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refractory rejection

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https://www.readbyqxmd.com/read/27926596/donor-genotype-and-intragraft-expression-of-cyp3a5-reflect-the-response-to-steroid-treatment-during-acute-renal-allograft-rejection
#1
N V Rekers, T M Flaig, M J K Mallat, M J Spruyt-Gerritse, M Zandbergen, J D H Anholts, I M Bajema, M C Clahsen-van Groningen, J Yang, J W de Fijter, F H J Claas, S Brakemeier, N Lachmann, R Kreutz, E de Heer, K Budde, J Bolbrinker, M Eikmans
BACKGROUND: Glucocorticoid-refractory acute rejection is a risk factor for inferior renal allograft outcome. We investigated genetic predisposition to the response to steroid treatment of acute allograft rejection. METHODS: Single nucleotide polymorphisms of genes involved in glucocorticoid signaling (GR, GLCCI1) and drug metabolism and transport (CYP3A5, ABCB1, and PXR) were analyzed in kidney transplant recipients (1995-2005, Leiden cohort, n=153) treated with methylprednisolone...
December 6, 2016: Transplantation
https://www.readbyqxmd.com/read/27862703/alemtuzumab-campath-1h-therapy-for-refractory-rejections-in-pediatric-heart-transplant-recipients
#2
Bibhuti Das, Vivian Dimas, Kristine Guleserian, Chantale Lacelle, Kristin Anton, Lindy Moore, Robert Morrow
Despite substantial improvements in survival after pediatric heart transplantation, refractory rejection remains a major cause of morbidity and mortality. We have utilized ALE (Campath-1H) in six consecutive patients with refractory rejection. These rejection episodes persisted despite conventional treatment, which included intravenous methylprednisolone, rituximab, immunoglobulin G, and antithymocyte globulin. In our series, after ALE therapy, LV SF increased from 22%±5% to 33%±5% (P=.01). However, in our series, ALE therapy neither led to persistent LV function recovery nor could it prevent subsequent antibody-mediated rejection...
November 11, 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/27849440/use-of-cidofovir-for-cytomegalovirus-disease-refractory-to-ganciclovir-in-solid-organ-recipients
#3
Hugo Bonatti, Costi D Sifri, Clara Larcher, Stefan Schneeberger, Camille Kotton, Christian Geltner
BACKGROUND: Solid organ transplantation (SOT) frequently is complicated by cytomegalovirus (CMV) infections. Cidofovir (CDV) is active against CMV, including many ganciclovir (GCV)-resistant mutants, but often is considered to be too nephrotoxic for use after organ transplantation. PATIENTS AND METHODS: Seven males and two females (median age 50.1 years), including two kidney/pancreas, four lung, one small bowel, and two hand recipients, received CDV for refractory CMV disease...
November 16, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27807488/uveitis-and-myositis-as-immune-complications-in-chemorefractory-nk-t-cell-nasal-type-lymphoma-successfully-treated-with-allogeneic-stem-cell-transplant
#4
Maria José Gómez-Crespo, Aránzazu García-Raso, Jose Luis López-Lorenzo, Teresa Villaescusa, María Rodríguez-Pinilla, José Fortes, Cristina Serrano, Salma Machan, Pilar Llamas, Raúl Córdoba
NK/T-cell lymphomas are a group of clonal proliferations of NK- or, rarely, T-cell types and have peculiar clinicopathologic features. Most common site of involvement is the upper aerodigestive tract (nasal cavity, nasopharynx, paranasal sinuses, and palate). Association of autoimmune paraneoplastic disorders with NK/T-cell lymphomas is not well studied. Our patient was diagnosed with NK/T-cell lymphoma stage IV with skin involvement and treated frontline with CHOEP regimen. While he was under treatment, two immune complications presented: anterior uveitis of autoimmune origin refractory to steroids and myositis in lower limbs muscles...
2016: Case Reports in Hematology
https://www.readbyqxmd.com/read/27795623/rituximab-in-the-treatment-of-refractory-late-acute-antibody-mediated-rejection-our-initial-experience
#5
M Surendra, S B Raju, N Raju, S Chandragiri, K K Mukku, M S Uppin
Antibody-mediated rejection (AMR) is not uncommon after renal transplantation and is harder to handle compared to cell-mediated rejection. When refractory to conventional therapies, rituximab is an attractive option. This study aims to examine the effectiveness of rituximab in refractory late acute AMR. This is a retrospective study involving nine renal transplant recipients. Four doses of rituximab were administered at weekly interval for 4 weeks, at a dose of 375 mg/m(2). The mean age of patients was 35.3 ± 7...
September 2016: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/27752765/acute-kidney-transplant-rejection-mediated-by-angiotensin-ii-type-1-receptor-antibodies-in-a-pediatric-hyperimmune-patient
#6
Isabella Guzzo, Federica Morolli, Francesca Diomedi Camassei, Antonina Piazza, Elvira Poggi, Luca Dello Strologo
BACKGROUND: Several cases of severe antibody-mediated rejection (AMR) secondary to antibodies against the angiotensin II type 1 receptor (AT1R-Ab) have been described with variable outcome. CASE-DIAGNOSIS/TREATMENT: We report the case of a 13-year-old boy whose first kidney transplant failed due to steroid-resistant acute cellular rejection, with the subsequent development of sensitization. He received a second kidney transplant which was complicated by early humoral rejection, with weakly positive staining for the complement degradation product C4d...
January 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27749560/pyoderma-gangrenosum-preceding-the-onset-of-extranodal-natural-killer-t-cell-lymphoma-a-case-report
#7
Ting-Hua Yang, Chung-Hong Hu, Hsiou-Hsin Tsai
INTRODUCTION: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that may be associated with systemic diseases. The association of PG with lymphoid malignancies has rarely been reported. Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare but aggressive entity with a poor prognosis. Here, we report the case of a patient who had idiopathic PG refractory to systemic steroids and subsequently developed ENKTL. CASE REPORT: A 70-year-old man presented with a 2-month history of intermittent fever and multifocal painful papules, plaques, and ulcerations on his extremities...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27684823/clinical-evaluation-of-deep-anterior-lamellar-keratoplasty-using-glycerol-cryopreserved-corneal-tissues-for-refractory-herpetic-stromal-keratitis-an-observational-study
#8
Xin Liu, Qi Zhou, Xinyu Huang, Zhenxing Liu, Yanlong Bi
The study aimed to evaluate the therapeutic effects of deep anterior lamellar keratoplasty (DALK) using glycerol-cryopreserved corneal tissues (GCCTs) in patients with refractive herpes simplex keratitis (HSK). This article was a retrospective, noncomparative, and interventional case series. Patients with HSK underwent DALK using GCCTs at Shanghai Tongji Hospital from 2012 to 2015. The best spectacle corrected visual acuity, recurrent inflammation, graft status, postoperative central graft thickness, and pre/postoperative complications were detected...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27670223/extracorporeal-membrane-oxygenation-for-hemophagocytic-lymphohistiocytosis
#9
Victoria Anne Saites, Rachel Hadler, Jacob Thomas Gutsche, Krzysztof Laudanski
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare hematological disease characterized by an excessive inflammatory response to various triggers, resulting in rapid multi-organ failure. Its incidence may be underestimated due to its rarity, its variable clinical presentation, and its high mortality rate prior to diagnosis. Oftentimes, HLH is mistaken for refractory sepsis and improperly treated as such. Left untreated, the disease is universally fatal. With treatment, case series of adults with HLH report a 30-day mortality of up to 44% and an overall mortality of up to 75%...
September 27, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27619734/heart-failure-therapies-new-strategies-for-old-treatments-and-new-treatments-for-old-strategies
#10
REVIEW
Marc K Halushka, Richard N Mitchell, Robert F Padera
Heart failure, whether acute or chronic, remains a major health care crisis affecting almost 6 million Americans and over 23 million people worldwide. Roughly half of those affected will die within 5 years, and the annual cost exceeds $30 billion in the US alone. Although medical therapy has made some modest inroads in partially stemming the heart failure tsunami, there remains a significant population for whom medication is unsuccessful or has ceased being effective; such patients can benefit from heart transplantation or mechanical circulatory support...
November 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
https://www.readbyqxmd.com/read/27602507/trial-of-decompressive-craniectomy-for-traumatic-intracranial-hypertension
#11
Peter J Hutchinson, Angelos G Kolias, Ivan S Timofeev, Elizabeth A Corteen, Marek Czosnyka, Jake Timothy, Ian Anderson, Diederik O Bulters, Antonio Belli, C Andrew Eynon, John Wadley, A David Mendelow, Patrick M Mitchell, Mark H Wilson, Giles Critchley, Juan Sahuquillo, Andreas Unterberg, Franco Servadei, Graham M Teasdale, John D Pickard, David K Menon, Gordon D Murray, Peter J Kirkpatrick
Background The effect of decompressive craniectomy on clinical outcomes in patients with refractory traumatic intracranial hypertension remains unclear. Methods From 2004 through 2014, we randomly assigned 408 patients, 10 to 65 years of age, with traumatic brain injury and refractory elevated intracranial pressure (>25 mm Hg) to undergo decompressive craniectomy or receive ongoing medical care. The primary outcome was the rating on the Extended Glasgow Outcome Scale (GOS-E) (an 8-point scale, ranging from death to "upper good recovery" [no injury-related problems]) at 6 months...
September 22, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27597379/acute-antibody-mediated-rejection-in-abo-compatible-pediatric-liver-transplant-recipients-case-series-and-review-of-the-literature
#12
Laura J Wozniak, Bita V Naini, Michelle J Hickey, Sarathi Bhattacharyya, Elaine F Reed, Ronald W Busuttil, Douglas G Farmer, Jorge H Vargas, Robert S Venick, Sue V McDiarmid
Acute AMR is well reported following ABO-incompatible LTx. However, it remains uncommon in ABO-compatible LTx. It typically presents with graft dysfunction ≤2 weeks post-LTx and is often associated with graft loss. We report the clinical presentation, treatment regimen, and outcome of six pediatric LTx recipients diagnosed with early acute AMR based on (i) clinical signs of graft dysfunction, (ii) histopathology indicative of acute injury ± C4d staining, and (iii) presence of HLA DSA. All patients developed elevated ALT and GGT ≤ 45 days post-LTx...
September 5, 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/27499223/immunological-complications-of-blood-transfusions
#13
Anneke Brand
Most adverse blood transfusion (BT) events are immune-mediated and in the majority of severe reactions antibodies can be identified as causal factors. Alloimmunization not only causes symptomatic reactions, transfused cells can also be (silently) destroyed. Immunization by BT can contribute to hemolytic disease of the newborn as well as to allograft rejection after transplantation. Reversely, pregnancy and transplantation may evoke immunity hampering transfusion therapy. Besides causing mortality and morbidity, alloimmunization has a huge economic impact...
July 2016: La Presse Médicale
https://www.readbyqxmd.com/read/27479183/hla-dpb1-mismatch-alleles-represent-powerful-leukemia-rejection-antigens-in-cd4-t-cell-immunotherapy-after-allogeneic-stem-cell-transplantation
#14
W Herr, Y Eichinger, J Beshay, A Bloetz, S Vatter, C Mirbeth, E Distler, U F Hartwig, S Thomas
Refractory or relapsed acute myeloid leukemia (AML) represents a frequent complication after allogeneic hematopoietic stem-cell transplantation (HSCT). We show herein that primary in vitro stimulation of CD45RA-selected CD4 T cells of stem-cell donors with 10/10 HLA-matched AML blasts results in expansion of cytolytic T-lymphocytes (CTL) that almost all recognize HLA-DPB1 mismatch alleles, which clinically occur in up to 80% of donor-patient pairs. Primary AML blasts were found to strongly express HLA-DPB1, whereas fibroblasts and keratinocytes used as surrogate target cells for graft-versus-host disease did express HLA-DPB1 only upon IFN-γ pre-treatment...
September 2, 2016: Leukemia: Official Journal of the Leukemia Society of America, Leukemia Research Fund, U.K
https://www.readbyqxmd.com/read/27476075/spleen-tyrosine-kinase-a-crucial-player-and-potential-therapeutic-target-in-renal-disease
#15
Terry King-Wing Ma, Stephen P McAdoo, Frederick Wai-Keung Tam
Spleen tyrosine kinase (Syk), a 72 kDa cytoplasmic non-receptor protein-tyrosine kinase, plays an important role in signal transduction in a variety of cell types. Ever since its discovery in the early 1990s, there has been accumulating evidence to suggest a pathogenic role of Syk in various allergic disorders, autoimmune diseases and malignancies. Additionally, there is emerging data from both pre-clinical and clinical studies that Syk is implicated in the pathogenesis of proliferative glomerulonephritis (GN), including anti-glomerular basement membrane disease, anti-neutrophil cytoplasmic antibody-associated GN, lupus nephritis and immunoglobulin A nephropathy (IgAN)...
2016: Nephron
https://www.readbyqxmd.com/read/27438241/assessment-of-nanofiltration-and-reverse-osmosis-potentialities-to-recover-metals-sulfuric-acid-and-recycled-water-from-acid-gold-mining-effluent
#16
Bárbara C Ricci, Carolina D Ferreira, Larissa S Marques, Sofia S Martins, Míriam C S Amaral
This work assessed the potential of nanofiltration (NF) and reverse osmosis (RO) to treat acid streams contaminated with metals, such as effluent from the pressure oxidation process (POX) used in refractory gold ore processing. NF and RO were evaluated in terms of rejections of sulfuric acid and metals. Regarding NF, high sulfuric acid permeation (∼100%), was observed, while metals were retained with high efficiencies (∼90%), whereas RO led to high acid rejections (<88%) when conducted in pH values higher than 1...
2016: Water Science and Technology: a Journal of the International Association on Water Pollution Research
https://www.readbyqxmd.com/read/27289448/-disseminated-fungal-infection-due-to-magnusiomyces-capitatus-in-a-liver-graft-patient
#17
C G Yapo-Kouadio, L Hasseine, B Goubaux, M Gari-Toussaint
Disseminated fungal infections due to Magnusiomyces capitatus are rare, occurring exclusively in immunocompromised patients. We report the first case in a liver transplant patient with chronic rejection and portal thrombosis who had a M. capitatus fungemia with a refractory septic shock. Despite an antibacterial and antifungal treatment with caspofungin empirical treatment, the patient died from multiple organ failure. Subsequently, mycological examinations of blood cultures, bronchoalveolar lavage fluid and urine were positive to M...
September 2016: Journal de Mycologie Médicale
https://www.readbyqxmd.com/read/27214874/splenic-irradiation-for-the-treatment-of-severe-antibody-mediated-rejection
#18
B J Orandi, B E Lonze, A Jackson, S Terezakis, E S Kraus, N Alachkar, S M Bagnasco, D L Segev, J B Orens, R A Montgomery
Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody-mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success at graft salvage, long-term graft survival and protection against transplant glomerulopathy with the use of eculizumab and splenectomy in addition to PP/IVIg. Splenectomy may be an important component of this combination therapy and is itself associated with a marked reduction in donor-specific antibody (DSA) production...
May 23, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27210774/rituximab-therapy-for-rejection-in-pediatric-heart-transplant
#19
Ilkay Erdogan, Birgul Varan, Atilla Sezgin, Arash Pirat, Pinar Zeyneloglu
OBJECTIVES: Humoral rejection is the B-cell-mediated production of immunoglobulin G antibody against the transplanted heart. Antibody-mediated rejection may be resistant to standard immunosuppressive therapy and is associated with high mortality and graft loss. Rituximab can be used to treat antibody-mediated rejection in heart transplant recipients. This retrospective study describes our experience with rituximab treatment in children with heart transplants. MATERIALS AND METHODS: We present 7 pediatric patients with antibody-mediated rejection who were treated with plasma exchange and rituximab therapy...
May 17, 2016: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/27184061/ultraviolet-b-irradiation-in-the-prevention-of-alloimmunization-in-a-dog-platelet-transfusion-model
#20
Sherrill J Slichter, Kraig Abrams, Irena Gettinger, Todd Christoffel, Lakshmi Gaur, Yvette Latchman, Karen Nelson, Esther Pellham, S Lawrence Bailey, Doug Bolgiano
BACKGROUND: Alloimmune platelet (PLT) refractoriness remains a significant problem for chronically transfused patients with thrombocytopenia. STUDY DESIGN AND METHODS: In a dog PLT transfusion model, we evaluated ultraviolet B irradiation (UV-B) of donor PLTs-either alone or in combination with centrifuge leukoreduction (C-LR) or filtration leukoreduction (F-LR)-to prevent refractoriness to donor PLTs and to induce tolerance to standard (STD) PLTs from the same donor or to tertiary donors...
May 17, 2016: Transfusion
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