Transplant Research and Risk Management最新文献_第9页

Liver transplantation in Egypt from West to East 从西到东的埃及肝移植

IF 0.9

Transplant Research and Risk Management Pub Date : 2010-04-07 DOI: 10.2147/TRRM.S8490

G. El-Gazzaz, A. El-elemi

{"title":"Liver transplantation in Egypt from West to East","authors":"G. El-Gazzaz, A. El-elemi","doi":"10.2147/TRRM.S8490","DOIUrl":"https://doi.org/10.2147/TRRM.S8490","url":null,"abstract":"Correspondence: Galal El-Gazzaz Department of Colorectal Surgery A30, Cleveland Clinic Foundation, Cleveland, Ohio-44195, USA Tel +1 216 444 3103 Email elgazzg@ccf.org Background: Egyptian patients with end-stage liver disease need to seek whole cadaveric liver transplantation (CLT) abroad. We studied the outcome of Egyptian patients who underwent CLT in China. Methods: Between 2004–2006, 22 patients who underwent CLT in China and attended two liver surgery outpatient clinics in Egypt for follow-up were included in the study. Demographic, preoperative, postoperative, and follow-up data after coming back from China were reviewed. Results: For 22 patients of median age 48 years (30–62) and with BMI 27.5 ± 6.2, the median follow-up was 23.5 months (range 1–48); 18 patients were males. Hepatitis C (HCV)-cirrhosis alone or with schistosomiasis was the main indication for CLT (n = 12); Hepatitis B (HBV)cirrhosis was the indication for transplantation in two patients, HCV-cirrhosis with hepatocellular carcinoma (HCC) in six, HBV-cirrhosis with HCC in one, and both HBVand HCV-related cirrhosis with HCC in another. There were eight deaths, one as a result of primary nonfunction, one because of postoperative bleeding, two because of recurrent HCV, and four because of recurrent HCC. Overall survival at one and three years was 68.5% and 64%, respectively, and 50% and 37.5% for HCC patients, respectively, while three-year survival was 80% for hepatitis patients. Twelve patients (54%) developed complications. Biliary complications occurred in 45% of cases. Conclusion: CLT tourism to China raises serious concerns regarding selection criteria and ethical issues. Furthermore, the negative impact of this practice on the successful setting up of LT programs in Egypt must be addressed carefully. In Egypt efforts should be directed to get legalization for CLT.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"41-46"},"PeriodicalIF":0.9,"publicationDate":"2010-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S8490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 18

Valganciclovir for the prophylaxis and treatment of cytomegalovirus infection in solid organ transplantation 缬更昔洛韦预防和治疗实体器官移植中巨细胞病毒感染

IF 0.9

Transplant Research and Risk Management Pub Date : 2010-03-30 DOI: 10.2147/TRRM.S5979

E. Ticehurst, J. Trofe‐Clark, E. Blumberg, R. Bloom

{"title":"Valganciclovir for the prophylaxis and treatment of cytomegalovirus infection in solid organ transplantation","authors":"E. Ticehurst, J. Trofe‐Clark, E. Blumberg, R. Bloom","doi":"10.2147/TRRM.S5979","DOIUrl":"https://doi.org/10.2147/TRRM.S5979","url":null,"abstract":"Cytomegalovirus (CMV) can be a problematic virus for solid organ transplant recipients affecting both morbidity and mortality. Valganciclovir (VGC) is a commonly utilized antiviral agent for the prevention of this virus post-transplantation and recently it has been evaluated for the treatment of CMV. It is a pro-drug of ganciclovir (GCV) and has increased bioavailability compared to GCV. It is unclear whether VGC is superior to intravenous or oral GCV in terms of efficacy and safety in the prevention of CMV particularly in the liver transplant population as there have been studies reporting inferiority while other studies have not. Despite this, VGC has been reported to be the most commonly utilized agent for CMV prophylaxis in the liver transplant population in the United States and Canada. This article reviews CMV and VGC in the context of solid organ transplant, describes and assesses selected studies that have been conducted using this agent in this patient population, and summarizes VGC's advantages and disadvantages. Additional studies are needed to further define VGC's role in the treatment of CMV in the solid organ transplantation population as there are an insufficient number of studies pertaining to CMV treatment and no studies have been performed to assess its role in the treatment of life-threatening CMV disease. VGC is non-inferior to GCV for CMV prevention in the solid organ transplant population with the exception of liver transplant recipients.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"29-39"},"PeriodicalIF":0.9,"publicationDate":"2010-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S5979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Moving towards implementation of a clinical ethics consultation program in Egyptian liver transplant units 在埃及肝移植单位实施临床伦理咨询方案

IF 0.9

Transplant Research and Risk Management Pub Date : 2010-03-16 DOI: 10.2147/TRRM.S8439

A. El-elemi, G. El-Gazzaz

{"title":"Moving towards implementation of a clinical ethics consultation program in Egyptian liver transplant units","authors":"A. El-elemi, G. El-Gazzaz","doi":"10.2147/TRRM.S8439","DOIUrl":"https://doi.org/10.2147/TRRM.S8439","url":null,"abstract":"Correspondence: AH El-Elemi Forensic Medicine and Clinical Toxicology Department, Suez Canal University, 58-60 Tarek Ebn Zeyad, ismailia, Egypt Tel +2 012 3705451 Fax +2 064 3209448 Email azza.el.elemi@utoronto.ca Abstract: The high prevalence of chronic liver disease in Egypt has led to increasing numbers of patients with end-stage liver disease in need of liver transplantation. To date, cadaveric liver transplantation is not legal in Egypt. However, introducing living-donor liver transplantation seems appropriate for patients who need transplantation. There are no clinical bioethicists in the Egyptian healthcare system. The idea of implementing an ethics consultation program has evolved as a response to complicated legal, ethical, and social dilemmas that accompany the transplantation process, especially in Egypt where organs are obtained by advertising without consideration of an acceptable level of risk to donors or recipients. Recommendations need to be made to start to implement bioethics consultation in liver transplantation units. To achieve this goal there is a need to develop training standards, credentials, and certification before embarking on clinical consultation to ensure good ethics practice in Egypt.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"23-27"},"PeriodicalIF":0.9,"publicationDate":"2010-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S8439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Low antigenicity of hematopoietic progenitor cells derived from human ES cells 源自人胚胎干细胞的造血祖细胞的低抗原性

IF 0.9

Transplant Research and Risk Management Pub Date : 2010-02-03 DOI: 10.2147/TRRM.S8272

Eun-Mi Kim, N. Zavazava

{"title":"Low antigenicity of hematopoietic progenitor cells derived from human ES cells","authors":"Eun-Mi Kim, N. Zavazava","doi":"10.2147/TRRM.S8272","DOIUrl":"https://doi.org/10.2147/TRRM.S8272","url":null,"abstract":"correspondence: nicholas Zavazava University of iowa hospitals and clinics, Department of internal Medicine, 200 hawkins Drive, c51-F, iowa city, iowa 52242, UsA Tel +1 319 384 6577 Fax +1 319 356 8280 email nicholas-zavazava@uiowa.edu Abstract: Human embryonic stem (hES) cells are essential for improved understanding of diseases and our ability to probe new therapies for use in humans. Currently, bone marrow cells and cord blood cells are used for transplantation into patients with hematopoietic malignancies, immunodeficiencies and in some cases for the treatment of autoimmune diseases. However, due to the high immunogenicity of these hematopoietic cells, toxic regimens of drugs are required for preconditioning and prevention of rejection. Here, we investigated the efficiency of deriving hematopoietic progenitor cells (HPCs) from the hES cell line H13, after co-culturing with the murine stromal cell line OP9. We show that HPCs derived from the H13 ES cells poorly express major histocompatibility complex (MHC) class I and no detectable class II antigens (HLA-DR). These characteristics make hES cell-derived hematopoietic cells (HPCs) ideal candidates for transplantation across MHC barriers under minimal immunosuppression.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"15-22"},"PeriodicalIF":0.9,"publicationDate":"2010-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S8272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Critical appraisal on the use of everolimus in renal transplantation as an immunosuppressant to prevent organ transplant rejection 在肾移植中使用依维莫司作为免疫抑制剂预防器官移植排斥反应的关键评价

IF 0.9

Transplant Research and Risk Management Pub Date : 2010-01-21 DOI: 10.2147/TRRM.S5135

F. Girón, Y. Baez

引用次数: 3

Optimizing use of basiliximab in liver transplantation 优化巴厘昔单抗在肝移植中的应用

IF 0.9

Transplant Research and Risk Management Pub Date : 2010-01-06 DOI: 10.2147/TRRM.S4829

C. Ramirez, Adam Bozdin, A. Frank, W. Maley, C. Doria

{"title":"Optimizing use of basiliximab in liver transplantation","authors":"C. Ramirez, Adam Bozdin, A. Frank, W. Maley, C. Doria","doi":"10.2147/TRRM.S4829","DOIUrl":"https://doi.org/10.2147/TRRM.S4829","url":null,"abstract":"Antibody induction therapy has not been part of standard immunosuppressive regimens in liver transplantation. However, in recent years there has been an upward trend in the use of antibody induction therapy in orthotopic liver transplantation (OLT), attributed mainly to the growing number of OLT recipients with renal dysfunction after the Model for End Stage Liver Disease (MELD) scoring system was adopted in 2002. Basiliximab, a chimeric monoclonal antibody, is the most frequently used induction antibody in OLT. Basiliximab targets the alpha chain of interleukin-2 receptors in activated T-lymphocytes, inhibiting T-lymphocyte proliferation responsible for acute cellular rejection. Basiliximab (given in two 20 mg doses intravenously on post OLT day 0 and 4) has an excellent efficacy and safety profile. Basiliximab induction also allows early steroid withdrawal or avoidance, as well as delayed introduction and minimization of calcineurin inhibitors (CNI) in the setting of renal insufficiency. Although its long-term effect on hepatitis C virus (HCV) recurrence post OLT is currently unknown, studies using basiliximab induction in steroid-free protocols suggest no harmful effect on histologic HCV recurrence and survival rates. Basiliximab is a well tolerated, effective and safe anti-rejection drug in pediatric and adult OLT recipients when given in conjunction with a CNI-based immunotherapy.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"2 1","pages":"1-10"},"PeriodicalIF":0.9,"publicationDate":"2010-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S4829","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Rituximab: An emerging therapeutic agent for kidney transplantation 利妥昔单抗:一种新兴的肾移植治疗药物

IF 0.9

Transplant Research and Risk Management Pub Date : 2009-10-19 DOI: 10.2147/TRRM.S6359

J. Kahwaji, C. Tong, S. Jordan, A. Vo

{"title":"Rituximab: An emerging therapeutic agent for kidney transplantation","authors":"J. Kahwaji, C. Tong, S. Jordan, A. Vo","doi":"10.2147/TRRM.S6359","DOIUrl":"https://doi.org/10.2147/TRRM.S6359","url":null,"abstract":"Rituximab (anti-CD20, anti-B-cell) is now emerging as an important drug for modification of B-cell and antibody responses in solid-organ transplant recipients. Its uses are varied and range from facilitating desensitization and ABO blood group-incompatible transplantation to the treatment of antibody-mediated rejection (AMR), post-transplant lymphoproliferative disorder (PTLD), and recurrent glomerular diseases in the renal allograft. Despite these uses, prospective randomized trials are lacking. Only case reports exist in regards to its use in de novo and recurrent diseases in the renal allograft. Recent reports suggests that the addition of rituximab to intravenous immunoglobulin (IVIG) may have significant benefits for desensitization and treatment of AMR and chronic rejection. Current dosing recommendations are based on data from United States Food and Drug Administration-approved indications for treatment of B-cell lymphomas and rheumatoid arthritis. From the initial reported experience in solid organ transplant recipients, the drug is well tolerated and not associated with increased infectious risks. However, close monitoring for viral infections is recommended with rituximab use. The occurrence of progressive multifocal leukoencephalopathy (PML) has been reported with rituximab use. However, this is rare and not reported in the renal transplant population. Here we will review current information regarding the effectiveness of rituximab as an agent for desensitization of highly human leukocyte antigen-sensitized and ABO-incompatible transplant recipients and its use in treatment of AMR. In addition, the post-transplant use of rituximab for treatment of PTLD and for recurrent and de novo glomerulonephritis in the allograft will be discussed. In summary, we will make recommendations based on existing literature and our extensive experience at Cedars-Sinai Medical Center for using rituximab in renal transplantation.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":"15-29"},"PeriodicalIF":0.9,"publicationDate":"2009-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S6359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68497164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Managing hepatitis C in liver transplant patients with recurrent infection 肝移植患者反复感染丙型肝炎的处理

IF 0.9

Transplant Research and Risk Management Pub Date : 2009-09-13 DOI: 10.2147/TRRM.S4615

T. Zimmermann, G. Otto, M. Schuchmann

{"title":"Managing hepatitis C in liver transplant patients with recurrent infection","authors":"T. Zimmermann, G. Otto, M. Schuchmann","doi":"10.2147/TRRM.S4615","DOIUrl":"https://doi.org/10.2147/TRRM.S4615","url":null,"abstract":"Hepatitis C virus (HCV) reinfection after liver transplantation (LT) and recurrent hepatitis C often lead to recurrent cirrhosis (RC). RC is one of the most frequent complications resulting in organ failure and early death after LT in HCV-positive patients with reported 5-year rates from 20% to 40%. As HCV-cirrhosis is one of the leading indications for LT, the therapeutic management is a central issue. To date, the best available therapy is a combination of pegylated interferon + ribavirin in patients with established recurrent hepatitis C proven by liver biopsy. Although increasing experience in using interferon therapy after LT has suggested better response rates, treatment is limited by a poor tolerability and high rates of severe side effects, necessitating lower doses or withdrawal of therapy. The extent to which dose reductions and the concomitant administration of growth factors affect virological response or prevent complications is still to be determined. Prospective clinical trials are mandatory to identify the best time point and schedule of antiviral treatment in transplant patients. Currently, therapeutic options need to be discussed for each individual patient. Therefore therapy should be carried out only in transplant centers with experience in managing hepatitis C after LT.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":"1-14"},"PeriodicalIF":0.9,"publicationDate":"2009-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S4615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3