellular matrix formation, which may lead to
severe neointimal hyperplasia with in-stent restenosis in 10-30% of cases.
Sirolimus, a naturally occurring macrocyclic lactone, has been identified as a
pharmacological cell cycle inhibitor with potent antiproliferative and
antimigratory effects on vascular smooth muscle cells in vitro. The systemic
administration of sirolimus has been shown to effectively reduce neointimal
hyperplasia in experimental restenosis models. Subsequently, sirolimus has been
incorporated at therapeutically important doses into biocompatible polymers,
which made it suitable for stent-based drug elution. Investigation of sirolimus
eluting stents in both experimental and clinical restenosis studies have
demonstrated dramatic reductions in neointimal hyperplasia. Accordingly,
sirolimus eluting stents offer an attractive mode of local drug delivery by
minimizing systemic toxicity and maximizing local dose requirements. In
addition, sirolimus eluting stents hold great promise to effectively prevent
restenosis. N. Ref:: 104
----------------------------------------------------
[132]
TÍTULO / TITLE: - Liver transplantation
for acute liver failure—better safe than sorry.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Nov;8(11):1063-4.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.35850
AUTORES
/ AUTHORS: - Schiodt FV; Lee WM N. Ref:: 22
----------------------------------------------------
[133]
TÍTULO / TITLE: - Limited sampling
strategies for estimating cyclosporin area under the concentration-time curve:
review of current algorithms.
REVISTA
/ JOURNAL: - Ther Drug Monit 2001 Apr;23(2):100-14.
AUTORES
/ AUTHORS: - David OJ; Johnston A
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pharmacology, St.
Bartholomew’s & the Royal London School of Medicine and Dentistry, United
Kingdom.
RESUMEN
/ SUMMARY: - Cyclosporin, the drug of first choice in
transplantation surgery, is characterized by a low therapeutic index and
variable absorption, so close monitoring of the drug is required to optimize
the dosing. Predose blood cyclosporin levels are measured routinely for
therapeutic monitoring, but this approach is not optimal because the area under
the concentration-time curve (AUC) correlates better with clinical events.
However, conventional methods of measuring AUC require many blood samples,
which is not viable in a routine clinical setting. AUC monitoring can be
simplified for use in a clinical setting by using a limited sampling strategy
(LSS) that allows AUC to be estimated using a small number of blood samples
collected at specific times. This article reviews the current literature on
estimating cyclosporin AUC using LSS. Thirty-eight papers suggesting the use of
specific time points were found. LSS has been developed for different
transplant types, with different dosing regimens, and with different assays.
Most authors suggested either two- or three-sample equations. Results from
authors who validated their models suggest that equations defined on one
transplant type may be applicable to other transplant types, to both adults and
children, and to early or late after transplantation. Moreover, it seems that
there is flexibility in the choice of equations available to clinicians. The
number of samples to collect for accurate estimations is a matter of debate,
but a wise choice can minimize the number. The choice of the optimal LSS and
validation are discussed. N.
Ref:: 102
----------------------------------------------------
[134]
TÍTULO / TITLE: - Sunscreens and immune
protection.
REVISTA
/ JOURNAL: - Br J Dermatol 2002 Jun;146(6):933-7.
AUTORES
/ AUTHORS: - Baron ED; Stevens SR
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University
Hospitals of Cleveland/Case Western Reserve University, 11100 Euclid Avenue,
Cleveland, OH 44145, USA. N.
Ref:: 44
----------------------------------------------------
[135]
TÍTULO / TITLE: - The role of in vitro
alloreactive T-cell functional tests in the selection of HLA matched and
mismatched haematopoietic stem cell donors.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 Aug;10(2-3):205-14.
AUTORES
/ AUTHORS: - Jeras M
INSTITUCIÓN
/ INSTITUTION: - Blood Transfusion Centre of Slovenia,
Tissue Typing Center, Ljubljana. matjaz.jeras@mf.uni-lj.si
RESUMEN
/ SUMMARY: - Acute graft vs. host (GVH) disease and
graft rejection are most frequently caused by undetected or disregarded
genetically based disparities between the donor and recipient of bone marrow
derived haematopoietic stem cells (HSC). Incompatibilities in extremely
polymorphic human leukocyte antigens (HLA), and in certain cases also minor
histocompatibility antigens, represent the most important driving force of such
unwanted events, threatening the successful outcome of haematopoietic stem cell
transplantation (HSCT). The complexity of HLA polymorphism can be precisely and
elegantly detected at the genomic level by several polymerase chain reaction
(PCR) based techniques that have strongly backed up its predecessor, the far
less informative classical serological typing. By applying these modern
technologies, we gain the deepest insight into HLA allelic specificities and
thus the possibility to, for example, trace and recruit unrelated
histocompatible donors for a given patient. In the case when exclusively
related intrafamilial HSC donors are being considered, we are confined to the
fact that only 25-30% of patients can expect a completely HLA identical donor to
be found within core or extended family members. The number of related as well
as unrelated donors can be increased if certain HLA mismatches are accepted.
When doing so, the precise definition of disparate histocompatibilty antigens
between the patient and a possible donor should be carried out. But this does
not give us the information about the functional immunogenicity of such
differences. Therefore, in vitro functional assays, quantitating the
alloreactive potential of lymphocyte T subsets, the central immunocompetent
cells, are more than necessary. By evaluating mixed lymphocyte reaction (MLR),
the analysis of helper T cell precursor (HTLp) and cytotoxic T cell precursor
(CTLp) frequencies, the allogeneic impact of class II and class I HLA mismatches
between a donor and graft recipient can be assessed and permissive disparities
defined. N. Ref:: 69
----------------------------------------------------
[136]
TÍTULO / TITLE: - T cell anergy and
costimulation.
REVISTA
/ JOURNAL: - Immunol Rev 2003 Apr;192:161-80.
AUTORES
/ AUTHORS: - Appleman LJ; Boussiotis VA
INSTITUCIÓN
/ INSTITUTION: - Department of Medical Oncology,
Dana-Farber Cancer Institute, Boston, MA 02115, USA.
RESUMEN
/ SUMMARY: - T lymphocytes play a key role in immunity
by distinguishing self from nonself peptide antigens and regulating both the
cellular and humoral arms of the immune system. Acquired, antigen-specific
unresponsiveness is an important mechanism by which T cell responses to antigen
are regulated in vivo. Clonal anergy is the term that describes T cell
unresponsiveness at the cellular level. Anergic T cells do not proliferate or
secrete interleukin (IL)-2 in response to appropriate antigenic stimulation.
However, anergic T cells express the IL-2 receptor, and anergy can be broken by
exogenous IL-2. Anergy can be induced by submitogenic exposure to peptide
antigen in the absence of a costimulatory signal provided by soluble cytokines
or by interactions between costimulatory receptors on T cells and
counter-receptors on antigen-presenting cells. The molecular events that
mediate the induction and maintenance of T cell anergy are the focus of this
review. The molecular consequences of CD28-B7 interaction are discussed as a
model for the costimulatory signal that leads to T cell activation rather than
the induction of anergy. N.
Ref:: 221
----------------------------------------------------
[137]
TÍTULO / TITLE: - Immunogenetic selection
of donors for haematopoietic stem cell transplantation: an approach.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 Aug;10(2-3):223-5.
AUTORES
/ AUTHORS: - Fischer G
INSTITUCIÓN
/ INSTITUTION: - Department for Blood Group Serology,
Vienna, Austria. gottfried.fischer@univie.ac.at
RESUMEN
/ SUMMARY: - Histocompatibility between the patient and
his donor is a prerequisite for the success of transplantation of
haematopoietic stem cells (HSCT). Histocompatibility testing is clinically
performed by HLA typing. HLA typing can be highly informative if performed in
families. In this case, comparatively little typing effort often allows to
predict the identity of whole HLA haplotypes. HLA typing becomes more
demanding, however, if unrelated individuals have to be considered as donors.
Given the huge diversity of HLA molecules the answer to the question, whether
patient and donor possess ‘matched’ HLA types requires considerable typing
effort. Interaction between the HLA typing laboratory and the clinician is
highly needed. It has to be agreed upon what loci are considered relevant and
what degree of resolution is necessary. Furthermore, a strategy has to be
developed, which ensures that a maximum of potential donors are tested in a
reasonable time frame avoiding at the same time a work-overload of the laboratory
and an excessive uneconomical typing effort. At present, experience with HSCT
with unrelated donors is limited. So there is no consent on the ‘correct’ way
of choosing unrelated donors. Each transplantation centre will have its own
characteristic needs, resources, manpower and skills; therefore, the ways vary
between centres. I want to present the approach in Vienna. N. Ref:: 7
----------------------------------------------------
[138]
TÍTULO / TITLE: - Improved outcome with
organs from carbon monoxide poisoned donors for intrathoracic transplantation.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2001 Sep;72(3):709-13.
AUTORES
/ AUTHORS: - Luckraz H; Tsui SS; Parameshwar J;
Wallwork J; Large SR
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit Papworth Hospital,
Papworth Everard, Cambridgeshire, United Kingdom. heyman.luckraz@papworth-tr.anglox.nhs.uk
RESUMEN
/ SUMMARY: - BACKGROUND: The success of intrathoracic
organ transplantation has lead to a growing imbalance between the demand and
supply of donor organs. Accordingly, there has been an expansion in the use of
organs from nonconventional donors such as those who died from carbon monoxide
poisoning. We describe our experience with 7 patients who were transplanted
using organs after fatal carbon monoxide poisoning. METHODS: A retrospective
study of the 1,312 intrathoracic organ transplants between January 1979 and
February 2000 was completed. Seven of these transplants (0.5%) were fulfilled with
organs retrieved from donors after fatal carbon monoxide poisoning. There were
six heart transplants and one single lung transplant. The history of carbon
monoxide inhalation was obtained in all of these donors. RESULTS: Five of 6
patients with heart transplant are alive and well with survival ranging from 68
to 1,879 days (mean, 969 +/- 823 days). One patient (a 29-year-old male) died
12 hours posttransplant caused by donor organ failure. The patient who had a
right single lung transplant did well initially after the transplant, but died
after 8 months caused by Pneumocystis carinii pneumonia. All those recipients
who were transplanted from carbon monoxide poisoned donors and ventilated for
more than 36 hours, survived for more than 30 days. Moreover, these donors were
assessed and optimized by the Papworth donor management protocol. CONCLUSIONS:
Carbon monoxide poisoned organs can be considered for intrathoracic
transplantation. In view of the significant risk of donor organ failure, a
cautious approach is still warranted. Ideally, the donor should be
hemodynamically stable for at least 36 hours from the time of poisoning and on
minimal support. A formal approach of invasive monitoring and active management
further improves the chances of successful outcome. N. Ref:: 33
----------------------------------------------------
[139]
TÍTULO / TITLE: - Is HLA matching
beneficial in liver transplantation?
REVISTA
/ JOURNAL: - Liver Transpl 2001 Sep;7(9):774-6.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2001.26924
AUTORES
/ AUTHORS: - Moore SB
N. Ref:: 17
----------------------------------------------------
[140]
TÍTULO / TITLE: - Proposed protocol to
reduce bacterial infectious complications in living related small bowel
transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 May;34(3):950.
AUTORES
/ AUTHORS: - Cicalese L; Sileri P; Coady N; Asolati M;
Rastellini C; Abcarian H; Benedetti E
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, University
of Illinois at Chicago, Chicago, Illinois 60610, USA. cicalese@uic.edu
----------------------------------------------------
[141]
TÍTULO / TITLE: - Computer applications
in the search for unrelated stem cell donors.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 Aug;10(2-3):227-40.
AUTORES
/ AUTHORS: - Muller CR
INSTITUCIÓN
/ INSTITUTION: - Zentrales Knochenmarkspender-Register fur
Deutschland, Ulm, Germany. carlheinz.mueller@zkrd.de
RESUMEN
/ SUMMARY: - The majority of patients which are
eligible for a blood stem cell transplantation from an allogeneic donor do not
have a suitable related donor so that an efficient unrelated donor search is a
prerequisite for this treatment. Currently, there are over 7 million volunteer
donors in the files of 50 registries in the world and in most countries the
majority of transplants are performed from a foreign donor. Evidently, computer
and communication technology must play a crucial role in the complex donor
search process on the national and international level. This article describes
the structural elements of the donor search process and discusses major
systematic and technical issues to be addressed in the development and
evolution of the supporting telematic systems. The theoretical considerations
are complemented by a concise overview over the current state of the art which
is given by describing the scope, relevance, interconnection and technical
background of three major national and international computer appliances: The
German Marrow Donor Information System (GERMIS) and the European Marrow Donor
Information System (EMDIS) are interoperable business-to-business e-commerce
systems and Bone Marrow Donors World Wide (BMDW) is the basic international
donor information desk on the web. N.
Ref:: 45
----------------------------------------------------
[142]
TÍTULO / TITLE: - Renal transplantation
dysfunction: the role of interventional radiology.
REVISTA
/ JOURNAL: - Clin Radiol 2002 Sep;57(9):772-83.
AUTORES
/ AUTHORS: - Sandhu C; Patel U
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, St George’s
Hospital, London, UK.
RESUMEN
/ SUMMARY: - The aim of this article is to review the
radiological management of complications following renal transplant. N. Ref:: 46
----------------------------------------------------
[143]
TÍTULO / TITLE: - The influence of organ
donor factors on early allograft function.
REVISTA
/ JOURNAL: - Curr Opin Urol 2003 Mar;13(2):99-104.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mou.0000058630.64616.1d
AUTORES
/ AUTHORS: - Schwarz C; Oberbauer R
INSTITUCIÓN
/ INSTITUTION: - Internal Medicine III, Department of
Nephrology, University of Vienna, Vienna, Austria.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Postischaemic acute
renal allograft failure is among the main risk factors for reduced transplant
survival. Although new immunosuppressive protocols have reduced the number of
acute rejections, the incidence of acute renal failure remained unchanged. On
the basis of histomorphology it is not possible to predict donor kidneys at
risk of subsequent failure. Some factors are associated with failure, but even
combinations of these risk factors can not precisely predict the development of
acute renal failure. Studies have therefore evaluated the influence of
demographic donor and recipient factors on acute renal failure. New biotechnology
and data mining tools are currently being used to study and identify the
molecular predictors of acute renal failure. RECENT FINDINGS: Recent studies
showed that donor factors contributed to approximately 40% of the variability
in early allograft function. Deductive approaches identified some isolated
molecular targets, such as adhesion molecules, as risk factors. Explorative
analysis of the entire human genome, however, identified several predictive
clusters of genes, which can be functionally grouped into categories such as
cell death, stress response, cell adhesion, transcription factors, inflammatory
response or cell cycle-related genes. Based on this information, preventative
strategies using antisense oligonucleotides or antibodies were adopted.
Clinical studies identified the use of catecholamines in the organ donor as
beneficial. All these efforts aim to reduce renal tubular damage. SUMMARY: A
detailed analysis of the molecular events and pathways of renal gene expression
in the donor and after reperfusion, together with sophisticated data analysis
tools, will provide new insights into the pathophysiology of acute renal
failure. N. Ref:: 53
----------------------------------------------------
[144]
TÍTULO / TITLE: - Classic specific
immunotherapy and new perspectives in specific immunotherapy for food allergy.
REVISTA
/ JOURNAL: - Allergy 2001;56 Suppl 67:121-4.
AUTORES
/ AUTHORS: - Burks W; Bannon G; Lehrer SB
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Allergy and
Immunology, University of Arkansas for Medical Sciences, Arkansas Children’s
Hospital, Little Rock, AR, USA. Burkswesley@uams.edu
RESUMEN
/ SUMMARY: - Food allergy is a major cause of
life-threatening hypersensitivity reactions. Food-induced anaphylaxis is the
most common reason for someone to present to the emergency department for an
anaphylactic reaction. The avoidance of the allergenic food is the only method
of preventing further reactions that is currently available for sensitized
patients. Strict avoidance of specific foods is the accepted treatment of
food-induced allergic reactions but is often an unrealistic therapeutic option
for food-induced hypersensitivity reactions for the many reasons previously
described. Desirable therapeutic strategies for the treatment and prevention of
food allergies must be safe, relatively inexpensive and easily administered.
Recent advances in the understanding of the immunological mechanisms underlying
allergic disease and better characterization of food allergens have greatly
expanded the potential therapeutic options for future use. Several different
forms of immunomodulatory therapies are currently under investigation: peptide
immunotherapy, mutated protein immunotherapy, allergen DNA immunization,
vaccination with immunostimulatory DNA sequences and anti-immunoglobulin E
(Anti-IgE) therapy. N.
Ref:: 20
----------------------------------------------------
[145]
TÍTULO / TITLE: - Indications and
criteria for liver transplantation for fulminant hepatic failure.
REVISTA
/ JOURNAL: - J Gastroenterol 2002;37 Suppl 13:74-7.
AUTORES
/ AUTHORS: - Fujiwara K; Mochida S
INSTITUCIÓN
/ INSTITUTION: - Third Department of Internal Medicine,
Saitama Medical School, Iruma-gun, Japan.
RESUMEN
/ SUMMARY: - Liver transplantation is the only
effective treatment for potentially fatal cases of fulminant hepatic failure.
However, it is very difficult to predict which cases will be fatal. The
mortality may depend on alternative medical therapies. According to a
nationwide survey of patients with fulminant hepatic failure presenting with
encephalopathy of a coma grade greater than II within 8 weeks from the first
symptoms of illness with a prothrombin time less than 40% of normal value,
there were 93 patients in 311 hospitals between January and December 1998 in
Japan. During this period, there were 11 patients with late-onset hepatic
failure. The etiology was HAV infection in 4%, HBV infection in 44%, and
nonA-nonB in 41%. Specific therapies were intensively used in all patients. The
mean survival rate was 41%, with differences depending on the etiology. Six
patients underwent liver transplantation, and 5 survived. In animal
experiments, sinusoidal fibrin deposition caused massive liver necrosis.
Activation of Kupffer cells and hepatic macrophages was a major contributing
factor of this development. There were different mechanisms of such fibrin
deposition. Tumor necrosis factor-alpha and superoxide anions released from
hepatic macrophages after endotoxin administration destroyed endothelial cells,
and then coagulopathy occurred in the sinusoids in rats given Propionibacteriom
acnes, while a tissue factor from Kupffer cells played that role in rats
undergoing partial hepatectomy. The prognosis of fulminant hepatic failure may
depend on the etiology. The indication for liver transplantation for this
disease must be carefully decided by analyzing the etiology, pathological
conditions, and response to therapies in each case. N. Ref:: 26
----------------------------------------------------
[146]
TÍTULO / TITLE: - A view on beta cell
transplantation in diabetes.
REVISTA
/ JOURNAL: - Ann N Y Acad Sci 2002 Apr;958:69-76.
AUTORES
/ AUTHORS: - Pipeleers D; Keymeulen B; Chatenoud L;
Hendrieckx C; Ling Z; Mathieu C; Roep B; Ysebaert D
INSTITUCIÓN
/ INSTITUTION: - Free University of Brussels (VUB),
Brussels, Belgium. Daniel.Pipeleers@vub.ac.be
RESUMEN
/ SUMMARY: - Organ donors also offer a source of
insulin-producing tissue that might be used for the treatment of diabetes.
Clinical protocols for transplantation of this tissue aim for the prevention of
chronic diabetes complications without introducing new serious side effects.
Pancreas and islet cell transplantation are discussed in this perspective. The
future of islet cell implants looks favorable but depends on finding ways to
induce immune tolerance to the donor beta cells. Clinical trials can take
advantage of relevant progress in animal models. In a limited study, recipient
treatment with antilymphocyte antibodies and culture of donor cell preparations
appeared useful to induce a state of operational immune tolerance in type 1
diabetic patients, as indirectly judged by graft survival and by analysis of
auto- and alloreactivities in recipients. Use of cultured beta cell
preparations also allows donor cell recruitment from suboptimal donor organs
and increases the degree of standardization and quality control of islet cell
grafts. The future of these grafts will depend on the development of techniques
for the neogenesis of beta cells. N.
Ref:: 47
----------------------------------------------------
[147]
TÍTULO / TITLE: - Understanding the
pathogenesis and the pathology of hyperacute cardiac rejection.
REVISTA
/ JOURNAL: - Cardiovasc Pathol 2002
May-Jun;11(3):171-6.
AUTORES
/ AUTHORS: - Rose AG
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine and
Pathology, University of Minnesota Medical School and Fairview-University
Medical Center, MMC 76, 420 Delaware Street SE, Minneapolis, MN 55455, USA. rosex031@tc.umn.edu
RESUMEN
/ SUMMARY: - The terminology of hyperacute rejection
(HAR) has become outmoded and confusing due both to advances that have been
made in delaying its onset and due to a proliferation of synonyms for the same
pathologic process. Until such time as antibody-mediated xenograft rejection
can be classified by the type of causative antibody, it is recommended that the
term hyperacute rejection be applied to antibody-mediated rejection with
classical HAR occurring within 24 h. Delayed HAR is the same pathologic process
encountered after 24 h. Recognition of the key role that venous thrombosis
plays in the pathogenesis of HAR allows the microscopist to intelligently
interpret biopsies from various portions of a transplanted organ according to
the pathologic effects of the obstructed venous drainage of the organ.
Particularly in the heart, HAR often shows different pathologic features in the
inner compared to the outer myocardium. Once xenografting becomes feasible, it
will be possible to apply a grading system of HAR in clinical practice. N. Ref:: 31
----------------------------------------------------
[148]
TÍTULO / TITLE: - Malnutrition, urocanic acid,
and sun may interact to suppress immunity in sojourners to high altitude.
REVISTA
/ JOURNAL: - Aviat Space Environ Med 2001
Feb;72(2):136-45.
AUTORES
/ AUTHORS: - Hug DH; Hunter JK; Dunkerson DD
INSTITUCIÓN
/ INSTITUTION: - Bacteriology Research Laboratory,
Department of Veterans Affairs Medical Center, Iowa City, IA 52246, USA. dhhug2@aol.com
RESUMEN
/ SUMMARY: - Irradiation of skin by ultraviolet
radiation in mice and humans leads to a suppression of cell-mediated immunity.
This process is initiated when one of the photoreceptors in skin,
trans-urocanic acid, is photoisomerized to cis-urocanic acid, an
immunomodulator. High levels of L-histidine, histamine, and trans-urocanic acid
are found in humans and animals when they are protein malnourished. Mice fed on
an elevated L-histidine diet have more trans-urocanic acid in the skin and are
more susceptible to UV-induced immune suppression. Sojourners to high altitudes
are malnourished, suffer protein catabolism, are exposed to sun, and often
acquire infectious diseases. There is evidence that sunscreens may not
adequately protect the immune system. Furthermore, UV intensity increases with
altitude. We propose a testable hypothesis: UV radiation causes photoimmune
suppression in sojourners to high altitude and this allows infectious diseases
to develop. The mechanism we propose includes protein malnutrition, high levels
of trans-urocanic acid, ultraviolet radiation, formation of cis-urocanic acid,
immune suppression, and infection. N.
Ref:: 119
----------------------------------------------------
[149]
TÍTULO / TITLE: - Living donor lung
transplantation: selection, technique, and outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3527-32.
AUTORES
/ AUTHORS: - Barr ML; Baker CJ; Schenkel FA; Bowdish
ME; Bremner RM; Cohen RG; Barbers RG; Woo MS; Horn MV; Wells WJ; Starnes VA
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiothoracic Surgery,
University of Southern California, Los Angeles, California 90033, USA. N. Ref:: 5
----------------------------------------------------
[150]
TÍTULO / TITLE: - Nutrition assessment
and support of organ transplant recipients.
REVISTA
/ JOURNAL: - JPEN J Parenter Enteral Nutr 2001
May-Jun;25(3):120-31.
AUTORES
/ AUTHORS: - Hasse JM
INSTITUCIÓN
/ INSTITUTION: - Transplantation Services, Baylor
University Medical Center, Dallas, Texas 75246, USA. jm.hasse@baylordallas.edu
RESUMEN
/ SUMMARY: - Timely nutrition assessment and
intervention in organ transplant recipients may improve outcomes surrounding
transplantation. A pretransplant nutrition assessment should include a variety
of parameters including physical assessment, history, anthropometric
measurements, and laboratory tests. Malnutrition compromises posttransplant
survival; prolonged waiting times worsen outcomes when patients are already
malnourished. Severe obesity may decrease graft function and survival in kidney
transplant recipients. In the pretransplant phase, nutritional goals include
optimization of nutritional status and treatment of nutrition-related symptoms
induced by organ failure. Enteral tube feeding is indicated for patients with
functional gastrointestinal tracts who are not eating adequately. Parenteral
nutrition is rarely needed pretransplant except in cases of intestinal failure.
When determining pretransplant nutrient requirements, nutritional status,
weight, age, gender, metabolic state, stage and type of organ failure,
malabsorption, induced losses, goals, and comorbid conditions must be
considered. During the acute posttransplant phase, adequate nutrition is
required to help prevent infection, promote wound healing, support metabolic
demands, replenish lost stores, and perhaps mediate the immune response.
Nutrient recommendations reflect posttransplant metabolic changes. The
appropriateness of posttransplant nutrition support depends on the prevalence
of malnutrition among patients with a specific type of organ failure and the
benefits when nutrition support is given. Organ transplantation complications
including rejection, infection, wound healing, renal insufficiency,
hyperglycemia, and surgical complications require specific nutritional
requirements and therapies. Many potential applications of nutrition in the
pre- and posttransplant phases exist and require further study. N. Ref:: 71
----------------------------------------------------
[151]
TÍTULO / TITLE: - Modulation of host
immunity by haematophagous arthropods.
REVISTA
/ JOURNAL: - Ann Trop Med Parasitol 2001
Dec;95(8):755-71.
●●
Enlace al texto completo (gratuito o de pago) 1080/0003498012011118
AUTORES
/ AUTHORS: - Schoeler GB; Wikel SK
INSTITUCIÓN
/ INSTITUTION: - Entomology Department, Naval Medical
Research Center Detachment, Unit 3800, APO AA 34031, USA.
RESUMEN
/ SUMMARY: - The medical and veterinary public-health
importance of haematophagous arthropods is immense and continuing to increase
because of the emergence of new vector-borne infectious agents and the
resurgence of well known ones. Control of blood-feeding arthropods and the
pathogens they transmit is compounded by drug, insecticide and acaricide
resistance. Novel control strategies are needed. Immunological control is one
very promising approach to these problems. In order to develop anti-arthropod
vaccines that block pathogen transmission and establishment, the immunological
interactions occurring at the interface of the blood-feeding arthropod and host
must be characterized. An important component of these interactions is
arthropod modulation of the host’s innate and acquired, specific immune
defences. This review discusses current knowledge regarding the ability of
haematophagous arthropods to alter their hosts’ immune defences, the impact of
those changes on pathogen transmission, the molecular bases for the
immunomodulation, and strategies for identification of the molecules in
arthropod saliva that are responsible for the immunomodulation. N. Ref:: 127
----------------------------------------------------
[152]
TÍTULO / TITLE: - Pretransplant
evaluation of renal transplant candidates.
REVISTA
/ JOURNAL: - Semin Nephrol 2002 Nov;22(6):515-25.
AUTORES
/ AUTHORS: - Gallon LG; Leventhal JR; Kaufman DB
INSTITUCIÓN
/ INSTITUTION: - Departments of Medicine and Surgery,
Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA.
L-Gallon @nwu.edu
RESUMEN
/ SUMMARY: - Kidney transplantation should be strongly
considered for all medically suitable patients with chronic and end-stage renal
disease (ESRD). Improvements in outcomes after renal transplantation have
resulted in a more liberal selection of patients. High-risk category patients
including human immunodeficiency virus (HIV)-positive, highly sensitized
patients, T-cell positive cross-match, and ABO blood group-incompatible
patients are now considered potential renal transplant candidates.
Unfortunately, the demand for kidney transplants far exceeds the supply of
available organs, causing a persistent increase in the number of patients on
the waiting list with a parallel increase in the waiting time for a cadaveric
kidney transplant. This has 2 major consequences. First, patients on the
waiting list are getting sicker and older. Second, living donors have assumed
increasing importance in renal transplantation. Pre-existing morbidities
including malignancies, cardiovascular disease, infections, and coagulopathies
should be extensively evaluated before proceeding to transplantation. Special
attention should be given to cardiovascular risk factors because the leading
cause of death after renal transplant is cardiovascular disease. A full
immunologic evaluation with ABO blood group determination, human leukocyte
antigen (HLA) typing, screening for antibody to HLA phenotypes, and
cross-matching need to be gathered before transplantation to avoid
antibody-mediated hyperacute rejection or to proceed with specific protocols in
highly sensitized or in positive T-cell cross-match patients. With the
increased rate of donation from living donors, regular follow-up evaluation of
kidney donors is recommended to detect hypertension or proteinuria in those who
may develop it. N.
Ref:: 72
----------------------------------------------------
[153]
TÍTULO / TITLE: - n-3 Fatty acids and
their role in nephrologic practice.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2001
Sep;10(5):639-42.
AUTORES
/ AUTHORS: - Donadio JV
INSTITUCIÓN
/ INSTITUTION: - Mayo Clinic and Foundation, Rochester,
Minnesota 55905, USA. donadio.james@mayo.edu
RESUMEN
/ SUMMARY: - During the past year, a newly reported
clinical trial has strengthened the argument for recommending daily treatment
with n-3 polyunsaturated fatty acids in patients with immunoglobulin A
nephropathy (the most common form of primary glomerulonephritis in the world)
who are at high risk for progression of renal disease. Studies are underway
that involve a combination of cyclosporine A, a commonly prescribed
immunosuppressive agent in solid-organ transplantation, with a high-potency n-3
polyunsaturated fatty acid to reduce cyclosporine toxicity. Two studies
reported during the past year show promise that dietary supplementation with
n-3 polyunsaturated fatty acids will substantially decrease vascular access
graft thrombosis in patients receiving maintenance hemodialysis, and may reduce
hypercalciuria in patients who suffer from kidney stones. N. Ref:: 26
----------------------------------------------------
[154]
TÍTULO / TITLE: - Reducing transplant
toxicity.
REVISTA
/ JOURNAL: - Curr Opin Hematol 2001 Nov;8(6):342-8.
AUTORES
/ AUTHORS: - Feinstein L; Storb R
INSTITUCIÓN
/ INSTITUTION: - Program in Transplantation Biology,
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle,
Washington 98109, USA.
RESUMEN
/ SUMMARY: - Conventional myeloablative allogeneic
hematopoietic cell transplantation produces considerable morbidity and
mortality. These generally limit this treatment to patients in good medical
condition who are younger than 55 years of age. T-cell-mediated
graft-versus-tumor effects play a key role in the elimination of malignancy
after allografting. Several investigators have sought to reduce regimen-related
toxicities while optimizing graft-versus-tumor effects. Strategies can be
broadly classified as (1) reduced-intensity regimens that retain some toxicity,
and (2) minimally myelosuppressive regimens that rely on immunosuppression for
allogeneic engraftment and resultant graft-versus-tumor effects. Although
follow-up has been short, preliminary results are encouraging. Current
challenges include defining a regimen that will facilitate full donor
engraftment while minimizing toxicities and graft-versus-host disease. If long-term
efficacy is demonstrated, such strategies will expand the options for patients
who would not qualify for conventional allogeneic transplants. N. Ref:: 57
----------------------------------------------------
[155]
TÍTULO / TITLE: - Solid-state fermentation:
a promising microbial technology for secondary metabolite production.
REVISTA
/ JOURNAL: - Appl Microbiol Biotechnol 2001
Apr;55(3):284-9.
AUTORES
/ AUTHORS: - Robinson T; Singh D; Nigam P
INSTITUCIÓN
/ INSTITUTION: - Biotechnology Research Group, University
of Ulster, Coleraine, UK.
RESUMEN
/ SUMMARY: - Solid state (substrate) fermentation (SSF)
has been used successfully for the production of enzymes and secondary
metabolites. These products are associated with the stationary phase of microbial
growth and are produced on an industrial scale for use in agriculture and the
treatment of disease. Many of these secondary metabolites are still produced by
submerged liquid fermentations (SmF) even though production by this method has
been shown to be less efficient than SSF. As large-scale production increases
further, so do the costs and energy demands. SSF has been shown to produce a
more stable product, requiring less energy, in smaller fermenters, with easier
downstream processing measures. In this article we review an important area of
biotechnology, since the recent evidence indicates that bacteria and fungi,
growing under SSF conditions, are more than capable of supplying the growing
global demand for secondary metabolites.
N. Ref:: 53
----------------------------------------------------
[156]
TÍTULO / TITLE: - Pretransfusion
compatibility testing for red blood cell administration.
REVISTA
/ JOURNAL: - Curr Opin Hematol 2001 Nov;8(6):397-404.
AUTORES
/ AUTHORS: - Shulman IA; Downes KA; Sazama K; Maffei LM
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, University of Southern California, Los Angeles, California 90033,
USA. ishulman@usc.edu
RESUMEN
/ SUMMARY: - The purpose of pretransfusion
compatibility testing is to prevent incompatible red blood cell transfusions
that could lead to immune mediated hemolytic transfusion reactions. Some
hemolytic transfusion reactions may have serious sequelae including
hemoglobinemia, disseminated intravascular coagulation, renal failure, and
death. This article reviews the most comprehensive recent analyses of the
laboratory methods used during pretransfusion compatibility testing in the
United States. Most of the laboratory practice data have been published in the
College of American Pathologists Transfusion Medicine Survey Sets and in a
national survey called the Pre-Transfusion Testing Survey. This article couples
and trends the data of these comprehensive surveys with an assessment of the
literature to present the current practice of pretransfusion compatibility
testing. N. Ref:: 60
----------------------------------------------------
[157]
TÍTULO / TITLE: - Frequency of use and
standards of care for the use of azathioprine and 6-mercaptopurine in the
treatment of inflammatory bowel disease: a systematic review of the literature
and a survey of Canadian gastroenterologists.
REVISTA
/ JOURNAL: - Can J Gastroenterol 2001 Jan;15(1):21-8.
AUTORES
/ AUTHORS: - Wallace TM; Veldhuyzen van Zanten SJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Dalhousie
University and Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
RESUMEN
/ SUMMARY: - OBJECTIVE: To identify the frequency of
use and appropriate monitoring guidelines for the adverse effects of
azathioprine and 6-mercaptopurine (6-MP) in the therapy of patients with
inflammatory bowel disease (IBD). METHODS: Surveys were sent to all physician
members of the Canadian Association of Gastroenterology. Physicians were asked
to describe their monitoring practices for IBD patients receiving azathioprine
or 6-MP. A systematic literature search was also performed using MEDLINE for
articles published in English between 1966 and 1999 using the MeSH terms
‘azathioprine’, ‘6-mercaptopurine’, ‘inflammatory bowel disease’ and ‘drug
monitoring’. RESULTS: Azathioprine and 6-MP were used to treat an average of 7%
of patients - a surprisingly low number given the proven efficacy of these
agents. All respondents reported monitoring complete blood counts (CBC), while
liver enzyme and pancreatic enzyme levels were monitored by 62% and 29% of
respondents, respectively. The most commonly reported initial CBC testing
frequencies were weekly (42%), monthly (26%) and biweekly (23%). From the
literature, it was determined that severe leukopenia (less than 2.10 g/L)
occurs in less than 2% of cases and is sometimes associated with serious
outcomes, including death. Most cases of severe leukopenia occurred abruptly,
early in treatment. Other reported adverse effects and incidences were
pancreatitis (3% to 5%), hepatotoxicity (less than 1%) and hypersensitivity (2%
to 3%). Data concerning an increased risk of non-Hodgkin’s lymphoma were
equivocal. CONCLUSIONS: Use of azathioprine or 6-MP is low in patients with
IBD. A CBC should be performed at weeks 1, 2, 4, 6, 8 and 12, with subsequent
testing every eight weeks for the duration of azathioprine or 6-MP treatment.
The evidence in support of pancreatic and hepatic monitoring is weak. The risk
of non-Hodgkin’s lymphoma is likely low.
N. Ref:: 49
----------------------------------------------------
[158]
TÍTULO / TITLE: - Mutations of the
hemochromatosis gene in Italian candidate blood donors with increased
transferrin saturation.
REVISTA
/ JOURNAL: - Hematol J 2003;4(6):436-40.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.thj.6200324
AUTORES
/ AUTHORS: - Velati C; Marlianici E; Rigamonti D;
Barillari G; Chiavilli F; Fugiani P; Garozzo G; Lancieri M; Rinaldi S; Testa D;
Sampietro M; Tavazzi D; Delbini P; Fargion S; Fiorelli G
INSTITUCIÓN
/ INSTITUTION: - Transfusional Centre of Ospedale Civile di
Sondrio, Sondrio, Italy.
RESUMEN
/ SUMMARY: - The aim of this study was to analyze the
role of HFE mutations in blood donors with iron parameters suggesting iron
overload, taking into account the regional distribution of HFE mutations in
Italy. We studied 5880 subjects undergoing evaluation for blood donation
eligibility, from different areas of Italy. Abnormal iron parameters were
defined as transferrin saturation (TS) >50% or >45% and serum ferritin
(SF) >300 or >250 microg/ml in males and females, respectively. Subjects
with increased TS and/or SF were re-tested and typed for HFE mutations C282Y
and H63D. A total of 548 individuals had increased iron parameters at first
testing. In total, 179/548 were available for retesting, and in 109 increased
TS and/or SF were confirmed. Increased TS was confirmed in 25 individuals,
among whom three were C282Y homozygotes and six were compound heterozygotes for
C282Y and H63D. Increased TS was more frequent in northern Italy than in
southern regions. In individuals with increased TS and/or SF, the frequency of
C282Y and H63D was 0.13 and 0.21 in northern-Italy versus 0.05 and 0.45 in
southern Italy (P=0.004 for H63D). Nine out of 10 individuals carrying
hemochromatosis-associated genotypes (including compound heterozygosity for
C282Y and H63D) originated from northern regions. Among controls, the allelic
frequencies of C282Y and H63D were 0.037 and 0.16 in the northern regions and
0.015 and 0.16 in the southern regions. In conclusion, over one-third of
individuals with persistently altered TS carried hemochromatosis-associated
genotypes, confirming that a diagnostic approach based on TS and genotyping of
selected cases may represent a viable screening procedure.
----------------------------------------------------
[159]
TÍTULO / TITLE: - Lymphocyte
costimulatory receptors in renal disease and transplantation.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Jan-Feb;15(1):7-16.
AUTORES
/ AUTHORS: - Biancone L; Deambrosis I; Camussi G
INSTITUCIÓN
/ INSTITUTION: - Chair of Nephrology, University of Turin,
Italy.
RESUMEN
/ SUMMARY: - Cell-to-cell signal exchange during
antigen presentation deeply influences the profile and extent of the immune
response. Together with the TCR/MHC-mediated signal, accessory signals are
provided to the T cell by the antigen-presenting cell (APC), through specific
receptor-ligand interactions that represent indispensable costimulation for
T-cell activation and survival. The main costimulatory pathways are the B7
family members and the CD40-CD154 receptor-ligand pair. B7-1 and B7-2
costimulate T-cells by binding to CD28. Their binding is prevented by the
neoexpression of CTLA4, a CD28 homologue that can deliver a negative signal.
Another CD28-like molecule, called ICOS (inducible costimulator), has been
described and binds B7RP-1, a third member of the B7 family, but not B7-1 and
B7-2. The CD40-CD154 interaction works as a two way costimulatory system by
triggering activation signals to both T-cell and APCs. Its importance is
highlighted by the discovery that mutations of the CD154 gene are responsible
for a severe human immunodeficiency. Disruption of the natural costimulatory
interaction was highly effective for prevention and treatment in several
experimental models of autoimmune disease and transplant rejection. This review
focuses on the most significant advances in understanding the
physiopathological events involving costimulatory molecules, and their impact
on renal diseases and transplantation. N.
Ref:: 65
----------------------------------------------------
[160]
TÍTULO / TITLE: - Identification of MHC
class II-restricted tumor antigens recognized by CD4+ T cells.
REVISTA
/ JOURNAL: - Methods 2003 Mar;29(3):227-35.
AUTORES
/ AUTHORS: - Wang RF
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology, The Center for
Cell and Gene Therapy, Baylor College of Medicine, ALKEK Building N1120, One
Baylor Plaza, Houston, TX 77030, USA. rongfuw@bcm.tmc.edu
RESUMEN
/ SUMMARY: - CD4+ T cells play a central role in
orchestrating host immune responses against cancer as well as autoimmune and
infectious diseases. Identification of major histocompatibility complex (MHC)
class II-restricted helper T peptides is important for development of effective
vaccines. The lack of effective methods to identify such T-cell peptides is a
major hurdle in the use of antigen-specific CD4+ T cells in cancer vaccines.
Here we describe a genetic targeting expression system for cloning genes
encoding for MHC class II-restricted tumor antigens recognized by
tumor-reactive CD4+ T cells. Helper T peptides are subsequently identified by
using synthetic peptides to test their ability to stimulate CD4+ T cells. N. Ref:: 40
----------------------------------------------------
[161]
TÍTULO / TITLE: - Immunosuppressants in
advanced clinical development for organ transplantation and selected autoimmune
diseases.
REVISTA
/ JOURNAL: - Expert Opin Emerg Drugs 2003 May;8(1):47-62.
AUTORES
/ AUTHORS: - Kovarik JM; Burtin P
INSTITUCIÓN
/ INSTITUTION: - Novartis Pharmaceuticals, 4002 Basel,
Switzerland. john.kovarik@pharma.novartis.com
RESUMEN
/ SUMMARY: - Immunosuppressants dampen the immune
response or restore balance among immune system components. They are primarily
used to prevent allograft rejection after organ transplantation and to prevent
or treat disease flares in autoimmune diseases. Immunosuppressants available at
present include the calcineurin inhibitors (cyclosporin, tacrolimus),
antimetabolites (azathioprine, leflunomide, methotrexate, mycophenolate
mofetil), antiproliferatives (sirolimus), monoclonal antibodies to T lymphocyte
(basiliximab, daclizumab, muromonab-CD3) and anticytokines (anakinra,
etanercept, infliximab). The immunosuppressive market grows at a rate of >
10% yearly, with total sales in 2001 of US$2.7 billion. Immunotherapy in
transplantation and autoimmune diseases is tending towards the use of
multi-drug regimens tailored for the individual patient. At least 23 new
immunosuppressants are currently in advanced clinical testing or
preregistration, and can be divided into three groups. First, emerging drugs
targeting intracellular ligands in immune cells are primarily analogues of
currently-marketed agents, which attempt to provide improved pharmaceutical or
safety profiles compared with the prototype compound. They are largely being
developed in organ transplantation. Second, emerging drugs targeting cell
surface ligands on immune cells attempt to antagonise novel molecular sites to
interfere with immune cell activation via costimulatory signals, immune cell
adhesion to tissues or the vasculature and immune cell trafficking. These
agents are being primarily developed in rheumatoid arthritis, psoriasis and/or
multiple sclerosis. Finally, emerging drugs acting as anticytokines, which
largely follow on from the success of those on the market, by antagonising the
function of tumour necrosis factor or a narrow selection of interleukins. All
are being assessed in rheumatoid arthritis. Drug development of
immunosuppressants is increasingly attempting to intervene in disease
progression over the long term. These efforts bring with them trial design and
regulatory issues, such as what markers can be used as trial outcome measures,
over what duration do trials need to be conducted and what labelling claims are
allowed. With the intensive activity in this field, it is likely that several
new drugs will reach the market in the coming decade. One caveat, however, is
that emerging immunosuppressants that are likely to capture a reasonable share
of this increasingly-fragmented market must demonstrate the ability to achieve
disease remission or long-term slowing of disease progression. N. Ref:: 55
----------------------------------------------------
[162]
TÍTULO / TITLE: - Resources for patients.
Transplant medications—Part 1: An overview.
REVISTA
/ JOURNAL: - Prog Transplant 2002 Mar;12(1):72, 71.
AUTORES
/ AUTHORS: - Cupples S
N. Ref:: 2
----------------------------------------------------
[163]
TÍTULO / TITLE: - Thalidomide: dual
benefits in palliative medicine and oncology.
REVISTA
/ JOURNAL: - Am J Hosp Palliat Care 2001
Sep-Oct;18(5):347-51.
AUTORES
/ AUTHORS: - Davis MP; Dickerson ED
INSTITUCIÓN
/ INSTITUTION: - Harry R. Horvitz Center for Palliative
Medicine (a World Health Organization Demonstration Project), Cleveland, Ohio,
USA.
RESUMEN
/ SUMMARY: - Thalidomide is an immunomodulator, anti-angiogenic
agent, anti-cytokine, and anti-integrin. Alone or in combination with other
drugs, thalidomide has also demonstrated anti-cachexin and anti-neoplastic
properties. Anorexia and cachexia are common symptoms of advanced cancer. Since
certain cytokines also promote tumor growth, we may have a class of agents with
palliative and anti-tumor benefits in combination with anti-neoplastics and
anti-cytokines, such as thalidomide. N.
Ref:: 56
----------------------------------------------------
[164]
TÍTULO / TITLE: - Medical management of
inflammatory bowel disease in the new millennium.
REVISTA
/ JOURNAL: - Compr Ther 2002 Spring;28(1):39-49.
AUTORES
/ AUTHORS: - Lombardi DA; Feller ER; Shah SA
INSTITUCIÓN
/ INSTITUTION: - Gastroenterology Division, Brown
University School of Medicine, One Randall Square, Providence, RI 02904, USA.
RESUMEN
/ SUMMARY: - The medical management of inflammatory
bowel disease in the new millennium requires integrating cost concerns with the
efficacy and safety profiles of the expanded therapeutic options available in
order to achieve optimal patient outcome.
N. Ref:: 111
----------------------------------------------------
[165]
TÍTULO / TITLE: - Cytomegalovirus. A
common virus causing serious disease.
REVISTA
/ JOURNAL: - Aust Fam Physician 2003 Oct;32(10):789-93.
AUTORES
/ AUTHORS: - Rawlinson W; Scott G
INSTITUCIÓN
/ INSTITUTION: - South Eastern Sydney Area Health Service,
Prince of Wales Hospital, Sydney Children’s Hospital, Royal Hospital for Women,
Faculties of Medicine and Science, University of New South Wales. w.rawlinson@unsw.edu.au
RESUMEN
/ SUMMARY: - BACKGROUND: Human cytomegalovirus (CMV) is
a herpes virus that causes severe illness and death in people whose immune
systems are compromised, including organ and bone marrow transplant recipients,
HIV infected people, those on immunosuppressive drugs and newborns infected
during pregnancy. OBJECTIVE: This article aims to present a clear guide to
diagnosis and treatment of CMV in at risk patients in the community.
DISCUSSION: Cytomegalovirus is a common infection in the community, but
diagnosis is often seen as difficult. The use of careful clinical assessment
tests and a clear diagnostic algorithm can provide appropriate diagnosis in
most immunocompromised patients, pregnant women and newborns with CMV.
Treatment strategies and available antivirals are improving, complementing the
advances made with diagnostic techniques and algorithms. N. Ref:: 27
----------------------------------------------------
[166]
TÍTULO / TITLE: - Selecting informative
data for developing peptide-MHC binding predictors using a query by committee
approach.
REVISTA
/ JOURNAL: - Neural Comput 2003 Dec;15(12):2931-42.
●●
Enlace al texto completo (gratuito o de pago) 1162/089976603322518803
AUTORES
/ AUTHORS: - Christensen JK; Lamberth K; Nielsen M;
Lundegaard C; Worning P; Lauemoller SL; Buus S; Brunak S; Lund O
INSTITUCIÓN
/ INSTITUTION: - Center for Biological Sequence Analysis,
BioCentrum-DTU, Technical University of Denmark, DK-2800 Lyngby, Denmark. jenskc@cbs.dtu.dk
RESUMEN
/ SUMMARY: - Strategies for selecting informative data
points for training prediction algorithms are important, particularly when data
points are difficult and costly to obtain. A Query by Committee (QBC) training
strategy for selecting new data points uses the disagreement between a
committee of different algorithms to suggest new data points, which most
rationally complement existing data, that is, they are the most informative
data points. In order to evaluate this QBC approach on a real-world problem, we
compared strategies for selecting new data points. We trained neural network
algorithms to obtain methods to predict the binding affinity of peptides
binding to the MHC class I molecule, HLA-A2. We show that the QBC strategy
leads to a higher performance than a baseline strategy where new data points
are selected at random from a pool of available data. Most peptides bind HLA-A2
with a low affinity, and as expected using a strategy of selecting peptides
that are predicted to have high binding affinities also lead to more accurate
predictors than the base line strategy. The QBC value is shown to correlate
with the measured binding affinity. This demonstrates that the different
predictors can easily learn if a peptide will fail to bind, but often conflict
in predicting if a peptide binds. Using a carefully constructed computational
setup, we demonstrate that selecting peptides with a high QBC performs better
than low QBC peptides independently from binding affinity. When predictors are
trained on a very limited set of data they cannot be expected to disagree in a meaningful
way and we find a data limit below which the QBC strategy fails. Finally, it
should be noted that data selection strategies similar to those used here might
be of use in other settings in which generation of more data is a costly
process.
----------------------------------------------------
[167]
TÍTULO / TITLE: - Immunization of
immunocompromised persons.
REVISTA
/ JOURNAL: - Immunol Allergy Clin North Am 2003
Nov;23(4):605-34, v-vi.
AUTORES
/ AUTHORS: - Weber DJ; Rutala WA
INSTITUCIÓN
/ INSTITUTION: - Adult Infectious Disease Division,
University of North Carolina School of Medicine, CB #7030, Bioinformatics
Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7030, USA. dweber@unch.unc.edu
RESUMEN
/ SUMMARY: - Advances in medicine, science, and
technology have led to increasing numbers of people in the general population
with altered host defenses. The risk for clinical infection in an
immunocompromised host, such as a person who has received a solid organ
transplant, is determined largely by the interaction between two factors: the
epidemiologic exposures the person encounters and the person’s net state of
immunosuppresson. Vaccination represents a crucial approach for preventing
infection in the general public and immunocompromised persons. This article
reviews the benefits of and risks for immunization in immunocompromised persons
and provides recommendations for the use of specific vaccines. N. Ref:: 129
----------------------------------------------------
[168]
TÍTULO / TITLE: - Influence of one human
leukocyte antigen mismatch on outcome of allogeneic bone marrow transplantation
from related donors.
REVISTA
/ JOURNAL: - Hematology 2003 Feb;8(1):27-33.
●●
Enlace al texto completo (gratuito o de pago) 1080/1024533031000072054
AUTORES
/ AUTHORS: - Hasegawa W; Lipton JH; Messner HA; Jamal
H; Yi QL; Daly AS; Kotchetkova N; Kiss TL
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow Transplant Service, Princess
Margaret Hospital/University Health Network, Toronto, Ont, M5G 2M9, Canada.
RESUMEN
/ SUMMARY: - This study compares the clinical outcomes
of 60 consecutive patients who received an allogeneic blood or marrow stem cell
transplant (BMT) from one Human Leukocyte Antigen (HLA) mismatched related
donors with those of 120 matched patients who had HLA identical sibling donors.
The control patients were matched for diagnosis, disease status, conditioning
regimen, and age at BMT. All patients received standard CYA and MTX for GVHD
prophylaxis. The probability of overall survival (OS) at 5 years was 35% in the
study group compared to 56% in the control group. The relapse rates and acute
GVHD rates did not differ between the two groups. Graft failure was a
significant problem in the study group compared to the control group (13 vs.
0%, p < 0.0001). All cases of graft failure occurred in patients with a
mismatch in the host-versus-graft direction. BMT-related deaths were also
increased in the study group. Forty percent of deaths were caused by infection
in the study group vs. 19% in the control group (p < 0.01). In conclusion,
the OS of patients receiving marrow/stem cells from one antigen mismatched
related donors was inferior to that of controls with HLA-identical related
donors. There was an increase in mortality related to infections occurring in
the setting of an increased frequency of graft failure in these patients. N. Ref:: 21
----------------------------------------------------
[169]
TÍTULO / TITLE: - Strategies for the
augmentation of grafted dopamine neuron survival.
REVISTA
/ JOURNAL: - Front Biosci 2003 May 1;8:s522-32.
AUTORES
/ AUTHORS: - Sortwell CE
INSTITUCIÓN
/ INSTITUTION: - Department of Neurological Sciences,
Research Center for Brain Repair, Rush-Presbyterian-St. Luke’s Medical Center,
Suite 200, 2242 West Harrison Street, Chicago, IL 60612, USA. csortwel@rush.edu
RESUMEN
/ SUMMARY: - The percentage of grafted embryonic DA
neurons that survive transplantation is low, estimated at 5-20%. Significant
agreement has emerged from the work of research groups worldwide that specific
conditions associated with the transplant procedure and post-transplantation
interval render grafted mesencephalic cells susceptible to apoptotic death.
Detrimental triggers including hypoxia/ischemia, trophic factor withdrawal, and
oxidative stress appear to exert the most impact on grafted DA neuron survival.
Treatment strategies that aim to reduce or eliminate the triggers of grafted
cell death appear to be more successful than approaches that target the
intracellular apoptotic cascade. In particular, treatment of mesencephalic cell
suspensions with isolated neurotrophic factors (GDNF, BDNF, NT 4/5) as well as
glial-derived factors, antioxidant therapies and augmentation of graft
vasculature have demonstrated consistent survival promoting effects. Caspase
inhibition, although initially quite promising, has not been demonstrated to
reliably increase grafted cell survival. Bcl-2 overexpression similarly has yet
to prove beneficial, although this may be due to biologically irrelevant levels
of bcl-2 present during the critical immediate post-grafting interval. Future
strategies will target a “cocktail” approach in which effective treatment
agents are combined to maximize grafted DA neuron survival. Refinements in ex
vivo transduction parameters will allow for efficient sustained delivery of
survival promoting agents to grafted cells. Once identified, the optimal survival-enhancing
treatment of grafted primary embryonic DA neurons should also benefit future
transplant therapies utilizing alternatively derived DA neurons. N. Ref:: 117
----------------------------------------------------
[170]
TÍTULO / TITLE: - Immunomodulatory drugs
for multiple sclerosis: a systematic review of clinical and cost effectiveness.
REVISTA
/ JOURNAL: - Expert Opin Pharmacother 2001
Apr;2(4):623-39.
AUTORES
/ AUTHORS: - Clegg A; Bryant J
INSTITUCIÓN
/ INSTITUTION: - Southampton Health Technology Assessments
Centre, Wessex Institute for Health Research and Development, University of
Southampton, Biomedical Sciences Building, Bassett Crescent East, Southampton
SO16 7PX, UK. a.clegg@soton.ac.uk
RESUMEN
/ SUMMARY: - Uncertainties about the clinical and cost
effectiveness of immunomodulatory drugs for multiple sclerosis (MS), as well as
concerns about funding treatment, continue to influence their use. The National
Institute for Clinical Excellence (NICE) in England and Wales has been
appraising the evidence on the clinical and cost effectiveness of IFN-beta and
glatiramer to provide guidance to the NHS. It has proved a difficult task. This
paper is an update of our systematic review which assesses the evidence on the
clinical and cost effectiveness of a range of immunomodulatory drugs for MS,
including azathioprine, IFN-beta, cladribine, cyclophosphamide, glatiramer,
intravenous immunoglobulin (IVIg), methotrexate and mitoxantrone. Searches of
electronic databases (such as Medline, Embase and the Cochrane Library) and
bibliographies of related papers, as well as consultation with experts, for
systematic reviews of randomised controlled trials (RCTs) and direct reports of
RCTs revealed 26 studies of clinical effectiveness and eight economic
evaluations that met the criteria for inclusion. The quality of the evidence
was often poor, affected by methodological limitations. Evidence on the
clinical effectiveness of immunomodulatory drugs showed some clinical effect,
with reductions in relapse rates and/or progression to disability for people
with MS. However, benefits from these drugs may be lessened by side effects.
Assessment of cost effectiveness was limited to IFN-beta and glatiramer,
showing that any benefit from these drugs was achieved at very high cost. The
inadequacies in the evidence of clinical and cost effectiveness on some
immunomodulatory drugs for the treatment of people with MS necessitate further
rigorous RCTs and comparative economic evaluations of different
alternatives. N.
Ref:: 50
----------------------------------------------------
[171]
TÍTULO / TITLE: - Recent developments in
the pharmacological treatment and prevention of corneal graft rejection.
REVISTA
/ JOURNAL: - Expert Opin Investig Drugs 2003
Jan;12(1):29-37.
AUTORES
/ AUTHORS: - Banerjee S; Dick AD
INSTITUCIÓN
/ INSTITUTION: - Division of Ophthalmology, School of
Medical Sciences, University Walk, Bristol, BS8 1TD, UK.
RESUMEN
/ SUMMARY: - At present, given the high initial success
rate of corneal transplantation (although late survival is poor),
immunosuppression is often reserved for ‘high-risk’ patients. Despite immune
privilege, corneal graft rejection remains the leading cause of corneal
allograft failure. Interpreting the limited and also restricted design of most
trials, immunosuppressive therapy has not enjoyed the success seen in solid
organ grafts. This review discusses the limited data available whilst proposing
newer therapies that have developed as a result of our increased understanding
of the immunobiology of corneal graft rejection. N. Ref:: 93
----------------------------------------------------
[172]
TÍTULO / TITLE: - Perspectives of
drug-eluting stents: the next revolution.
REVISTA
/ JOURNAL: - Am J Cardiovasc Drugs 2002;2(3):163-72.
AUTORES
/ AUTHORS: - Moses JW; Kipshidze N; Leon MB
INSTITUCIÓN
/ INSTITUTION: - Lenox Hill Heart and Vascular Institute of
New York and Cardiovascular Research Foundation, New York, New York 10021, USA.
jmoses@lenoxhill.net
RESUMEN
/ SUMMARY: - Coronary stent implantation has become a
well established therapy in the management of coronary artery disease (CAD).
Although the Stent Restenosis Study (STRESS) and Belgium-Netherlands Stent
(BENESTENT) trials demonstrated convincingly that stenting is superior to
percutaneous transluminal coronary angioplasty with respect to restenosis in de
novo lesions, there is, however, still a high incidence (10 to 50%) of
restenosis following stent implantation. Improvements in stent design and
implantation techniques resulted in an increase in the use of coronary stents
and today, in most centers in the US and Europe, stenting has become the
predominant form of nonsurgical revascularization accounting for about 80% of
all percutaneous coronary intervention procedures. Coronary stents provide
luminal scaffolding that virtually eliminates elastic recoil and remodelling.
Stents, however, do not decrease neointimal hyperplasia and in fact lead to an
increase in the proliferative comportment of restenosis. Agents that inhibit
cell-cycle progression indirectly have also been tested as inhibitors of
vascular proliferation. When coated onto stents, sirolimus, a macrolide
antibiotic with immunosuppressive properties, and paclitaxel and dactinomycin,
both chemotherapeutic agents, induced cell-cycle arrest in smooth muscle cells
(SMC) and inhibited neointimal formation in animal models. Preliminary clinical
studies with drug-eluting stents produced dramatic results eliminating
restenosis in large and mid-size arteries. Quantitative coronary angiography
and intravascular ultrasound demonstrated virtually complete inhibition of
tissue growth at 6 and 12 months after sirolimus-eluting stent implantation.
Results are also very encouraging with paclitaxel-coated stents. However, it
needs to be proven that current drug-eluting stents will produce similar
results in ‘real life’ interventional practice (long lesions, lesions in small
vessels, in vein grafts, chronic total occlusions, and bifurcated and ostial
lesions). The ongoing randomized, double-blind sirolimus-coated Bx Velocity
trade mark balloon expandable stent in the treatment of patients with de novo
coronary artery lesions (SIRIUS) trial may answer some of these concerns. With
further improvements, including the expansion of drug-loading capacity, double
coatings and coatings with programmable pharmacokinetic capacity using advances
in nanotechnology (which may allow for more precise and controlled release of less
toxic and improved molecules), we think that in the next few years the practice
of interventional cardiology may undergo major changes. A new era of dramatic
improvements in the treatment of CAD may have dawned. The prospect of approval
of this technology should herald a host of clinical trials to revisit basic
assumptions about the place of coronary stenting in the contemporary care of
obstructive (and nonobstructive) CAD. N.
Ref:: 76
----------------------------------------------------
[173]
TÍTULO / TITLE: - Pyogenic granuloma in a
renal transplant patient: case report.
REVISTA
/ JOURNAL: - Spec Care Dentist 2001
Sep-Oct;21(5):187-90.
AUTORES
/ AUTHORS: - al-Zayer M; da Fonseca M; Ship JA
INSTITUCIÓN
/ INSTITUTION: - Department of Orthodontics and Pediatric
Dentistry, University of Michigan School of Dentistry, 1011 N. University Ave.,
Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - This case report describes a 14-year-old
female referred to Pediatric Dentistry for evaluation and treatment of cyclosporine-induced
gingival hyperplasia. Examination of the anterior maxillary area showed a red,
vascular, exophytic, soft-tissue mass which had been excised a few months
earlier without a histopathologic examination being done. The mass did not
appear consistent with gingival overgrowth induced by long-term use of
medication, and thus an excisional biopsy was performed, which diagnosed the
lesion as a pyogenic granuloma. A review of the literature and management
recommendations are discussed. N.
Ref:: 20
----------------------------------------------------
[174]
TÍTULO / TITLE: - Clinical islet
transplantation.
REVISTA
/ JOURNAL: - Curr Diab Rep 2003 Aug;3(4):344-50.
AUTORES
/ AUTHORS: - Kaufman DB; Lowe WL Jr
INSTITUCIÓN
/ INSTITUTION: - Feinberg School of Medicine, Northwestern
University, Galter Pavilion, #17-200, 675 N. St. Clair Street, Chicago, IL
60611, USA. d-kaufman2@northwestern.edu
RESUMEN
/ SUMMARY: - Type 1 diabetes affects over 1 million
persons in the United States, with over 30,000 new cases diagnosed annually.
Transplantation of new insulin-producing b cells, in the form of the whole
pancreas or isolated islets, has been shown to ameliorate the disease by
eliminating the need for exogenous insulin and normalizing glycosylated
hemoglobin levels. Islet transplants are a particularly attractive form of
therapy because they are a minimally invasive procedure and are more likely to
be scaled-up to treat the large numbers of people affected by diabetes.
Currently, only a handful of programs have been successful in the endeavor.
Nevertheless, the early clinical experience strongly demonstrates that islet
transplantation is an effective treatment strategy in select patients with type
1 diabetes. To scale up this therapy and use it earlier in the disease and for
more people, the shortage of suitable donor tissue must be solved and the
requirement of lifelong immunosuppression must be minimized. N. Ref:: 69
----------------------------------------------------
[175]
TÍTULO / TITLE: - At-home self-care of
patients of long-term survival after renal transplantation: a survey of current
status.
REVISTA
/ JOURNAL: - Di Yi Jun Yi Da Xue Xue Bao 2002
Jan;22(1):86-7.
AUTORES
/ AUTHORS: - Wang JX; Shi HM
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Transplantation,
Nanfang Hospital, First Military Medical University, Guangzhou 510515.
RESUMEN
/ SUMMARY: - OBJECTIVE: To understand the current
status of at-home self-care implemented by patients with renal transplantation
of long-term survival, so as to provide the patients with adequate professional
advice and follow-up care after discharge from hospital. METHOD: A survey was
conducted in 248 patients who survived for over 3 years with functioning transplanted
kidneys by utilizing a self-designed questionnaire. RESULTS: The at-home
self-care was generally not well practiced by the patients with apparent lack
of self-care awareness and abilities. Though the current status problematic,
the survey showed that 96.32% of the patients wished to be informed about
self-care knowledge and skills. CONCLUSION: The patients currently lack at-home
self-care abilities and the medical staff should carefully design self-care
plans tailored to the needs of individual patient to improve the survival of
the patients and the transplanted kidneys as well.
----------------------------------------------------
[176]
TÍTULO / TITLE: - On the horizon:
tailor-made immunosuppression in renal transplantation.
REVISTA
/ JOURNAL: - Nephron Clin Pract 2003;94(1):c5-10.
●●
Enlace al texto completo (gratuito o de pago) 1159/000070818
AUTORES
/ AUTHORS: - Warrens AN
INSTITUCIÓN
/ INSTITUTION: - Faculty of Medicine, Imperial College
London, Hammersmith Campus, London, UK. a.warrens@ic.ac.uk
RESUMEN
/ SUMMARY: - Immunosuppression for renal
transplantation has undergone more changes over the last 8 years than at any
other time in its history. It is now possible to be more selective in the
matching of drugs with a given patient. This brings with it the option of
improving graft outcome and also minimizing adverse effects. It is an ongoing
process that will utilize agents working at different points in the activation
cascade of the CD4+ ‘helper’ T lymphocyte. It may also be possible to
manipulate the immune system such that the organ-specific immune response may
be switched off, or rendered ‘tolerant’, thus removing the need for any
immunosuppressive drugs. In this brief review, we shall address each of these
approaches and discuss other therapeutic avenues being investigated. N. Ref:: 13
----------------------------------------------------
[177]
TÍTULO / TITLE: - Advances in
immune-based therapies to improve solid organ graft survival.
REVISTA
/ JOURNAL: - Adv Intern Med 2001;47:293-331.
AUTORES
/ AUTHORS: - Rose SM; Turka L; Kerr L; Rotrosen D
INSTITUCIÓN
/ INSTITUTION: - Office of Clinical Applications, Division
of Allergy, Immunology, and Transplantation, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Md., USA. N. Ref:: 96
----------------------------------------------------
[178]
TÍTULO / TITLE: - Annual trends and
triple therapy--1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:247-69.
AUTORES
/ AUTHORS: - Nishikawa K; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, CA, USA.
RESUMEN
/ SUMMARY: - 1. Although the number of cadaver donor
transplants did not increase substantially over the past 10 years, unrelated
living donor grafts increased from 153 in 1991 to 1,661 through 2000. Use of
spousal and other unrelated donor organs contributed to this increase. There
was a modest increase in living-related donor transplants from 2,328 in 1991 to
3,451 in 2000. 2. Cadaver donor graft survival at one year improved from 84% in
1991 to 90% in 2000. In contrast, one-year graft survival of living donor
transplants only improved from 93% in 1991 to 95% in 2000. 3. Throughout the
10-year period, approximately 13% of transplants were repeat transplants from
cadaver donors and roughly 8% were regrafts from live donors. 4. Cadaver donor
transplants into White recipients declined from 68% in 1991 to 60% in 2000. For
living donors, the percentage of White patients remained constant at about 70%.
5. Graft survival in patients of all races was about equal at one year but
diverged at 3 years, with Asians having the highest and Blacks having the
lowest 3-year graft survival rates. 6. Average donor age increased from 31.7 in
1991 to 36 in 2000 for cadaveric donor transplants and 37.9 in 1991 to 40.4 in
2000 for living donor transplants. Cadaveric kidneys from donors older than 50
years of age yielded significantly lower 3-year graft survival. 7. Average recipient
age for cadaveric donor transplants increased from 42.1 in 1991 to 46.8 in
2000. The average recipient age for living donor transplants also increased
steadily from 33.7 in 1991 to 42.9 in 2000. There was relatively little effect
on graft survival rates for advanced age recipients. 8. The percentage of
sensitized recipients receiving cadaver donor grafts declined from 27% in 1991
to 21% in 2000. Similarly, sensitized recipients receiving living donor grafts
decreased from 17% in 1991 to 13% in 2000. Graft survival in patients with more
than 50% PRA was lower at 3 years for patients receiving cadaveric donor
grafts. Highly sensitized patients receiving living donor grafts had graft
survival rates similar to those who were not sensitized. 9. Cold ischemia times
decreased from an average of 24.2 hours in 1991 to 18.9 hours in 2000. Improved
graft survival rates over those 10 years were noted in all groups, and even
cold ischemia times more than 36 hours yielded 3-year graft survivals
comparable to those with lower cold ischemia times in 1998. 10. The need for
dialysis has remained constant at about 23% over the last 10 years for patients
receiving kidneys from cadaveric donors. The rate of dialysis for patients
receiving kidneys from living donors was about 5% for each of the 10 years
examined. First day anuria increased from 11% in 1991 to 16% in 2000 for
cadaver donor transplants and 3% in 1999 to 5% in 2000 for living donor grafts.
11. Cadaveric donor patients requiring dialysis had a 3-year graft survival rate
of 63% if there was no first day anuria and 56% if they had first day anuria.
This is in contrast to 80% 3-year graft survival for those with immediate
diuresis and no need for dialysis. The 3-year graft survival rate for those
receiving living donor grafts and needing dialysis was 58% if they had first
day diuresis and 41% if they ware anuric on the first day. Conversely, those
who had first day function and did not require dialysis had 89% 3-year graft
survival. 12. Among the patients receiving cadaveric grafts with first day
diuresis there was a marked reduction in those with rejection, from 21% in 1991
to 5% in 2000. Similarly, for this type of patient receiving living donor
grafts, the reduction was 17% in 1991 to 5% in 2000. However, graft survival
among these patients did not change significantly. The greatest improvement was
noted in those with first day anuria and no rejection. 13. Patients who did not
require dialysis, and had rejection prior to discharge decreased markedly from
17% in 1991 to 3% in 2000 in those receiving cadaveric grafts and 15% in 1991
to 3.9% in 2000 for those receiving living donors. Graft survival of cadaveric
transplants in those needing dialysis, with and without rejection, improved the
most in the 10 year period. 14. Hospitalization days for cadaveric transplant
recipients were reduced from 19 days in 1991 to 10 days in 2000 and 16 days in
1991 to 8 days in 2000 for recipients of living donor grafts. There was an
increase in discharge serum creatinine values from 2.3 mg/dl in 1991 to 3.3
mg/dl in 2000 for cadaver donor grafts. 15. Double therapy was utilized for
about 15% of cadaveric and living donors. There was a sharp increase in
induction therapy, peaking at 51% in 1994 and decreasing to 5% by 2000 for
cadaveric donor transplants. Induction did not improve graft survival for
either cadaver or living donor transplant recipients. 16. Triple therapy
improved graft survival of White and Black patients, but did not affect the
half-lives in either race. 17. The lower graft survival from older donors was
not affected by triple therapy for cadaver donor transplants. Triple therapy
removed the donor age effect for recipients of living donor grafts. 18. Triple
therapy practically eliminated the effect of sensitization for cadaveric donor
grafts. Both double and triple therapy virtually eliminated the sensitization
effect for living donors. 19. Triple therapy significantly improved the
survival of kidneys with more than 36 hours cold ischemia time so that 3-year
graft survival was 76% at 3 years compared with 81% for kidneys stored 1-12
hours. 20. Triple therapy improved the 3-year graft survival of kidneys with
first day anuria from 50% for double therapy to 69% for triple therapy in
cadaver donor transplants. For living donor transplants, there was a similar
improvement from 57% with double therapy to 72% with triple therapy. 21. Triple
therapy improved the 3-year cadaveric graft survival rate of kidneys requiring
dialysis from 51% with double therapy to 67% for triple therapy. There was a
similar improvement for living donors needing dialysis from 37% to 61% at 3
years.
----------------------------------------------------
[179]
TÍTULO / TITLE: - Ethical aspects of
living donor kidney transplantation and recipient adherence to treatment.
REVISTA
/ JOURNAL: - Prog Transplant 2003 Jun;13(2):105-9.
AUTORES
/ AUTHORS: - Wright L; Daar AS
INSTITUCIÓN
/ INSTITUTION: - University Health Network, Toronto,
Ontario.
RESUMEN
/ SUMMARY: - Living donor kidney transplantation
comprises approximately 30% of kidney transplantations in the United States and
is an effective form of renal replacement therapy, with low risk to the donor.
Twenty percent of living donors do not have a genetic relationship with their
recipients. In the selection of living donors, guiding ethical principles
include altruism, the absence of coercion or monetary reward, patient autonomy,
beneficence, and nonmaleficence. In order for the benefit of living donor
kidney transplantation to outweigh the risk, evidence that the proposed
recipient will care for the transplanted organ must exist. Nonadherence to
treatment has been identified as a major risk factor for graft rejection. When
nonadherence to treatment regimens leads to loss of the graft, the consequences
are felt by the recipient, donor, and the treatment team. The decision to
transplant an organ to a noncompliant patient from a cadaveric or a living
donor raises issues of patient autonomy, justice, paternalism, and benevolence
versus nonmaleficence. N.
Ref:: 31
----------------------------------------------------
[180]
TÍTULO / TITLE: - Nutritional strategies
to minimise exercise-induced immunosuppression in athletes.
REVISTA
/ JOURNAL: - Can J Appl Physiol 2001;26 Suppl:S23-35.
AUTORES
/ AUTHORS: - Gleeson M; Lancaster GI; Bishop NC
INSTITUCIÓN
/ INSTITUTION: - School of Sport and Exercise Sciences,
University of Birmingham, Edgbaston, Birmingham B15 2TT, England.
RESUMEN
/ SUMMARY: - Strenuous prolonged exertion and heavy
training are associated with depressed immune function. Furthermore, improper
nutrition can compound the negative influence of heavy exertion on
immunocompetence. Dietary deficiencies of protein and specific micronutrients
have long been associated with immune dysfunction. An adequate intake of iron,
zinc, and vitamins A, E, B6 and B12 is particularly important but excess
intakes can also impair immune function. Immune system impairment has also been
associated with excess intake of fat. To maintain immune function, athletes
should eat a well balanced diet sufficient to meet their energy requirements.
An athlete exercising in a carbohydrate-depleted state experiences larger
increases in circulating stress hormones and a greater perturbation of several
immune function indices. Conversely, consuming carbohydrate during exercise
attenuates rises in stress hormones such as cortisol and appears to limit the
degree of exercise-induced immunosuppression, at least for non-fatiguing bouts
of exercise. Strong evidence that high doses of antioxidant vitamins, glutamine
supplementation or echinacea extracts can prevent exercise-induced
immunosuppression is lacking. N.
Ref:: 46
----------------------------------------------------
[181]
TÍTULO / TITLE: - Non-ribosomal peptide
synthetases as technological platforms for the synthesis of highly modified
peptide bioeffectors—Cyclosporin synthetase as a complex example.
REVISTA
/ JOURNAL: - Biotechnol Annu Rev 2003;9:151-97.
AUTORES
/ AUTHORS: - Velkov T; Lawen A
INSTITUCIÓN
/ INSTITUTION: - Monash University, Department of
Biochemistry and Molecular Biology, School of Biomedical Sciences, P.O. Box
13D, Melbourne, Victoria 3800, Australia.
RESUMEN
/ SUMMARY: - Many microbial peptide secondary
metabolites possess important medicinal properties, of which the immunosuppressant
cyclosporin A is an example. The enormous structural and functional diversity
of these low-molecular weight peptides is attributable to their mode of
biosynthesis. Peptide secondary metabolites are assembled non-ribosomally by
multi-functional enzymes, termed non-ribosomal peptide synthetases. These
systems consist of a multi-modular arrangement of the functional domains
responsible for the catalysis of the partial reactions of peptide assembly. The
extensive homology shared among NRPS systems allows for the generalisation of
the knowledge garnered from studies of systems of diverse origins. In this
review we shall focus the contemporary knowledge of non-ribosomal peptide
biosynthesis on the structure and function of the cyclosporin biosynthetic
system, with some emphasis on the re-direction of the biosynthetic potential of
this system by combinatorial approaches.
N. Ref:: 205
----------------------------------------------------
[182]
TÍTULO / TITLE: - Neuropeptides and
neuroendocrine hormones in ultraviolet radiation-induced immunosuppression.
REVISTA
/ JOURNAL: - Methods 2002 Sep;28(1):97-103.
AUTORES
/ AUTHORS: - Seiffert K; Granstein RD
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Joan and
Sanford I. Weill Medical College of Cornell University, New York, NY 10021,
USA.
RESUMEN
/ SUMMARY: - Exposure of the skin to ultraviolet
radiation (UVR) can lead to deleterious effects such as sunburn, photoaging,
and the development of skin cancer. UVR has also been shown to reduce local and
systemic immune responses in humans and animals. In the recent past it has
become clear that neuropeptides mediate some of the effects of UVR-induced
immunosuppression. Among the neuropeptides released from cutaneous nerves after
exposure to UVR, calcitonin gene-related peptide (CGRP) has been examined most
extensively. It appears to lead to a reduction of contact hypersensitivity by
inducing mast cells to degranulate and thus release tumor necrosis factor alpha
(TNF-alpha) and, most likely, interleukin (IL)-10. Nitric oxide, which is
coreleased with CGRP, seems to also play a role in immunosuppression through a
yet undiscovered mechanism of action, while substance P may have
counterregulatory effects. New evidence suggests that the release of neuropeptides
from cutaneous sensory c-fibers after UVR is induced by keratinocyte-derived
nerve growth factor. UVR can also induce epidermal and some dermal cells, such
as melanocytes, keratinocytes, and dermal microvascular epithelial cells, to
produce proopiomelanocortin (POMC) and its derivatives. The POMC product
alpha-melanocyte-stimulating hormone (alpha-MSH) has been implicated in
suppression of contact hypersensitivity and induction of hapten-specific
tolerance, most likely by inducing keratinocytes and monocytes to produce the
anti-inflammatory cytokine IL-10. Other POMC derivatives have not yet been
investigated with regard to a possible role in UVR-induced effects on
immunity. N. Ref:: 58
----------------------------------------------------
[183]
TÍTULO / TITLE: - Long-term outcome after
liver transplantation in children.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Feb;6(1):30-6.
AUTORES
/ AUTHORS: - Bucuvalas JC; Ryckman FC
INSTITUCIÓN
/ INSTITUTION: - Pediatric Liver Care Center, Children’s
Hospital Research Foundation, Cincinnati, Ohio 45229, USA. john.buc@chmcc.org
RESUMEN
/ SUMMARY: - Children (defined as under 18 yr of age)
account for approximately 12.5% of all liver transplants in the United States. Even
though the annual number of liver transplantation procedures remains relatively
constant, the population of long-term survivors of liver transplantation has
grown. Presently, the population of long-term survivors of liver
transplantation is 10-fold greater then the number of transplantations carried
out each year. For long-term survivors of liver transplantation, the goal is to
maintain graft function and wellness while decreasing the morbidity associated
with long-term immunosuppression. The primary diagnosis leading to liver
transplantation in children do not recur in the allograft. Consequently, many
of the complications of liver transplantation, both early and long term, relate
to the need for immunosuppression. Children may be at increased risk to develop
significant end-organ damage as a result of increased serum lipid levels,
elevated blood pressure, altered glucose metabolism, decreased renal function,
cancer, and diminished bone accretion that occur as a result of
immunosuppressive therapy or complications of therapy. As survival rates have
increased, health care providers have begun to assess health-related quality of
life. We will review our current knowledge of long-term outcome following
pediatric liver transplantation in children.
N. Ref:: 61
----------------------------------------------------
[184]
TÍTULO / TITLE: - Do we have unrealistic
expectations of the potential of immuno-nutrition?
REVISTA
/ JOURNAL: - Can J Appl Physiol 2001;26 Suppl:S36-44.
AUTORES
/ AUTHORS: - Cynober LA
INSTITUCIÓN
/ INSTITUTION: - Clinical Biochemistry Laboratory and
INSERM U341, Hotel-Dieu Hospital, Laboratory of Biological Nutrition, School of
Pharmacy, Paris 5 University, France.
RESUMEN
/ SUMMARY: - Heavy sports training schedules and
competition is often associated with immuno-suppression, and so there is a
theoretical justification for providing athletes with nutrients that display
immuno-regulatory properties. Among such immuno-nutrients, considerable
attention has been paid in recent years to two amino acids, arginine (ARG) and
glutamine (GLN). ARG and GLN availability regulate the function of T
lymphocytes, macrophages and polymorphonuclear cells. ARG acts through nitric
oxide and polyamine synthesis. The mechanism of action of GLN in immune cells remains
unclear. Experience in clinical nutrition suggests that an ARG-enriched diet
may limit infectious morbidity in critically ill patients. Data concerning
oral/enteral GLN supplementation are more controversial. There have been few
trials of supplementation in sports medicine, but results are promising,
justifying further studies in which dosages and administration schedules should
be taken into account. N.
Ref:: 23
----------------------------------------------------
[185]
TÍTULO / TITLE: - Effects of low-dose
ultraviolet radiation on in vivo human cutaneous recall responses.
REVISTA
/ JOURNAL: - Australas J Dermatol 2001 Aug;42(3):161-7.
AUTORES
/ AUTHORS: - Damian DL; Barnetson RS; Halliday GM
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine (Dermatology),
Melanoma and Skin Cancer Research Institute, University of Sydney at Royal
Prince Alfred Hospital, Sydney, Australia.
RESUMEN
/ SUMMARY: - Relatively few studies have examined the
effects of low-dose ultraviolet (UV) radiation on in vivo human cutaneous
immunity, or the ability of sunscreens to prevent UV-induced immunosuppression.
We have studied the effects of solar-simulated UV radiation on nickel contact
hypersensitivity (CHS) in nickel-allergic volunteers, and on delayed type
hypersensitivity responses in Mantoux-positive volunteers. Nickel CHS and
Mantoux responses were significantly suppressed by acute, suberythemal UV
exposures equivalent to less than 8 min summer sunlight. Both UVA and UVB
wavebands were immunosuppressive, but UVA-induced immunosuppression was
transient, whereas UVB had a more sustained effect. Dose-responses for UV
immunosuppression were determined using the nickel method, enabling calculation
of in vivo sunscreen immune protection factors in a manner analogous with sun
protection factor measurement. Sunscreens were found to confer significantly
less protection against UV-induced immunosuppression than against UV-induced
erythema. N. Ref:: 68
----------------------------------------------------
[186]
TÍTULO / TITLE: - Varicella vaccination
in pediatric kidney transplant candidates.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Apr;6(2):97-100.
AUTORES
/ AUTHORS: - Furth SL; Fivush BA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, the Welch Center
for Prevention, Epidemiology and Clinical Research, The Johns Hopkins Medical
Institutions, Baltimore, Maryland, USA. sfurth@jhmi.edu
RESUMEN
/ SUMMARY: - Existing studies support the use of
varicella vaccine in a two-dose regimen in patients with renal disease prior to
transplantation. Levels of anti-varicella zoster virus antibody should be
monitored on a regular basis after immunization, and where a loss of a
previously protective antibody titer occurs, a third booster dose should be
considered pretransplant. Further data need to be collected regarding the use
of the vaccine in seronegative patients who have already undergone
transplantation. N.
Ref:: 22
----------------------------------------------------
[187]
TÍTULO / TITLE: - Pharmacoeconomics of
drug therapy for atopic dermatitis.
REVISTA
/ JOURNAL: - Expert Opin Pharmacother 2002
Mar;3(3):249-55.
AUTORES
/ AUTHORS: - Lamb SR; Rademaker M
INSTITUCIÓN
/ INSTITUTION: - Leeds Centre of Dermatology, Great George
Street, Leeds, West Yorkshire, LS1 3EX, UK.
RESUMEN
/ SUMMARY: - Atopic dermatitis is an increasingly
prevalent common childhood disease. While the majority of patients have mild
disease, atopic dermatitis can cause considerable distress to patients and
their caregivers, with significant social and financial cost to families. With
a prevalence of 15 - 20% in Western countries, atopic dermatitis also has a
considerable health and societal cost to the community. Many new treatments
have been shown to be therapeutically effective, particularly in severe
disease, including cyclosporin A (Neoral, Novartis AG), interferon, tacrolimus
(Fujisawa Pharmaceutical Co. Ltd.) and iv. immunoglobulin. These are expensive
when compared to standard treatments like emollients and topical
corticosteroids and have significant adverse effects that limit their use.
Additional costs related to monitoring are incurred and the long-term safety of
these treatments is yet to be determined. However, an advantage over more
traditional therapies is their ability to produce benefits even after treatment
ceases. Treatments that produce long-term remissions have a greater likelihood
of being cost-effective. With monetary constraints on healthcare and the
importance governments place on reducing drug costs, economic evaluations are
becoming an increasingly important factor for drug acceptance. Those evaluating
cost-effectiveness should pay particular attention to the potential reduction
in indirect and intangible costs. Unfortunately, there is a dearth of
cost-effectiveness studies in atopic eczema and this needs to be addressed with
some urgency. N.
Ref:: 43
----------------------------------------------------
[188]
TÍTULO / TITLE: - Immune suppression and
considerations for dental care.
REVISTA
/ JOURNAL: - Dent Clin North Am 2003 Oct;47(4):709-31,
vii.
AUTORES
/ AUTHORS: - Parisi E; Glick M
INSTITUCIÓN
/ INSTITUTION: - Division of Oral Medicine, University of
Medicine and Dentistry of New Jersey, 110 Bergen Street, D-860, Newark, NJ
07103, USA. parisier@umdnj.edu
RESUMEN
/ SUMMARY: - Immunocompromised individuals present a
challenge to oral health care providers. As the spectrum of patients with
dysfunctional immune responses continues to broaden, practitioners should be
able to identify these patients, understand the potential for complications,
and manage their dental care safely and effectively. This article reviews
various immune deficiencies, addresses complications that may result from an
individual’s immune status, and discusses dental considerations for these
patients. N. Ref:: 80
----------------------------------------------------
[189]
TÍTULO / TITLE: - Bioinformatics tools
for identifying class I-restricted epitopes.
REVISTA
/ JOURNAL: - Methods 2003 Mar;29(3):289-98.
AUTORES
/ AUTHORS: - Martin W; Sbai H; De Groot AS
INSTITUCIÓN
/ INSTITUTION: - EpiVax, Inc., Providence, Rhode Island,
USA.
RESUMEN
/ SUMMARY: - The lack of simple methods to identify
relevant T-cell epitopes, the high mutation rate of many pathogens, and
restriction of T-cell response to epitopes due to human lymphocyte antigen
(HLA) polymorphism have significantly hindered the development of cytotoxic
T-lymphocyte (CTL) epitope-based or “epitope-driven” vaccines. Previously, CTL
epitopes were mapped using large arrays of overlapping synthetic peptides. The
large number of protein sequences available for mapping is now making this
method prohibitively expensive and time-consuming. Bioinformatics tools such as
EpiMatrix and Conservatrix, which search for unique or multi-HLA-restricted
(promiscuous) T-cell epitopes and identify epitopes that are conserved across
variant strains of the same pathogen, accelerate epitope mapping. These tools
offer a significant advantage over other methods of epitope selection because
high-throughput screening can be performed in silico, followed by confirmatory
studies in vitro. CTL epitopes discovered using these tools might be used to
develop novel vaccines and therapeutics for the prevention and treatment of
infectious diseases such as human immunodeficiency virus, hepatitis C,
tuberculosis, and some cancers. N.
Ref:: 65
----------------------------------------------------
[190]
TÍTULO / TITLE: - The use of
bioinformatics for identifying class II-restricted T-cell epitopes.
REVISTA
/ JOURNAL: - Methods 2003 Mar;29(3):299-309.
AUTORES
/ AUTHORS: - Bian H; Reidhaar-Olson JF; Hammer J
INSTITUCIÓN
/ INSTITUTION: - Section of Bioinformatics, Genetics and
Genomics, Hoffmann-La Roche Inc., 340 Kingsland Street, Nutley, NJ 07110-1199,
USA. hongjin.bian@roche.com
RESUMEN
/ SUMMARY: - An important step in the design of subunit
vaccines is the identification of promiscuous T helper cell epitopes in sets of
disease-specific gene products. Most of the epitope prediction models are based
on HLA-II peptide binding, which constitutes a major bottleneck in the natural
selection of epitopes. Here we describe a computer model, TEPITOPE, that
enables the systematic prediction of promiscuous peptide ligands for a broad
range of HLA binding specificity. We show how to apply the TEPITOPE prediction
model to identify T-cell epitopes, and provide examples of its successful
application in the context of oncology, allergy, and infectious and autoimmune
diseases. N. Ref:: 17
----------------------------------------------------
[191]
TÍTULO / TITLE: - Lung transplantation.
Recipient selection.
REVISTA
/ JOURNAL: - Chest Surg Clin N Am 2003
Aug;13(3):405-28, v.
AUTORES
/ AUTHORS: - Yu AD; Garrity ER
INSTITUCIÓN
/ INSTITUTION: - Division of Pulmonary and Critical Care
Medicine, Loyola University Medical Center, 2160 S. First Avenue, Building 54,
Room 131A, Maywood, IL 60153, USA.
RESUMEN
/ SUMMARY: - Since international recommendations for
lung transplant recipients were made in 1998, newer tools for predicting
mortality in patients who have end-stage lung disease have been investigated.
This article reviews studies for predicting mortality in obstructive,
restrictive, pulmonary vascular, and suppurative/bronchiectatic lung disease.
Newer considerations for alternative treatments, postoperative risks, and
contraindications are also examined. The article aims to provide more accurate
data for selecting patients who will benefit from lung transplantation. N. Ref:: 101
----------------------------------------------------
[192]
TÍTULO / TITLE: - The challenge of
managing the care of older heart transplant recipients.
REVISTA
/ JOURNAL: - AACN Clin Issues 2002 Feb;13(1):114-31.
AUTORES
/ AUTHORS: - Baas LS; Bell B; Stuebbe SD; Giesting R;
Wagoner LE
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati College of
Nursing, PO Box 210038, Cincinnati, OH 45221-0038, USA. Linda.baas@uc.edu
RESUMEN
/ SUMMARY: - Age is perhaps the most controversial
exclusion criterion for heart transplantation. One concern focuses on whether
chronological or functional age is the better predictor of positive outcomes
when considering heart transplantation for an elderly patient with end-stage
heart disease. Another concern is related to the philosophical and ethical
rationale for allocation of scarce resources to those near the end of a normal
life expectancy. However, the number of people who are older than age 65 years
and have received a donor heart has increased and will continue to due to aging
of the people who received a transplant a decade ago, as well as the growing
number of people who undergo heart transplantation after the age of 65. In either
case, the nurse must be aware of age-related concerns in this vulnerable
population. N. Ref:: 36
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[193]
TÍTULO / TITLE: - Human herpesvirus type
8 infections among solid organ transplant recipients.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Jun;6(3):187-92.
AUTORES
/ AUTHORS: - Allen UD
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases,
Department of Pediatrics, Hospital for Sick Children, University of Toronto,
Canada. Upton.allen@sickkids.on.ca
RESUMEN
/ SUMMARY: - Human herpes virus 8 (HHV-8) is known to
be associated with Kaposi’s sarcoma (KS), primary effusion lymphoma (PEL) and a
form of Castleman’s disease. Recently, it has also been shown to be associated
with acute bone marrow failure in transplant patients. While, the full spectrum
of clinical manifestations due to HHV-8 is yet to be defined in transplant
recipients, it is known to cause post-transplant KS as a result of primary as
well as secondary infection. This review will discuss the possible role of
HHV-8 as a cause of disease in solid organ transplant recipients by focussing
on important issues, including the biology of the virus, epidemiology, clinical
manifestations, laboratory diagnosis and treatment, followed by a discussion of
issues of relevance to the pediatric transplant recipient. N. Ref:: 56
----------------------------------------------------
[194]
TÍTULO / TITLE: - Use of mutant mice in
photoimmunological and photocarcinogenic investigations.
REVISTA
/ JOURNAL: - Methods 2002 Sep;28(1):130-7.
AUTORES
/ AUTHORS: - Beissert S
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
Munster, Von-Esmarch-Strasse 58, D-48149 Munster, Germany. beisser@uni-muenster.de
RESUMEN
/ SUMMARY: - The mechanisms underlying UV-induced
immunosuppression and the development of UV-induced skin cancer have been
intensively investigated for decades. In particular, UV-induced DNA damage and
UV-induced suppression of cellular immune responses were analyzed in great
detail. During this time, several cellular and genetic pathways were
identified, that are involved in photoimmunology and photocarcinogenesis.
However, the direct effects of the complex UV-induced pathways on
immunosuppression or on cutaneous tumor generation in vivo have not been able
to be characterized with certainty so far. With the increasing availability of
mutant mice that lack or overexpress certain genes, more information can be
obtained with respect to the functional importance of individual gene products
and the signaling pathways involved in UV-mediated immunomodulation and cancer
development. This article is an overview of the results of UV-induced
immunosuppression and photocarcinogenesis experiments obtained in different
mutant mice. N.
Ref:: 56
----------------------------------------------------
[195]
TÍTULO / TITLE: - Pediatric recipients of
living donor lobar lung transplants: postoperative care.
REVISTA
/ JOURNAL: - Prog Transplant 2002 Jun;12(2):81-5.
AUTORES
/ AUTHORS: - Horn MV; Schenkel FA; Woo MS; Starnes VA
INSTITUCIÓN
/ INSTITUTION: - Childrens Hospital Los Angeles, Calif.,
USA.
RESUMEN
/ SUMMARY: - Bilateral living donor lobar lung
transplantation is a treatment option for selected children and adults with
end-stage lung disease. Careful donor evaluation, skilled intraoperative
management and surgical technique, and diligent immediate postoperative care
and follow-up all contribute to better outcomes. Although medical management of
whole lung transplant recipients in the immediate postoperative period is
similar to that of lobar lung transplant recipients, there are specific
differences. Anatomical distinctions, such as the entire cardiac output flowing
to 2 lobes instead of 5, and thoracic space issues with simultaneous mechanical
ventilation and chest tube suction, contribute to these differences. Early
postoperative care, including initial postoperative stabilization, ventilation,
fluid management, rejection/infection surveillance and prophylaxis, and
beginning rehabilitation, can be adapted to ensure successful outcomes in these
patients. N. Ref:: 8
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[196]
TÍTULO / TITLE: - Center and other factor
effects in recipients of living-donor kidney transplants.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:209-21.
AUTORES
/ AUTHORS: - Gjertson DW
RESUMEN
/ SUMMARY: - 1. LIVING DONOR KIDNEY TRANSPLANTS: Using
1996-2001 UNOS Registry data, we assessed the joint influence of center, 19
pre- and 5 posttransplant factors on renal allograft function in 21,830
patients transplanted with living donor kidneys. During an initial risk period,
21,033 recipients were projected to keep their grafts through one year (an
average 96.4% one-year graft survival), and, in a second risk period, 17,775
recipients were projected to keep their grafts through 5 years (84.5%
conditional 5-year graft survival after surviving one year posttransplant). 2.
CENTER EFFECTS: Following multivariate log-linear analysis, 57.5% and 26.5% of
assignable variation in one- and 5-year living-donor graft survival rates were
due to the variation across 234 transplant centers. Center effect dominated
other factors in influencing early outcomes among living kidney donor
transplants. A program’s size was associated with this center effect since all
large centers (400+ living donor kidneys) had better-than-average one-year
graft survival rates, whereas smaller centers (< or = 100 grafts) had wide
ranges in short-term outcomes (87-100%). Center size did not play a role in
explaining long-term variation, and the extent to which uniformity in care
remains the responsibility of the original center needs to be investigated. 3.
PRETRANSPLANT FACTOR EFFECTS: The impact of the 19 pretransplant cofactors on
short-term outcomes among living donor transplants was clinically
small—adjusted one-year graft survival rates across all categories exceeded
94%. However, their long-term effects were stronger and more typical of
cadaveric results. The following 4 factors, each explaining > 10% of the
assignable variation in conditional 5-year graft survival, were ranked and
independently yielded poor results: 1) kidneys from parental donors; 2) grafts
in male recipients; 3) teenage/adult recipients (> 12 years); and 4) black
recipients. Recipient’s original disease and body mass index, donor’s race and
age, and HLA matching were highly significant factors, but their impact on
long-term graft survival was less than those observed previously in cadaveric
renal transplants. 4. POSTTRANSPLANT FACTOR EFFECTS: Short- and long-term
outcomes were relatively stable regardless of the maintenance drug initiated at
hospital discharge. Living donor transplant outcomes were similar for Neoral
versus Tacrolimus and for MMF versus azathioprine. Kidney graft survival among
living donor transplants was strongly affected by delays in graft function or
acute rejection episodes. 5. CONCLUSIONS: During the first year posttransplant,
the benefits of receiving a living donor kidney (versus a cadaver kidney)
mitigate negative cofactor risks of graft failure. Beyond one-year, recipients
of living donor kidneys are subjected to the same deleterious effects from
cofactors and early posttransplant events that impact the long-term graft
survival following cadaveric transplantation.
----------------------------------------------------
[197]
TÍTULO / TITLE: - Vitamins and
immunocompetence.
REVISTA
/ JOURNAL: - Bibl Nutr Dieta 2001;(55):200-5.
AUTORES
/ AUTHORS: - Blumberg JB; Hughes DA
INSTITUCIÓN
/ INSTITUTION: - USDA Human Nutrition Research Center on
Aging, Tufts University, Boston, Mass., USA. Blumberg@bnrc.tufts.edu N. Ref:: 24
----------------------------------------------------
[198]
TÍTULO / TITLE: - Photoimmune suppression
and photocarcinogenesis.
REVISTA
/ JOURNAL: - Front Biosci 2002 Mar 1;7:d684-703.
AUTORES
/ AUTHORS: - Ullrich SE
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology, The University
of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. sullrich@mdanderson.org
RESUMEN
/ SUMMARY: - The primary cause of non-melanoma skin
cancer, the most prevalent form of human neoplasia, is the ultraviolet (UV)
radiation found in sunlight. Exposing mice to UV radiation induces skin cancers
that are highly antigenic. Upon transfer of an UV-induced skin cancer to a
normal syngeneic mouse, the tumor cells are recognized and rapidly destroyed by
the immune system of the recipient. This raises the question of how these
cancers avoided immune destruction during their development in the
UV-irradiated host. This question was answered when it was discovered that in
addition to being carcinogenic, UV radiation was also immunosuppressive.
Studies with immune suppressed transplantation recipients, and biopsy proven
skin cancer patients have confirmed that UV-induced immune suppression is a
risk factor for skin cancer development in humans. It is of great importance,
therefore, to understand the mechanisms underlying UV-induced immune
suppression. The focus of this manuscript will be to use some examples from the
more recent scientific literature to review the mechanisms by which UV
radiation suppresses the immune response and allows for the progressive
outgrowth of antigenic skin tumors. N.
Ref:: 160
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[199]
TÍTULO / TITLE: - Crossmatch tests—an
analysis of UNOS data from 1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:237-46.
AUTORES
/ AUTHORS: - Cho YW; Cecka JM
RESUMEN
/ SUMMARY: - Based on more than 20,000 cadaver donor
transplants reported to UNOS between 1991-2000 with crossmatch results, the
following observations were made: 1. One-hundred sixty-nine transplants
performed despite a positive T-cell NIH crossmatch (usually with an historical
serum sample) were reported to UNOS and had 5%, 6%, 7%, and 11% lower graft
survival at one, 6, 12, and 24 months after transplantation compared with
negative crossmatch transplants, respectively. 2. Transplants with a positive
T-cell FCXM (n = 714) yielded 4%, 7%, and 9% lower graft survival at one, 6,
and 12 months after transplantation compared with negative crossmatch transplants,
respectively. 3. Transplants with a positive B-cell crossmatch using NIH, Wash,
AHG or flow cytometry XM yielded statistically significantly lower (4-6%) graft
survival rates compared with B-cell negative crossmatch transplants. 4. The
differences in graft survival rates comparing recipients with a positive versus
a negative T-cell crossmatch test (NIH, AHG, and FCXM) were significant in
univariate analyses; however, only the NIH and FCXM showed a significant effect
on graft survival after adjustment of other factors in a multivariate analysis.
5. Regrafted patients with a positive T- and B-cell FCXM experienced a higher
incidence of primary nonfunction (12%) compared with those who had a negative
T- and B-cell FCXM (1%; P < 0.001). Flow cytometric or ELISA screening of
patient sera in addition to conventional cytotoxic crossmatch tests can provide
additional information to aid in the final decision of renal transplantation.
----------------------------------------------------
[200]
TÍTULO / TITLE: - Sensitization 2001.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:271-8.
AUTORES
/ AUTHORS: - Hardy S; Lee SH; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, California, USA.
RESUMEN
/ SUMMARY: - 1. The rate of transfusion decreased from
64% in 1992 to 36% in 2000. This need for transfusions continued despite the
introduction of erythropoetin. Females were transfused more frequently than
males. SLE patients were transfused more often than those with other diseases.
2. Transfusions no longer had a beneficial effect on the outcome of
transplantation, but rather with more transfusions, the graft outcome became
lower, as might be expected. 3. Rejection of a kidney transplant had the
strongest effect on sensitization, followed by transfusion and then
pregnancies. Females were more susceptible to sensitization than males.
Although non-transfused males should not have been sensitized, as many as 13%
were reported to have antibodies. As many as 20% of nulliparous females without
transfusions also were reported to have antibodies. 4. SLE patients were most
often sensitized among patients with various diseases. Females of all diseases
were more sensitized than males. 5. Unsensitized regraft patients had a 3%
lower 3-year graft survival than unsensitized first graft patients. Among
sensitized patients, regraft patients had a 4% lower graft survival than
sensitized first graft patients. 6. Patients with polycystic kidney disease had
the highest 3-year graft survival in both the sensitized and non-sensitized
patients. Sensitization to a PRA level of less than 50% was not detrimental to
patients with all the various diseases. 7. For cadaver donor regraft patients,
HLA-DR mismatch had a greater effect than AB mismatch. There was a 10 percentage
point lower 3-year graft survival in cadaver donor regraft patients mismatched
for 2 DR antigens than mismatched for 0 DR antigens. 8. For living donor
transplants, regrafts from 0 AB or 0 DR mismatched transplants had the same
graft survival as first transplants.
----------------------------------------------------