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Bahakel HK, Pellet Madan R, Danziger-Isakov L. Approach to suspected donor-derived infections. Front Pediatr 2023; 11:1265023. [PMID: 37859774 PMCID: PMC10583714 DOI: 10.3389/fped.2023.1265023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Prevention of donor-derived disease among pediatric solid organ transplant recipients requires judicious risk-benefit assessment. Comprehensive guidelines outline specific donor risk factors and post-transplant monitoring strategies to prevent and mitigate transmission of HIV, hepatitis B, and hepatitis C. However, elimination of unanticipated donor-derived infections remains challenging. The objectives of this review are to (1) define risk of anticipated vs. unanticipated disease transmission events in pediatric solid organ transplant recipients; (2) discuss donor presentations that confer greater risk of unanticipated disease transmission; (3) develop a matrix for consideration of donor acceptance; and (4) discuss limitations and future directions for donor screening. Although solid organ transplant confers inherent risk of infection transmission, the risk of significant disease transmission events may be mitigated by a comprehensive approach including donor assessment, consideration of recipient need, post-transplant monitoring, and early intervention.
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Affiliation(s)
- Hannah Kinard Bahakel
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Rebecca Pellet Madan
- Division of Pediatric Infectious Diseases, New York University Langone Health, New York, NY, United States
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, United States
| | - Lara Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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2
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Moghadamnia M, Eshaghi H, Alimadadi H, Dashti-Khavidaki S. A quick algorithmic review on management of viral infectious diseases in pediatric solid organ transplant recipients. Front Pediatr 2023; 11:1252495. [PMID: 37732007 PMCID: PMC10507262 DOI: 10.3389/fped.2023.1252495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Pediatric solid organ transplant is a life-saving procedure for children with end-stage organ failure. Viral infections are a common complication following pediatric solid organ transplantation (SOT), which can lead to increased morbidity and mortality. Pediatric solid organ transplant recipients are at an increased risk of viral infections due to their immunosuppressed state. The most commonly encountered viruses include cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), varicella-zoster virus (VZV), adenoviruses, and BK polyomavirus. Prevention strategies include vaccination prior to transplantation, post-transplant prophylaxis with antiviral agents, and preemptive therapy. Treatment options vary depending on the virus and may include antiviral therapy and sometimes immunosuppression modification. This review provides a Quick Algorithmic overview of prevention and treatment strategies for viral infectious diseases in pediatric solid organ transplant recipient.
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Affiliation(s)
- Marjan Moghadamnia
- Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Eshaghi
- Department of Infectious Diseases, Pediatrics’ Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Alimadadi
- Department of Gastroenterology, Children’s Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Simin Dashti-Khavidaki
- Department of Pharmacotherapy, Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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3
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Hintz S, Finn JA, Emery Tavernier RL, Miller I, Moore KM, Leese M, Arbisi PA. Examining the Performance of the MMPI-2-RF in a Sample of Pretransplant Military Veterans. J Pers Assess 2023; 105:679-690. [PMID: 36383162 PMCID: PMC10185711 DOI: 10.1080/00223891.2022.2141640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022]
Abstract
The present study aimed to describe the personality and psychopathology dimensions reported by veterans seeking organ transplantation, as well as to identify those dimensions associated with subsequent presurgical recommendations and transplant outcomes. Data were collected from 245 veterans undergoing a pretransplant psychological evaluation that included the MMPI-2-RF. Three treatment recommendations resulting from these evaluations, three recommendation adherence variables, and two transplant outcomes were extracted from electronic medical records. The sample's MMPI-2-RF scale scores were compared to the normative sample and two other presurgical samples and contrasted across subgroups defined by organ transplanted. Point-biserial correlations and logistic regression analyses examined associations between MMPI-2-RF scale scores and the eight measured outcomes. Results indicated that over-reporting, internalizing tendencies, negative emotionality, and a lack of positive emotions were uniquely predictive of mental health treatment recommendation, whereas somatic over-reporting, externalizing tendencies, and disinhibition were predictive of substance use treatment recommendation. Veterans who reported higher levels of activation were less likely to initiate mental health treatment. Finally, veterans with greater somatic preoccupation were less likely to be listed for organ transplant. More suspicious and mistrustful veterans were less likely to receive the transplant. These findings offer support for the role of the MMPI-2-RF in veteran pretransplant evaluations.
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Affiliation(s)
- Samuel Hintz
- Mental Health Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Jacob A Finn
- Rehabilitation & Extended Care Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Psychiatry & Behavioral Sciences, University of MN-Twin Cities, Duluth, Minnesota
| | - Rebecca L Emery Tavernier
- Mental Health Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Family Medicine and BioBehavioral Health, University Minnesota Medical School-Duluth, Duluth, Minnesota
| | - Ivy Miller
- Mental Health Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Kelly M Moore
- Mental Health Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Mira Leese
- Mental Health Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Paul A Arbisi
- Mental Health Department, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Psychiatry & Behavioral Sciences, University of MN-Twin Cities, Duluth, Minnesota
- Department of Psychology, University of MN-Twin Cities, Minneapolis, Minnesota
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4
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Pozzetto B, Grard G, Durand G, Paty MC, Gallian P, Lucas-Samuel S, Diéterlé S, Fromage M, Durand M, Lepelletier D, Chidiac C, Hoen B, Nicolas de Lamballerie X. Arboviral Risk Associated with Solid Organ and Hematopoietic Stem Cell Grafts: The Prophylactic Answers Proposed by the French High Council of Public Health in a National Context. Viruses 2023; 15:1783. [PMID: 37766192 PMCID: PMC10536626 DOI: 10.3390/v15091783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Diseases caused by arboviruses are on the increase worldwide. In addition to arthropod bites, most arboviruses can be transmitted via accessory routes. Products of human origin (labile blood products, solid organs, hematopoietic stem cells, tissues) present a risk of contamination for the recipient if the donation is made when the donor is viremic. Mainland France and its overseas territories are exposed to a complex array of imported and endemic arboviruses, which differ according to their respective location. This narrative review describes the risks of acquiring certain arboviral diseases from human products, mainly solid organs and hematopoietic stem cells, in the French context. The main risks considered in this study are infections by West Nile virus, dengue virus, and tick-borne encephalitis virus. The ancillary risks represented by Usutu virus infection, chikungunya, and Zika are also addressed more briefly. For each disease, the guidelines issued by the French High Council of Public Health, which is responsible for mitigating the risks associated with products of human origin and for supporting public health policy decisions, are briefly outlined. This review highlights the need for a "One Health" approach and to standardize recommendations at the international level in areas with the same viral epidemiology.
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Affiliation(s)
- Bruno Pozzetto
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
- GIMAP Team, CIRI-Centre International de Recherche en Infectiologie, Université Jean Monnet de Saint-Etienne, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, 42023 Saint-Etienne, France
- Department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Gilda Grard
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France; (G.G.); (G.D.); (X.N.d.L.)
- French Armed Forces Biomedical Research Institute (IRBA), Valérie-André, 91220 Brétigny-sur-Orge, France
| | - Guillaume Durand
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France; (G.G.); (G.D.); (X.N.d.L.)
- French Armed Forces Biomedical Research Institute (IRBA), Valérie-André, 91220 Brétigny-sur-Orge, France
| | - Marie-Claire Paty
- Santé Publique France, The French Public Health Agency, 94410 Saint-Maurice, France;
| | - Pierre Gallian
- Etablissement Français du Sang, 93218 Saint-Denis, France;
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), 13385 Marseille, France
| | | | | | - Muriel Fromage
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), 93200 Saint-Denis, France;
| | - Marc Durand
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
| | - Didier Lepelletier
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
| | - Christian Chidiac
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
- Department of Infectious and Tropical Diseases, University Hospital of Lyon, 69002 Lyon, France
| | - Bruno Hoen
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
- Department of Infectious Diseases, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Xavier Nicolas de Lamballerie
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France; (G.G.); (G.D.); (X.N.d.L.)
- French Armed Forces Biomedical Research Institute (IRBA), Valérie-André, 91220 Brétigny-sur-Orge, France
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), 13385 Marseille, France
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5
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Vaidya GN, Anaya P, Ignaszewski M, Kolodziej A, Malyala R, Sekela M, Birks E. Patterns and outcomes of COVID-19 donor utilization for heart transplant. Clin Transplant 2023; 37:e14917. [PMID: 36681878 DOI: 10.1111/ctr.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND The outcomes following COVID-19 positive donor (CPD) utilization for heart transplant are unknown. METHODS UNOS database was analyzed for heart transplants performed from the declaration of COVID-19 pandemic until September 30, 2022. RESULT Since the onset of pandemic, there were 9876 heart transplants reported. COVID-19 antigen or NAT results were available in 7698 adult donors within 14 days of donation, of which 177 (2.3%) were positive. There was no difference in recipient demographics, including age (COVID positive donor vs. negative: 55 vs. 56 years, p = .2) and BMI. Listing status 1 and 2 were similar in both groups (7% vs. 10% and 48% vs. 49% respectively, p = .4). Durable and temporary mechanical support were similar in both groups pre-transplant (both groups 33%, p = .9). There was no difference in days on the waitlist (median 31 days, p = .9). Simultaneous renal transplant rates were similar (11% vs. 10%, p = .9). CPD utilization has increased since the onset of the pandemic, and the adoption is present across most UNOS regions. Post-transplant, there was no difference in length of stay (median 16 vs. 17 days, p = .9) and acute rejection episodes prior to discharge (3% vs. 8%, p = .1). In survival analysis of 90-day follow up, number of deaths reported were comparable (5% in both groups, p = .9) Follow-up LVEF was comparable (62% vs. 60%, p = .4). CONCLUSION Active COVID-19 infection in donors did not affect survival or rejection rates in the short-term post-heart transplant.
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Affiliation(s)
| | - Paul Anaya
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Maya Ignaszewski
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Andrew Kolodziej
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Rajasekhar Malyala
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Sekela
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Emma Birks
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
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6
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Salehi S, Afzali S, Shahi A, Amirzargar AA, Mansoori Y. Potential Roles of Long Noncoding RNAs as Therapeutic Targets in Organ Transplantation. Front Immunol 2022; 13:835746. [PMID: 35359941 PMCID: PMC8962195 DOI: 10.3389/fimmu.2022.835746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Organ transplantation is the most preferred treatment option for end-stage organ diseases; however, allograft rejection is the major hurdle in successful long-term transplant survival. In spite of developing better HLA matching and more effective immunosuppressive regimen, one-year graft survival has been increased by nearly 90% and the incidence of acute rejection by one-year post-transplantation has been decreased by 12.2% in the last decades, chronic allograft rejection has remained as one of the major obstacles to the long-lasting survival of the transplanted allograft. Therefore, seemingly preventing the allograft rejection and inducing immunological tolerance against transplanted allografts is one of the primary goals in transplantation research to enable long-lasting graft survival. Various mechanisms such as long noncoding RNAs (lncRNAs) have been proposed that induce immune tolerance by modulating the gene expression and regulating innate and adaptive immune responses during transplantation. Besides, because of involvement in regulating epigenetic, transcriptional, and post-translational mechanisms, lncRNAs could affect allograft status. Therefore, these molecules could be considered as the potential targets for prediction, prognosis, diagnosis, and treatment of graft rejection. It is suggested that the noninvasive predictive biomarkers hold promise to overcome the current limitations of conventional tissue biopsy in the diagnosis of rejection. Hence, this review aims to provide a comprehensive overview of lncRNAs and their function to facilitate diagnosis, prognosis, and prediction of the risk of graft rejection, and the suggestive therapeutic choices after transplantation.
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Affiliation(s)
- Saeedeh Salehi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Afzali
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Shahi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Akbar Amirzargar
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Mansoori
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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7
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Yuksel M, Akturk H, Mizikoglu O, Toroslu E, Arikan C. A single-center report of COVID-19 disease course and management in liver transplanted pediatric patients. Pediatr Transplant 2021; 25:e14061. [PMID: 34076953 PMCID: PMC8237072 DOI: 10.1111/petr.14061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND In 2019, SARS-CoV-2 causing COVID-19 emerged. Severe COVID-19 symptoms may evolve by virtue of hyperactivation of the immune system. Equally, immunocompromised patients may be at increased risk to develop COVID-19. However, treatment guidelines for children following liver transplantation are elusive. METHODS As a liver transplantation center, we diagnosed and followed up 10 children (male/female: 8/2) with a median age of 8.5 years (IQR: 5.2-11.0), with COVID-19 post-liver transplant between March 2019 and December 2020. COVID-19 diagnosis was based on PCR test and or florid X-ray findings compatible with COVID-19 in the absence of other cause. We retrospectively collected clinical and laboratory data from electronic patient records following written consent from patients/parents. RESULTS Nine patients were diagnosed as definitive (PCR positive) with one patient being diagnosed as probable COVID-19. Seven patients recovered without any support whereas three were admitted for non-invasive oxygenation. Lymphopenia and/or high levels of serum IL-6 were detected in four patients. Six patients mounted anti-SARS-CoV-2 antibodies at median 30 days (IQR: 26.5-119.0) following COVID-19 diagnosis. Antibiotic therapy, favipiravir, anakinra, and IVIG were used as treatment in 4,1,1 and 2 patients, respectively. Furthermore, we kept the tacrolimus with or without everolimus but stopped MMF in 2 patients. Importantly, liver allograft function was retained in all patients. CONCLUSIONS We found that being immunocompromised did not affect disease severity nor survival. Stopping MMF yet continuing with tacrolimus was an apt treatment modality in these patients.
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Affiliation(s)
- Muhammed Yuksel
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey,Koç University Research Center for Translational Medicine (KUTTAM)‐Liver Immunology LabIstanbulTurkey
| | - Hacer Akturk
- Koç University Pediatric infectious diseasesIstanbulTurkey
| | - Ozlem Mizikoglu
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey
| | - Ertug Toroslu
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey
| | - Cigdem Arikan
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey,Koç University Research Center for Translational Medicine (KUTTAM)‐Liver Immunology LabIstanbulTurkey
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8
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Al-Thani H, Abdelrahman H, Barah A, Asim M, El-Menyar A. Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center. Ther Clin Risk Manag 2021; 17:333-343. [PMID: 33907407 PMCID: PMC8064722 DOI: 10.2147/tcrm.s303518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center. Methods We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients’ data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry. Results A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma&Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ali Barah
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
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9
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Williams GJ, Webster AC, Thompson JF. Organ transplantation and outcomes in patients with a past history of melanoma: A systematic review and meta-analysis. Clin Transplant 2021; 35:e14287. [PMID: 33720403 DOI: 10.1111/ctr.14287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The incidence of melanoma is steadily rising around the world. There is uncertainty about the safety of solid organ transplantation in patients with a prior history of melanoma. AIM To review studies reporting patients with a history of melanoma before solid organ transplantation. METHODS Electronic searches of Medline, Embase, and the Cochrane library up to March 2020. All study designs, in any language and without sample size restriction, were eligible for inclusion. Risk of bias was assessed using established tools, and meta-analysis was performed using a random-effects model. RESULTS We identified 41 studies reporting 703 100 transplant recipients and 1692 had pre-transplantation melanomas. Risk of death, expressed as a hazard ratio, in patients with pre-transplantation melanoma relative to those without prior melanoma, was 1.32 (95% CI: 1.09-1.59). After transplantation, 13.1% of patients with pre-transplantation melanoma developed new or recurrent melanoma (IQR: 4.8%-18.2%). CONCLUSIONS Around 1-in-400 transplant recipients had a prior history of melanoma. This was associated with a greater than 1-in-10 risk of new or recurrent melanoma after transplantation and an increased risk of death. A 5-year waiting time between a melanoma diagnosis and transplantation has been recommended based on historic registry data, but very little additional information is available to justify or revise this.
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Affiliation(s)
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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10
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Ritter A, Badir S, Mansour M, Segal Z, Ad-El D, Bachar G, Shpitzer T, Popovtzer A, Mizrachi A. Solid organ transplantation worsens the prognosis of patients with cutaneous squamous cell carcinoma of the head and neck region-Comparison between solid organ transplant recipients and immunocompetent patients. Head Neck 2020; 43:884-894. [PMID: 33247523 DOI: 10.1002/hed.26546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma of the head and neck (CSCC-HN) appears to behave more aggressively in immunosuppressed patients. We aimed to investigate this hypothesis by comparing solid organ transplant recipients (SOTR) with CSCC-HN to immunocompetent patients. METHODS A retrospective comparative study was conducted for SOTR and immunocompetent patients who were treated for CSCC-HN. RESULTS A total of 177 SOTR and 157 immunocompetent patients with CSCC-HN were included. Lymph node metastases were more common in the SOTR group (9% vs 3%), and distant metastases occurred only in SOTR (3% of patients). SOTR had a higher rate of recurrences (19% vs 10%), which were mostly regional (7%) and distant (3%). The 2-year disease-specific survival of SOTR was lower (93% vs 100%). CONCLUSIONS SOTR with CSCC-HN has significantly worse outcomes compared to immunocompetent patients. Solid-organ transplantation should be regarded as a negative prognostic factor in patients with CSCC-HN.
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Affiliation(s)
- Amit Ritter
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samih Badir
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Mansour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva, Israel
| | - Zvi Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva, Israel
| | - Dean Ad-El
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva, Israel
| | - Gideon Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Bianco V, Kilic A, Gleason TG, Aranda-Michel E, Harinstein ME, Thoma F, Navid F, Sultan I. Outcomes in patients with solid organ transplants undergoing cardiac surgery. J Thorac Cardiovasc Surg 2019; 160:701-707. [PMID: 31564544 DOI: 10.1016/j.jtcvs.2019.07.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Long-term outcomes after cardiac surgery in solid organ transplant recipients are limited in the contemporary literature. The objective of this study is to evaluate postoperative outcomes in these patients, including variables associated with mortality and readmissions. METHODS All adults undergoing isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve cardiac surgical procedures from 2011 to 2018 were included in this study. Patients with solid organ transplants undergoing cardiac surgery were studied. Primary outcomes included operative (30-day) and 5-year mortality. RESULTS A total of 11,190 patients underwent isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve operations at our institution from 2011 to 2018. Of these, 129 patients (1%) had solid organ transplants and underwent isolated coronary artery bypass grafting (n = 84), isolated valve (n = 30), or coronary artery bypass grafting + valve (n = 15). Type of organ transplant included 84 patients (65%) with kidney, 27 patients (21%) with liver, 9 patients (7%) with heart, and 9 patients (7%) with lung transplants. The median Society of Thoracic Surgeons Predicted Risk Of Mortality for the cohort was 2.73 (Q1-Q3: 1.67-6.33). Three patients (2%) had an operative (30-day) mortality. Significant variables associated with 5-year mortality on multivariable Cox regression analysis included chronic obstructive pulmonary disease (hazard ratio, 2.44; 1.01-5.90; P = .048) and congestive heart failure (hazard ratio, 4.45; 1.81-10.9; P = .001). Significant variables associated with 5-year readmissions included chronic obstructive pulmonary disease, dialysis dependence, and concomittant valve surgery with coronary artery bypass grafting. Five-year readmission rate was 88%, and patients with valve operations (± coronary artery bypass grafting) had significantly lower (P = .009) freedom from readmission (6%). CONCLUSIONS Cardiac surgery can be performed with low operative mortality and good long-term survival in patients with solid organ transplants. Five-year hospital readmissions are common, with significantly more readmissions in patients who had valve procedures.
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Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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12
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Min S, Papaz T, Lafreniere-Roula M, Nalli N, Grasemann H, Schwartz SM, Kamath BM, Ng V, Parekh RS, Manlhiot C, Mital S. A randomized clinical trial of age and genotype-guided tacrolimus dosing after pediatric solid organ transplantation. Pediatr Transplant 2018; 22:e13285. [PMID: 30178515 DOI: 10.1111/petr.13285] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/03/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Tacrolimus pharmacokinetics are influenced by age and CYP3A5 genotype with CYP3A5 expressors (CYP3A5*1/*1 or *1/*3) being fast metabolizers. However, the benefit of genotype-guided dosing in pediatric solid organ transplantation has been understudied. OBJECTIVE To determine whether age and CYP3A5 genotype-guided starting dose of tacrolimus result in earlier attainment of therapeutic drug concentrations. SETTING Single hospital-based transplant center. METHODS This was a randomized, semi-blinded, 30-day pilot trial. Between 2012 and 2016, pediatric patients listed for solid organ transplant were consented and enrolled into the study. Participants were categorized as expressors, CYP3A5*1/*1 or CYP3A5*1/*3, and nonexpressors, CYP3A5*3/*3. Patients were stratified by age (≤ or > 6 years) and randomized (2:1) after transplant to receive genotype-guided (n = 35) or standard (n = 18) starting dose of tacrolimus for 36-48 hours and were followed for 30 days. RESULTS Median age at transplant in the randomized cohort was 2.1 (0.75-8.0) years; 24 (45%) were male. Participants in the genotype-guided arm achieved therapeutic concentrations earlier at a median (IQR) of 3.4 (2.5-6.6) days compared to those in the standard dosing arm of 4.7 (3.5-8.6) days (P = 0.049), and had fewer out-of-range concentrations [OR (95% CI) = 0.60 (0.44, 0.83), P = 0.002] compared to standard dosing, with no difference in frequency of adverse events between the two groups. CONCLUSIONS CYP3A5 genotype-guided dosing stratified by age resulted in earlier attainment of therapeutic tacrolimus concentrations and fewer out-of-range concentrations.
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Affiliation(s)
- Sandar Min
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tanya Papaz
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nadya Nalli
- Department of Pharmacy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hartmut Grasemann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven M Schwartz
- Department of Cardiac Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Binita M Kamath
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Ng
- Transplant and Regenerative Medicine Centre, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Cardiovascular Data Management Centre (CVDMC) Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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13
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Zheng CX, Sui BD, Hu CH, Qiu XY, Zhao P, Jin Y. Reconstruction of structure and function in tissue engineering of solid organs: Toward simulation of natural development based on decellularization. J Tissue Eng Regen Med 2018; 12:1432-1447. [PMID: 29701314 DOI: 10.1002/term.2676] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 10/13/2017] [Accepted: 04/16/2018] [Indexed: 12/21/2022]
Abstract
Failure of solid organs, such as the heart, liver, and kidney, remains a major cause of the world's mortality due to critical shortage of donor organs. Tissue engineering, which uses elements including cells, scaffolds, and growth factors to fabricate functional organs in vitro, is a promising strategy to mitigate the scarcity of transplantable organs. Within recent years, different construction strategies that guide the combination of tissue engineering elements have been applied in solid organ tissue engineering and have achieved much progress. Most attractively, construction strategy based on whole-organ decellularization has become a popular and promising approach, because the overall structure of extracellular matrix can be well preserved. However, despite the preservation of whole structure, the current constructs derived from decellularization-based strategy still perform partial functions of solid organs, due to several challenges, including preservation of functional extracellular matrix structure, implementation of functional recellularization, formation of functional vascular network, and realization of long-term functional integration. This review overviews the status quo of solid organ tissue engineering, including both advances and challenges. We have also put forward a few techniques with potential to solve the challenges, mainly focusing on decellularization-based construction strategy. We propose that the primary concept for constructing tissue-engineered solid organs is fabricating functional organs based on intact structure via simulating the natural development and regeneration processes.
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Affiliation(s)
- Chen-Xi Zheng
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China.,Research and Development Center for Tissue Engineering, Fourth Military Medical University, Shaanxi, China
| | - Bing-Dong Sui
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China.,Research and Development Center for Tissue Engineering, Fourth Military Medical University, Shaanxi, China
| | - Cheng-Hu Hu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China.,Xi'an Institute of Tissue Engineering and Regenerative Medicine, Xi'an, Shaanxi, China
| | - Xin-Yu Qiu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China.,Research and Development Center for Tissue Engineering, Fourth Military Medical University, Shaanxi, China
| | - Pan Zhao
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China.,Xi'an Institute of Tissue Engineering and Regenerative Medicine, Xi'an, Shaanxi, China
| | - Yan Jin
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China.,Research and Development Center for Tissue Engineering, Fourth Military Medical University, Shaanxi, China
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Marcus N, Amir AZ, Grunebaum E, Dipchand A, Hebert D, Ng VL, Walters T, Avitzur Y. De Novo Allergy and Immune-Mediated Disorders Following Solid-Organ Transplantation-Prevalence, Natural History, and Risk Factors. J Pediatr 2018; 196:154-160.e2. [PMID: 29395171 DOI: 10.1016/j.jpeds.2017.11.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/11/2017] [Accepted: 11/15/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To describe the prevalence, natural course, outcome, and risk factors of post-transplant de novo allergy and autoimmunity. STUDY DESIGN A cross-sectional, cohort study of all children (<18 years) who underwent a solid-organ transplantation, between 2000 and 2012, in a single transplant center, with a follow-up period of 6 months or more post-transplant and without history of allergy or immune-mediated disorder pretransplant. RESULTS A total of 626 eligible patients were screened, and 273 patients (160 males; 59%) met the inclusion criteria; this included 111 liver, 103 heart, 52 kidney, and 7 multivisceral recipients. Patients were followed for a median period of 3.6 years. A total of 92 (34%) patients (42 males, 46%) developed allergy or autoimmune disease after transplantation, with a high prevalence among liver (41%), heart (40%), and multivisceral (57%) transplant recipients compared with kidney recipients (4%; P < .001). Post-transplant allergies included eczema (n = 44), food allergy (22), eosinophilic gastrointestinal disease (11), and asthma (28). Autoimmunity occurred in 18 (6.6%) patients, presenting mainly as autoimmune cytopenia (n = 10). In a multivariate analysis, female sex, young age at transplantation, family history of allergy, Epstein-Barr virus infection, and elevated eosinophil count >6 months post-transplantation were associated with an increased risk for allergy or autoimmunity. Two patients (0.7%) died from autoimmune hemolytic anemia and hemophagocytic lymphohistiocytosis, and 52 episodes of post-transplant allergy, autoimmunity, and immune-mediated disorders (37%) did not improve over time. CONCLUSIONS Allergy and autoimmunity are common in pediatric liver, heart, and multivisceral transplant recipients and pose a significant health burden. Further studies are required to clarify the mechanisms behind this post-transplant immune dysregulation.
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Affiliation(s)
- Nufar Marcus
- Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kipper Institute for Allergy and Immunology, Schneider Children's Medical Center of Israel, University of Tel-Aviv, Tel-Aviv, Israel
| | - Achiya Z Amir
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; The Pediatric Gastroenterology, Hepatology & Nutrition Clinic, Tel-Aviv Medical Center, University of Tel-Aviv, Tel-Aviv, Israel
| | - Eyal Grunebaum
- Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anne Dipchand
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Diane Hebert
- Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Walters
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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15
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Lin W, Mou L, Tu H, Zhu L, Wang J, Chen J, Hu Y. Clinical analysis of hyperkalemic renal tubular acidosis caused by calcineurin inhibitors in solid organ transplant recipients. J Clin Pharm Ther 2016; 42:122-124. [PMID: 27966241 DOI: 10.1111/jcpt.12485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Calcineurin inhibitor (CNI)-based immunosuppressive regimen is widely used for preventing rejection in solid organ transplantation. Hyperkalemic renal tubular acidosis (RTA) caused by CNI is uncommon and potentially underappreciated. We reported four such cases to increase awareness of this risk and to provide recommendations for its management based on our experience. CASE SUMMARY Four middle-aged males underwent solid organ transplant (two kidneys, one liver, one heart) and were treated with CNI-based immunosuppressive regimen (one cyclosporine A, three tacrolimus). On post-operative day 13-35, hyperkalemic hyperchloremic non-gap metabolic acidosis developed. All patients had relatively preserved renal function, normal urine output and plasma aldosterone level. Reduction in CNI dosage was partly effective; the patient on cyclosporine A was treated with fludrocortisone, and two others temporarily switched to sirolimus (SRL). WHAT IS NEW AND CONCLUSION We should alert for CNI-induced hyperkalemic RTA in transplant recipients. By CNI dosage reduction or adding low dose fludrocortisone, or temporarily switching to SRL, the prognosis of CNI-induced hyperkalemic RTA is favourable.
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Affiliation(s)
- W Lin
- Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - L Mou
- Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - H Tu
- Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - L Zhu
- Department of Nephrology, Binjiang Branch Hospital, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - J Wang
- Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - J Chen
- Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Y Hu
- Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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16
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Rouse GE, Hardinger K, Tsapepas D, Tichy EM. A Comparison of Histamine Receptor Antagonists Versus Proton Pump Inhibitor Gastrointestinal Ulcer Prophylaxis in Kidney Transplant Recipients. Prog Transplant 2016; 27:4-9. [PMID: 27650918 DOI: 10.1177/1526924816669725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There are several different agents that can be used for gastrointestinal (GI) ulcer prophylaxis in posttransplant recipients, such as histamine-2 receptor antagonists (H2RA) or proton pump inhibitors (PPIs). RESEARCH QUESTION This study was conducted to compare the incidence of adverse kidney events in transplant recipients who received prophylaxis with H2RAs or PPIs. DESIGN This retrospective study included all kidney transplant recipients from 3 transplant centers who were transplanted in 2009 through 2011. The primary objective was to compare the incidence of adverse events posttransplant, defined as the incidence of pneumonia, Clostridium difficile, hip fractures, GI bleeding, cytomegalovirus, organ rejection, and bacteremia. RESULTS A total of 211 patients were included in the study; of which 35 were included in the PPI group and 176 were included in the H2RA group. There were no significant differences between groups in regard to incidence of GI bleeding events or other adverse events. DISCUSSION These findings suggest there is a low incidence of GI ulcers and upper GI bleeding events after kidney transplantation with the use of H2RAs or PPIs. Additionally, there are similar rates of adverse events when comparing H2RAs versus PPIs for GI ulcer prophylaxis.
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Affiliation(s)
- Ginger E Rouse
- 1 Medical ICU, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA
| | - Karen Hardinger
- 2 Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Demetra Tsapepas
- 3 Department of Pharmacy, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Eric M Tichy
- 4 Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA
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17
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Abstract
Background: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompromised patients despite concern of potential nephrotoxicity. Methods: We conducted a retrospective 5-year review at Boston Children's Hospital of 16 patients (mean age = 6.5 years) receiving 19 courses of CDV. During therapy all pertinent data elements were reviewed to characterize potential response to therapy and incidence of renal dysfunction. Results: Of the 19 CDV courses prescribed, 16 courses (84%) were in patients who had a positive blood ADV Polymerase chain reaction (PCR) alone or in combination with positive ADV PCR/ Direct Immunofluorescence Assay (DFA) at another site. Respiratory symptoms with or without pneumonia were the most common presentation (10/19, 53%). In the majority of blood positive courses (10/16, 63%), viral clearance was also accompanied by clinical response. This was not the case in four courses where patients expired despite viral clearance, including one in which death was directly attributable to adenovirus. There was reversible renal dysfunction observed during the use of CDV. Conclusions: CDV appeared safe and reasonably tolerated for treatment of ADV in this pediatric population and was associated with viral response and clinical improvement in the majority of patients but reversible renal dysfunction was a side effect. Further studies of the efficacy of CDV for immunocompromised children with ADV infection are warranted.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alana Arnold
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Jones
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Al Patterson
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Program for Patient Quality and Safety, Boston Children's Hospital, Boston, MA, USA
| | - Marvin Harper
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ofer Levy
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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18
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Abstract
Background: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompromised patients despite concern of potential nephrotoxicity. Methods: We conducted a retrospective 5-year review at Boston Children's Hospital of 16 patients (mean age = 6.5 years) receiving 19 courses of CDV. During therapy all pertinent data elements were reviewed to characterize potential response to therapy and incidence of renal dysfunction. Results: Of the 19 CDV courses prescribed, 16 courses (84%) were in patients who had a positive blood ADV Polymerase chain reaction (PCR) alone or in combination with positive ADV PCR/ Direct Immunofluorescence Assay (DFA) at another site. Respiratory symptoms with or without pneumonia were the most common presentation (10/19, 53%). In the majority of blood positive courses (10/16, 63%), viral clearance was also accompanied by clinical response. This was not the case in four courses where patients expired despite viral clearance, including one in which death was directly attributable to adenovirus. There was reversible renal dysfunction observed during the use of CDV. Conclusions: CDV appeared safe and reasonably tolerated for treatment of ADV in this pediatric population and was associated with viral response and clinical improvement in the majority of patients but reversible renal dysfunction was a side effect. Further studies of the efficacy of CDV for immunocompromised children with ADV infection are warranted.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alana Arnold
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Jones
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Al Patterson
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Program for Patient Quality and Safety, Boston Children's Hospital, Boston, MA, USA
| | - Marvin Harper
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ofer Levy
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Sibal A, Malhotra S, Guru FR, Bhatia V, Kapoor A, Seth S, Jerath N, Jasuja S, Rajkumari V, Wadhawan M, Aggarwal DK, Guleria S, Shrivastava RN, Gupta S. Experience of 100 solid organ transplants over a five-yr period from the first successful pediatric multi-organ transplant program in India. Pediatr Transplant 2014; 18:740-5. [PMID: 25092050 DOI: 10.1111/petr.12324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/28/2022]
Abstract
To analyze the clinical profile and outcome of pediatric patients who had undergone a liver and/or RT at our center over a five yr period, case records of all the patients who had undergone a liver or RT were analyzed retrospectively. One hundred solid organ transplants were performed at our center between January 2007 and January 2012. These included 50 liver, 44 renal, one sequential liver and renal, and two CLKT. BA was the most common indication for an LT (38%). At a median follow-up of two yr three months, the patient survival was 88%. The most common indication for an RT was chronic glomerulonephritis (54.5%). At a median follow-up of three yr, the survival was 91%. The CLKT were performed for hyperoxaluria. Two yr post LT, a sequential RT was performed for ESRD resulting from transplant associated microangiopathy. All patients received a living related graft. The common post-operative complications were infections, vascular complications, and graft dysfunction. Survival rates for liver and RT at our center are comparable to those in the established centers in the West.
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Affiliation(s)
- Anupam Sibal
- Apollo Centre of Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, India
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20
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Febrero B, Ríos A, López-Navas A, Martínez-Alarcón L, Almela J, Sánchez Á, Sánchez J, Parrilla JJ, Ramírez P, Parrilla P. A multicenter study of the attitude of secondary school teachers toward solid organ donation and transplantation in the southeast of Spain. Clin Transplant 2014; 28:259-66. [PMID: 24476384 DOI: 10.1111/ctr.12308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Teachers play a fundamental role in providing information to adolescents and could influence their attitudes. OBJECTIVES To analyze the attitude of teachers toward organ donation and the concept of brain death (BD); the psychosocial variables related to attitude; and the information provided to pupils. METHODS A multicenter study was carried out using a random sample of secondary school teaching staff from 10 schools (n = 327) in the southeast of Spain. Attitude toward organ donation was assessed using a validated questionnaire that was self-administered and completed anonymously. RESULTS The questionnaire completion rate was 88% (n = 288), with 75% (n = 215) in favor of organ donation, 23% had doubts, and 2% were not in favor. Regarding the knowledge of BD, 62% (n = 179) accepted that this meant a person's death. The variables associated with a more favorable attitude included conversations with family and friends (p < 0.05); a partner's favorable opinion (OR 3.194); knowledge of the concept of BD (p = 0.006); being a blood donor (OR 8.264); and a favorable attitude toward autopsy (OR 4.716). Teachers provided information about organ donation to pupils in 16% of cases (n = 47). CONCLUSIONS Seventy-five percent of teachers are in favor of organ donation. Their attitude is affected by psychosocial factors.
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Affiliation(s)
- Beatriz Febrero
- Proyecto Colaborativo Internacional Donante, Murcia, Spain; Regional Transplant Center, Consejería de Sanidad, Servicio Murciano de Salud, Murcia, Spain; Transplant Unit, Surgery Service, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Murcia, Spain; Department of Surgery, Pediatrics and Obstetrics and Gynecology, University of Murcia, Murcia, Spain
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Rabinovics N, Mizrachi A, Hadar T, Ad-El D, Feinmesser R, Guttman D, Shpitzer T, Bachar G. Cancer of the head and neck region in solid organ transplant recipients. Head Neck 2013; 36:181-6. [PMID: 23554129 DOI: 10.1002/hed.23283] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Solid organ recipients are at an increased risk of developing various malignancies. We investigated the incidence, clinical features, and outcome of patients diagnosed with head and neck cancer after organ transplantation. METHODS A retrospective analysis was undertaken of patients who underwent solid organ transplantation (kidney, liver, lung, heart) treated at our institution from 1992 to 2010. RESULTS Of 2817 organ recipients, 175 patients (6.1%) developed 391 head and neck malignancies. Cutaneous malignancies were the most common (93%): squamous cell carcinoma (SCC; 51%) and basal cell carcinoma (BCC; 42%). The average interval from transplantation to diagnosis of head and neck malignancy was 7.3 years, with liver recipients diagnosed earlier. Eighteen percent of patients presented with an aggressive pattern of head and neck cancer, including 24% of patients with cutaneous SCC. CONCLUSION Organ transplantation recipients are at a higher risk to develop head and neck cancer with an aggressive behavior characterized by multiple recurrences and decreased survival.
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Affiliation(s)
- Naomi Rabinovics
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Azeka E, Auler Júnior JOC, Fernandes PMP, Nahas WC, Fiorelli AI, Tannuri U, Cristofani LM, Caiero MT, Dulley FL, Paggiaro ADO, Bacchella T. Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008. Clinics (Sao Paulo) 2009; 64:127-34. [PMID: 19219318 PMCID: PMC2666479 DOI: 10.1590/s1807-59322009000200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 10/29/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.
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Affiliation(s)
- Estela Azeka
- Solid Organ and tissue Transplantation Committee, University of São Paulo Medical School, São Paulo/SP, Brazil.
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