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tacrolimus and sirolimus

Y S de Boer, R Liberal, D Vergani, G Mieli-Vergani
Background and aims: Juvenile autoimmune liver disease (JAILD) includes paediatric forms of autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC). Since evidence is scarce, there are currently no evidence-based management guidelines for juvenile AIH. This survey was carried out amongst the paediatric members of the International AIH Group (IAIHG) to describe their practices in the management of JAILD. Methods: An online survey questionnaire was distributed to members of the IAIHG with active practice (https://www...
August 2018: United European Gastroenterology Journal
Amandeep Salhotra, Matthew Mei, Tracey Stiller, Sally Mokhtari, Alex F Herrera, Robert Chen, Leslie Popplewell, Jasmine Zain, Haris Ali, Karamjeet Sandhu, Elizabeth Budde, Auayporn Nademanee, Stephen J Forman, Ryotaro Nakamura
Current standard of care for patients with Hodgkin's and non-Hodgkin's lymphoma is high does conditioning with autologous stem cell transplantation (ASCT). For some patients (i.e., highest risk disease, insufficient stem cell number after mobilization, or patients whose bone marrow is involved with the disease) allogeneic transplantation (alloHCT) offers potential cure. However, majority of patients undergoing alloHCT, receive reduced intensity conditioning as preparative regimen and studies assessing outcomes of patients after alloHCT with myeloablative conditioning (MAC) are limited...
September 15, 2018: Biology of Blood and Marrow Transplantation
Lin Zhou, Li-Chao Pan, Yong-Gen Zheng, Guo-Sheng Du, Xiao-Qian Fu, Zhi-Dong Zhu, Ji-Yong Song, Zhi-Jia Liu, Xiang-Zheng Su, Wen Chen, De-Hua Zheng, Long-Long Suo, Shao-Zhen Yang
Although liver transplantation (LT) lengthens the survival time of patients with hepatocellular carcinoma (HCC), LT patients exhibit a high recurrence rate; particularly those that had advanced HCC associated with the tumor biological characteristics and long-term application of immunosuppressants. A consensus on optimal prophylaxis and treatment for recurrent HCC following LT does not currently exist. The present study retrospectively analyzed data from 36 non-University of California at San Francisco criteria-eligible patients with advanced HCC who underwent LT, and then treated them with sirolimus (SRL)-based therapy with thymalfasin and huaier granules (SRL+, n=18), or with tacrolimus-based therapy (controls; n=18)...
October 2018: Oncology Letters
E Karakulska-Prystupiuk, G Basak, J Dwilewicz-Trojaczek, M Paluszewska, P Boguradzki, W Jędrzejczak
BACKGROUND: There are only a few cases of pericarditis complications following allogeneic bone marrow transplantation described in the literature and there are no data available on the risk and frequency of this condition. The aim of this study was to assess the frequency of exudative pericarditis complicating chronic graft-vs-host disease in allogeneic hematopoietic cell transplant recipients. METHODS: Retrospective analysis involved a group of 105 patients of the Outpatient Transplantation Service of the Department of Hematology, Medical University of Warsaw, who received transplants in the years 2010-2016 and were evaluated for the years 2014-2016...
September 2018: Transplantation Proceedings
Hui Yang, Wei Wang, Xiaopeng Hu, Xiaodong Zhang, Lihong Liu
RATIONALE: Drug-induced angioedema has been reported as an adverse effect of many different drugs. But small bowel angioedema associated with sirolimus (SRL) used was barely understood. It must be necessary to report a case suffering from small bowel angioedema with detailed discussion and literature review. PATIENT CONCERNS: A 38-year-old Chinese woman presented with generalized gastric pain in the following day after renal transplantation. The patient began to crampy abdominal pain accompanied by nausea, vomiting, and diarrhea on postoperative day 6 (POD)...
August 2018: Medicine (Baltimore)
A Tarasewicz, A Dębska-Ślizień, B Rutkowska, E Szurowska, M Matuszewski
Mammalian target of rapamycin inhibitors (mTORI) are increasingly used in the treatment of tuberous sclerosis complex (TSC) and as immunosuppressants after organ transplantation. In TSC patients, mTORI are the treatment of choice after kidney transplantation. It is still under debate if benefits from long-term mTORI use will not be limited by side effects. MATERIALS AND METHODS: We report long-term follow-up data of the first TSC patient after kidney transplantation treated with sirolimus de novo...
July 2018: Transplantation Proceedings
Farhad Khimani, George B McDonald, Howard M Shulman, Brian Betts, Frederick Locke, Hugo Fernandez, Claudio Anasetti, Joseph Pidala
Sirolimus-based graft vs. host disease (GVHD) prophylaxis is associated with higher incidence of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) after allogeneic hematopoietic cell transplantation (HCT). However, whether the clinical manifestations and prognosis of VOD/SOS differs when diagnosed in the setting of sirolimus-based GVHD prophylaxis is not well studied. To address this question, we examined presenting features and treatment outcome of VOD/SOS cases identified in a large retrospective cohort of consecutive HCT procedures (n = 818 total, sirolimus (SIR)/tacrolimus (TAC) n = 308, and methotrexate (MTX) or mycophenolate mofetil (MMF)/TAC n = 510)...
June 12, 2018: Bone Marrow Transplantation
Apurva D Patel, Brian Lowes, Mohammed A Chamsi-Pasha, Stanley J Radio, Marshall Hyden, Ronald Zolty
CLINICAL FEATURES: Giant cell myocarditis (GCM) is a rare and a rapidly progressive disorder with fatal outcomes such that patients often require heart transplantation. We present a case of recurrent GCM in a transplanted patient with a history of Crohn disease requiring a novel therapeutic approach. THERAPEUTIC CHALLENGE: After the orthotopic heart transplantation, GCM recurred on aggressive immunosuppression over the months, which included corticosteroids, basiliximab, tacrolimus, antithymocyte globulin, and rituximab...
May 30, 2018: American Journal of Therapeutics
S Davis, J Gralla, L Chan, A Wiseman, C L Edelstein
BACKGROUND: The mammalian target of rapamycin (mTOR) pathway has been shown to be central to cyst formation and growth in patients with autosomal dominant polycystic kidney disease (ADPKD). Drugs that suppress mTOR signaling are frequently used as antiproliferative agents for maintenance immunosuppression in patients who have undergone kidney transplantation. The aim of this study was to determine the effect of sirolimus, an mTOR inhibitor, on cyst volume regression in patients with ADPKD who have undergone renal transplantation...
June 2018: Transplantation Proceedings
Aleksandra Wilk, Dagmara Szypulska-Koziarska, Karolina Kędzierska-Kapuza, Agnieszka Kolasa-Wołosiuk, Kamila Misiakiewicz-Has, Kazimierz Ciechanowski, Barbara Wiszniewska
A negative result of therapy based on immunosuppressive drugs is its leading to pathological alterations in the organ, including liver. Use of immunosuppressive medication may also lead to organized and genetically controlled cell death - apoptosis. The aim of this study was to examine histopathological changes in the livers of rats treated with immunosuppressive drugs, and also to determine the effects of different groups of immunosuppressive drugs on apoptosis activity in the hepatocytes of rat livers. The study was conducted on archival material obtained from Department of Nephrology, Transplantology and Internal Medicine of the Independent Public Clinical Hospital No...
May 16, 2018: Transplant Immunology
R Erro, Ruggero Bacchin, F Magrinelli, P Tomei, C Geroin, G Squintani, A Lupo, G Zaza, M Tinazzi
INTRODUCTION: Tremor is the most frequent and disabling neurological side effect under Calcineurin inhibitor-induced immunosuppression, but no studies have defined its phenomenology, severity, distribution, the impact on quality of life, as well as of other neurological symptoms associated. METHODS: 126 consecutive kidney-transplanted patients, under treatment with Cyclosporin A, Tacrolimus and non-Calcineurin inhibitors, within therapeutic range, were enrolled...
July 2018: Journal of Neurology
Johan Noble, Thomas Jouve, Lionel Rostaing, Paolo Malvezzi
Cornerstone immunosuppressive therapy currently relies on immediate-release tacrolimus, a calcineurin inhibitor (CNI) that is potentially nephrotoxic and is more diabetogenic than cyclosporine A. Two new formulations of tacrolimus have been launched: an extended-release formulation (Advagraf®/Astagraf XL®, Astellas company) and a long-lasting formulation (Envarsus®, Veloxis company). Area covered: Herein, we assess the efficacy of an extended-release formulation of tacrolimus (Advagraf®/Astagraf XL®) used in conjunction with or without an induction therapy (i...
June 2018: Expert Review of Clinical Immunology
Jonathan A Fridell, Richard S Mangus, Jeanne M Chen, Tim E Taber, Arianna E Cabrales, Asif A Sharfuddin, Muhammad S Yaqub, John A Powelson
Graft survival following pancreas transplant alone (PTA) is inferior to other pancreas transplants. Steroid elimination is appealing, but a two-drug maintenance strategy may be inadequate. Additionally, recipients tend to have diabetic nephropathy and do not tolerate nephrotoxic medications. A three-drug maintenance strategy permits immunosuppression through different mechanisms as well as an opportunity to use lower doses of the individual medications. Induction consisted of five doses of rabbit antithymocyte globulin (1 mg/kg/dose)...
May 8, 2018: American Journal of Transplantation
G Schmalz, L Berisha, H Wendorff, F Widmer, A Marcinkowski, H Teschler, U Sommerwerck, R Haak, O Kollmar, D Ziebolz
BACKGROUND: Aim of this study was to investigate the association of the time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected periodontal pathogenic bacteria of immunosuppressed patients after solid organ transplantation (SOT). MATERIAL AND METHODS: 169 Patients after SOT (lung, liver or kidney) were included and divided into subgroups according their time under (0-1, 1-3, 3-6, 6-10 and >10 years) and form of immunosuppression (Tacrolimus, Cyclosporine, Mycophenolate, Glucocorticoids, Sirolimus and monotherapy vs...
May 1, 2018: Medicina Oral, Patología Oral y Cirugía Bucal
Karin Gmitterová, Michal Minár, Miroslav Žigrai, Zuzana Košutzká, Alice Kušnírová, Peter Valkovič
BACKGROUND: Hepatic encephalopathy may manifest by a wide spectrum of neuropsychiatric symptoms, including cognitive impairment, seizures or extrapyramidal symptoms. The liver transplant can lead to improvement of the signs of encephalopathy but subsequent immunosuppressive treatment might possess pronounced neurotoxicity. CASE PRESENTATION: We present a case report of a patient with chronic liver disease who developed signs of Parkinsonism after an orthotopic liver transplant, with consecutive immunosuppressant treatment with tacrolimus...
April 20, 2018: BMC Neurology
C G Marmanillo, C Langaro, J E Nicoluzzi, R T Belila, M Macri, R Zamprogna, M Luvizotto, M Takahashi
BACKGROUND: The most common multiple-organ transplant is the simultaneous pancreas-kidney transplantation (SPK). It is usually offered to patients who have insulin-dependent diabetes mellitus and those with diabetic nephropathy and renal failure that has already been established. In this study we present the results of 15 years of SPK in a transplant hospital center in Paraná, Brazil, and evaluated survival, immunosuppression, and transplant-related problems. METHODS: This study was a retrospective analysis of 131 SPK transplants performed at the Angelina Caron Hospital between January 2001 and December 2015...
April 2018: Transplantation Proceedings
Patricia Cristina Grenzi, Érika Fernandes Campos, Hélio Tedesco-Silva, Claudia Rosso Felipe, Maria Fernanda Soares, José Medina-Pestana, Hinrich Peter Hansen, Maria Gerbase-DeLima
BACKGROUND: Soluble CD30 (sCD30) is a suggested marker for kidney transplantation outcomes. We investigated whether sCD30 serum levels are influenced by immunosuppression and whether they correlate with findings in protocol biopsies and with CD30 gene expression in peripheral blood mononuclear cells (PBMC). METHODS: We studied 118 kidney transplant recipients that initially received tacrolimus (TAC) and, at month-3, were converted or not to sirolimus (SRL). RESULTS: sCD30 serum levels gradually declined after transplantation, being the decline more pronounced in the SRL group...
July 2018: Human Immunology
Chengcheng Fu, Jia Chen, Yang Xu, Depei Wu
PURPOSE: The purpose of this retrospective study was to analyze the dose adjustment of immunosuppressants (cyclosporine, tacrolimus and sirolimus) for the patients with allogeneic hematopoietic stem cell and solid-organ (heart/lung) transplantation during co-administration of posaconazole. METHODS: MEDLINE, EMBASE and Cochrane Library were searched from January 1, 2000 to June 30, 2017 for clinical reports of patients who received allogeneic hematopoietic stem cell and organ transplantation and were co-administered posaconazole and immunosuppressants (cyclosporine, tacrolimus or sirolimus)...
March 27, 2018: Clinical and Investigative Medicine. Médecine Clinique et Experimentale
José Luis Piñana, Alejandro Perez-Pitarch, Beatriz Guglieri-Lopez, Estela Giménez, Juan Carlos Hernandez-Boluda, María José Terol, Rafael Ferriols-Lisart, Carlos Solano, David Navarro
Sirolimus appears to protect against cytomegalovirus (CMV) in organ transplant recipients. The effect of this drug in allogeneic hematopoietic stem cell transplantation recipients remains unexplored. By means of multivariate continuous-time Markov model analyses, we identified 3 independent covariates that significantly impacted the risk of CMV DNAemia: recipient/donor CMV serostatus, tacrolimus exposure, and sirolimus exposure. CMV-seropositive recipients with CMV-seronegative donors had a significantly higher probability of having detectable CMV DNAemia...
March 30, 2018: American Journal of Transplantation
Fevzi F Yalniz, Mohammad H Murad, Stephanie J Lee, Steven Z Pavletic, Nandita Khera, Nilay D Shah, Shahrukh K Hashmi
Given the increasing incidence of chronic graft-versus-host disease (cGVHD) and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost-effectiveness analysis for the frequently utilized agents in steroid-refractory cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis, pomalidomide, and methotrexate...
March 14, 2018: Biology of Blood and Marrow Transplantation
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