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https://www.readbyqxmd.com/read/29470425/major-histocompatibility-complex-and-hematopoietic-stem-cell-transplantation-beyond-the-classical-hla-polymorphism
#1
REVIEW
Alice Bertaina, Marco Andreani
Allogeneic hematopoietic stem cell transplantation (HSCT) represents a curative treatment for many patients with hematological malignant or non-malignant disorders. Evaluation of potential donors for HSCT includes a rigorous assessment of the human leukocyte antigens (HLA) match status of family members, and the identification of suitable unrelated donors. Genes encoding transplantation antigens are placed both within and outside the major histocompatibility complex (MHC). The human MHC is located on the short arm of chromosome 6 and contains a series of genes encoding two distinct types of highly polymorphic cell surface glycoproteins...
February 22, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29469043/viscoelastic-testing-in-liver-disease
#2
Jessica P E Davis, Patrick G Northup, Stephen H Caldwell, Nicolas M Intagliata
Long thought to be hypocoagulable, new evidence suggests cirrhosis patients have "rebalanced" coagulation in the setting of decreased synthesis of both pro- and anti-coagulant factors. Traditional testing like PT/INR reflects only the decreased synthesis of pro-coagulant factors and thus does not correspond to bleeding or clotting risk in this population. In this review, we discuss the use of viscoelastic testing (VET), an assay of global hemostasis in cirrhosis patients. We describe the technique and interpretation of commercially available VET and assess the application of VET in both transplant and non-transplant cirrhosis populations...
March 1, 2018: Annals of Hepatology
https://www.readbyqxmd.com/read/29438096/fda-approval-summary-lenalidomide-as-maintenance-therapy-after-autologous-stem-cell-transplant-in-newly-diagnosed-multiple-myeloma
#3
Elizabeth Dianne Pulte, Andrew Dmytrijuk, Lei Nie, Kirsten B Goldberg, Amy E McKee, Ann T Farrell, Richard Pazdur
On February 22, 2017, the U.S. Food and Drug Administration (FDA) granted approval for the use of lenalidomide as maintenance therapy after autologous hematopoietic stem cell transplantation (auto-HSCT) for patients with multiple myeloma. The approval was based on evidence from two randomized, blinded trials of maintenance lenalidomide versus placebo in patients with myeloma who had undergone auto-HSCT along with a third trial of lenalidomide versus no therapy. Each of the trials demonstrated superior progression-free survival for the patients treated with lenalidomide...
February 7, 2018: Oncologist
https://www.readbyqxmd.com/read/29434492/sr-16234-a-novel-selective-estrogen-receptor-modulator-for-pain-symptoms-with-endometriosis-an-open-label-clinical-trial
#4
Tasuku Harada, Ikuko Ohta, Yusuke Endo, Hiroshi Sunada, Hisashi Noma, Fuminori Taniguchi
Background: SR-16234 is a selective estrogen receptor modulator (SERM) structurally different from approved SERM and has been reported to have estrogen receptor (ER) α antagonistic activity and strong affinity with a weak partial agonistic activity to ERβ receptor. SR-16234 showed strong inhibitory effects on transplanted endometrial cysts in the endometriosis model of rat and mouse. In this clinical trial, efficacy and safety of SR-16234 have been evaluated in endometriosis patients...
December 2017: Yonago Acta Medica
https://www.readbyqxmd.com/read/29407334/intravenous-immunoglobulins-in-the-prevention-of-rejection-of-a-second-or-third-kidney-graft
#5
D Glotz, L Rostaing, P Merville, J-P Squifflet, Y Lebranchu
BACKGROUND: Intravenous immunoglobulin (IVIg) reduces acute rejection episodes in kidney transplantation, but adverse events (AEs) are common. The aim of this study was to assess whether human IVIg enhances immunosuppressive effects without increasing AEs in the prevention of acute kidney graft rejection. METHODS: Patients receiving a second or third kidney graft were treated with standard immunosuppressant therapy with (n = 18) or without (n = 10) IVIg. The primary efficacy endpoint was biopsy-proven acute rejection (BPAR) rate at 3 months, and secondary endpoints included acute rejection rate at 12 months, intensity of rejection, and patient survival...
January 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29406443/extended-pancreas-donor-program-the-expand-study-a-prospective-multicenter-trial-testing-the-use-of-pancreas-donors-over-age-50
#6
Andrea Proneth, Andreas A Schnitzbauer, Peter Schenker, Andreas Wunsch, Falk Rauchfuss, Helmut Arbogast, Steffen Manekeller, Silvio Nadalin, Michael Heise, Michael A Ströhlein, Bernhard Banas, Peter Schemmer, Thomas Becker, Wolf O Bechstein, Andreas Pascher, Richard Viebahn, Edward K Geissler, Hans J Schlitt, Stefan A Farkas
BACKGROUND: Pancreas transplantation is the only curative treatment option for patients with juvenile diabetes. Organ shortage and restrictive allocation criteria are the main reasons for increasing waitlists leading to severe morbidity and mortality. We designed a study to increase the donor pool with extended donor criteria (EDC) organs (donor age 50-60 years or BMI 30-34kg/m). METHODS: Utilization of EDC organs required the implementation of a new allocation system within Eurotransplant...
February 5, 2018: Transplantation
https://www.readbyqxmd.com/read/29388675/influenza-vaccines-in-immunosuppressed-adults-with-cancer
#7
REVIEW
Roni Bitterman, Noa Eliakim-Raz, Inbal Vinograd, Anca Zalmanovici Trestioreanu, Leonard Leibovici, Mical Paul
BACKGROUND: This is an update of the Cochrane review published in 2013, Issue 10.Immunosuppressed cancer patients are at increased risk of serious influenza-related complications. Guidelines, therefore, recommend influenza vaccination for these patients. However, data on vaccine effectiveness in this population are lacking, and the value of vaccination in this population remains unclear. OBJECTIVES: To assess the effectiveness of influenza vaccine in immunosuppressed adults with malignancies...
February 1, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29374527/autologous-hematopoietic-stem-cell-transplantation-for-systemic-sclerosis-a-systematic-review-and-meta-analysis
#8
Roni Shouval, Nadav Furie, Pia Raanani, Arnon Nagler, Anat Gafter-Gvili
Autologous hematopoietic stem cell transplantation (AHSCT) has been proposed as a therapeutic modality for severe Systemic Sclerosis (SSc). We set to systematically review and meta-analyze the efficacy and safety of AHSCT in SSc. Randomized controlled trials (RCTs) and retrospective studies comparing AHSCT to standard immunosuppressive therapy were included. Of 363 titles screened from multiple databases, 15 were extracted for further investigation, and 4 met inclusion criteria (3 RCTs and 1 retrospective analysis)...
January 24, 2018: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29362897/early-double-j-stent-removal-in-renal-transplant-patients-to-prevent-urinary-tract-infection-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#9
Dafna Yahav, Hefziba Green, Noa Eliakim-Raz, Eytan Mor, Shahid Husain
Ureteral stents are routinely used in renal transplant and are associated with reduced urological complications but increased urinary tract infections (UTIs). There is no agreement on the preferred time to removal of stents after transplantation. We performed a systematic review and meta-analysis of all randomized controlled trials (RCTs) comparing stent duration of <14 days vs > =14 days. Electronic databases were searched to identify RCTs that compared early vs late stent removal. Primary outcome was urinary tract infections...
January 24, 2018: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/29360184/risk-adapted-gvhd-prophylaxis-with-post-transplantation-cyclophosphamide-in-adults-after-related-unrelated-and-haploidentical-transplantations
#10
Ivan S Moiseev, Olga V Pirogova, Alexandr L Alyanski, Elena V Babenko, Tatyana L Gindina, Elena I Darskaya, Olga A Slesarchuk, Tatyana A Bykova, Alexei B Chukhlovin, Dmitrii E Pevtcov, Sergey N Bondarenko, Boris V Afanasyev
INTRODUCTION: Although a number of studies were published on the efficacy of post-transplantation cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis, no large studies prospectively evaluated this strategy in related, unrelated and haploidentical grafts. METHODS: In this study GVHD prophylaxis for 57 matched bone marrow (MBM) grafts consisted of single-agent PTCy, for 88 matched PBSC grafts (MPBSC) - of PTCy, tacrolimus and mycophenolate mofetil (MMF) 30 mg/kg, and for 55 mismatched grafts (MMG)- of PTCy, tacrolimus and MMF 45 mg/kg...
January 23, 2018: European Journal of Haematology
https://www.readbyqxmd.com/read/29359868/personalized-subcutaneous-administration-of-hepatitis-b-surface-antibodies-without-nucleos-t-ide-analogs-for-patients-at-risk-of-renal-failure-after-liver-transplantation-a-prospective-single-center-cohort-study
#11
Rob Bielen, Geert Robaeys, Sigrid Schelfhout, Diethard Monbaliu, Schalk Van der Merwe, Jacques Pirenne, Frederik Nevens
Currently, nucleos(t)ide analogs (NAs) in monotherapy are favored as prophylaxis against hepatitis B recurrence after liver transplantation. However, in patients at risk of renal failure, renal safety of NAs is of concern. We investigated the safety and efficacy of subcutaneous (SC) hepatitis B immunoglobulins (HBIG) in monotherapy. This is a single-arm prospective trial in patients transplanted >1 year. We included 43 Caucasian patients. The majority was treated with calcineurin inhibitors, and several patients had other risk factors for renal impairment as well: diabetes mellitus (n = 10/43), arterial hypertension (n = 11/43), and hyperlipidemia (=10/43)...
January 23, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/29358182/blinatumomab-for-minimal-residual-disease-in-adults-with-b-precursor-acute-lymphoblastic-leukemia
#12
Nicola Gökbuget, Hervé Dombret, Massimiliano Bonifacio, Albrecht Reichle, Carlos Graux, Christoph Faul, Helmut Diedrich, Max S Topp, Monika Brüggemann, Heinz-August Horst, Violaine Havelange, Julia Stieglmaier, Hendrik Wessels, Vincent Haddad, Jonathan E Benjamin, Gerhard Zugmaier, Dirk Nagorsen, Ralf C Bargou
Approximately 30-50% of adults with acute lymphoblastic leukemia (ALL) in hematologic complete remission following multiagent therapy exhibit minimal residual disease (MRD) by reverse transcriptase-polymerase chain reaction or flow cytometry. MRD is the strongest predictor of relapse in ALL. In this open-label, single-arm study, adults with B-cell precursor ALL in hematologic complete remission with MRD (≥10-3 ) received blinatumomab 15 µg/m2 /day by continuous intravenous infusion for up to four cycles...
January 22, 2018: Blood
https://www.readbyqxmd.com/read/29356765/resolving-malnutrition-with-parenteral-nutrition-before-liver-transplant-in-biliary-atresia
#13
Danielle Wendel, Melissa Mortensen, Alisha Harmeson, Michele L Shaffer, Evelyn Hsu, Simon Horslen
OBJECTIVE: Malnutrition is a common complication of end-stage liver disease (ESLD) associated with poor liver transplant outcomes. Nasogastric feeds are used for nutritional supplementation, but some patients remain malnourished. Parenteral nutrition (PN) can be effective, but has potential complications. The primary objective was to evaluate the effect of PN on anthropometric measures in children with ESLD awaiting liver transplant. Secondary objectives were evaluation of PN-associated complications, liver function tests, pediatric end-stage liver disease scores, waitlist time, and post-transplant length of stay (total and time in the intensive care unit)...
February 2018: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29353109/shortened-duration-tacrolimus-after-nonmyeloablative-hla-haploidentical-bmt
#14
Yvette L Kasamon, Ephraim J Fuchs, Marianna Zahurak, Gary L Rosner, Heather J Symons, Douglas E Gladstone, Carol Ann Huff, Lode J Swinnen, Robert A Brodsky, William H Matsui, Ivan Borrello, Satish Shanbhag, Kenneth R Cooke, Richard F Ambinder, Leo Luznik, Javier Bolaños-Meade, Richard J Jones
With posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis, nonmyeloablative HLA-haploidentical (NMA haplo) and HLA-matched blood or marrow transplantation (BMT) have comparable outcomes. Early discontinuation of immunosuppression may reduce relapse, as well as improve immune reconstitution, but may increase GVHD. We conducted a prospective trial of NMA haplo BMT for patients with hematologic malignancies (median age, 61), evaluating the safety of early discontinuation of tacrolimus...
January 15, 2018: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29350831/randomized-trial-on-extended-versus-modified-right-lobe-grafts-in-live-donor-liver-transplantation
#15
Christi Titus Varghese, Viju Kumar Bharathan, Unnikrishnan Gopalakrishnan, Dinesh Balakrishnan, Ramachandran N Menon, Othiyil Vayoth Sudheer, Puneet Dhar, Sudhindran Surendran
Despite advances in the practice of live donor liver transplantation (LDLT), the optimum surgical approach with respect to the middle hepatic vein (MHV) in right lobe LDLT remains undefined. We designed a randomized trial to compare the early postoperative outcomes in recipients and donors between extended right lobe grafts (ERG: transection plane was maintained to the left of MHV, and division of MHV performed beyond the segment VIII vein) and modified right lobe grafts (MRG: transection plane was maintained to the right of MHV, the segment V and VIII drainage was reconstructed using a conduit of recipient portal vein)...
January 19, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29350710/exercise-intervention-attrition-compliance-adherence-and-progression-following-hematopoietic-stem-cell-transplantation%C3%A2
#16
Tara Peters, Ruby Erdmann, Eileen Danaher Hacker
BACKGROUND: Exercise is widely touted as an effective intervention to optimize health and well-being after high-dose chemotherapy and hematopoietic stem cell transplantation. 
. OBJECTIVES: This article reports attrition, compliance, adherence, and progression from the strength training arm of the single-blind randomized, controlled trial Strength Training to Enhance Early Recovery (STEER). 
. METHODS: 37 patients were randomized to the intervention and participated in a structured strength training program introduced during hospitalization and continued for six weeks after release...
February 1, 2018: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/29348924/mortality-and-hospitalizations-in-intensive-dialysis-a-systematic-review-and-meta-analysis
#17
Anna Mathew, Jody-Ann McLeggon, Nirav Mehta, Samuel Leung, Valerie Barta, Thomas McGinn, Gihad Nesrallah
Background: Survival and hospitalization are critically important outcomes considered when choosing between intensive hemodialysis (HD), conventional HD, and peritoneal dialysis (PD). However, the comparative effectiveness of these modalities is unclear. Objective: We had the following aims: (1) to compare the association of mortality and hospitalization in patients undergoing intensive HD, compared with conventional HD or PD and (2) to appraise the methodological quality of the supporting evidence...
2018: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/29337426/prospective-randomized-study-of-conversion-from-tacrolimus-to-cyclosporine-a-to-improve-glucose-metabolism-in-patients-with-posttransplant-diabetes-mellitus-after-renal-transplantation
#18
Karl M Wissing, Daniel Abramowicz, Laurent Weekers, Klemens Budde, Thomas Rath, Oliver Witzke, Nilufer Broeders, Mireille Kianda, Dirk Rj Kuypers
Tacrolimus (TAC) increases the risk of posttransplant diabetes (PTDM) as compared to cyclosporine A (CYC). The present 12-months, multi-center, investigator-driven, prospective, randomized study was designed to assess whether conversion from tacrolimus to cyclosporine A can reverse PTDM after renal transplantation. Predominantly Caucasian patients with PTDM according to the 2005 ADA criteria were randomized to either replacement of tacrolimus with cyclosporine or continuation of their tacrolimus-based regimen after stratification for type of glucose-lowering therapy, steroid therapy and hepatitis C status...
January 16, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29326124/bortezomib-based-immunosuppression-after-reduced-intensity-conditioning-hematopoietic-stem-cell-transplantation-randomized-phase-ii-results
#19
John Koreth, Haesook T Kim, Paulina B Lange, Samuel J Poryanda, Carol G Reynolds, Sharmila Chamling Rai, Philippe Armand, Corey S Cutler, Vincent T Ho, Brett Glotzbecker, Rushdia Yusuf, Sarah Nikiforow, Yi-Bin Chen, Bimalangshu Dey, Malgorzata McMasters, Jerome Ritz, Bruce R Blazar, Robert J Soiffer, Joseph H Antin, Edwin P Alyea
A prior phase I/II trial of bortezomib/tacrolimus/methotrexate prophylaxis after HLA-mismatched reduced intensity conditioning allogeneic hematopoietic stem cell transplantation documented low acute graft versus host disease incidence, with promising overall and progression-free survival. We performed an open-label 3-arm 1:1:1 phase II randomized-controlled-trial comparing grade II-IV acute graft versus host disease between conventional tacrolimus/methotrexate (A) versus bortezomib/tacrolimus/methotrexate (B); and versus bortezomib/sirolimus/tacrolimus (C), in reduced intensity conditioning allogeneic transplantation recipients lacking HLA-matched related donors...
January 11, 2018: Haematologica
https://www.readbyqxmd.com/read/29319572/vascularized-composite-allotransplantation-of-the-elbow-joint-a-cadaveric-study
#20
Mitchell A Pet, Angelo B Lipira, Yusha Liu, Dennis Kao, Jason H Ko
BACKGROUND: Surgical options for the unreconstructable elbow are limited to arthrodesis, total arthroplasty, or osteoarticular allograft reconstruction. Each of these options is limited by severe functional impairment and/or high complication rates. Vascularized allotransplantation of the elbow joint has the potential to mitigate these complications. In this study, we describe our technique for harvesting the elbow for vascularized joint transplantation and demonstrate the flap's vascularity using contrast angiography...
January 9, 2018: Annals of Plastic Surgery
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