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Solid-organ Transplantation (solid-organ + transplantation)

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Selected Abstracts

Metabolic Syndrome and Solid-Organ Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010
A. Sharif
The metabolic syndrome is proposed as a cluster of known cardiovascular risk factors, interrelated by a common pathophysiological defect, that symbolize a heightened metabolic burden. Advocates of the concept argue that it is a predictor for both diabetes and cardiovascular disease, complications of great importance posttransplantation. The abundant medical literature on the topic is now expanding into the field of transplantation with evidence linking the metabolic syndrome to adverse patient and graft outcomes. Although the implications posttransplantation are significant, controversy surrounds the concept and the topic has not previously been reviewed in the context of solid-organ transplantation. The purpose of this review is to update transplant clinicians with our current understanding of the metabolic syndrome, review the transplantation literature and examine the controversies surrounding the concept. [source]

Regression of post-transplant Kaposi's sarcoma using sirolimus

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2006
N. KOLHE
Summary Kaposi's sarcoma (KS) is a recognised complication following kidney transplantation, but the incidence varies according to the geographical area. Although it is a rare tumour, its incidence increases dramatically after solid-organ transplantation. The immunosuppressive medications reactivate human herpes virus 8, which has been proposed as the offending agent. The usual treatment of KS is to reduce immunosuppression, chemotherapy and radiotherapy. Nevertheless, the mortality still remains considerably high and has been reported between 8 and 14%. Sirolimus (SRL) has properties which may be useful in the management of some post-transplant tumours such as KS. We report a renal transplant patient with KS, who had multiple relapses after radiotherapy but responded well to the change of immunosuppression from cyclosporine to SRL. [source]

Treatment of chronic hepatitis E in liver transplant recipients with pegylated interferon alpha-2b

LIVER TRANSPLANTATION, Issue 4 2010
Elizabeth B. Haagsma
Hepatitis E virus (HEV) infections are known to run a self-limiting course. Recently, chronic hepatitis E has been described in immunosuppressed patients after solid-organ transplantation. Besides the general recommendation to lower the immunosuppressive medication in these patients, there is currently no specific treatment. We here describe the successful use of pegylated interferon alpha-2b in the treatment of 2 liver transplant recipients who suffered a chronic HEV infection for 9 years (case A) or 9 months (case B). After 4 weeks of therapy, a 2-log decrease (case A) and a 3-log decrease (case B) in the viral load were observed. In case A, who received treatment for 1 year, serum viral RNA became undetectable from week 20 onward, and serum liver enzymes normalized completely. In case B, interferon was discontinued at week 16 because of a lack of a further decline in the viral load. However, 4 weeks after the cessation of therapy, viral RNA was no longer detectable in the serum, and this was probably related to a further decline in the immunosuppressive medication. Liver tests normalized completely. In both cases, no relapse has been noted so far. We conclude that pegylated interferon alpha-2b may be useful in the treatment of chronic HEV infections in patients in whom the reduction of the immunosuppressive medication alone is not sufficient. Liver Transpl , 2010. © 2010 AASLD. [source]

Impact of donor infections on outcome of orthotopic liver transplantation

LIVER TRANSPLANTATION, Issue 5 2003
Michael Angelis
Infection occurs when microbial agents enter the host, either through airborne transmission or by direct contact of a substance carrying the infectious agent with the host. Human body fluids, solid organs, or other tissues often are ideal vectors to support microbial agents and can transmit infections efficiently from donor to recipient. In the case of blood transfusion and tissue transplantation, the main consequence of such a transmission is infection of the recipient. However, in the case of solid-organ transplantation, and particularly for liver transplantation, donor infections are not only transmitted to the recipient, the donor infection also may affect the donated liver's preservability and subsequent function in the recipient irrespective of the systemic consequences of the infection. In addition, solid organ recipients of infected organs are less able to respond to the infectious agent because of their immunosuppressive treatment. Thus, transmission of infections from organ donor to liver recipient represents serious potential risks that must be weighed against a candidate's mortality risk without the transplant. However, the ever-increasing gap between the number of donors and those waiting for liver grafts makes consideration of every potential donor, regardless of the infection status, essential to minimize waiting list mortality. In this review, we will focus on assessing the risk of transmission of bacterial, fungal, viral, and parasitic infectious agents from cadaveric liver donors to recipients and the effect such a transmission has on liver function, morbidity, and mortality. We will also discuss risk-benefit deliberations for using organs from infected donors for certain types of recipients. These issues are critically important to maximize the use of donated organs but also minimize recipient morbidity and graft dysfunction. [source]

Metabolic Syndrome and Solid-Organ Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010
A. Sharif
The metabolic syndrome is proposed as a cluster of known cardiovascular risk factors, interrelated by a common pathophysiological defect, that symbolize a heightened metabolic burden. Advocates of the concept argue that it is a predictor for both diabetes and cardiovascular disease, complications of great importance posttransplantation. The abundant medical literature on the topic is now expanding into the field of transplantation with evidence linking the metabolic syndrome to adverse patient and graft outcomes. Although the implications posttransplantation are significant, controversy surrounds the concept and the topic has not previously been reviewed in the context of solid-organ transplantation. The purpose of this review is to update transplant clinicians with our current understanding of the metabolic syndrome, review the transplantation literature and examine the controversies surrounding the concept. [source]

Treatment-dependent Loss of Polyfunctional CD8+ T-cell Responses in HIV-infected Kidney Transplant Recipients Is Associated with Herpesvirus Reactivation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009
O. Gasser
Antiretroviral-therapy has dramatically changed the course of HIV infection and HIV-infected (HIV(+)) individuals are becoming more frequently eligible for solid-organ transplantation. However, only scarce data are available on how immunosuppressive (IS) strategies relate to transplantation outcome and immune function. We determined the impact of transplantation and immune-depleting treatment on CD4+ T-cell counts, HIV-, EBV-, and Cytomegalovirus (CMV)-viral loads and virus-specific T-cell immunity in a 1-year prospective cohort of 27 HIV(+) kidney transplant recipients. While the results show an increasing breadth and magnitude of the herpesvirus-specific cytotoxic T-cell (CTL) response over-time, they also revealed a significant depletion of polyfunctional virus-specific CTL in individuals receiving thymoglobulin as a lymphocyte-depleting treatment. The disappearance of polyfunctional CTL was accompanied by virologic EBV-reactivation events, directly linking the absence of specific polyfunctional CTL to viral reactivation. The data provide first insights into the immune-reserve in HIV+ infected transplant recipients and highlight new immunological effects of thymoglobulin treatment. Long-term studies will be needed to assess the clinical risk associated with thymoglobulin treatment, in particular with regards to EBV-associated lymphoproliferative diseases. [source]

Symptomatic Pulmonary Allograft Kaposi's Sarcoma in Two Lung Transplant Recipients

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2008
S. J. Sathy
Kaposi's sarcoma (KS) is associated with solid-organ transplantation, but is extremely rare after lung transplantation. In this report, we describe two unique cases of lung transplant recipients who developed KS in the lung allograft and were treated with sirolimus and liposomal doxorubicin. One patient survived 12 months after the diagnosis of KS; the other survived 3 months after diagnosis and was found to have concomitant EBV-negative, HHV-8-positive B-cell lymphoma. We demonstrate a partial response of pulmonary KS to reduced immunosuppression and the initiation of sirolimus in one patient, as well as an association between increasing HHV-8 viremia and progression of pulmonary KS. Our report highlights the importance of secondary malignancies in patients with transplant-related KS and supports the association between HHV-8 infection and EBV-negative PTLD. [source]

Immunity, Homing and Efficacy of Allogeneic Adoptive Immunotherapy for Posttransplant Lymphoproliferative Disorders

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2007
M. K. Gandhi
Adoptive immunotherapy using autologous Epstein-Barr virus (EBV)-specific cytotoxic T-lymphocytes (auto-CTL) can regress posttransplant lymphoproliferative disorders (PTLD). Widespread applicability of auto-CTL remains constrained. Generation is time-consuming, and auto-CTL cannot be established in patients treated with the B-cell depleting antibody rituximab. By contrast, pregenerated allogeneic CTL (allo-CTL) offers immediate accessibility. Allo-CTL has previously shown efficacy in "early" polyclonal- PTLD. We treated three patients with aggressive, advanced monoclonal-PTLD following solid-organ transplantation. All were refractory to at least three prior therapies. Despite HLA disparity, there was negligible toxicity, with early in vivo antiviral efficacy and reconstitution of EBV peptide-specific immunity. Two patients attained complete remission (CR). One remains in CR 17 months following therapy, coincident with persistence of donor-derived tumor targeted EBV-specific CTL; the other died of non-PTLD related pathology. In the third patient, autopsy demonstrated homing of allo-CTL at the tumor site. Larger prospective studies of EBV-specific allo-CTL in PTLD are warranted. [source]