Alemtuzumab Induction in Non-Hepatitis C Positive Liver Transplant Recipients
|
|
- Rosemary Fowler
- 5 years ago
- Views:
Transcription
1 LIVER TRANSPLANTATION 17:32-37, 2011 ORIGINAL ARTICLE Alemtuzumab Induction in Non-Hepatitis C Positive Liver Transplant Recipients Josh Levitsky, 1,2 Kavitha Thudi, 1 Michael G. Ison, 1,3 Edward Wang, 1,4 and Michael Abecassis 1 1 Comprehensive Transplant Center, 2 Division of Hepatology, Department of Medicine, 3 Division of Infectious Diseases, Department of Medicine, and 4 Division of Biostatistics and Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL Limited data exist for the use of alemtuzumab (AL) induction in liver transplantation (LT) recipients. We compared the outcomes of hepatitis C virus negative LT recipients who received AL induction followed by tacrolimus and mycophenolate mofetil without steroids to cohort who received no AL induction, tacrolimus, and a steroid taper. Fifty-five AL-induced recipients were compared to 85 non AL-induced recipients with similar characteristics. Two-year patient survival (80% versus 88.2%, P ¼ ) and graft survival (76.4% versus 82.4%, P ¼ ) were not significantly different between the AL and non-al groups, respectively. Other outcomes, including acute rejection (20% versus 30.3%), renal dysfunction (creatinine levels: versus mg/dl), and immunosuppressant monotherapy (29.1% versus 44.3%), were not significantly different between the AL and non-al groups, respectively (P > 0.05). The number of rejection episodes (12 versus 42, P ¼ 0.02) and the number of patients with new-onset hypertension (3 versus 15, P ¼ 0.03) were lower in the AL group, although the incidence of all posttransplant infections was higher with AL (63.6% versus 44.3%, P ¼ 0.03), primarily because of an increase in viral infections. In conclusion, a steroid-free AL induction regimen was associated with less hypertension and rejection but with more infectious complications; thus, the overall benefit of AL induction in LT recipients is called into question. Liver Transpl 17:32-37, VC 2011 AASLD. Received June 7, 2010; accepted August 21, The practice of induction therapy is increasing in liver transplantation (LT) centers. This is likely related to the higher percentage of patients with cirrhosis and perioperative renal dysfunction and thus to the need to delay the administration of nephrotoxic immunosuppressive agents such as calcineurin inhibitors. In addition, by depleting alloreactive clonal populations, lymphodepletion therapy may theoretically promote immunosuppression minimization or even withdrawal, although the latter practice is not widely accepted. 1,2 Alemtuzumab (AL) or Campath-1H (Genzyme, Cambridge, MA) is a humanized rat monoclonal antibody directed against the CD52 antigen on peripheral blood mononuclear cells. 3 Its efficacy as induction therapy for preventing rejection after solid organ transplantation has been reported, although it is Food and Drug Administration approved only for the treatment of chronic lymphocytic leukemia. 4,5 The available data concerning the use of AL induction in LT recipients are limited to only a few previous reports that have demonstrated mixed results. 6-8 In addition, rapidly progressive hepatitis C virus (HCV) recurrence has been associated with AL induction, likely because of profound lymphodepletion. 9 In this article, we report the outcomes of HCV-negative LT recipients who received a steroid-free AL induction regimen followed by calcineurin inhibitor and mycophenolate mofetil (MMF) therapy and compare them to the outcomes of similar patients receiving a standard immunosuppressive regimen without AL induction. Our goal was to determine any risks or benefits of AL induction therapy for the design of future immunosuppressive protocols in this population. PATIENTS AND METHODS This study is a retrospective case-control study of HCV-negative LT recipients receiving AL induction Abbreviations: AL, alemtuzumab; CMV, cytomegalovirus; Dþ/R, donor-positive/recipient-negative; HCV, hepatitis C virus; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; MMF, mycophenolate mofetil. Address reprint requests to Josh Levitsky, M.D., M.S., Division of Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1900, Chicago, IL FAX: ; j-levitsky@northwestern.edu DOI /lt View this article online at wileyonlinelibrary.com. LIVER TRANSPLANTATION.DOI /lt. Published on behalf of the American Association for the Study of Liver Diseases VC 2011 American Association for the Study of Liver Diseases.
2 LIVER TRANSPLANTATION, Vol. 17, No. 1, 2011 LEVITSKY ET AL. 33 therapy at Northwestern Memorial Hospital between 2002 and Patients with HCV or acute liver failure and those receiving split, living related, donor after cardiac death, or combined organ transplants were excluded from the analysis. The controls consisted of all LT recipients with similar inclusion criteria who did not receive AL induction and underwent transplantation in the previous era at our institution. Because AL induction was the standard of care for non-hcv patients between 2002 and 2006, no concurrent control group was available for that time period; therefore, a control group from the previous era ( ) was used. The reviewed records included our institution s paper and electronic medical and transplant databases. The study protocol was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Both AL-induced patients and controls received intravenous methylprednisolone (500 mg in the operating room, 250 mg on postoperative day 1, and 125 mg on postoperative day 2). The immunosuppression protocol for the AL-induced patients was as follows: intravenous AL (30 mg) in the operating room; tacrolimus (0.2 mg/kg/day), which was started on postoperative day 1; and MMF (2000 mg daily), which was started on postoperative day 2. This group did not receive corticosteroids for maintenance immunosuppression, except after the treatment of acute cellular rejection. The control group received tacrolimus (0.2 mg/kg/day), which was started on postoperative day 1, and prednisone (20 mg daily), which was started on day 3. Prednisone was tapered off within 6 months, except for those who required it for other reasons. Similar tacrolimus trough levels were targeted for the 2 groups (10-12 ng/ml in the first month and 5-10 ng/ml thereafter). Protocol liver biopsies were not performed at our institution. In both groups, liver biopsy was performed when acute cellular rejection was suspected, but no formal criteria for the performance of biopsy were followed (ie, at the discretion of the treating physician). A protocol for the management of acute cellular rejection was followed for both groups: (1) intravenous methylprednisolone (500 mg) was used for 3 days and was followed by a steroid taper to prednisone (20 mg) at the end of 7 days, and (2) biopsy-confirmed steroid-refractory rejection was treated with intravenous muromonab-cd3 (5 mg daily) for 7 to 10 days. Rejection was graded according to standard criteria. 10 All AL-induced patients and controls received oral valganciclovir or ganciclovir for 3 to 6 months for cytomegalovirus (CMV) prophylaxis according to the donor/recipient status: donor-positive/recipient-negative (Dþ/R ) patients received 6 months of antiviral prophylaxis, whereas patients with all other serotypes received 3 months of antiviral prophylaxis. All patients received oral nystatin for 3 months and trimethoprim/sulfamethoxazole for 1 year for fungal and Pneumocystis carinii pneumonia prophylaxis, respectively. No patients discontinued anti-infective prophylaxis earlier than these established time points. Infectious complications within 2 years of transplantation were recorded in the same transplant databases and electronic medical records for both groups and for both LT eras. All infections were confirmed by culture, viral titer, or tissue analysis or, in some instances, clinically (ie, varicella and herpes simplex skin infections). The primary outcome of the study was the incidence of acute rejection within 2 years after transplantation. Secondary outcomes that were assessed included the rates of patient and graft survival, infection, renal dysfunction, malignancy, and metabolic abnormalities (hypertension and diabetes), and the percentages of patients on immunosuppressant monotherapy at 2 years. New-onset hypertension was diagnosed when 2 or more recordings of a systolic blood pressure greater than 140 mm Hg and a diastolic blood pressure greater than 90 mm Hg occurred in conjunction with the use of postoperative antihypertensive agents for more than 3 months, in the absence of preexisting hypertension. New-onset diabetes was diagnosed if the fasting glucose level was greater than 126 mg/dl or any value was greater than 200 mg/dl in conjunction with the use of postoperative hypoglycemic agents for more than 3 months, in the absence of preexisting diabetes. The Student t test and chi-square analysis were used for parametric variables, and the Wilcoxon rank-sum test and Fisher s exact test were performed for comparisons of nonparametric continuous and categorical variables, respectively. Kaplan- Meier analyses of patient and graft survival were performed, and comparisons were made between the AL and non-al groups by the log-rank test. A P value less than 0.05 was considered statistically significant. RESULTS Demographics One hundred eight LT recipients received the AL induction regimen in the time period of the study. Patients were excluded from our analysis for the following reasons: undergoing combined liver-kidney transplantation (39), being HCV-positive (12), undergoing living donor transplantation (1), and undergoing transplantation for acute liver failure (1). Thus, 55 AL-induced recipients without HCV met the inclusion criteria for the study group. Eighty-five non-al controls without HCV meeting similar inclusion criteria were randomly selected. The patient characteristics were comparable in the 2 groups, except that the creatinine level at transplantation was higher in the AL group versus the non-al group ( versus mg/dl, P ¼ 0.03; Table 1). Rejection Eleven patients (20%) in the AL group had 12 episodes of rejection, whereas 24 patients (30.3%) in the control group had 42 episodes of rejection (Table 2).
3 34 LEVITSKY ET AL. LIVER TRANSPLANTATION, January 2011 The mean number of days to first rejection was lower in the AL group versus the non-al group ( versus days), although this was not TABLE 1. Patient Characteristics Non-AL AL Group (n ¼ 55) Group (n ¼ 85) P Value Male (%) Age (years) Caucasian (%) Pre-LT complications (%) Ascites Hepatic encephalopathy Variceal hemorrhage Etiology (%) Alcohol Cryptogenic Autoimmune Hepatitis B virus Hepatocellular carcinoma Other Calculated MELD score Creatinine (mg/dl) Pre-LT diabetes (%) Body mass index at LT (kg/m 2 ) CMV Dþ/R status (%) Donor age (years) Cold ischemia time (hours) statistically significant (P ¼ 0.5). Thus, although the overall percentages of patients developing at least 1 episode of rejection were similar in the 2 groups (P ¼ 0.13), the non-al controls had statistically more episodes of rejection over time (2 per patient; P ¼ 0.02). There was 1 severe rejection episode in the AL group that required muromonab-cd3; there were 3 severe rejection episodes in the control group, and 2 required muromonab-cd3. All rejection episodes resolved and no patients developed chronic rejection or lost their graft. The total number of biopsy procedures was higher in the non-al control group versus the AL group (55 versus 25, P ¼ 0.008) as there were more rejection episodes in the control group. Patient and Graft Survival There were 11 deaths (20%) in the AL cohort due to following etiologies: sepsis (2), ischemic cholangiopathy and graft failure (1), malignancy (5: recurrent hepatoma, leukemia, metastatic angiosarcoma, glioblastoma multiforme, and metastatic colon carcinoma), cardiac arrest (2), and unknown (1). Ten patients (11.8%) died in the non-al control group for the following reasons: sepsis (1), respiratory failure (3), malignancy [4: recurrent hepatoma (3) and recurrent cholangiocarcinoma (1)], and gastrointestinal bleeding (2). According to Kaplan-Meier analysis, 2- year patient survival was not significantly different between the AL and non-al groups (Fig. 1). Two patients in the AL group and 5 patients in the non-al group underwent retransplantation (1.8% versus 7.1%, P ¼ 0.15). One of the 2 patients in the AL group had ischemic cholangiopathy, and the other had hepatic artery thrombosis. The causes of retransplantation in the non-al group included ischemic cholangiopathy (2), hepatic artery thrombosis (1), portal vein thrombosis (1), and primary nonfunction (1). Two- TABLE 2. Two-Year Patient Outcomes AL Group (n ¼ 55) Non-AL Group (n ¼ 85) P Value Rejection Patients [n (%)] 11 (20) 24 (30.3) 0.13 Episodes (n) Steroid-refractory [n (%)] 1 (1.8) 3 (3.8) 0.88 Infection Patients [n (%)] 35 (63.6) 35 (44.3) 0.03 Episodes (n) Viral (n) 13 2 < Bacterial (n) Fungal (n) White blood cell count ( cells/ll) Creatinine (mg/dl) Dialysis [n (%)] 1 (1.8) 0 (0) 0.87 Retransplantation [n (%)] 2 (1.8) 5 (7.1) 0.15 Monotherapy [n (%)] 16 (29.1) 35 (44.3) 0.07 Malignancy [n (%)] 7 (12.7) 15 (18.9) 0.33 New-onset diabetes [n (%)] 3 (5.5) 11 (13.9) 0.11 New-onset hypertension [n (%)] 3 (5.5) 15 (18.9) 0.03
4 LIVER TRANSPLANTATION, Vol. 17, No. 1, 2011 LEVITSKY ET AL. 35 Figure 1. Kaplan-Meier analysis demonstrating no difference in long-term patient survival between AL-infused LT recipients and non AL-infused LT recipients. Figure 2. Kaplan-Meier analysis demonstrating no difference in long-term graft survival between AL-infused LT recipients and non AL-infused LT recipients. year graft survival was also not significantly different between the AL and non-al groups (Fig. 2). Infectious Complications The rate of posttransplant infections was significantly higher in the AL group versus the control group, primarily because of viral etiologies. Thirty-five patients (63.6%) in the AL group had a total of 50 episodes, whereas 35 patients (44.3%) in the control group had a total of 42 episodes (Table 2). There was no significant difference in the mean number of days from LT to the first infection (any type) between the AL and non-al groups ( versus days, P ¼ 0.15). In addition, 4 of 35 AL patients and 5 of 35 non-al patients experienced rejection within 90 days of the first infectious episode (P ¼ 0.87). Although the bacterial and fungal infection rates were not statistically different, the rate of viral infections was significantly higher in the AL group versus the control group (13/55 versus 2/85, P < ). In the AL group, 14% of the viral infections (80% in the Dþ/ R group and 83.3% in the first post-lt year) were due to CMV, 8% were due to varicella zoster virus, and 2% were due to herpes simplex virus; the viral infections in the non-al group (2%) occurred in the second post-lt year and were due to varicella zoster. Two of the Dþ/R patients with CMV infections in the AL group had end organ involvement (CMV disease: colitis and hepatitis) that responded to intravenous ganciclovir therapy. All the varicella and herpes infections were localized to the skin and not ophthalmologic or disseminated. None of the patients had postherpetic neuralgia or other complications. Other Outcomes The rates of development of renal dysfunction, malignancy, leukopenia, and new-onset diabetes and the percentages of patients who were on a single immunosuppressive agent at 2 years were not statistically different between the 2 groups (Table 2). However, the incidence of new-onset hypertension was higher in the non-al group versus the AL group (18.9% versus 5.5%, P ¼ 0.03) DISCUSSION Our study demonstrates some potential benefits and risks of AL induction in LT recipients. Although the total number of rejection episodes and the rate of new-onset hypertension were lower with AL induction therapy, the risk of infection was significantly higher than the risk in the non AL-induced cohort. The benefit of avoiding more than 1 acute rejection episode appears to be counteracted by the risk of viral infections (particularly CMV). Our findings are not surprising because AL causes profound, long-lasting lymphodepletion, which subsequently leads to a lower rate of late rejection but a higher risk of late-onset infections. In addition, none of the other major endpoints, including patient and graft survival, renal dysfunction, and the percentage weaned to maintenance monotherapy, were different between the AL-induced and non AL-induced groups. Therefore, the overall added advantage of AL induction in LT recipients is questionable. AL has been used successfully as induction therapy, mainly for patients undergoing nonhepatic solid organ transplantation. Steroid-free regimens designed to reduce the incidence of metabolic complications from steroids have been used with AL induction. AL use has been thought to additionally promote the concept of prope tolerance: allograft function is maintained with minimal immunosuppression, so the incidence of long-term adverse effects of calcineurin inhibitors, such as nephrotoxicity, may be reduced. 11 The data on AL use for LT are, however, limited to reports from single centers. Researchers at the University of Miami reported their experience with AL
5 36 LEVITSKY ET AL. LIVER TRANSPLANTATION, January 2011 induction in 40 patients and updated their results with a subsequent study of 77 patients. 7,8 These observations showed a significant reduction in the acute rejection rate in the AL group versus the non- AL group, but there was no significant difference in the patient or graft survival rates or in the rates of opportunistic infections between the groups. The AL group also had a lower incidence of nephrotoxicity, which was thought to be due to the use of lower calcineurin inhibitor doses and trough levels. They also reported AL use for intestinal and multivisceral transplantation and demonstrated a trend toward reduced rejection with AL induction without an increase in the incidence of opportunistic infections. 6 Although our results are somewhat similar to those of other reports in terms of rejection (there were fewer patients with multiple rejection episodes in our AL group), we observed a significantly higher rate of viral infectious complications. 6-9,12,13 This occurred even though we used a single-dose, steroid-free AL induction regimen, whereas others used repeat AL dosing. The discrepancy in infectious outcomes could be related to several important factors. Our standard 30-mg AL dose (instead of weight-based dosing) may have contributed to the overimmunosuppressed state. In addition, our steroid-free protocol involved the use of adjunctive MMF because we were concerned about rejection with calcineurin inhibitor monotherapy immediately after transplantation. However, other studies not using MMF reported reduced rejection rates without increases in infectious complications, 7-9 so the combination of AL and MMF in our patients likely led to more marrow toxicity. It is also worth noting that no patients in the non- AL group had CMV infections, and this was likely because of the lower intensity of their immunosuppression regimen (higher number of rejection episodes). That said, this control group s unusually low rate of viral infections contributed to the statistically significant difference versus the AL group and also might not be representative of rates seen in similar cohorts in the literature. Finally, it is possible that differences in the dosing and length of antiviral prophylaxis in our cohorts and other studies could explain the observed discrepancy. Notably, the majority of our AL patients who developed a CMV infection had undergone previous dose reductions of valganciclovir to 450 mg every other day because of lymphopenia. This further emphasizes the importance of maintaining adequate antiviral prophylaxis and avoiding other marrow-suppressive therapy (ie, MMF) in this population. Our study is consistent with other reports demonstrating a higher risk of infectious complications. In a study by Silveira et al., 14 the incidence of cryptococcocal infections was significantly higher in patients receiving more than 1 dose of AL versus those receiving conventional immunosuppression without induction. In another study by Peleg et al., 15 organ transplant recipients receiving AL did not experience an increased incidence of opportunistic infections unless they were being treated with AL for rejection and with more than 1 AL dose. On the basis of our data and others data, a number of general conclusions can be made. First, prolonged anti-infectious prophylaxis (particularly antiviral prophylaxis) may be required after AL induction. Second, much less maintenance immunosuppression, particularly in the LT population, may be needed with AL induction. Calcineurin inhibitor monotherapy with or without steroids may be adequate to prevent rejection and not lead to higher rates of infection. Finally, weight-based single doses of AL for induction are likely to reduce complications in comparison with standard or multiple-dosing regimens. These conclusions are, however, based only on the limited data available and not on randomized controlled trials. Finally, the issue of HCV-positive recipients deserves mention. These patients have been excluded from previous studies because it has been demonstrated that AL-induced lymphodepletion may result in rapidly progressive HCV recurrence and graft failure. 10 This has not been demonstrated consistently with other lymphodepletion (anti-thymocyte globulin) and nonlymphodepletion (interleukin-2 inhibitor) induction protocols in this population. Because 4 of our 12 initial HCV-positive recipients developed rapid HCV recurrence and graft failure after AL induction (these patients were excluded from this report; the data are not shown), we discontinued this practice in mid 2002 and used AL induction only in non-hcv patients. Hence, unless other data prove otherwise, HCV-positive patients should not be given AL as either induction or rejection therapy. Our study has several limitations. The collected data are retrospective in nature and subject to potential bias. In addition, our data concern patients who were followed at a single institution and may not be applicable to recipients at other centers. The patients in the 2 groups did not undergo transplantation during the same period because non-hcv patients between 2002 and 2006 received AL induction. To address this issue, we randomly selected patients from a pool of previous patients meeting inclusion criteria similar to those for the AL group; however, prednisone (not MMF) was used in the control group. A control group with identical immunosuppression except for AL (tacrolimus and MMF alone with no prednisone) was unfortunately not available at our institution for comparison. However, the baseline characteristics of the 2 populations, except for the immunosuppressive regimen and a small difference in the creatinine levels, were similar, so the impact of this confounder is likely low. In conclusion, in light of the risks and benefits, our observations suggest that induction therapy with AL in all LT recipients (HCV-positive and HCV-negative) does not appear to be beneficial in comparison with a standard regimen. Prolonged anti-infective prophylaxis and minimized immunosuppression are likely needed to reduce infectious complications if AL induction is being considered. Further prospective studies addressing these concerns are required to justify the use of AL in the LT population.
6 LIVER TRANSPLANTATION, Vol. 17, No. 1, 2011 LEVITSKY ET AL. 37 REFERENCES 1. Calne RY. Prope tolerance the future of organ transplantation from the laboratory to the clinic. Int Immunopharmacol 2005;5: Calne R, Moffatt SD, Friend PJ, Jamieson NV, Bradley JA, Hale G, et al. Campath IH allows low-dose cyclosporine monotherapy in 31 cadaveric renal allograft recipients. Transplantation 1999;68: Dhesi S, Boland B, Colquhoun S. Alemtuzumab and liver transplantation: a review. Curr Opin Organ Transplant 2009;14: Magliocca J, Knechtle S. The evolving role of alemtuzumab (Campath-1H) for immunosuppressive therapy in organ transplantation. Transpl Int 2006;19: Stuart FP, Leventhal JR, Kaufman DB, Stuart J, Abecassis M, Fryer JP, et al. Alemtuzumab facilitates prednisone free immunosuppression in kidney transplant recipients with no early rejection. Am J Transplant 2002;2(suppl3): Tzakis AG, Kato T, Nishida S, Levi DM, Madariaga JR, Nery JR, et al. Preliminary experience with Campath 1H (C1H) in intestinal and liver transplantation. Transplantation 2003;75: Tzakis AG, Tryphonopoulos P, Kato T, Nishida S, Levi DM, Madariaga JR, et al. Preliminary experience with alemtuzumab (Campath-1H) and low dose tacrolimus immunosuppression in adult liver transplantation. Transplantation 2004;77: Tryphonopoulos P, Madariaga JR, Kato T, Nishida S, Levi DM, Moon J, et al. The impact of Campath 1H induction in adult liver allotransplantation. Transplant Proc 2005;37: Marcos A, Eghtesad B, Fung JJ, Fontes P, Patel K, Devera M, et al. Use of alemtuzumab and tacrolimus monotherapy for cadaveric liver transplantation: with particular reference to hepatitis C virus. Transplantation 2004;78: Banff schema for grading liver allograft rejection: an international consensus document. HEPATOLOGY 1997;25: Calne R, Friend P, Moffatt S, Bradley A, Hale G, Firth J, et al. Prope tolerance, perioperative Campath 1H, and low-dose cyclosporine monotherapy in renal allograft recipients. Lancet 1998;351: Alcaide ML, Abbo L, Pano JR, Gaynor JJ, Tryphonopoulos P, Weppler D, et al. Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab. Clin Transplant 2008;22: Malek SK, Obmann MA, Gotoff RA, Foltzer MA, Hartle JE, Potdar S. Campath-1H induction and incidence of infectious complications in adult renal transplantation. Transplantation 2006;81: Silveira FP, Husain S, Kwak EJ, Linden PK, Marcos A, Shapiro R, et al. Cryptococcosis in liver and kidney transplant recipients receiving antithymocyte globulin or alemtuzumab. Transpl Infect Dis 2007;9: Peleg AY, Husain S, Kwak EJ, Silveira FP, Ndirangu M, Tran J, et al. Opportunistic infections in 547 organ transplant recipients receiving alemtuzumab humanized monoclonal CD-52 antibody. Clin Infect Dis 2007;44:
Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation
LIVER TRANSPLANTATION 12:1210-1214, 2006 ORIGINAL ARTICLE Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation Ashesh Shah, 1 Avinash Agarwal, 1 Richard Mangus,
More informationEfficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function
ArtIcle Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function Guodong Chen, 1 Jingli Gu, 2 Jiang Qiu, 1 Changxi
More informationTransplant Hepatology
Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified
More informationEuropean Risk Management Plan. Measures impairment. Retreatment after Discontinuation
European Risk Management Plan Table 6.1.4-1: Safety Concern 55024.1 Summary of Risk Minimization Measures Routine Risk Minimization Measures Additional Risk Minimization Measures impairment. Retreatment
More informationPUO in the Immunocompromised Host: CMV and beyond
PUO in the Immunocompromised Host: CMV and beyond PUO in the immunocompromised host: role of viral infections Nature of host defect T cell defects Underlying disease Treatment Nature of clinical presentation
More informationSerum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
More informationBK virus infection in renal transplant recipients: single centre experience. Dr Wong Lok Yan Ivy
BK virus infection in renal transplant recipients: single centre experience Dr Wong Lok Yan Ivy Background BK virus nephropathy (BKVN) has emerged as an important cause of renal graft dysfunction in recent
More informationOverview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
More informationIncreased Early Rejection Rate after Conversion from Tacrolimus in Kidney and Pancreas Transplantation
Increased Early Rejection Rate after Conversion from Tacrolimus in Kidney and Pancreas Transplantation Gary W Barone 1, Beverley L Ketel 1, Sameh R Abul-Ezz 2, Meredith L Lightfoot 1 1 Department of Surgery
More informationThis study is currently recruiting participants.
A Two Part, Phase 1/2, Safety, PK and PD Study of TOL101, an Anti-TCR Monoclonal Antibody for Prophylaxis of Acute Organ Rejection in Patients Receiving Renal Transplantation This study is currently recruiting
More informationImmunosuppressants. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Immunosuppressants Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Immunosuppressive Agents Very useful in minimizing the occurrence of exaggerated or inappropriate
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationProspective, Randomized, Multi-Center Trial of Antibody Induction Therapy in Simultaneous Pancreas-Kidney Transplantation
American Journal of Transplantation 2003; 3: 855 864 Copyright # Blackwell Munksgaard 2003 Blackwell Munksgaard ISSN 1600-6135 Prospective, Randomized, Multi-Center Trial of Antibody Therapy in Simultaneous
More informationExperience with Liver Transplantation in patients over 65 years of Age at the Hospital Pablo Tobón Uribe in Medellin, Colombia from 2004 to 2010
Original articles Experience with Liver Transplantation in patients over 65 years of Age at the Hospital Pablo Tobón Uribe in Medellin, Colombia from 2004 to 2010 Octavio Muñoz, MD, 1 Laura Ovadía, MD,
More informationSINCE the introduction of Imuran and
Cadaveric Renal Transplantation With Cyclosporin-A and Steroids T. R. Hakala, T. E. Starzl, J. T. Rosenthal, B. Shaw, and S. watsuki SNCE the introduction of muran and prednisone in 1961, and despite the
More informationIs Cytomegalovirus Infection Dangerous in Cytomegalovirus-Seropositive Recipients After Liver Transplantation?
LIVER TRANSPLANTATION 17:446 455, 2011 ORIGINAL ARTICLE Is Cytomegalovirus Infection Dangerous in Cytomegalovirus-Seropositive Recipients After Liver Transplantation? Jong Man Kim, 1 Sung-Joo Kim, 1 Jae-Won
More informationAlemtuzumab Induction in Renal Transplantation
original article Induction in Renal Transplantation Michael J. Hanaway, M.D., E. Steve Woodle, M.D., Shamkant Mulgaonkar, M.D., V. Ram Peddi, M.D., Dixon B. Kaufman, M.D., Ph.D., M. Roy First, M.D., Richard
More informationPost Operative Management in Heart Transplant นพ พ ชร อ องจร ต ศ ลยศาสตร ห วใจและทรวงอก จ ฬาลงกรณ
Post Operative Management in Heart Transplant นพ พ ชร อ องจร ต ศ ลยศาสตร ห วใจและทรวงอก จ ฬาลงกรณ Art of Good Cooking Good Ingredient Good donor + OK recipient Good technique Good team Good timing Good
More informationORIGINAL ARTICLE. Eric F. Martin, 1 Jonathan Huang, 3 Qun Xiang, 2 John P. Klein, 2 Jasmohan Bajaj, 4 and Kia Saeian 1
LIVER TRANSPLANTATION 18:914 929, 2012 ORIGINAL ARTICLE Recipient Survival and Graft Survival are Not Diminished by Simultaneous Liver-Kidney Transplantation: An Analysis of the United Network for Organ
More informationLiver Transplantation: The End of the Road in Chronic Hepatitis C Infection
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat
More informationOverall Goals and Objectives for Transplant Hepatology EPAs:
Overall Goals and Objectives for Transplant Hepatology EPAs: 1. DIAGNOSTIC LIST During the one-year Advanced Pediatric Transplant Hepatology Program, fellows are expected to develop comprehensive skills
More informationSolid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions
Solid Organ Transplantation 1 Chapter 55. Solid Organ Transplant, Self-Assessment Questions Questions 1 to 9 are related to the following case: A 38-year-old white man is scheduled to receive a living-unrelated
More informationPotential Catalysts in Therapeutics
LIVER TRANSPLANTATION 20:S22 S31, 2014 SUPPLEMENT Potential Catalysts in Therapeutics Bruce A. Luxon Division of Gastroenterology-Hepatology, University of Iowa, Iowa City, IA Received July 23, 2014; accepted
More informationAmerican Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc.
American Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc. 2009 The Authors Journal compilation 2009 The American Society of Transplantation and the American Society of Transplant
More informationBK Virus (BKV) Management Guideline: July 2017
BK Virus (BKV) Management Guideline: July 2017 BK virus has up to a 60-80% seroprevalence rate in adults due to a primary oral or respiratory exposure in childhood. In the immumocompromised renal transplant
More informationEmerging Drug List EVEROLIMUS
Generic (Trade Name): Manufacturer: Everolimus (Certican ) Novartis Pharmaceuticals NO. 57 MAY 2004 Indication: Current Regulatory Status: Description: Current Treatment: Cost: Evidence: For use with cyclosporine
More informationLiver Transplantation Evaluation: Objectives
Liver Transplantation Evaluation: Essential Work-Up Curtis K. Argo, MD, MS VGS/ACG Regional Postgraduate Course Williamsburg, VA September 13, 2015 Objectives Discuss determining readiness for transplantation
More informationImmune Cell Function Assay
Immune Cell Function Assay Policy Number: 2.04.56 Last Review: 12/2017 Origination: 12/2015 Next Review: 12/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide coverage for
More informationLiving Donor Renal Transplantation Using Alemtuzumab Induction and Tacrolimus Monotherapy
American Joumal of Transplantation 26; 6: 249-2417 Blackwell Munksgaard 26 The Authors Journal compilation 26 The American Society of Transplantation and the American Society of Transplant Surgeons doi:
More informationLate-Onset Cytomegalovirus (CMV) in Lung Transplant Recipients: Can CMV Serostatus Guide the Duration of Prophylaxis?
American Journal of Transplantation 2013; 13: 376 382 Wiley Periodicals Inc. C Copyright 2012 American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2012.04339.x
More informationChapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
More informationLiterature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: CICLOSPORIN Protocol number: CV 06
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: CICLOSPORIN Protocol number: CV 06 Indication: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION IN ADULTS
More informationEvaluation of a Weight-based Rabbit Anti-thymocyte Globulin Induction Dosing Regimen for Kidney Transplant Recipients
Evaluation of a Weight-based Rabbit Anti-thymocyte Globulin Induction Dosing Regimen for Kidney Transplant Recipients Catherine A. Pennington, 1 Sarah M. Tischer, 1 Eliza Lee, 2 Sun Lee, 2 James Sindelar,
More informationI topic liver transplantation (OLT) to avoid organ
ORIGINAL ARTICLES Long-Term Immunosuppression Without Corticosteroids After Orthotopic Liver Transplantation: A Positive Therapeutic Aim Gerald M. Fraser, * Kons tantinos Grammous tianos, Jayendravandan
More informationPancreas After Islet Transplantation: A First Report of the International Pancreas Transplant Registry
American Journal of Transplantation 2016; 16: 688 693 Wiley Periodicals Inc. Brief Communication Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:
More informationFor Immediate Release Contacts: Jenny Keeney Astellas US LLC (847)
For Immediate Release Contacts: Jenny Keeney Astellas US LLC (847) 317-5405 Lauren McDonnell GolinHarris (312) 729-4233 ASTELLAS RECEIVES FDA APPROVAL FOR USE OF PROGRAF (TACROLIMUS) IN CONJUNCTION WITH
More informationClinical decisions regarding immunosuppressive
PHARMACOLOGIC THERAPIES AND RATIONALES * Stuart D. Russell, MD ABSTRACT This article reviews evidence related to the use of induction therapy and longer-term combination immunosuppressive drug regimens
More informationCases: CMV, HCV, BKV and Kidney Transplantation. Simin Goral, MD University of Pennsylvania Medical Center
Cases: CMV, HCV, BKV and Kidney Transplantation Simin Goral, MD University of Pennsylvania Medical Center Disclosures Grant support: Otsuka Pharmaceuticals, Astellas Pharma, Angion, AstraZeneca, and Kadmon
More informationLong-term prognosis of BK virus-associated nephropathy in kidney transplant recipients
Original Article Kidney Res Clin Pract 37:167-173, 2018(2) pissn: 2211-9132 eissn: 2211-9140 https://doi.org/10.23876/j.krcp.2018.37.2.167 KIDNEY RESEARCH AND CLINICAL PRACTICE Long-term prognosis of BK
More informationRECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY
RECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY By VIRGINIA C. CLARK A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
More informationImmunosuppression Induction With Rabbit Anti-Thymocyte Globulin With or Without Rituximab in 1000 Liver Transplant Patients With Long-Term Follow-Up
LIVER TRANSPLANTATION 18:786-795, 2012 ORIGINAL ARTICLE Immunosuppression Induction With Rabbit Anti-Thymocyte Globulin With or Without Rituximab in 1000 Liver Transplant Patients With Long-Term Follow-Up
More informationPOST TRANSPLANT OUTCOMES IN PSC
POST TRANSPLANT OUTCOMES IN PSC Kidist K. Yimam, MD Medical Director, Autoimmune Liver Disease Program Division of Hepatology and Liver Transplantation California Pacific Medical Center (CPMC) PSC Partners
More informationDiltiazem use in tacrolimus-treated renal transplant recipients Kothari J, Nash M, Zaltzman J, Prasad G V R
Diltiazem use in tacrolimus-treated renal transplant recipients Kothari J, Nash M, Zaltzman J, Prasad G V R Record Status This is a critical abstract of an economic evaluation that meets the criteria for
More informationLiver Transplant Immunosuppression
Liver Transplant Immunosuppression Michael Daily, MD, MS, FACS Surgical Director, Kidney and Pancreas Transplantation University of Kentucky Medical Center Disclosures No financial disclosures I will be
More informationPrevalence and Risk Factors of Recurrent Cytomegalovirus Infection in Kidney Transplant Recipients
TRANSPLANTATION Prevalence and Risk Factors of Recurrent Cytomegalovirus Infection in Kidney Transplant Recipients Mohsen Nafar, 1 Azamolsadat Roshan, 2 Fatemeh Pour-Reza-Gholi, 1 Fariba Samadian, 1 Pedram
More informationLong term liver transplant management
Long term liver transplant management Dr Bill Griffiths Cambridge Liver Unit Royal College of Physicians 5.7.17 Success of Liver Transplantation Current survival, 1 st elective transplant: 1 yr survival
More informationORIGINAL ARTICLE. Received March 14, 2007; accepted August 29, 2007.
LIVER TRANSPLANTATION 14:173-180, 2008 ORIGINAL ARTICLE A Randomized, Prospective, Pharmacoeconomic Trial of Neoral 2-Hour Postdose Concentration Monitoring Versus Tacrolimus Trough Concentration Monitoring
More informationNephrology Grand Rounds
Nephrology Grand Rounds PTLD in Kidney Transplantation Charles Le University of Colorado 6/15/12 Objectives Background Pathogenesis Epidemiology and Clinical Manifestation Incidence Risk Factors CNS Lymphoma
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: TACROLIMUS Protocol number: CV 43
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: TACROLIMUS Protocol number: CV 43 Indications: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION IN ADULTS.
More informationSolid organ transplantation is a major achievement of. Liver Transplantation: Current Status and Novel Approaches to Liver Replacement
GASTROENTEROLOGY 2001;120:749 762 Liver Transplantation: Current Status and Novel Approaches to Liver Replacement EMMET B. KEEFFE Division of Gastroenterology and Hepatology, Department of Medicine, Stanford
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2010 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE I INTRODUCTION 1 II
More informationImmunosuppression: evolution in practice and trends,
American Journal of Transplantation 25; 5 (Part 2): 874 886 Blackwell Munksgaard Blackwell Munksgaard 25 Immunosuppression: evolution in practice and trends, 1993 23 Ron Shapiro a,, James B. Young b, Edgar
More informationClinical Aspect and Application of Laboratory Test in Herpes Virus Infection. Masoud Mardani M.D,FIDSA
Clinical Aspect and Application of Laboratory Test in Herpes Virus Infection Masoud Mardani M.D,FIDSA Shahidhid Bh BeheshtiMdi Medical lui Universityit Cytomegalovirus (CMV), Epstein Barr Virus(EBV), Herpes
More informationLIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES
LIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES No conflict of interest Objectives Introduction Methods Results Conclusions Objectives Introduction Methods Results Conclusions
More informationDonor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation
8 Original Article Donor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation Neema Kaseje 1 Samuel Lüthold 2 Gilles Mentha 3 Christian Toso 3 Dominique Belli 2 Valérie McLin 2 Barbara
More informationSerologic Markers CONVENTIONAL ANTIBODIES ANTIBODIES UNCONVENTIONAL. AIH Type I
Autoimmune Hepatitis By Thomas Frazier Objective What we need to know about AIH Diagnosis Treatment Difficulties in both Liver transplantation concerns AASLD Guidelines: Hepatology. 2010 Jun;51(6):2193-213.
More informationLiver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995
Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Steven H. Belle, Kimberly C. Beringer, and Katherine M. Detre T he Scientific Liver Transplant Registry (LTR) was established
More informationResearch Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database
Transplantation Volume 2013, Article ID 269096, 7 pages http://dx.doi.org/10.1155/2013/269096 Research Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients:
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Lefaucheur C, Loupy A, Vernerey D, et al. Antibody-mediated
More informationIntravenous immunoglobulin in BK virus nephropathy
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2014 Intravenous immunoglobulin in BK virus nephropathy Elizabeth I. Anyaegbu Driscoll Children's Hospital Stanley
More informationLiver Transplant: What s Different? Brian Lin, MD, FACEP Emergency Medicine, Kaiser Permanente, San Francisco UCSF Clinical Assistant Professor
Liver Transplant: What s Different? Brian Lin, MD, FACEP Emergency Medicine, Kaiser Permanente, San Francisco UCSF Clinical Assistant Professor No Disclosures. Background 45 years 1998-2008: 90,830 transplants
More informationHLA and Non-HLA Antibodies in Transplantation and their Management
HLA and Non-HLA Antibodies in Transplantation and their Management Luca Dello Strologo October 29 th, 2016 Hystory I 1960 donor specific antibodies (DSA): first suggestion for a possible role in deteriorating
More informationPharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents
BUMC Proceedings 1999;12:110-112 Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents CHERYLE GURK-TURNER, RPH Department of Pharmacy Services, BUMC wo mouse/human
More informationPancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP
Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP Pancreas transplant recipients are usually under age 50. The majority of pancreas transplants are performed on diabetics, who are generally
More informationEvaluation of clinical outcomes of prophylactic versus preemptive cytomegalovirus strategy in liver transplant recipients
Xavier University of Louisiana From the SelectedWorks of Ifeanyi Onor, PharmD, BCPS June, 2013 Evaluation of clinical outcomes of prophylactic versus preemptive cytomegalovirus strategy in liver transplant
More informationIntron A Hepatitis C. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.05 Subject: Intron A Hepatitis C Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: AZATHIOPRINE Protocol number: CV 04
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: AZATHIOPRINE Protocol number: CV 04 Indication: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION LIVER
More informationControversies in Renal Transplantation. The Controversial Questions. Patrick M. Klem, PharmD, BCPS University of Colorado Hospital
Controversies in Renal Transplantation Patrick M. Klem, PharmD, BCPS University of Colorado Hospital The Controversial Questions Are newer immunosuppressants improving patient outcomes? Are corticosteroids
More informationLiver Transplantation
1 Liver Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr History Development of Liver transplantation
More informationIntruduction PSI MODE OF ACTION AND PHARMACOKINETICS
Multidisciplinary Insights on Clinical Guidance for the Use of Proliferation Signal Inhibitors in Heart Transplantation Andreas Zuckermann, MD et al. Department of Cardio-Thoracic Surgery, Medical University
More informationDate: 23 June Context and policy issues:
Title: Basiliximab for Immunosuppression During a Calcineurin Inhibitor Holiday in Renal Transplant Patients with Acute Renal Dysfunction: Guidelines for Use and a Clinical and Cost-Effectiveness Review
More informationREACH Risk Evaluation to Achieve Cardiovascular Health
Dyslipidemia and transplantation History: An 8-year-old boy presented with generalized edema and hypertension. A renal biopsy confirmed a diagnosis of focal segmental glomerulosclerosis (FSGS). After his
More informationORIGINAL ARTICLE. Hung-Tien Kuo, 1,2 Erik Lum, 1 Paul Martin, 3 and Suphamai Bunnapradist ORIGINAL ARTICLE
ORIGINAL ARTICLE Effect of Diabetes and Acute Rejection on Liver Transplant Outcomes: An Analysis of the Organ rocurement and Transplantation Network/United Network for Organ Sharing Database Hung-Tien
More informationResearch Article A Decade of Experience Using mtor Inhibitors in Liver Transplantation
Transplantation Volume 2011, Article ID 913094, 7 pages doi:10.1155/2011/913094 Research Article A Decade of Experience Using mtor Inhibitors in Liver Transplantation Jeffrey Campsen, 1, 2 Michael A. Zimmerman,
More informationImmunosuppressive Strategies in Liver Transplantation for Hepatitis C
Trends in Transplantation Transplant. 2010;4:78-85 Immunosuppressive Strategies in Liver Transplantation for Hepatitis C Timothy M. Clifford 1-3, Michael F. Daily 1,3 and Roberto Gedaly 1,3 1 UK HealthCare,
More informationSteroid-Resistant Acute Rejections After Liver Transplant
ARTICLE Steroid-Resistant Acute Rejections After Liver Transplant Cem Aydogan, 1 Sinasi Sevmis, 1 Sema Aktas, 1 Hamdi Karakayali, 1 Beyhan Demirhan, 2 Mehmet Haberal 1 Abstract Objectives: Liver transplant
More informationClinical Outcomes of Renal Transplantation in Hepatitis C Virus Positive Recipients
Original Research Article Clinical Outcomes of Renal Transplantation in Hepatitis C Virus Positive Recipients Surendran Sujit 1*, N. Gopalakrishnan 2 1 Assistant Professor, 2 Professor and Head Department
More informationSteroid-Free Maintenance Immunosuppression After Heart Transplantation
Steroid-Free Maintenance Immunosuppression After Heart Transplantation Timothy E. Oaks, MD, Thomas Wannenberg, MD, Sherry A. Close, BSN, Laura E. Tuttle, BSN, and Neal D. Kon, MD Departments of Cardiothoracic
More informationvalganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd
valganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd 17 December 2010 The Scottish Medicines Consortium (SMC) has completed its assessment of the
More informationORIGINAL ARTICLE. Received August 2, 2011; accepted November 9, 2011.
LIVER TRANSPLANTATION 18:347-354, 2012 ORIGINAL ARTICLE Retrospective Review of the Incidence of Cytomegalovirus Infection and Disease After Liver Transplantation in Pediatric Patients: Comparison of Prophylactic
More informationTolerance Induction in Transplantation
Tolerance Induction in Transplantation Reza F. Saidi, MD, FACS, FICS Assistant Professor of Surgery Division of Organ Transplantation Department of Surgery University of Massachusetts Medical School Percent
More informationImmunopathology of T cell mediated rejection
Immunopathology of T cell mediated rejection Ibrahim Batal MD Columbia University College of Physicians & Surgeons New York, NY, USA Overview Pathophysiology and grading of TCMR TCMR is still a significant
More informationPredictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
More informationChapter 22: Hematological Complications
Chapter 22: Hematological Complications 22.1: Perform a complete blood count at least (Not Graded): daily for 7 days, or until hospital discharge, whichever is earlier; two to three times per week for
More informationEffect of Calcineurin Inhibitors on Survival and Histologic Disease Severity in HCV-Infected Liver Transplant Recipients
LIVER TRANSPLANTATION 12:762-767, 2006 ORIGINAL ARTICLE Effect of Calcineurin Inhibitors on Survival and Histologic Disease Severity in HCV-Infected Liver Transplant Recipients Marina Berenguer, 1 Victoria
More informationAlemtuzumab Induction and Steroid-Free Maintenance Immunosuppression in Pancreas Transplantation
American Journal of Transplantation 2008; 8: 2126 2131 Wiley Periodicals Inc. C 2008 The Authors Journal compilation C 2008 The American Society of Transplantation and the American Society of Transplant
More informationPrimary CMV Infections Are Common in Kidney Transplant Recipients After 6 Months Valganciclovir Prophylaxis
American Journal of Transplantation 2010; 10: 2026 2032 Wiley Periodicals Inc. C 2010 The Authors Journal compilation C 2010 The American Society of Transplantation and the American Society of Transplant
More informationVirus Reviews and Research
Virus Reviews and Research Sociedade Brasileira de Virologia journal homepage: www.sbv.org.br/vrr/ Research Article ACTIVE CYTOMEGALOVIRUS (CMV) INFECTION IN LIVER RECIPIENTS IN A HIGH CMV SEROPREVALENCE
More informationAn increasing number of organ procurement organizations
Comparison of Histidine-Tryptophan-Ketoglutarate Solution and University of Wisconsin Solution in Intestinal and Multivisceral Transplantation Richard S. Mangus, A. Joe Tector, Jonathan A. Fridell, Marwan
More information5/9/2018. Bone marrow failure diseases (aplastic anemia) can be cured by providing a source of new marrow
5/9/2018 or Stem Cell Harvest Where we are now, and What s Coming AA MDS International Foundation Indianapolis IN Luke Akard MD May 19, 2018 Infusion Transplant Conditioning Treatment 2-7 days STEM CELL
More informationNephrology Dialysis Transplantation
Nephrol Dial Transplant (1999) 14: 394 399 Original Article Nephrology Dialysis Transplantation Reduced kidney transplant rejection rate and pharmacoeconomic advantage of mycophenolate mofetil Rudolf P.
More information2017 BANFF-SCT Joint Scientific Meeting. Personalized Medicine in Liver Transplantation
2017 BANFF-SCT Joint Scientific Meeting Personalized Medicine in Liver Transplantation Miquel Navasa Liver Transplant Unit. Hospital Clínic. Barcelona. Barcelona, March 2017 Disclosures Consultant for
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 2, by the Massachusetts Medical Society VOLUME 342 M ARCH 2, 2 NUMBER 9 IMPROVED GRAFT SURVIVAL AFTER RENAL TRANSPLANTATION IN THE UNITED STATES, 1988 TO
More informationUse of immune function test in monitoring immunosuppression in liver transplant recipients
Clin Transplant 2012: 26: 826 832 DOI: 10.1111/j.1399-0012.2012.01632.x 2012 John Wiley & Sons A/S. Use of immune function test in monitoring immunosuppression in liver transplant recipients Te HS, Dasgupta
More information1. Discuss the basic pathophysiology of end-stage liver and kidney failure.
TRANSPLANT SURGERY ROTATION (PGY1, 2) A. Medical Knowledge Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of a variety of disease processes. The resident will be exposed
More informationThis was a multicenter study conducted at 11 sites in the United States and 11 sites in Europe.
Protocol CAM211: A Phase II Study of Campath-1H (CAMPATH ) in Patients with B- Cell Chronic Lymphocytic Leukemia who have Received an Alkylating Agent and Failed Fludarabine Therapy These results are supplied
More information