P1794CHANGES IN PHARMACOKINETIC PROFILE OF MYCOPHENOLATE MOFETIL AND TACROLIMUS IN THE TRANSPLANTED PATIENT AFTER BOWEL SURGERY: A PROSPECTIVE COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nuria Montero ◽  
Alexandre Favà ◽  
Anna Manonelles ◽  
José González Costello ◽  
Edoardo Melilli ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Intestinal Resection ◽  
Pharmacokinetic Profile ◽  
Cardiac Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Post Dose ◽  
Transplant Patients ◽  
Bowel Surgery ◽  
Terminal Ileostomy

Abstract Background and Aims Considering the particular pharmacokinetic (PK) profile of mycophenolate (MMF/MPS) with the important contribution of enterohepatic recirculation (EHC) and the potential alteration in tacrolimus (TAC) exposure, a PK study in solid-organ transplant patients who had undergone intestinal resection was carried out. Method This is a prospective single-center study of MMF/MPS and TAC exposure changes after bowel resection and after reconstruction. Whole blood samples were collected at the following time points: 0, 0.5, 1, 1.5, 2, 4, 6, 8 and 12 hours post-dose. Areas under the curves (AUCs) were determined in both conditions: with ileostomy and after bowel reconstruction. Results Six renal and two cardiac transplant recipients were included. Four subjects completed both pre- and post-reconstruction surgery procedures. Different intestinal anatomic resections were performed (Table 1). Patients with terminal ileostomy showed an under exposure to MMF/MPS. In three patients, initial MPA levels were on target, but they decreased >80% after 4 hours post-drug administration. After bowel reconstruction, the AUC increased maintaining MMF/MPA levels during 12h (Table 2). Before bowel reconstruction, TAC trough levels were within therapeutic target but, after reconstruction, AUCs normalized by dose were much higher than the expected. Conclusion Transplant recipients with ileostomy showed infra-exposure to mycophenolate. After 4 hours post-dose, MMF/MPA was undetectable because of the absence of EHC, which was recovered after anatomical correction. TAC exposure was higher after bowel reconstruction suggesting changes in the absorption. The use of mTORi in such clinical situations would be an alternative.

Neurocognitive Effects of Solid Organ Transplantation

2010 ◽  
Author(s):  
Nataliya Zelikovsky ◽  
Debra S. Lefkowitz
Keyword(s):  
Organ Transplantation ◽  
Survival Rates ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Chronic Illnesses ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Neurocognitive Outcomes ◽  
Medical Advances

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for transplant recipients. In 2008, there were 1,964 solid organ transplants performed for children under age 18 (2007 Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR] Annual Report 1997–2006). Currently, approximately 1,830 pediatric patients are awaiting some type of solid organ transplant (2007 OPTN/SRTR Annual Report 1997–2006). Organ transplantation in children is relatively recent compared to other treatments for children with chronic illnesses. The focus over the first few decades has been on medical advances and improving survival rates for transplant patients. In the recent years, increasing attention has been given to the developmental, neurocognitive, and psychosocial outcomes prior to transplant and in the short-term period post transplant. Most chronic illnesses and acute traumatic medical events have implications for neurocognitive outcomes. End-stage disease of the liver, kidney, heart, and lung are all believed to affect intellectual, academic, and neurocognitive functions. Gross neurodevelopmental deficits have become less common due to early medical intervention (e.g., improved nutrition, surgical intervention, reduced exposure to aluminum (Warady 2002). Organ transplantation is believed to ameliorate the deleterious long-term developmental and neurocognitive effects, but this topic has received little attention in the literature, and the available results with regard to intellectual, academic, and neurodevelopmental results have been mixed. In a combined sample of solid organ transplant patients, 40% had clinically significant cognitive delays (Brosig et al. 2006). Examining the impact of different underlying disease processes and transplantation of each solid organ separately is critical. Thus, we discuss the neurocognitive outcomes of each organ group separately in this chapter. Neurocognitive outcomes can be assessed in a variety of ways depending upon the age of the child. Among infants and toddlers, neurocognitive functioning is measured by an assessment of motor function, social and environmental interaction, and language development. Assessment of older children may involve the evaluation of intelligence, academic achievement, emotional and behavioral functioning, and adaptive skills.

Transplant-Associated Skin Cancer: Role of Reducing Immunosuppression

2007 ◽  
Vol 5 (5) ◽  
pp. 541-549 ◽  
Author(s):  
Marcy Neuburg
Keyword(s):  
Skin Cancer ◽  
Therapeutic Strategy ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cutaneous Malignancy ◽  
Transplant Patients ◽  
Historic Review ◽  
Solid Organ Transplant Recipients

This article explores the role of reducing immunosuppression as a therapeutic strategy for the problem of transplant-associated skin cancer. The specific issue of immunosuppression reduction is based on a brief historic review of the epidemiology of skin cancer in transplant patients, followed by a description of the role of immunosuppression as a cause of skin cancer. Finally, the literature pertaining to the hypothesis that reducing immunosuppression in solid organ transplant recipients favorably impacts both the incidence of cutaneous malignancy and outcomes relating to individual aggressive malignancies is presented.

scholarly journals Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Samir J. Patel ◽  
Samantha A. Kuten ◽  
Richard J. Knight ◽  
Dana M. Hong ◽  
A. Osama Gaber
Keyword(s):  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Mild Disease ◽  
Reduced Dose ◽  
Transplant Patients ◽  
Hyperimmune Globulin ◽  
Stable Renal Function ◽  
Kidney Transplant Patients ◽  
Cmv Disease

Ganciclovir-resistant cytomegalovirus (CMV) is associated with significant morbidity in solid organ transplant recipients. Management of ganciclovir-resistant CMV may be complicated by nephrotoxicity which is commonly observed with recommended therapies and/or rejection induced by “indirect” viral effects or reduction of immunosuppression. Herein, we report a series of four high serologic risk (donor CMV positive/recipient CMV negative) kidney transplant patients diagnosed with ganciclovir-resistant CMV disease. All patients initially developed “breakthrough” viremia while still receiving valganciclovir prophylaxis after transplant and were later confirmed to exhibit UL97 mutations after failing to eradicate virus on adequate dosages of valganciclovir. The patients were subsequently and successfully treated with reduced-dose (1-2 mg/kg) cidofovir and CMV-hyperimmune globulin, given in 2-week intervals. In addition, all patients exhibited stable renal function after completion of therapy, and none experienced acute rejection. The combination of reduced-dose cidofovir and CMV-hyperimmune globulin appeared to be a safe and effective regimen in patients with mild disease due to ganciclovir-resistant CMV.

Incidence and Treatment of Cancer in Transplant Recipients

1998 ◽  
Vol 8 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Maureen P. Flattery
Keyword(s):  
De Novo ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Cardiac Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Organ Rejection ◽  
Increased Risk ◽  
Actuarial Risk

Solid organ transplantation has been an accepted mode of therapy for the treatment of end-stage organ diseases for many years. Recipients' survival, however, has been hindered by organ rejection and the comorbid diseases that develop as a result of immunosuppressive therapy. In particular, organ transplant recipients have an increased risk of developing cancer de novo after transplantation. Prevalence ranges from 4 to 18% with an average incidence of 6%. Data submitted to the Cincinnati transplant tumor registry have revealed that cancers prevalent in the general population exhibited no increase in rate and may even show a slight decline in the transplant population. Length of survival after transplantation is associated with the likelihood of having cancer; the longer the recipient survives, the greater the chance. The actuarial risk among 124 cardiac transplant recipients was 2.7+/-1.9% at 1 year and 25.6+/-11% at 5 years. This article will review the current literature on the incidence and treatment of cancer in solid organ transplant recipients.

scholarly journals Effects of Isavuconazole on the Plasma Concentrations of Tacrolimus among Solid-Organ Transplant Patients

2017 ◽  
Vol 61 (9) ◽  
Author(s):  
Ryan M. Rivosecchi ◽  
Cornelius J. Clancy ◽  
Ryan K. Shields ◽  
Christopher R. Ensor ◽  
Michael A. Shullo ◽  
...  
Keyword(s):  
Plasma Concentrations ◽  
Organ Transplant ◽  
Tacrolimus Concentration ◽  
Therapeutic Drug ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Dose Ratio ◽  
Transplant Patients ◽  
Daily Dose ◽  
Liver Transplant Recipients

ABSTRACT We evaluated the interaction between isavuconazole and tacrolimus among 55 organ transplant recipients. After isavuconazole discontinuation, the tacrolimus concentration/dose ratio normalized by weight (C/D) was reduced by 16%. Liver transplant recipients experienced the largest C/D reduction. A 1.3-fold decrease in tacrolimus daily dose was required to maintain desired tacrolimus levels. There was considerable interpatient variability in the magnitude of the drug interaction. Tacrolimus doses should not be adjusted uniformly but, rather, be guided by therapeutic drug monitoring.

scholarly journals Improving Transplant Medication Safety Through a Technology and Pharmacist Intervention (ISTEP): Protocol for a Cluster Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Casey L Hall ◽  
Cory E Fominaya ◽  
Mulugeta Gebregziabher ◽  
Sherry K Milfred-LaForest ◽  
Kelsey M Rife ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medication Safety ◽  
Organ Transplant ◽  
Pharmacist Intervention ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Randomized Controlled ◽  
Transplant Patients ◽  
Cluster Randomized

BACKGROUND Medication errors, adverse drug events, and nonadherence lead to increased health care utilization and increased risk of adverse clinical outcomes, including graft loss, in solid organ transplant recipients. Veterans living with organ transplants represent a population that is at substantial risk for medication safety events and fragmented care coordination issues. To improve medication safety and long-term clinical outcomes in veteran transplant patients, interventions should address interorganizational system failures and provider-level and patient-level factors. OBJECTIVE This study aims to measure the clinical and economic effectiveness of a pharmacist-led, technology-enabled intervention, compared with usual care, in veteran organ transplant recipients. METHODS This is a 24-month prospective, parallel-arm, cluster-randomized, controlled multicenter study. The pharmacist-led intervention uses an innovative dashboard system to improve medication safety and health outcomes, compared with usual posttransplant care. Pharmacists at 10 study sites will be consented into this study before undergoing randomization, and 5 sites will then be randomized to each study arm. Approximately, 1600 veteran transplant patients will be included in the assessment of the primary outcome across the 10 sites. RESULTS This study is ongoing. Institutional review board approval was received in October 2018 and the study opened in March 2019. To date there are no findings from this study, as the delivery of the intervention is scheduled to occur over a 24-month period. The first results are expected to be submitted for publication in August 2021. CONCLUSIONS With this report, we describe the study design, methods, and outcome measures that will be used in this ongoing clinical trial. Successful completion of the Improving Transplant Medication Safety through a Technology and Pharmacist Intervention study will provide empirical evidence of the effectiveness of a feasible and scalable technology-enabled intervention on improving medication safety and costs.

Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients

2021 ◽  
Vol 15 (5) ◽  
pp. 1064-1067
Author(s):  
M Asim Rana ◽  
M Ahad Qayyum ◽  
Amer Latif ◽  
M Afzal Bhatti ◽  
Syed Arsalan Khalid ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Interquartile Range ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Transplant Patients ◽  
Solid Organ Transplant Recipients ◽  
Overall Mortality

Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir.Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center. Keywords: Incidence, Outcome, COVID-19, Infection

scholarly journals 1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S581-S582
Author(s):  
Maria A Mendoza ◽  
Mohammed A Raja ◽  
Gemma Rosello ◽  
Shweta Anjan ◽  
Jacques Simkins ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lung Transplant ◽  
Respiratory Virus ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Virus Infections ◽  
Transplant Patients ◽  
Respiratory Virus Infections

Abstract Background Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients. Table 1: Patients characteristics Table 2: Concomitant infections Methods Retrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study. Results One hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (>137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively. Conclusion Most of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies. Disclosures Michele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)

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