Journal articles: 'Organ transplantation; Immunosuppression'

1

Oka, Takahiro. "Immunosuppression in Organ Transplantation." Japanese Journal of Pharmacology 64 (1994): 3. http://dx.doi.org/10.1016/s0021-5198(19)35809-3.

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Oka, Takahiro, and Norio Yoshimura. "Immunosuppression in Organ Transplantation." Japanese Journal of Pharmacology 71, no. 2 (1996): 89–100. http://dx.doi.org/10.1254/jjp.71.89.

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Carpenter, Charles B. "Immunosuppression in Organ Transplantation." New England Journal of Medicine 322, no. 17 (April 26, 1990): 1224–26. http://dx.doi.org/10.1056/nejm199004263221709.

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Sonmez, Yusuf Ercin. "Future of Solid Organ Transplantation: Organ-Specific Tolerance." KIDNEYS 10, no. 3 (September 15, 2021): 130–36. http://dx.doi.org/10.22141/2307-1257.10.3.2021.239589.

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A transplant between two people who are not genetically identical is called an allotransplant and the process is called allotransplantation. Donor organs and tissues can be from people who are living, or people who have died because of a significant brain injury or lack of circulation. Allotransplantation can create a rejection process where the immune system of the recipient attacks the foreign donor organ or tissue and destroys it. The recipient may need to take immunosuppressive medication for the rest of their life to reduce the risk of rejection of the donated organ. In general, deliberately induced immunosuppression is performed to prevent the body from rejecting an organ transplant. The adverse effects associated with these agents and the risks of long-term immunosuppression present a number of challenges for the clinician. Immune tolerance, or immunological tolerance, or immunotolerance, is a state of unresponsiveness of the immune system to substances or tissue that have the capacity to elicit an immune response in a given organism.

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Starzl, Thomas E., Noriko Murase, Kareem Abu-Elmagd, Edward A. Gray, Ron Shapiro, Bijan Eghtesad, Robert J. Corry, et al. "Tolerogenic immunosuppression for organ transplantation." Lancet 361, no. 9368 (May 2003): 1502–10. http://dx.doi.org/10.1016/s0140-6736(03)13175-3.

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Jasiak, Natalia M., and Jeong M. Park. "Immunosuppression in Solid-Organ Transplantation." Critical Care Nursing Quarterly 39, no. 3 (2016): 227–40. http://dx.doi.org/10.1097/cnq.0000000000000117.

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Eggleton, Alison. "Immunosuppression following solid organ transplantation." Nurse Prescribing 12, no. 6 (June 2, 2014): 274–75. http://dx.doi.org/10.12968/npre.2014.12.6.274.

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Ohara, Margaret M. "Immunosuppression in solid organ transplantation." Topics in Clinical Nutrition 7, no. 3 (July 1992): 6–11. http://dx.doi.org/10.1097/00008486-199206000-00003.

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9

Pezze, JL. "RATG: implications for nursing care in organ transplantation." Critical Care Nurse 10, no. 9 (October 1, 1990): 18–19. http://dx.doi.org/10.4037/ccn1990.10.9.18.

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Proper immunosuppression is a key element determining the survival of patients undergoing organ transplantation. RATG is one of several immunosuppressive agents available for use. Nurses need to recognize the unique challenges that RATG poses for patient and dosage preparation, along with those affecting its administration and post administration. Doing so can effectively aid the transplanted patient in achieving optimal immunosuppression with the least amount of unpleasant effects. The hospital stay for a transplant patient can be very frustrating and exhausting. Nursing interventions that limit these effects can foster a more desirable patient experience.

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Cai, Songjie, and Anil Chandraker. "Cell Therapy in Solid Organ Transplantation." Current Gene Therapy 19, no. 2 (August 20, 2019): 71–80. http://dx.doi.org/10.2174/1566523219666190603103840.

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Transplantation is the only cure for end-stage organ failure. Current immunosuppressive drugs have two major limitations: 1) non antigen specificity, which increases the risk of cancer and infection diseases, and 2) chronic toxicity. Cell therapy appears to be an innovative and promising strategy to minimize the use of immunosuppression in transplantation and to improve long-term graft survival. Preclinical studies have shown efficacy and safety of using various suppressor cells, such as regulatory T cells, regulatory B cells and tolerogenic dendritic cells. Recent clinical trials using cellbased therapies in solid organ transplantation also hold out the promise of improving efficacy. In this review, we will briefly go over the rejection process, current immunosuppressive drugs, and the potential therapeutic use of regulatory cells in transplantation.

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Goldraich, Livia A., Santiago A. Tobar Leitão, Fernando L. Scolari, Fabiana G. Marcondes-Braga, Marcely G. Bonatto, Dipika Munyal, Jennifer Harrison, et al. "A Comprehensive and Contemporary Review on Immunosuppression Therapy for Heart Transplantation." Current Pharmaceutical Design 26, no. 28 (August 31, 2020): 3351–84. http://dx.doi.org/10.2174/1381612826666200603130232.

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: Heart transplantation is the standard of therapy for patients with end-stage heart disease. Since the first human-to-human heart transplantation, performed in 1967, advances in organ donation, surgical techniques, organ preservation, perioperative care, immunologic risk assessment, immunosuppression agents, monitoring of graft function and surveillance of long-term complications have drastically increased recipient survival. However, there are yet many challenges in the modern era of heart transplantation in which immunosuppression may play a key role in further advances in the field. A fine-tuning of immune modulation to prevent graft rejection while avoiding side effects from over immunosuppression has been the vital goal of basic and clinical research. Individualization of drug choices and strategies, taking into account the recipient's clinical characteristics, underlying heart failure diagnosis, immunologic risk and comorbidities seem to be the ideal approaches to improve post-transplant morbidity and survival while preventing both rejection and complications of immunosuppression. : The aim of the present review is to provide a practical, comprehensive overview of contemporary immunosuppression in heart transplantation. Clinical evidence for immunosuppressive drugs is reviewed and practical approaches are provided. Cardiac allograft rejection classification and up-to-date management are summarized. Expanding therapies, such as photophoresis, are outlined. Drug-to-drug interactions of immunosuppressive agents focused on cardiovascular medications are summarized. Special situations involving heart transplantation such as sarcoidosis, Chagas diseases and pediatric immunosuppression are also reviewed. The evolution of phamacogenomics to individualize immunosuppressive therapy is described. Finally, future perspectives in the field of immunosuppression in heart transplantation are highlighted.

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Cajanding, Ruff. "Immunosuppression following organ transplantation. Part 1: mechanisms and immunosuppressive agents." British Journal of Nursing 27, no. 16 (September 6, 2018): 920–27. http://dx.doi.org/10.12968/bjon.2018.27.16.920.

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13

Ford, K. A. "Paediatric immunosuppression following solid organ transplantation." Archives of Disease in Childhood - Education and Practice 91, no. 3 (October 1, 2006): ep87-ep91. http://dx.doi.org/10.1136/adc.2004.070052.

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Agarwal, Avinash, and Mark D. Pescovitz. "Immunosuppression in pediatric solid organ transplantation." Seminars in Pediatric Surgery 15, no. 3 (August 2006): 142–52. http://dx.doi.org/10.1053/j.sempedsurg.2006.03.002.

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15

Kasiske, Bertram L. "Payment for Immunosuppression After Organ Transplantation." JAMA 283, no. 18 (May 10, 2000): 2445. http://dx.doi.org/10.1001/jama.283.18.2445.

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Stegall, Mark D., and Jeffrey L. Platt. "Tolerance for immunosuppression in organ transplantation." Liver Transplantation 10, no. 4 (2004): 573–75. http://dx.doi.org/10.1002/lt.20135.

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Harrison, Jennifer J., Jeffrey R. Schiff, Christian J. Coursol, Christopher J. A. Daley, Anne I. Dipchand, Norine M. Heywood, Tammy M. Keough-Ryan, et al. "Generic Immunosuppression in Solid Organ Transplantation." Transplantation 93, no. 7 (April 2012): 657–65. http://dx.doi.org/10.1097/tp.0b013e3182445e9d.

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Luo, Gaoxing, Edward M. Falta, and Eric A. Elster. "Steroid-free immunosuppression in organ transplantation." Current Diabetes Reports 5, no. 4 (July 2005): 305–10. http://dx.doi.org/10.1007/s11892-005-0028-x.

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Ruiz, Paulina, Paula Maldonado, Yessia Hidalgo, Alejandra Gleisner, Daniela Sauma, Cinthia Silva, Juan Jose Saez, Sarah Nuñez, Mario Rosemblatt, and Maria Rosa Bono. "Transplant Tolerance: New Insights and Strategies for Long-Term Allograft Acceptance." Clinical and Developmental Immunology 2013 (2013): 1–15. http://dx.doi.org/10.1155/2013/210506.

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One of the greatest advances in medicine during the past century is the introduction of organ transplantation. This therapeutic strategy designed to treat organ failure and organ dysfunction allows to prolong the survival of many patients that are faced with no other treatment option. Today, organ transplantation between genetically dissimilar individuals (allogeneic grafting) is a procedure widely used as a therapeutic alternative in cases of organ failure, hematological disease treatment, and some malignancies. Despite the potential of organ transplantation, the administration of immunosuppressive drugs required for allograft acceptance induces severe immunosuppression in transplanted patients, which leads to serious side effects such as infection with opportunistic pathogens and the occurrence of neoplasias, in addition to the known intrinsic toxicity of these drugs. To solve this setback in allotransplantation, researchers have focused on manipulating the immune response in order to create a state of tolerance rather than unspecific immunosuppression. Here, we describe the different treatments and some of the novel immunotherapeutic strategies undertaken to induce transplantation tolerance.

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Wang, Hua, Miguel C. Sobral, Tracy Snyder, Yevgeny Brudno, Vijay S. Gorantla, and David J. Mooney. "Clickable, acid labile immunosuppressive prodrugs for in vivo targeting." Biomaterials Science 8, no. 1 (2020): 266–77. http://dx.doi.org/10.1039/c9bm01487j.

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Chua, Alfred WY, Matthew J. Chua, Brian P. Harrisberg, and Chandra M. Kumar. "Review of anaesthetic management for cataract surgery in transplant recipients." Anaesthesia and Intensive Care 48, no. 1 (January 2020): 25–35. http://dx.doi.org/10.1177/0310057x19891737.

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The prevalence of transplantation is on the increase worldwide. Corneal transplantation is the most common form of human donor transplantation. Transplantation of other organs and bone marrow is established treatment for various end-organ failure and many haematological conditions, respectively. Success and survival of these patients have increased with advances in immunosuppression. Unfortunately, these patients are susceptible to cataract formation as a consequence of immunosuppressive therapy and accelerated progression of several diseases. Topical anaesthesia and regional ophthalmic blocks are ideal for cataract surgery in cooperative adults. General anaesthesia may be required in children, for extremely anxious or claustrophobic adults and for complex surgery such as simultaneous cataract and corneal transplantation. The perioperative anaesthetic management of cataract surgery in a transplant recipient is no different to a standard technique in a healthy adult, but additional challenges are posed by the underlying pathology necessitating transplantation, function of the transplanted organ, physiological and pharmacological problems of allograft denervation, side-effects of immunosuppression, risk of infection and potential for rejection. This narrative review summarises optimal anaesthetic management in transplant recipients undergoing cataract surgery.

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Brasile, Lauren, Nicholas Henry, and Bart Stubenitsky. "The Feasibility of Organ-Specific Immunosuppression." Transplantation 102 (July 2018): S365. http://dx.doi.org/10.1097/01.tp.0000543115.14299.b9.

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23

Alagoz, Selma, Serkan Feyyaz Yalin, Sibel Gulcicek, Nurgul Ozgur, Mehmet Riza Altiparmak, and Nurhan Seyahi. "A Solid Mass in the Chest Wall." Progress in Transplantation 26, no. 4 (September 20, 2016): 386–88. http://dx.doi.org/10.1177/1526924816663517.

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Posttransplant lymphoproliferative disorder (PTLD) is one of the most common malignancies after kidney transplantation. Different clinical and histopathological forms of PTLD related to immunosuppression can be observed after organ transplantations. We report a 42-year-old woman who had undergone deceased donor renal transplantation with an unusual presentation of PTLD. The immunosuppressive treatment was discontinued and appropriate chemotherapy was started. However, the patient died despite this treatment. Different presentations of PTLD in transplant patients should also be kept in mind.

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Taylor, Rachel M., Aileen Parke, and Helen Day. "Immunosuppression for solid organ transplantation in children." Paediatric Care 16, no. 2 (March 2004): 39–43. http://dx.doi.org/10.7748/paed2004.03.16.2.39.c901.

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Rachel, M., Aileen Parke, and Helen Day. "Immunosuppression for solid organ transplantation in children." Paediatric Nursing 16, no. 2 (March 2004): 39–43. http://dx.doi.org/10.7748/paed.16.2.39.s26.

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Pratschke, J., S. G. Tullius, and P. Neuhaus. "Immunosuppression in Solid Organ Transplantation: A Review." Graft 5, no. 6 (September 1, 2002): 338–43. http://dx.doi.org/10.1177/1522162802005006003.

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Fredericks, Salim, David W. Holt, and Iain A. M. MacPhee. "The Pharmacogenetics of Immunosuppression for Organ Transplantation." American Journal of PharmacoGenomics 3, no. 5 (2003): 291–301. http://dx.doi.org/10.2165/00129785-200303050-00001.

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Knechtle, Stuart J., and Daniel C. Brennan. "Starting Well: Induction Immunosuppression after Organ Transplantation." Transplant International 26, no. 7 (June 11, 2013): 661. http://dx.doi.org/10.1111/tri.12124.

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29

Monaco, Anthony P. "Development of clinical immunosuppression for organ transplantation." Japanese Journal of Surgery 18, no. 2 (March 1988): 119–30. http://dx.doi.org/10.1007/bf02471419.

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30

Müller, Veronika, Zsuzsanna Kováts, and Gábor Horváth. "Pulmonary infections following solid organ transplantation." Orvosi Hetilap 153, no. 23 (June 2012): 899–903. http://dx.doi.org/10.1556/oh.2012.29395.

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Solid organ transplantation is the standard of care for selected patients with severe vital organ dysfunction. The need for immunosuppression to prevent organ rejection is a common characteristic of recipients. Immunosuppression increases the risk of infections, especially with low virulence opportunistic pathogens. Infections following solid organ transplantation mainly affect the lungs and the airways. Establishing the diagnosis includes a wide spectrum of pulmonary diagnostics, high standard microbiological analysis and various imaging methods. With the improvement of treatment options, the number of kidney, liver, heart and lung transplant recipients is increasing and, therefore, more and more physicians may meet pulmonary complications in these patients. Orv. Hetil., 2012, 153, 899–903.

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McDevitt, Lisa M. "Immunosuppressive Agents on the Horizon." Journal of Pharmacy Practice 16, no. 6 (December 2003): 434–41. http://dx.doi.org/10.1177/0897190003259384.

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The evolution of immunosuppression in organ transplantation has resulted in decreasing rates of rejection and improved allograft survival. The current successes, however, comes at the price of intense drug monitoring, frequent adverse affects, and long-term toxicity. New immunosuppressive agents offer the hope for decreased toxicity and improved long-term results. This article highlights those novel agents that are currently in late-stage clinical studies including new calcineurin inhibitor analogs and formulations, mycophenolate acid sodium, everolimus, FK-778, FTY720, and various monoclonal antibodies. The diverse mechanisms of action of these agents, coupled with promising efficacy and adverse effect profiles, may land each of them a unique niche for immunosuppression in organ transplantation.

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Spearman, C. W. N., and Z. A. Barday. "Immune tolerance and immunosuppression in solid organ transplantation." South African Medical Journal 104, no. 11 (October 6, 2014): 795. http://dx.doi.org/10.7196/samj.8960.

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33

Winkler, Michael. "Cyclosporin as Baseline Immunosuppression in Solid Organ Transplantation." BioDrugs 14, no. 3 (September 2000): 185–93. http://dx.doi.org/10.2165/00063030-200014030-00004.

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Khanna, A. "Cell cycle control and immunosuppression in organ transplantation." Transplantation Proceedings 33, no. 3 (May 2001): 2101–6. http://dx.doi.org/10.1016/s0041-1345(01)01963-7.

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Formica, Richard N., Amy L. Friedman, and Marc I. Lorber. "Evolving role of sirolimus immunosuppression after organ transplantation." Current Opinion in Organ Transplantation 7, no. 4 (December 2002): 353–58. http://dx.doi.org/10.1097/00075200-200212000-00009.

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Punnett, Angela Susanne. "Malignancy Following Solid Organ and Hematopoietic Stem Cell Transplantation." Oncology & Hematology Review (US) 02 (2009): 49. http://dx.doi.org/10.17925/ohr.2009.02.0.49.

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There is a growing appreciation of the increased risk for malignancy following solid organ and hematopoietic stem cell transplantation as the survival of these patient populations increases overall. The risk for malignancy is related to a complex interaction of type, degree, and duration of immunosuppression, viral status, and recipient age. Most of the malignancies documented are common in the general population but occur with increasing incidence and have significant implications for post-transplant surveillance. Post-transplant lymphoproliferative disorder is specific to the transplant population and remains a treatment challenge. The development of novel immunosuppressive agents, the use of individualized immunosuppressive regimens, and collaborative therapeutic trials are necessary to advance clinical care for these patients. This article will review the current issues around malignancy in the post-transplant patient population.

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Podoltsev, Nikolai A., Ivan Bustillo, Xiaopan Yao, Haibei Liu, and Dennis L. Cooper. "Post-Transplantation Lymphoproliferative Disorders (PTLD) Management in Solid Organ Transplantation (SOT) Recipients." Blood 118, no. 21 (November 18, 2011): 4941. http://dx.doi.org/10.1182/blood.v118.21.4941.4941.

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Abstract Abstract 4941 Introduction: PTLD are lymphoid proliferations that develop as a consequence of immunosuppression in 1% of SOT recipients. The majority of PTLD are associated with Epstein-Barr virus (EBV) infection, as therapeutic immunosuppression causes decreased T-cell surveillance, increasing the proliferative potential of EBV in latently infected B-cells. PTLD may manifest as early lesions including polyclonal plasmacytic hyperplasia and infectious mononucleosis-like PTLD as well as monoclonal polymorphic PTLD. Patients who develop polymorphic PTLD, universally associated with EBV and occurring early after transplant, usually have good prognosis and respond well to reduction of immunosuppression and antiviral therapy. Monomorphic PTLD is indistinguishable from a subset of B-cell and much less frequently T-cell lymphomas that occur in immunocompetent individuals. Monomorphic PTLD in SOT patients frequently involve extranodal sites as well as the allograft and causes significant morbidity and mortality in this group of patients. There is no universally accepted treatment strategy for monomorphic PTLD as randomized trials are lacking with most of the data coming from prospective and retrospective cohort trials evaluating heterogeneous populations of patients. Standard therapy consists of a stepwise treatment approach, aimed at partially restoring cellular immunity by reduction of immunosuppression (RI) sometimes in combination with or followed by rituximab. If there is no response chemotherapy is initiated. However, this strategy is vague as there are no clear rules for how much and for how long immunosuppression is reduced and may be associated with both graft loss and disease progression. We believe that aggressive monomorphic PTLD patients can be successfully treated by employing aggressive chemo-immunotherapy and withdrawal of standard immunosuppressive agents. We prefer to use “dose dense” administration schedule to 1) provide intensive therapy and 2) provide strong enough immunosuppression to prevent rejection. This retrospective study was designed to assess the outcome of such a strategy in monomorphic PTLD patients treated at the Yale Cancer Center (YCC) over a 15 year period. Patients and Methods: We identified patients with the PTLD after SOT by searching Yale Tumor Registry. Patients were eligible for selection if they were diagnosed with PTLD after SOT between January 1st of 1995 and December 31st of 2009 provided they were 18 years of age or older at the time of diagnosis (diagnosis criteria). We planned to analyze the outcomes among patients treated with combined approach (treatment criteria). Sixteen patients met inclusion criteria. Results: Out of 16 identified patients 11 received kidney, 1 kidney and pancreas, 3 heart and 1 liver transplants. Thirteen patients (81%) were diagnosed with diffuse large B cell lymphoma (DLBCL), 3 with Burkitt or Burkitt-like lymphoma (19%). All patients were treated with a combined approach with most of the patients (n=11, 69%) receiving CHOP-R every 2 weeks (“dose dense”). 10 out of the 16 patients had EBV positive lymphoma (62%). Only one patient had early PTLD (< 1 year after SOT) which was EBV positive. 6 out of 15 patients with late PTLD had EBV negative tumors. 9 (56%) patients had an advanced stage disease and 13 (81%) had extranodal involvement. One patient who developed PTLD after kidney transplantation had graft involvement with PTLD. Complete response (CR) was seen in all but one patient (94%). Median overall survival and median progression free survival were 5.39 years. Only 3 patients died due to PTLD and median cause specific survival time has not been reached. Out of the 16 patients, 4 had graft rejection and graft loss due to PTLD. Both the PTLD related-graft-rejection rate and graft loss rate were 25% with 95% CI (0.07-0.52). Conclusion: Combined therapy approach utilized at the YCC yields excellent results for patients with monomorphic PTLD after SOT. High CR rate, low number of PTLD-related deaths and low graft rejection /graft loss rate make this strategy an appealing option in the treatment armamentarium for this disease. Disclosures: No relevant conflicts of interest to declare.

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Pőcze, Balázs, Péter Németh, and Róbert Langer. "Recent options in drug therapy after solid organ transplantation." Orvosi Hetilap 153, no. 33 (August 2012): 1294–301. http://dx.doi.org/10.1556/oh.2012.29343.

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Solid organ transplantation has shown improvement in patient and graft survival rates due to the development of immunosuppression in the last fifty years; however only the last two decades led to the development of new, baseline immunosuppressive drugs that avoid the unlikely side effects of calcineurin inhibitors, especially nephrotoxicity. The transplanted organ is foreign to the host and, therefore, it induces a complex immune response of the recipient. In this review, a brief outline of immune response is given, followed by the introduction of new immunosuppressive drugs acting via variant pathways. These are compounds which are already in use or becoming shortly available and are potential future alternatives for the calcineurin inhibitors. This paper highlights the role of co-stimulation blockade with belatacept and the recently even more intensively studied field of tolerance induction. Orv. Hetil., 2012, 153, 1294–1301.

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Stadlbauer, V. "Immunosuppression and probiotics: are they effective and safe?" Beneficial Microbes 6, no. 6 (December 1, 2015): 823–28. http://dx.doi.org/10.3920/bm2015.0065.

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This opinion statement discusses indications, efficacy and safety of probiotics in immunosuppressed patients. The best evidence available is for the prophylaxis of infections in patients after liver transplantation and for patients with liver cirrhosis. For other organ transplantations and for bone marrow transplantation the efficacy of probiotic interventions has not been proven yet, but in these patient groups safety is a concern. Also in critically ill patients, the data on efficacy are inconclusive and safety is a concern. In HIV patients and patients after major surgery, probiotic bacteria seem to be safe since there are no associations with increased risks of side effects.

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Scarritt, Michelle E., and Stephen F. Badylak. "Organ engineering: promise, progress and perspective." Biochemist 38, no. 4 (August 1, 2016): 20–23. http://dx.doi.org/10.1042/bio03804020.

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The only curative treatment option for patients with end-stage organ failure is transplantation. Organ engineering offers an alternative to traditional transplantation that may address the critical shortage of donor organs and eliminate the need for recipient immunosuppression. Organ engineering may be accomplished through the use of scaffold – support structures that contain the architecture of an organ. As organs are exceedingly complex, creating an organ scaffold is a difficult task; however, organ scaffolds can be derived through a process known as decellularization, which is the mechanical, chemical and/or enzymatic removal of cells from a tissue or organ. Through decellularization of xenogenic (animal) organs, biocompatible extracellular matrix (ECM) scaffolds can be produced that retain the complex macroscopic and microscopic structure and composition of the native organ ECM. These 3D ECM scaffolds are ideal for engineering human organs.

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Miller, David M., Thomas B. Thornley, Dale L. Greiner, and Aldo A. Rossini. "Viral Infection: A Potent Barrier to Transplantation Tolerance." Clinical and Developmental Immunology 2008 (2008): 1–14. http://dx.doi.org/10.1155/2008/742810.

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Transplantation of allogeneic organs has proven to be an effective therapeutic for a large variety of disease states, but the chronic immunosuppression that is required for organ allograft survival increases the risk for infection and neoplasia and has direct organ toxicity. The establishment of transplantation tolerance, which obviates the need for chronic immunosuppression, is the ultimate goal in the field of transplantation. Many experimental approaches have been developed in animal models that permit long-term allograft survival in the absence of chronic immunosuppression. These approaches function by inducing peripheral or central tolerance to the allograft. Emerging as some of the most promising approaches for the induction of tolerance are protocols based on costimulation blockade. However, as these protocols move into the clinic, there is recognition that little is known as to their safety and efficacy when confronted with environmental perturbants such as virus infection. In animal models, it has been reported that virus infection can prevent the induction of tolerance by costimulation blockade and, in at least one experimental protocol, can lead to significant morbidity and mortality. In this review, we discuss how viruses modulate the induction and maintenance of transplantation tolerance.

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Bauer, Andrea C., Rodrigo F. Franco, and Roberto C. Manfro. "Immunosuppression in Kidney Transplantation: State of the Art and Current Protocols." Current Pharmaceutical Design 26, no. 28 (August 31, 2020): 3440–50. http://dx.doi.org/10.2174/1381612826666200521142448.

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Currently, kidney transplantation is the best treatment option for kidney failure for a majority of eligible patients. It is associated with a better quality of life and reduced mortality as compared to staying on dialysis. Many of the improvements in kidney transplant outcomes, observed in recent decades, are due to more efficient immunosuppression strategies. Therefore, developing expertise in the management of immunosuppressive drugs is key to the success of kidney transplantation. In this review, the historical aspects of organ transplant immunosuppression are briefly addressed and the basis of the allograft immune response to contextualize the main topic is provided, which is a deeper view of the immunosuppressive agents, including their known mechanisms of action, pharmacokinetics, interactions, toxicities, and clinical use. The most commonly used immunosuppressive protocols employed based on patients' and donors' characteristics are also presented here.

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ROSSINI, ALDO A., DALE L. GREINER, and JOHN P. MORDES. "Induction of Immunologic Tolerance for Transplantation." Physiological Reviews 79, no. 1 (January 1, 1999): 99–141. http://dx.doi.org/10.1152/physrev.1999.79.1.99.

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Rossini, Aldo A., Dale L. Greiner, and John P. Mordes. Induction of Immunologic Tolerance for Transplantation. Physiol. Rev. 79: 99–141, 1999. — In the second half of the 20th century, the transplantation of replacement organs and tissues to cure disease has become a clinical reality. Success has been achieved as a direct result of progress in understanding the cellular and molecular biology of the immune system. This understanding has led to the development of immunosuppressive pharmaceuticals that are part of nearly every transplantation procedure. All such drugs are toxic to some degree, however, and their chronic use, mandatory in transplantation, predisposes the patient to the development of infection and cancer. In addition, many of them may have deleterious long-term effects on the function of grafts. New immunosuppressive agents are constantly under development, but organ transplantation remains a therapy that requires patients to choose between the risks of their primary illness and its treatment on the one hand, and the risks of life-long systemic immunosuppression on the other. Alternatives to immunosuppression include modulation of donor grafts to reduce immunogenicity, removal of passenger leukocytes, transplantation into immunologically privileged sites like the testis or thymus, encapsulation of tissue, and the induction of a state of immunologic tolerance. It is the last of these alternatives that has, perhaps, the most promise and most generic applicability as a future therapy. Recent reports documenting long-term graft survival in the absence of immunosuppression suggest that tolerance-based therapies may soon become a clinical reality. Of particular interest to our laboratory are transplantation strategies that focus on the induction of donor-specific T-cell unresponsiveness. The basic biology, protocols, experimental outcomes, and clinical implications of tolerance-based transplantation are the focus of this review.

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Cipriani, Lynne, and Sarah A. Martin. "Current Controversies in Pediatric Transplantation." AACN Advanced Critical Care 5, no. 3 (August 1, 1994): 263–77. http://dx.doi.org/10.4037/15597768-1994-3006.

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Transplantation in children has become a therapeutic option for several end stage organ diseases. The kidney, liver, and heart are the most common organs transplanted; however, an increasing number of children are undergoing successful intestine, lung, and multiple organ transplant combinations. Through case study reports, emerging transplant options for the child experiencing end stage liver, intestine, heart, and lung failure are described. Critical care nurses play a crucial role in the postoperative recovery of these patients. An understanding of the transplant process and consequences of immunosuppression will help the critical care nurse identify signs of rejection, infection, and posttransplant lymphoprolifcrative disease

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45

Leek, Rachael, Erika Aldag, Iram Nadeem, Vikraman Gunabushanam, Ajay Sahajpal, David J. Kramer, and Thomas J. Walsh. "Scedosporiosis in a Combined Kidney and Liver Transplant Recipient: A Case Report of Possible Transmission from a Near-Drowning Donor." Case Reports in Transplantation 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/1879529.

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Scedosporium spp. are saprobic fungi that cause serious infections in immunocompromised hosts and in near-drowning victims. Solid organ transplant recipients are at increased risk of scedosporiosis as they require aggressive immunosuppression to prevent allograft rejection. We present a case of disseminated Scedosporium apiospermum infection occurring in the recipient of a combined kidney and liver transplantation whose organs were donated by a near-drowning victim and review the literature of scedosporiosis in solid organ transplantation.

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46

Schwartz, Lora, Jo Augustine, Joann Raymer, Vincent Canzanello, Sandra Taler, and Stephen Textor. "Nurse Management of Posttransplant Hypertension in Liver Transplant Patients." Journal of Transplant Coordination 6, no. 3 (September 1996): 139–44. http://dx.doi.org/10.1177/090591999600600308.

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Abstract:

Hypertension develops soon after organ transplantation using cyclosporine- or FK506-based immunosuppression. Sustained rises in blood pressure require intervention to reduce the risk of intracranial bleeding and other cardiovascular complications. Antihypertensive treatment is complicated by reduced renal function and potential interference with absorption and/or metabolism of cyclosporine or FK506. To manage early and long-term hypertension related to immunosuppression with cyclosporine or FK506 and prednisone following orthotopic liver transplantation, a comprehensive nurse-managed hypertension clinic was developed. Blood pressure, heart rate, and antihypertensive and immunosuppressive regimens were evaluated according to a standard protocol at 1, 4, 12, 24, and 36 months after orthotopic liver transplantation. Data indicate that posttransplantation hypertension develops within the first months after orthotopic liver transplantation and persists indefinitely. If comprehensively managed by the hypertension nurse-clinician, the percentage of controlled hypertension patients can increase over time.

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Krenzien, Felix, Abdallah ElKhal, Markus Quante, Hector Rodriguez Cetina Biefer, Uehara Hirofumi, Steven Gabardi, and Stefan G. Tullius. "A Rationale for Age-Adapted Immunosuppression in Organ Transplantation." Transplantation 99, no. 11 (November 2015): 2258–68. http://dx.doi.org/10.1097/tp.0000000000000842.

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48

Dobrolet, N. C., G. J. Boyle, M. G. Michaels, G. Kurland, S. J. Corey, K. S. Lawrence, and S. A. Webber. "NEUTROPENIA IN PEDIATRIC THORACIC ORGAN RECIPIENTS ON TACROLIMUS IMMUNOSUPPRESSION." Transplantation 67, no. 7 (April 1999): S181. http://dx.doi.org/10.1097/00007890-199904150-00723.

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49

Liu, Quan, Yong Wang, Atsunori Nakao, Wensheng Zhang, Vijay Gorantla, and Xin Xiao Zheng. "Heart Allograft Tolerance Induced and Maintained by Vascularized Hind-Limb Transplant in Rats." Clinical and Developmental Immunology 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/483856.

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Organ/tissue transplantation has become an effective therapy for end-stage diseases. However, immunosuppression after transplantation may cause severe side effects. Donor-specific transplant tolerance was proposed to solve this problem. In this study, we report a novel method for inducing and maintaining heart allograft tolerance rats. First, we induced indefinite vascularized hind-limb allograft survival with a short-term antilymphocyte serum + Cyclosporine A treatment. Peripheral blood chimerism disappeared 6-7 weeks after immunosuppression was withdrawn. Then the recipients accepted secondary donor-strain skin and heart transplantation 200 days following vascularized hind-limb transplantation without any immunosuppression, but rejected third party skin allografts, a status of donor-specific tolerance. The ELISPOT results suggested a mechanism of clone deletion. These findings open new perspectives for the role of vascularized hind-limb transplant in the induction and maintenance of organ transplantation tolerance.

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Schonder, Kristine S., George V. Mazariegos, and Robert J. Weber. "Adverse Effects of Immunosuppression in Pediatric Solid Organ Transplantation." Pediatric Drugs 12, no. 1 (February 2010): 35–49. http://dx.doi.org/10.2165/11316180-000000000-00000.

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Journal articles on the topic 'Organ transplantation; Immunosuppression'

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