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Immunosuppression withdrawal

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https://www.readbyqxmd.com/read/29345747/recurrent-iga-nephropathy-after-renal-transplantation-and-steroid-withdrawal
#1
Maria Cristina di Vico, Maria Messina, Fabrizio Fop, Antonella Barreca, Giuseppe Paolo Segoloni, Luigi Biancone
Immunoglobulin A Nephropathy (IgAN), is the most common primary glomerulonephritis; the reported recurrence rate of IgAN after renal transplantation is as high as 13-50%. The impact of immunosuppressive therapy and steroid withdrawal on the risk of recurrence of IgAN is still under debate. We performed a retrospective single center study, selecting 123 kidney transplants (rtx) in 120 patients, between January 1995 and December 2012, with IgAN on the native kidney. In 51/123 at least one post transplantation biopsy for clinical indication was performed; in 28/51 transplants IgAN recurrence (IgANr) was demonstrated...
January 18, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29330112/macrochimerism-and-clinical-transplant-tolerance
#2
REVIEW
John D Scandling, Stephan Busque, Robert Lowsky, Judith Shizuru, Asha Shori, Edgar Engleman, Kent Jensen, Samuel Strober
Current theory holds that macrochimerism is essential to the development of transplant tolerance. Hematopoietic cell transplantation from the solid organ donor is necessary to achieve macrochimerism. Over the last 10 to 20 years, trials of tolerance induction with combined kidney and hematopoietic cell transplantation have moved from the preclinical to the clinical arena. The achievement of macrochimerism in the clinical setting is challenging, and potentially toxic due to the conditioning regimen necessary to hematopoietic cell transplantation and due to the risk of graft-versus-host disease...
January 9, 2018: Human Immunology
https://www.readbyqxmd.com/read/29329627/comparative-efficacy-of-curcumin-and-paromomycin-against-cryptosporidium-parvum-infection-in-a-balb-c-model
#3
Mohammad Asadpour, Fatemeh Namazi, Seyed Mostafa Razavi, Saeed Nazifi
Cryptosporidium is a ubiquitous protozoan parasite causing gastrointestinal disorder in various hosts worldwide. The disease is self-limiting in the immunocompetent but life-threatening in immunodeficient individuals. Investigations to find an effective drug for the complete elimination of the Cryptosporidium infection are ongoing and urgently needed. The current study was undertaken to examine the anti-cryptosporidial efficacy of curcumin in experimentally infected mice compared with that of paromomycin. Oocysts were isolated from a pre-weaned dairy calf and identified as Cryptosporidium parvum using a nested- polymerase chain reaction (PCR) on Small subunit ribosomal ribonucleic acid (SSU rRNA) gene and sequencing analysis...
January 30, 2018: Veterinary Parasitology
https://www.readbyqxmd.com/read/29316067/deep-sequencing-shows-low-level-oncogenic-hepatitis-b-virus-variants-persisting-post-liver-transplant-despite-potent-anti-hbv-prophylaxis
#4
Keith Ck Lau, Carla Osiowy, Elizabeth Giles, Beth Lusina, Guido van Marle, Kelly W Burak, Carla S Coffin
Recent studies suggest that withdrawal of hepatitis B immune globulin (HBIG) and nucleos(t)ide analogues (NA) prophylaxis may be considered in HBV surface antigen (HBsAg) negative liver transplant (LT) recipients with a low risk of disease recurrence. However, the frequency of occult HBV infection (OBI) and HBV variants after LT in the current era of potent NA therapy is unknown. 12 LT recipients on prophylaxis were tested in matched plasma and peripheral blood mononuclear cells (PBMC) for HBV quasispecies by in-house nested PCR and next generation sequencing of amplicons...
January 6, 2018: Journal of Viral Hepatitis
https://www.readbyqxmd.com/read/29307647/subsequent-non-melanoma-skin-cancers-and-impact-of-immunosuppression-in-liver-transplant-recipients
#5
Pamela Funk-Debleds, Emilie Ducroux, Olivier Guillaud, José Ursic-Bedoya, Evelyne Decullier, Mélanie Vallin, Sylvie Euvrard, Georges-Philippe Pageaux, Olivier Boillot, Jérôme Dumortier
BACKGROUND: Non-melanoma skin cancers (NMSC) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors. OBJECTIVES: To describe subsequent NMSC in a large cohort of liver transplant recipients (LTR) with long follow-up, and to analyze the factors influencing it, including immunosuppressive regimen. METHODS: Ninety-eight LTR (76 male) with a personal post-transplant history of squamous-cell carcinoma (SCC), basal-cell carcinoma (BCC) or Bowen's disease were included, with a median follow-up of 12...
January 4, 2018: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/29297205/cyclophosphamide-for-connective-tissue-disease-associated-interstitial-lung-disease
#6
REVIEW
Hayley Barnes, Anne E Holland, Glen P Westall, Nicole Sl Goh, Ian N Glaspole
BACKGROUND: Approximately one-third of individuals with interstitial lung disease (ILD) have associated connective tissue disease (CTD). The connective tissue disorders most commonly associated with ILD include scleroderma/systemic sclerosis (SSc), rheumatoid arthritis, polymyositis/dermatomyositis, and Sjögren's syndrome. Although many people with CTD-ILD do not develop progressive lung disease, a significant proportion do progress, leading to reduced physical function, decreased quality of life, and death...
January 3, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29281643/4-aminopyridyl-based-lead-compounds-targeting-cyp51-prevent-spontaneous-parasite-relapse-in-a-chronic-model-and-improve-cardiac-pathology-in-an-acute-model-of-trypanosoma-cruzi-infection
#7
Claudia Magalhaes Calvet, Jun Yong Choi, Diane Thomas, Brian Suzuki, Ken Hirata, Sharon Lostracco-Johnson, Liliane Batista de Mesquita, Alanderson Nogueira, Marcelo Meuser-Batista, Tatiana Araujo Silva, Jair Lage Siqueira-Neto, William R Roush, Mirian Claudia de Souza Pereira, James H McKerrow, Larissa M Podust
BACKGROUND: Chagas disease, caused by the protozoan Trypanosoma cruzi, is the leading cause of heart failure in Latin America. The clinical treatment of Chagas disease is limited to two 60 year-old drugs, nifurtimox and benznidazole, that have variable efficacy against different strains of the parasite and may lead to severe side effects. CYP51 is an enzyme in the sterol biosynthesis pathway that has been exploited for the development of therapeutics for fungal and parasitic infections...
December 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/29274236/successful-steroid-withdrawal-guided-by-surveillance-biopsies-a-single-center-experience
#8
Caroline Wehmeier, Patricia Hirt-Minkowski, Patrizia Amico, Argyrios Georgalis, Helmut Hopfer, Jürg Steiger, Michael Dickenmann, Stefan Schaub
Steroid withdrawal following renal transplantation is challenging and widely debated. This retrospective study aimed at investigating the frequency and determinants of successful steroid withdrawal guided by surveillance biopsies. We analysed 156 pre-transplant DSA-negative renal transplants receiving basiliximab induction and maintenance immunosuppression with tacrolimus-mycophenolate-steroids. The absence of rejection in surveillance biopsies at 3 or 6 months post-transplant initiated steroid withdrawal, which was monitored by subsequent indication and/or surveillance biopsies...
December 23, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/29262323/extracellular-atp-activates-the-nlrp3-inflammasome-and-is-an-early-danger-signal-of-skin-allograft-rejection
#9
Joaquín Amores-Iniesta, Maria Barberà-Cremades, Carlos M Martínez, José A Pons, Beatriz Revilla-Nuin, Laura Martínez-Alarcón, Francesco Di Virgilio, Pascual Parrilla, Alberto Baroja-Mazo, Pablo Pelegrín
Immune cells are equipped with a number of receptors that recognize sterile injury and pathogens. We find that host immune cells release ATP as an inflammatory signal in response to allogeneic transplantation. ATP then acts via a feedback mechanism on the P2X7 channel to activate the NLRP3 inflammasome and subsequently process and release interleukin (IL)-18. This process is a necessary stage in the deleterious Th1 response against allotransplantation via interferon-γ production. Lack of IL-18 resulted in a decrease in graft-infiltrating CD8 cells but an increase in regulatory T cells...
December 19, 2017: Cell Reports
https://www.readbyqxmd.com/read/29239457/opioids-and-immunosupression-in-oncological-postoperative-patients
#10
José Luis Bonilla-García, Manuel Cortiñas-Sáenz, Esperanza Del Pozo-Gavilán
INTRODUCTION: Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anesthesia Care Unit (PACU)-acquired infection after a schedule of sedoanalgesia of at least 6 days. METHOD: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion...
September 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/29238601/clinicians-approaches-to-management-of-background-treatment-in-patients-with-sle-in-clinical-remission-results-of-an-international-observational-survey
#11
Pintip Ngamjanyaporn, Eoghan M McCarthy, Jamie C Sergeant, John Reynolds, Sarah Skeoch, Benjamin Parker, Ian N Bruce
Background: The definition of remission in systemic lupus erythematosus (SLE) remains unclear, especially how background treatment should be interpreted. Objective: To determine preferences of clinicians in treatment of patients in clinical remission from SLE and to assess how previous severity, duration of remission and serology influence changes in treatment. Methods: We undertook an internet-based survey of clinicians managing patients with SLE...
2017: Lupus Science & Medicine
https://www.readbyqxmd.com/read/29227569/new-diagnosis-of-bullous-pemphigoid-after-withdrawal-of-immunosuppressive-therapy-in-a-failed-renal-transplant-recipient-on-hemodialysis
#12
Sohail Abdul Salim, Litty Thomas, Amanda Quorles, Seyed Mehrdad Hamrahian, Tibor Fülöp
The occurrence of the autoimmune blistering disease, bullous pemphigoid (BP), in patients with failed renal allograft is rare and the few reported cases suggest various provocative factors without reaching a consensus. Here we report the case of a patient presenting with bullous lesions soon after the complete discontinuation of immunosuppressant therapy following renal allograft failure. Skin biopsy confirmed the diagnosis of BP. Administration of systemic corticosteroid controlled the occurrence of BP lesions in our patient...
December 11, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29199436/-considerations-on-the-treatment-of-iga-nephropathy-on-the-basis-of-the-results-of-the-latest-studies-stop-igan-testing-nefigan
#13
Judit Nagy, Balázs Sági, Judit Máté, Tibor Vas, Tibor Kovács
IgA nephropathy is an immune-mediated chronic glomerulonephritis with a great variability in clinical presentation and outcome. The disease can progress to end-stage renal failure in 25% of patients. For this reason we should identify patients with potential to progress. Most important risk factors for progression are persistent proteinuria, hypertension, decreased renal function and some histological lesions. The actually suggested treatment is summarized in KDIGO Clinical Practice Guideline from 2012. They suggest to give firstly non-specific supportive treatment (especially renin-angiotensin system blocking agents)...
December 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/29191961/intragraft-molecular-pathways-associated-with-tolerance-induction-in-renal-transplantation
#14
Lorenzo Gallon, James M Mathew, Sai Vineela Bontha, Catherine I Dumur, Pranav Dalal, Lakshmi Nadimpalli, Daniel G Maluf, Aneesha A Shetty, Suzanne T Ildstad, Joseph R Leventhal, Valeria R Mas
The modern immunosuppression regimen has greatly improved short-term allograft outcomes but not long-term allograft survival. Complications associated with immunosuppression, specifically nephrotoxicity and infection risk, significantly affect graft and patient survival. Inducing and understanding pathways underlying clinical tolerance after transplantation are, therefore, necessary. We previously showed full donor chimerism and immunosuppression withdrawal in highly mismatched allograft recipients using a bioengineered stem cell product (FCRx)...
November 30, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29157988/de-novo-thrombotic-microangiopathy-after-kidney-transplantation
#15
REVIEW
Neetika Garg, Helmut G Rennke, Martha Pavlakis, Kambiz Zandi-Nejad
Thrombotic microangiopathy (TMA) is a serious complication of transplantation that adversely affects kidney transplant recipient and allograft survival. Post-transplant TMA is usually classified into two categories: 1) recurrent TMA and 2) de novo TMA. Atypical hemolytic uremic syndrome (aHUS) resulting from dysregulation and over-activation of the alternate complement pathway is a rare disease but the most common diagnosis associated with recurrence in the allografts. De novo TMA, on the other hand, represents an overwhelming majority of the cases of post-transplant TMA and is a substantially more heterogeneous entity than recurrent aHUS...
November 4, 2017: Transplantation Reviews
https://www.readbyqxmd.com/read/29151264/renal-protection-strategies-after-heart-transplantation
#16
REVIEW
Daniel Reichart, Hermann Reichenspurner, Markus Johannes Barten
Renal dysfunction caused by calcineurin inhibitor (CNI) nephrotoxicity occurs often and contributes significantly to late mortality after heart transplantation (HTx). Over the last decades, this has prompted many clinical studies in an effort to develop kidney-protecting immunosuppressive strategies including delayed CNI start, minimization, withdrawal or even de-novo CNI avoidance. In the past, these strategies often failed due to the lack of efficacy. Since 2009, novel CNI-reducing strategies are under investigation...
November 19, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/29150986/memory-t-cells-are-significantly-increased-in-rejecting-liver-allografts-of-rhesus-monkeys
#17
Hwajung Kim, Hyeyoung Kim, Sun-Kyung Lee, Xue-Li Jin, Tae Jin Kim, Chanho Park, Jae-Il Lee, Hyo-Sin Kim, Suk Kyun Hong, Kyung Chul Yoon, Sung Woo Ahn, Kyoung-Bun Lee, Nam-Joon Yi, Jaeseok Yang, Kwang-Woong Lee, Wayne J Hawthorne, Kyung-Suk Suh
INTRODUCTION: The Rhesus monkey (RM) is an excellent preclinical model in kidney, heart and islet transplantation that has provided the basis for new immunosuppressive protocols for clinical studies. However, there remain relatively few liver transplantation (LT) models in nonhuman primates. In this study, we analyzed the immune cell populations of PBMCs and secondary lymphoid organs along with livers of normal rhesus monkeys and compared them to those of rejecting liver transplanted recipient's following withdrawal of immunosuppression...
November 18, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/29145342/evaluation-of-anti-desmoglein-1-and-anti-desmoglein-3-autoantibody-titers-in-pemphigus-patients-at-the-time-of-the-initial-diagnosis-and-after-clinical-remission
#18
Irene Russo, Francesco Paolo De Siena, Andrea Saponeri, Mauro Alaibac
It has been suggested that anti-desmoglein autoantibody titers could be helpful in follow-up and therapeutic management of pemphigus patients. However, there is no consensus regarding the relationship between anti-desmoglein autoantibody titers and clinical activity of pemphigus.The aim of our study was to evaluate if clinical remission of pemphigus relates to the presence of anti-desmoglein autoantibodies.Thirty patients with pemphigus vulgaris and 7 patients with pemphigus foliaceous were included in the study...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29128025/posttransplant-lymphoproliferative-disorder-in-solid-organ-and-hematopoietic-stem-cell-transplantation
#19
REVIEW
Sarah J Nagle, Ran Reshef, Donald E Tsai
Posttransplant lymphoproliferative disorders (PTLD) represent an immunosuppression-related lymphoid or plasmacytic proliferation that occur in the setting of solid organ transplant or allogeneic hematopoietic stem cell transplantation (HSCT). PTLD is a devastating consequence of HSCT and solid organ transplantation with a high morbidity and mortality. Most commonly, PTLD is related to Epstein-Barr virus (EBV) infection, but an increasing number of non-EBV-related cases are occurring. Initial therapy involves withdrawal of immunosuppression with or without antibody or cytotoxic chemotherapy...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29116676/salvage-therapy-with-topical-posaconazole-in-lung-transplant-recipients-with-invasive-scedosporium-infection
#20
Amparo Solé, Ana A García-Robles, Carlos Jordá, Enrique Cases Viedma, Nuria Mancheño, José Luis Poveda-Andrés, Juan Pablo Reig Mezquida, Javier Pemán
Scedosporium is an important pathogen in cystic fibrosis (CF) and post-transplant, but it rarely causes invasive infection. Treatment remains challenging, particularly due to the inherent resistance to multiple antifungal agents. We present three complicated invasive tracheobronchial and lung Scedosporium apiospermum infections following lung transplant. In two of three cases, the infection was clinically and radiologically cured with frequent cleansing bronchoscopies, combining triazole with terbinafine therapy and nebulized posaconazole...
November 8, 2017: American Journal of Transplantation
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