The current state of, and future prospects for, cardiac transplantation in children

2003 ◽  
Vol 13 (1) ◽  
pp. 64-83 ◽  
Author(s):  
Steven A. Webber
Keyword(s):  
Cardiac Transplantation ◽  
Solid Organ Transplantation ◽  
Complex Congenital Heart Disease ◽  
Solid Organ ◽  
Term Survival ◽  
Current State ◽  
Improved Outcomes ◽  
Great Hope ◽  
Immunosuppressive Medications

During the last two decades, several advances have resulted in marked improvement in medium-term survival, with excellent quality of life, in children undergoing cardiac transplantation. Improved outcomes reflect better selection of donors and recipients, increased surgical experience in transplantation for complex congenital heart disease, development of effective surveillance for rejection, and wider choice of immunosuppressive medications. Despite all of these advances, recipients continue to suffer from the adverse effects of non-specific immunosupression, including infections, induction of lymphoproliferative disorders and other malignancies, renal dysfunction, and other important end-organ toxicities. Furthermore, newer immunosuppressive regimes, thus far, appear to have had relatively little impact on the incidence of chronic rejection. Progress in our understanding of the immunologic mechanisms of rejection and graft acceptance should lead to more targeted immunosuppressive therapy and avoidance of non-specific immunosupression. The ultimate goal is to induce a state of tolerance, wherein the recipient will accept the allograft indefinitely, without the need for long-term immunusupression, and yet remain immuno-competent to all non-donor antigens. This quest is currently being realized in many animal models of solid organ transplantation, and offers great hope for the future.

scholarly journals A case of rhabdomyolysis after atorvastatin therapy of a liver transplant recipient receiving immunosuppressive therapy with cyclosporine

2021 ◽  
Vol 13 (2) ◽  
pp. 158-164
Author(s):  
A. V. Shabunin ◽  
S. P. Loginov ◽  
P. A. Drozdov ◽  
I. V. Nesterenko ◽  
D. A. Makeev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Drug Interactions ◽  
Liver Transplant ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Muscle Pain ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Term Survival

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.

scholarly journals Solid Organ Transplantation in Patients With a History of Lymphoma

2018 ◽  
Vol 14 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Philip J. Bierman
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Supporting Evidence ◽  
Solid Organ ◽  
Post Transplantation ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Lymphoma Treatment ◽  
History Of

There is an increasing number of long-term survivors of Hodgkin and non-Hodgkin lymphoma. These people may have a need for subsequent solid organ transplantation, often as a result of late effects of their lymphoma treatment. There is abundant literature demonstrating that patients with a history of lymphoma are appropriate candidates for solid organ transplantation. Long-term survival without relapse and with a functioning graft is possible. Patients with a history of post-transplantation lymphoproliferative disorders and patients who have received a prior hematopoietic stem-cell transplantation may also be candidates. Although high-level supporting evidence is not available, most guidelines recommend a waiting period of 2 to 5 years after lymphoma treatment before patients undergo solid organ transplantation. Each patient with a history of lymphoma requires a multidisciplinary approach and should be evaluated on a case-by-case basis before consideration of solid organ transplantation.

scholarly journals Mechanisms and clinical applications of immunosuppressive medications

2020 ◽  
Vol 63 (5) ◽  
pp. 251-258
Author(s):  
Kyo Won Lee
Keyword(s):  
T Cells ◽  
Metabolic Diseases ◽  
Opportunistic Infections ◽  
Survival Rates ◽  
Interleukin 2 ◽  
Solid Organ Transplantation ◽  
New Drugs ◽  
Solid Organ ◽  
Immunosuppressive Medications

Immunosuppressive medications and regimens have evolved with significant advancements in the understanding of the immunologic process after solid organ transplantation. Medications can block the communication between antigen-presenting cells and T-cells, the activation and proliferation of T-cells, antibody production by plasma cells, and the activation of the complement system by antibodies. T-cell depleting antibodies and interleukin-2 receptor blockers are commonly used during induction therapy. Calcineurin inhibitors, antimetabolites, antiproliferative agents, and corticosteroids are commonly used in maintenance therapy regimens. These medications decrease the rates of rejection episodes and markedly increase the survival rates of short-term grafts. However, in terms of the survival rate of long-term grafts, there is still room for improvement. Opportunistic infections, development of cancer, metabolic diseases, and calcineurin inhibitor toxicity are hurdles in the improvement in survival rates of long-term grafts. Therefore, many efforts are being taken to overcome these hurdles, such as the development of new drugs, individualization of immunosuppression, and induction of immune tolerance.

Dose effects of cyclosporine and risk of cancer after heart transplantation

2017 ◽  
Vol 05 (01) ◽  
pp. 1-15
Keyword(s):  
Heart Transplantation ◽  
Treatment Options ◽  
Survival Rates ◽  
Solid Organ Transplantation ◽  
Solid Cancer ◽  
Solid Organ ◽  
Term Survival ◽  
Study Results ◽  
Risk Of Cancer

Cyclosporine is a potent immunosuppressant medication that is considered a disease modifying antirheumatic drug (DMARD) and used as treatment options after heart transplantation to improved long-term survival rates. The increased incidence of cancer after heart transplantation is well established in the literature, yet outcome studies of quantitative dose of cyclosporin related to cancer remains unclear. This prospective study was conducted between 1998 and 2013 and is based on 102 patients who had previously received heart transplant. The study results indicate that the average patient age was 65 years and the interval between transplantation and the appearance of solid cancer was 4.5 years (P < 0.002; OR = 2.02; 95% CI [1.59–2.29], P < 0.0002). However, the current study does draw much-needed attention to concerns about overall immunosuppressant exposure and its relationship to long-term outcomes after solid organ transplantation to reduce future cancer risk and more research for alternative drug level monitoring are important.

Simultaneous orthotopic transplantation of carotid and aorta in the rat by the sleeve technique

2002 ◽  
Vol 36 (4) ◽  
pp. 426-431 ◽  
Author(s):  
A. Labat ◽  
D. Calise ◽  
J. C. Thiers ◽  
M. T. Pieraggi ◽  
A. Cerene ◽  
...  
Keyword(s):  
Overall Survival ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Technical Failure ◽  
Overall Survival Rate ◽  
Orthotopic Transplantation ◽  
Term Survival ◽  
Immunological Factors ◽  
Sleeve Anastomosis

Graft vascular disease (GVD) remains the major limitation to long-term survival after solid organ transplantation. Aortic or carotid allografts in rats have been shown to be useful models because similar changes to those observed in man develop within weeks. Both immunological and non-immunological factors influence the process of GVD and a method that could permit rapid multiple arterial allotransplantation in the rat would be of great value. We performed simultaneous orthotopic aortic and carotid allotransplantations in 25 rats. The vessels were anastomosed using a sleeve technique. No immunosuppression was given. The animals were killed at 15, 30, or 60 days and histological analyses of the grafts were performed. The overall survival rate was 80% and the incidence of technical failure was very low. The histopathological aspect revealed typical progressive GVD. In conclusion, we have developed a new model of simultaneous aortic and carotid transplantation in rats. This model, which incorporates a modification of the sleeve anastomosis, is rapid and yields an easy tool to investigate immunological and non-immunological processes driving GVD.

Long-Term Survival of Salvage Cardiac Transplantation for Infective Endocarditis

2011 ◽  
Vol 92 (5) ◽  
pp. e93-e94 ◽  
Author(s):  
Manuel L. Fernández Guerrero ◽  
Gonzalo Aldámiz ◽  
Julián Bayón ◽  
Victor Artíz Cohen ◽  
Julián Fraile
Keyword(s):  
Infective Endocarditis ◽  
Cardiac Transplantation ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Future of Solid Organ Transplantation: Organ-Specific Tolerance

KIDNEYS ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 130-136
Author(s):  
Yusuf Ercin Sonmez
Keyword(s):  
Immune System ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Immunological Tolerance ◽  
The Body ◽  
Solid Organ ◽  
Donor Organ ◽  
Organ Specific ◽  
Specific Tolerance

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.

scholarly journals Mesenchymal Stromal Cell Therapy in Solid Organ Transplantation

2021 ◽  
Vol 11 ◽  
Author(s):  
Manuel Alfredo Podestà ◽  
Giuseppe Remuzzi ◽  
Federica Casiraghi
Keyword(s):  
Organ Transplantation ◽  
Patient Survival ◽  
Immunosuppressive Agents ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Clinical Models ◽  
Transplant Failure

Transplantation is the gold-standard treatment for the failure of several solid organs, including the kidneys, liver, heart, lung and small bowel. The use of tailored immunosuppressive agents has improved graft and patient survival remarkably in early post-transplant stages, but long-term outcomes are frequently unsatisfactory due to the development of chronic graft rejection, which ultimately leads to transplant failure. Moreover, prolonged immunosuppression entails severe side effects that severely impact patient survival and quality of life. The achievement of tolerance, i.e., stable graft function without the need for immunosuppression, is considered the Holy Grail of the field of solid organ transplantation. However, spontaneous tolerance in solid allograft recipients is a rare and unpredictable event. Several strategies that include peri-transplant administration of non-hematopoietic immunomodulatory cells can safely and effectively induce tolerance in pre-clinical models of solid organ transplantation. Mesenchymal stromal cells (MSC), non-hematopoietic cells that can be obtained from several adult and fetal tissues, are among the most promising candidates. In this review, we will focus on current pre-clinical evidence of the immunomodulatory effect of MSC in solid organ transplantation, and discuss the available evidence of their safety and efficacy in clinical trials.

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