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https://www.readbyqxmd.com/read/28942074/immunosuppression-for-the-uveitides
#1
REVIEW
Douglas A Jabs
The uveitides are a collection of more than 30 diseases characterized by intraocular inflammation. Many cases of juvenile idiopathic arthritis-associated uveitis, many cases of intermediate uveitis, and most cases of posterior and panuveitides requiring treatment are treated with corticosteroids and immunosuppression. Disease-specific, time-updated modeling of clinical data for several uveitides suggests superior prevention of ocular complications and visual outcomes with immunosuppression. These studies also suggest that oral corticosteroids at doses low enough for safe long-term therapy (i...
September 20, 2017: Ophthalmology
https://www.readbyqxmd.com/read/28878864/use-of-everolimus-in-liver-transplantation
#2
REVIEW
Mei-Ling Yee, Hui-Hui Tan
In recent years, the use of mammalian target of rapamycin inhibitors has gained traction in their use as alternative or adjunct immunosuppressants in the post-liver transplantation (LT) setting. The efficacy of everolimus (EVR) in de novo LT is established and a reasonable time to initiate EVR is 30 d from LT surgery. Initiating EVR early post-LT allows for calcineurin inhibitor (CNI) reduction, thus reducing nephrotoxicity in LT recipients. However, data is inadequate on the appropriate timing for conversion from CNI to EVR maintenance in order to achieve optimal renoprotective effect without compromising drug efficacy...
August 18, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28691954/maintenance-belatacept-based-immunosuppression-in-lung-transplantation-recipients-who-failed-calcineurin-inhibitors
#3
Carlo J Iasella, Ryan J Winstead, Cody A Moore, Bruce A Johnson, Ayelet T Feinberg, Matthew R Morrell, J W Awori Hayanga, Elizabeth A Lendermon, Adriana Zeevi, John F McDyer, Christopher R Ensor
BACKGROUND: Traditional immunosuppressive regimens (ISR) used in lung transplantation rely on calcineurin inhibitors (CNI) that occasionally cause severe adverse reactions necessitating discontinuation. Belatacept is a novel costimulation antagonist approved for use in renal transplantation which lacks data in lung transplantation. This series aims to describe the response to belatacept ISR in 11 lung transplantation recipients after CNI failure. METHODS: Single center, retrospective medical record review of adult lung transplant recipients (LTR) before and after conversion to belatacept-based ISR...
July 6, 2017: Transplantation
https://www.readbyqxmd.com/read/28457399/polyomavirus-nephropathy-ten-year-experience
#4
J S Costa, E Ferreira, R Leal, N Bota, C Romãozinho, V Sousa, C Marinho, L Santos, F Macário, R Alves, J Pratas, M Campos, A Figueiredo
BACKGROUND: Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL)...
May 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28405602/cognitive-evaluation-in-liver-transplant-patients-under-calcineurin-inhibitor-maintenance-therapy
#5
Nils Heits, Dalibor Keserovic, Niclas Mund, Nicola Ehmke, Alexander Bernsmeier, Alexander Hendricks, Rainer Gunther, Karsten Witt, Thomas Becker, Felix Braun
BACKGROUND: Neurological disorders due to calcineurin inhibitor (CNI) treatment pose a well-known problem after liver transplantation (LTx). In this study, the impact of CNIs on cognitive functioning during maintenance therapy was analyzed. A possible improvement of cognitive functioning, compliance and health-related quality of life (HRQoL) after conversion to a once-daily tacrolimus formulation was prospectively assessed. METHODS: In a cross-section analysis cognitive functioning of living donors (LD), waiting list patients and LTx patients was tested using a 4 times trail making test (4-TTMT)...
April 2017: Transplantation Direct
https://www.readbyqxmd.com/read/27861314/effect-of-the-direct-oral-anticoagulants-rivaroxaban-and-apixaban-on-the-disposition-of-calcineurin-inhibitors-in-transplant-recipients
#6
Thomas Vanhove, Isabel Spriet, Pieter Annaert, Johan Maertens, Johan Van Cleemput, Robin Vos, Dirk Kuypers
BACKGROUND: Calcineurin inhibitors (CNIs) and direct oral anticoagulants (DOACs) share certain metabolic pathways, but whether DOACs influence CNI exposure has not been assessed. METHODS: A single-center retrospective analysis was performed including 39 organ recipients treated with the combination of a CNI and rivaroxaban (n = 29) or apixaban (n = 10). Dose-corrected CNI trough concentrations (C0/D) during 200 days before and after DOAC initiation were recorded (n = 261), together with covariates known to influence CNI disposition such as steroid dose and hematocrit...
November 17, 2016: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/27742293/efficacy-and-safety-of-monotherapy-with-mycophenolate-mofetil-in-liver-transplantation-patients-with-nephrotoxicity
#7
C M Cruz, S Pereira, J Gandara, S Ferreira, V Lopes, J Daniel, H P Miranda
Calcineurin inhibitors (CNI) are the base of immunosuppressive regimens in liver transplantation but they are associated with significant side effects, namely nephrotoxicity, which leads to increased morbidity and mortality. Through time, mycophenolate mofetil (MMF) as monotherapy has been suggested as an alternative in patients with CNI-related toxicity, but still no consensus has been reached as to its efficacy. We have evaluated the safety, efficacy, and tolerability of MMF monotherapy in selected patients, developing CNI-associated events, focusing primarily on kidney dysfunction...
September 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27500271/a-proposal-for-early-dosing-regimens-in-heart-transplant-patients-receiving-thymoglobulin-and-calcineurin-inhibition
#8
REVIEW
Markus J Barten, Uwe Schulz, Andres Beiras-Fernandez, Michael Berchtold-Herz, Udo Boeken, Jens Garbade, Stephan Hirt, Manfred Richter, Arjang Ruhpawar, Jan Dieter Schmitto, Felix Schönrath, Rene Schramm, Martin Schweiger, Markus Wilhelm, Andreas Zuckermann
There is currently no consensus regarding the dose or duration of rabbit antithymocyte globulin (rATG) induction in different types of heart transplant patients, or the timing and intensity of initial calcineurin inhibitor (CNI) therapy in rATG-treated individuals. Based on limited data and personal experience, the authors propose an approach to rATG dosing and initial CNI administration. Usually rATG is initiated immediately after exclusion of primary graft failure, although intraoperative initiation may be appropriate in specific cases...
June 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27496436/prospective-assessment-of-hepcidin-in-relation-to-delayed-or-immediate-graft-function-in-patients-undergoing-kidney-transplantation
#9
J Malyszko, R Kowalewski, J Glowinski, J Malyszko, E Koc-Zorawska, I Glowinska, U Lebkowska, M Gacko
BACKGROUND: Hepcidin is a peptide hormone that regulates iron homeostasis. Hepcidin may represent an early, predictive biomarker of acute kidney injury, another model of ischemia-reperfusion injury. Urinary hepcidin-25 has been shown to be elevated in patients who do not develop acute kidney injury. Creatinine is an unreliable indicator during acute changes in kidney; therefore, the aim of the study was to assess whether hepcidin could predict renal outcome in 31 consecutive patients undergoing kidney allograft transplantation...
June 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27495768/use-of-everolimus-in-liver-transplantation-recommendations-from-a-working-group
#10
REVIEW
Paolo De Simone, Stefano Fagiuoli, Matteo Cescon, Luciano De Carlis, Giuseppe Tisone, Riccardo Volpes, Umberto Cillo
Immunosuppression after liver transplantation (LT) is presently based on use of calcineurin inhibitors (CNI), although they are associated with an increased incidence of renal dysfunction, cardiovascular complications, and de novo and recurrent malignancies. Over the past decade, mammalian target of rapamycin inhibitors have received considerable attention as immunosuppressants because they are associated with a more favorable renal profile versus CNI, as well as antiproliferative activity in clinical studies...
February 2017: Transplantation
https://www.readbyqxmd.com/read/27260644/effect-of-everolimus-initiation-and-early-calcineurin-inhibitor-withdrawal-on-myocardial-foxp3-regulatory-t-cells-in-heart-transplantation
#11
Kiran Mirza, Finn Gustafsson, Lars Gullestad, Satish Arora, Claus Andersen
BACKGROUND: Through immunosuppression CD4+FoxP3+ regulatory T-cells (Tregs) play an indispensable role in allograft rejection. Post-HTx treatment with everolimus is associated with slower progression of cardiac allograft vasculopathy (CAV) - chronic rejection - than CNI based therapy. We hypothesized treatment with everolimus reduced the risk of CAV by modulating myocardial FoxP3 levels. METHODS: 15 patients from the Schedule trial comparing everolimus, MMF, steroid and early CNI (Everolimus, n=8) withdrawal to conventional CNI based immunosuppression (Controls, n=7) after de novo HTx were included and FoxP3+ cells were quantified in 56 endomyocardial biopsies, and compared in the two patient groups...
September 2016: Transplant Immunology
https://www.readbyqxmd.com/read/27134877/evaluation-of-renal-allograft-biopsies-for-graft-dysfunction-and-relevance-of-c4d-staining-in-antibody-mediated-rejection
#12
Clement Wilfred Devadass, Aruna Vishwanth Vanikar, Lovelesh Kumar Nigam, Kamal Vinod Kanodia, Rashmi Dalsukhbhai Patel, Kyasakkala Sannaboraiah Vinay, Himanshu V Patel
INTRODUCTION: Biopsy remains gold standard for diagnosis of Graft Dysfunction (GD). It guides clinical management, provides valuable insights into pathogenesis of early and late allograft injury and is indispensable for distinguishing rejection from non- rejection causes of GD. AIM: The primary aim of the study was to evaluate the diverse histomorphological lesions in renal allograft biopsy (RAB). Further, we determined the frequency of peritubular capillary (PTC) C4d positivity and its correlation with microvascular inflammation in Antibody Mediated Rejection (AMR)...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27003330/tacrolimus-concentration-dose-ratio-is-associated-with-renal-function-after-liver-transplantation
#13
Gerold Thölking, Lea Siats, Christian Fortmann, Raphael Koch, Anna Hüsing, Vito R Cicinnati, Hans Ulrich Gerth, Heiner H Wolters, Christoph Anthoni, Hermann Pavenstädt, Barbara Suwelack, Hartmut H Schmidt, Iyad Kabar
BACKGROUND: The calcineurin inhibitor (CNI) tacrolimus (Tac) is an effective immunosuppressant used after liver transplantation (LTx), but is often associated with CNI nephrotoxicity. Currently, there is no simple clinical predictor for CNI nephrotoxicity after LTx. We hypothesized that the Tac metabolism rate - defined as the blood concentration normalized by its daily dose (the C/D ratio) - is associated with post-LTx renal impairment. MATERIAL AND METHODS: We analyzed the relationship between the C/D ratio and post-transplant renal function in 179 patients who underwent LTx between 2000 and 2012 and were initially immunosuppressed with Tac, mycophenolate mofetil, and prednisolone...
March 22, 2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/26912551/treatment-with-glucocorticoids-or-calcineurin-inhibitors-in-primary-fsgs
#14
COMPARATIVE STUDY
Louis-Philippe Laurin, Adil M Gasim, Caroline J Poulton, Susan L Hogan, J Charles Jennette, Ronald J Falk, Bethany J Foster, Patrick H Nachman
BACKGROUND AND OBJECTIVES: In primary FSGS, calcineurin inhibitors have primarily been studied in patients deemed resistant to glucocorticoid therapy. Few data are available about their use early in the treatment of FSGS. We sought to estimate the association between choice of therapy and ESRD in primary FSGS. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used an inception cohort of patients diagnosed with primary FSGS by kidney biopsy between 1980 and 2012...
March 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/26707323/race-calcineurin-inhibitor-exposure-and-renal-function-after-solid-organ-transplantation
#15
MULTICENTER STUDY
L Yessayan, A Shafiq, E Peterson, K Wells, Y Hu, L K Williams, D Lanfear
BACKGROUND: Calcineurin-inhibitor (CNI)-induced nephrotoxicity frequently complicates transplantation. African-Americans are at a greater risk of renal failure than the general population. We investigated whether race was an effect modifier of the relationship between CNI exposure and kidney function after nonrenal solid organ transplantation. METHODS: This is a retrospective cohort study of 1609 patients who underwent initial nonrenal solid organ transplantation between January 2000 and June 2012...
December 2015: Transplantation Proceedings
https://www.readbyqxmd.com/read/26613512/effects-of-mtor-and-calcineurin-inhibitors-combined-therapy-in-epstein-barr-virus-positive-and-negative-burkitt-lymphoma-cells
#16
Sylvia J Wowro, Katharina R L Schmitt, Giang Tong, Felix Berger, Stephan Schubert
Post-transplant lymphoproliferative disorder is a severe complication in solid organ transplant recipients, which is highly associated with Epstein-Barr virus infection in pediatric patients and occasionally presents as Burkitt- or Burkitt-like lymphoma. The mammalian target of rapamycin (mTOR) pathway has been described as a possible antitumor target whose inhibition may influence lymphoma development and proliferation after pediatric transplantation. We treated Epstein-Barr virus positive (Raji and Daudi) and negative (Ramos) human Burkitt lymphoma derived cells with mTOR inhibitor everolimus alone and in combination with clinically relevant immunosuppressive calcineurin inhibitors (tacrolimus or cyclosporin A)...
January 2016: International Immunopharmacology
https://www.readbyqxmd.com/read/26512166/maintenance-therapy-of-facial-seborrheic-dermatitis-with-0-1-tacrolimus-ointment
#17
Hye One Kim, Yoon Seok Yang, Hyun Chang Ko, Gyung Moon Kim, Sang Hyun Cho, Young Joon Seo, Sang Wook Son, Jong Rok Lee, Joong Sun Lee, Sung Eun Chang, Jae We Che, Chun Wook Park
BACKGROUND: Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. OBJECTIVE: The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. METHODS: During the initial stabilization period, patients with facial SD or AD applied 0...
October 2015: Annals of Dermatology
https://www.readbyqxmd.com/read/26293038/evolution-of-renal-function-in-renal-allograft-recipients-under-various-everolimus-based-immunosuppressive-regimens
#18
C Skalioti, S Marinaki, M Darema, S Lionaki, N Antonakopoulos, G Zavos, J Boletis
BACKGROUND: Long-term allograft survival is a major challenge in kidney transplantation. This study sought to estimate the evolution of renal function in patients receiving different immunosuppressive regimens based on everolimus (EVR). METHODS: Ninety-nine renal allograft recipients were included in a 12-month open-label, noninterventional, prospective, single-center study. Patients were divided into 2 groups, de novo and late conversion to EVR. RESULTS: Group A included 40 patients under calcineurin inhibitor (CNI) plus EVR...
July 2015: Transplantation Proceedings
https://www.readbyqxmd.com/read/26257963/giant-cell-myocarditis-not-always-a-presentation-of-cardiogenic-shock
#19
Rose Tompkins, William J Cole, Barry P Rosenzweig, Leon Axel, Sripal Bangalore, Anuradha Lala
Giant cell myocarditis is a rare and often fatal disease. The most obvious presentation often described in the literature is one of rapid hemodynamic deterioration due to cardiogenic shock necessitating urgent consideration of mechanical circulatory support and heart transplantation. We present the case of a 60-year-old man whose initial presentation was consistent with myopericarditis but who went on to develop a rapid decline in left ventricular systolic function without overt hemodynamic compromise or dramatic symptomatology...
2015: Case Reports in Cardiology
https://www.readbyqxmd.com/read/26226408/clinical-utility-of-computed-tomography-and-magnetic-resonance-imaging-for-diagnosis-of-posterior-reversible-encephalopathy-syndrome-after-stem-cell-transplantation-in-children-and-adolescents
#20
Christopher E Dandoy, Luke L Linscott, Stella M Davies, James L Leach, Kasiani C Myers, Javier El-Bietar, Ranjit S Chima, Abigail Pate, Adam Nelson, Gregory Wallace, Hector R Wong, Sonata Jodele
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by vision changes, altered mental status, and seizures, typically caused by an acute rise in blood pressure. PRES has been reported after hematopoietic stem cell transplantation (HSCT) in association with hypertension from calcineurin inhibitors and corticosteroids. The imaging evaluation of PRES after HSCT in children and young adults has not been well described. We performed a retrospective review of all HSCT recipients presenting to the intensive care unit with new neurologic symptoms...
November 2015: Biology of Blood and Marrow Transplantation
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