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mycophenolate neutropenia

Jaime A Campbell, John R Krause
Prolonged immunosuppression in solid organ transplant recipients has been considered a risk for developing opportunistic infections and malignancies. Acute leukemia is a rare complication. We report a case of acute promyelocytic leukemia (APL) (FAB M3) after cadaveric renal transplant for focal segmental glomerulosclerosis in a 24-year-old woman. Her immunosuppressive therapy included tacrolimus, mycophenolate mofetil, and prednisone. Approximately 2 years after transplant, she became pancytopenic, prompting administration of filgrastim...
October 2016: Proceedings of the Baylor University Medical Center
Faouzi Saliba, Lionel Rostaing, Jean Gugenheim, François Durand, Sylvie Radenne, Vincent Leroy, Martine Neau-Cransac, Yvon Calmus, Ephrem Salamé, Georges-Philippe Pageaux, Christophe Duvoux, Naila Taguieva, Gilles Sinnasse-Raymond, Mylène Sebagh, Didier Samuel, Pierre Marquet
BACKGROUND: We conducted a randomized multicenter open-label trial in de novo liver transplant recipients to assess the feasibility and potential benefit of a corticosteroid (CS)-free regimen coupled with tacrolimus (Tac) and dose-intensified mycophenolate mofetil (MMF) further adjusted individually. METHODS: Adult liver transplant recipients were randomized on the day of transplantation to a CS-free regimen with Tac and MMF starting at 3 g/d and dose adjusted from day 5 according to mycophenolic acid (MPA) exposure (arm A) or a regimen with CS maintained up to 6 months, Tac and fixed-dose MMF (2 g/d) (arm B)...
August 2016: Transplantation
Shuichiro Fujinaga, Kanako Ozawa, Koji Sakuraya, Akifumi Yamada, Toshiaki Shimizu
BACKGROUND: Rituximab (RTX) is regarded as a relatively safe and effective treatment for children with steroid-dependent nephrotic syndrome (SDNS). However, late-onset adverse events after RTX, including neutropenia, hypogammaglobulinemia, and increased risk of infections, have been rarely reported in this cohort. MATERIALS AND METHODS: This was a single-center retrospective analysis of adverse events during B-cell depletion periods after a single dose of RTX (375 mg/m2) in 60 patients with complicated SDNS (total 126 doses)...
June 2016: Clinical Nephrology
Taha Sachak, Michael A Arnold, Bita V Naini, Rondell P Graham, Sejal S Shah, Michael Cruise, Jason Y Park, Lindsey Clark, Laura Lamps, Wendy L Frankel, Nicole Theodoropoulos, Christina A Arnold
Neutropenic enterocolitis (NE) is a deadly ileocecal-based disease seen in patients with a recent history of chemotherapy. As histology is not included in the current diagnostic criteria, the pathologic features of NE are poorly understood. We undertook a multi-institutional study of NE, and report helpful clinical clues, such as immunosuppression (n=20/20), recent chemotherapy (n=17/18), neutropenia (n=16/18) gastrointestinal symptoms (n=19/19), abnormal imaging studies of the cecum/right colon (n=11/14), and positive microbiological studies (n=13/15)...
December 2015: American Journal of Surgical Pathology
Esthela Loyo, Luis J Jara, Persio David López, Ana Carolina Puig
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) has been recently proposed by Shoenfeld and Agmon-Levin as a new entity that comprises several conditions: the macrophagic-myofasciitis syndrome, the Gulf War syndrome, silicosis and post-vaccination phenomena, autoimmunity related to infectious fragments, hormones, aluminum, silicone, squalene oil, and pristane. We report the case of a 23-year-old woman who developed serial episodes of high fever, extreme fatigue, transient thrombocytopenia, multiple cervical adenopathies, hepatosplenomegaly, anemia, neutropenia, severe proteinuria and urine sediment abnormalities, elevated serum ferritin levels, and transient low positive antinuclear antibodies 1 year after she had a nickel-titanium chin implant for cosmetic reasons...
April 2013: Auto- Immunity Highlights
Rachel Becker-Cohen, Efrat Ben-Shalom, Choni Rinat, Sofia Feinstein, Michael Geylis, Yaacov Frishberg
BACKGROUND: Infections are an important cause of morbidity and mortality in solid organ transplant recipients. Neutrophils play a crucial role in the initial host defense against bacterial pathogens. Neutropenia is not uncommon after renal transplantation in adults; however, there are scarce published data in children. We conducted a historical cohort study to evaluate the incidence, clinical course, and management of severe neutropenia after renal transplantation in children. METHODS: In a single-center study, we collected clinical and laboratory data on all children (<20 years) who underwent renal transplantation from January 2005 to March 2014...
November 2015: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
J Draibe, R Poveda, X Fulladosa, A Vidaller, C Zulberti, M Gomà, R Pujol, È Ripoll, J Torras, J M Grinyó
INTRODUCTION: Standard therapy with corticosteroids (CS) and cyclophosphamide (CYC) followed by azathioprine has been shown to improve renal and patient survival in ANCA-associated renal vasculitis (rAAV). Mycophenolate mofetil (MF) has been progressively introduced for the treatment of rAAV in the last years because of its immunosuppressive efficacy combined with a lower toxicity profile. In this study, we retrospectively analyse the results of the introduction of MF for maintenance and induction therapy in rAAV in our institution from 2001 to 2013...
April 2015: Nephrology, Dialysis, Transplantation
Teruhiko Imamura, Koichiro Kinugawa, Kent Doi, Masaru Hatano, Takeo Fujino, Osamu Kinoshita, Kan Nawata, Eisei Noiri, Shunei Kyo, Minoru Ono
Recently, the mammalian target of rapamycin inhibitor everolimus (EVL) has been introduced as a novel immunosuppressant for heart transplant (HTx) recipients, and is expected to preserve renal function compared to conventional calcineurin inhibitors (CNIs). However, a considerable number of recipients treated with EVL were not free from worsening renal function regardless of CNI reduction. Data were collected retrospectively from 27 HTx recipients who had received EVL (trough concentration, 3.1-9.2 ng/mL) along with reduced CNIs (%decreases in trough concentration, 27...
2015: International Heart Journal
Pu Li, Ping Huang, Ye Yang, Mu Hao, Hongwei Peng, Fei Li
Autoimmune lymphoproliferative syndrome (ALPS), a disorder characterized by immune dysregulation due to disrupted lymphocyte homeostasis, is mainly resulted from the mutations in FAS-mediated apoptotic pathway. In addition, other mutations of the genes such as Fas-ligand (FASLG), Caspase 10 (CASP10) and Caspase 8 (CASP8), NRAS and KRAS have also been observed in a small number of patients with ALPS or ALPS-related disorders. However, approximately 20-30% of patients with ALPS have unidentified defect. Its clinical manifestations observed in multiple family members include unexplained lymphadenopathy, hepatosplenomegaly, autoimmune cytopenias such as thrombocytopenia, neutropenia, and anemia due to excessive production of antibodies by lymphocytes, elevated number of double-negative T (DNT) cells, and increased risk of lymphoma...
February 2016: Clinical Reviews in Allergy & Immunology
M W F van den Hoogen, E G Kamburova, M C Baas, E J Steenbergen, S Florquin, H J P M Koenen, I Joosten, L B Hilbrands
We evaluated the efficacy and safety of rituximab as induction therapy in renal transplant patients. In a double-blind, placebo-controlled study, 280 adult renal transplant patients were randomized between a single dose of rituximab (375 mg/m(2)) or placebo during transplant surgery. Patients were stratified according to panel-reactive antibody (PRA) value and rank number of transplantation. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil and steroids. The primary endpoint was the incidence of biopsy proven acute rejection (BPAR) within 6 months after transplantation...
February 2015: American Journal of Transplantation
Pi Chun Cheng, Damien Patel, Gabriel Bosslet
SESSION TITLE: Critical Care Student/Resident CasesSESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 04:30 PM - 05:30 PMINTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome of excess inflammation and immune activation that can lead to progressive multiorgan failure. HLH's clinical presentation can vary significantly, making its diagnosis challenging in the ICU. We present a case of HLH with massive retroperitoneal lipomatosis, an association which has not yet been described...
October 1, 2014: Chest
Keiyu Matsumoto, Takashi Kobayashi, Kaoru Murakami, Kazutoshi Okubo, Hiromitsu Negoro, Naoki Terada, Yoshio Sugino, Toshinari Yamasaki, Yoshiyuki Matsui, Takahiro Inoue, Tomomi Kamba, Koji Yoshimura, Osamu Ogawa
A 20-year-old man with end-stage renal disease was scheduled to have an ABO-incompatible living kidney transplantation donated by his mother. His complete blood count including differential white blood cell count was normal before preoperative immunosuppressive therapy including mycophenolate mofetil (MMF), tacrolimus (FK506), and prednisolone was started 3 weeks before the operation. The dosage of MMF was initially 2,000 mg/day, but was reduced to 500 mg/day due to diarrhea 10 days before the operation. He received rituximab 13 days before the operation...
June 2014: Hinyokika Kiyo. Acta Urologica Japonica
Kazuya Kabei, Junji Uchida, Tomoaki Iwai, Takeshi Yamasaki, Nobuyuki Kuwabara, Toshihide Naganuma, Norihiko Kumada, Tatsuya Nakatani
INTRODUCTION: Using rituximab, we have performed successful ABO-incompatible kidney transplantations in recipients without splenectomy as well as in those with high pretransplant anti-A/B antibody titers. A common and increasingly recognized toxicity of rituximab is late-onset neutropenia (LON), defined as unexplained grades III to IV neutropenia occurring at least 4weeks after the last dose of rituximab in the absence of an alternative explanation. PATIENTS AND METHODS: Between May 2006 and December 2011, 25 patients who received rituximab underwent successful ABO-incompatible kidney transplantation and were enrolled as the subjects in this study...
August 2014: Transplant Immunology
Fuad S Shihab, Ali Olyaei, Anne Wiland, Kevin McCague, Douglas J Norman
Tacrolimus exposure and renal function data to 36 months post-transplant were analyzed from the prospective, observational Mycophenolic acid Observational REnal transplant (MORE) registry in which de novo kidney transplant patients were managed according to local practice. Tacrolimus trough (C0 ) concentration at month 12 was stratified as low (<6 ng/mL), moderate (6-8 ng/mL), or high (>8 ng/mL) in 724 patients. Estimated glomerular filtration rate (eGFR) was stratified as low (<60 mL/min/1.73 m(2) ) or high (≥60 mL/min/1...
July 2014: Clinical Transplantation
Olivier Aubert, Rebecca Sberro-Soussan, Anne Scemla, Nicole Casadevall, Irène Teyssandier, Frank Martinez, Olivier Hermine, Christophe Legendre, Bruno Varet, Flore Sicre De Fontbrune
BACKGROUND: Neutropenia is common after kidney transplantation and is associated with an increased incidence of infections. Drug toxicities are the main causes of posttransplant neutropenia (PTN), mainly related to immunosuppressive drugs as mycophenolic acid (MPA) and anti-infectious agents, but some PTN remain unexplained. METHODS: Between January 2012 and January 2013, cultures of autologous granulocytic progenitors from bone marrow aspirate were performed in two patients with unexplained severe neutropenia...
April 15, 2014: Transplantation
Kimi Ueda, Kevin M McCague, Anne Wiland, V Ram Peddi
BACKGROUND: Prospective, long-term data on corticosteroid withdrawal (CSW) versus corticosteroid continuation (CSC) following kidney transplantation are scarce. MATERIAL/METHODS: The Mycophenolic Renal Transplant (MORE) Registry was a prospective, observational study of de novo kidney transplant patients receiving mycophenolic acid (MPA) and standard of care. Adult patients receiving tacrolimus and enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) at time of transplant were analyzed to 4 years according to CSW by month 3 (n=363) or CSC (n=509)...
2014: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Eirini Savvidaki, Panagiotis Kazakopoulos, Evangelos Papachristou, Dimitrios Karavias, Vasilios Zavvos, Georgios Voliotis, Pantelitsa Kalliakmani, Markos Marangos, Dimitrios S Goumenos
OBJECTIVES: Neutropenia after kidney transplant is an adverse event usually treated with a dosage reduction of mycophenolic acid. We evaluated the efficacy and safety of substituting mycophenolic acid with everolimus in patients with persistent neutropenia after kidney transplant. MATERIALS AND METHODS: This study was a retrospective analysis. A total of 17 patients who were initially treated with mycophenolic acid (1912 ± 196 mg/d), calcineurin inhibitors, and methylprednisolone for kidney transplant were included...
February 2014: Experimental and Clinical Transplantation
Lenaïg Le Clech, Pascal Hutin, Solène Le Gal, Gaëlle Guillerm
Opportunistic infections cause a significant morbidity and mortality in immunocompromised patients. We describe the case of a patient with skin fusariosis and a probable cerebral toxoplasmosis after UCB stem cell transplantation for B-cell acute lymphoblastic leukaemia. Fusarium species (spp) infections are difficult to treat. To date, there has been no consensus on the treatment of fusariosis and the management of its side effects. Given the negative pretransplant Toxoplasma serology in this case, identifying the origin of the Toxoplasma infection was challenging...
2014: BMJ Case Reports
Teruhiko Imamura, Koichiro Kinugawa, Minoru Ono, Yukie Kagami, Miyoko Endo, Shun Minatsuki, Hironori Muraoka, Naoko Kato, Toshiro Inaba, Hisataka Maki, Masaru Hatano, Atsushi Yao, Shunei Kyo, Issei Komuro
The long-term survival of heart transplantation (HTx) recipients has increased significantly in recent years, however, the nephrotoxic adverse effects of calcineurin inhibitors (CNIs) are still a major concern. Recently, an inhibitor of mammalian target of rapamycin, everolimus (EVL), has emerged as an alternative immunosuppressant drug that may allow CNI dosage reduction and thereby spare renal function. Data were collected from 20 HTx recipients who had received EVL (target trough level 3-8 ng/mL) along with a dose reduction of CNIs and/or mycophenolate mophetil (MMF) and had been followed for 1 year...
2013: International Heart Journal
J Pazik, M Ołdak, Z Lewandowski, M Podgórska, E Sitarek, R Płoski, Z Gałazka, A Kwiatkowski, J Malejczyk, M Durlik
BACKGROUND: Uridine diphosphate glucuronosyltransferase (UGT2B7) is responsible for conversion of mycophenolic acid to mycophenolic acyl-glucuronide (acylMPAG). Conflicting data exist regarding the role of UGT2B7 p.His268Tyr (802C>T, rs7439366) variant in the clinical course following organ transplantation. STUDY AIM: The aim of this study was to reveal an association between UGT2B7 p.His268Tyr (802C>T, rs7439366) polymorphism and kidney transplantation outcome...
May 2013: Transplantation Proceedings
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