scholarly journals Neurological complications of solid organ transplantation

2017 ◽  
Vol 75 (10) ◽  
pp. 736-747 ◽  
Author(s):  
José Luiz Pedroso ◽  
Lívia Almeida Dutra ◽  
Pedro Braga-Neto ◽  
Agessandro Abrahao ◽  
João Brainer Clares de Andrade ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Prognostic Significance ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Surgical Techniques ◽  
Neurological Complications ◽  
Immunosuppressive Drugs ◽  
Solid Organ ◽  
Neurological Manifestations ◽  
Diagnostic Challenge

ABSTRACT Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased patient survival and improved quality of life. New surgical techniques and immunosuppressive drugs have been developed to achieve better outcomes. However, the variety of neurological complications following solid organ transplantation is broad and carries prognostic significance. Patients may have involvement of the central or peripheral nervous system due to multiple causes that can vary depending on time of onset after the surgical procedure, the transplanted organ, and the intensity and type of immunosuppressive therapy. Neurological manifestations following solid organ transplantation pose a diagnostic challenge to medical specialists despite extensive investigation. This review aimed to provide a practical approach to help neurologists and clinicians assess and manage solid organ transplant patients presenting with acute or chronic neurological manifestations.

scholarly journals Tuberculosis in solid organ transplantation: Prospects and challenges in the brazilian context

2014 ◽  
Vol 17 (4) ◽  
pp. 444-451
Author(s):  
Isabela Dias Lauar ◽  
Gerusa Coelho Vaz ◽  
Roberta Romanelli ◽  
Taciana de Figueiredo Soares ◽  
Auro Sergio Perdigão de Brito ◽  
...  
Keyword(s):  
Patient Care ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Immunosuppressive Drugs ◽  
Solid Organ Transplant ◽  
Therapeutic Management ◽  
Solid Organ ◽  
Atypical Presentation

The management of tuberculosis (TB) in candidates and recipients of solid organs poses several challenges. Among them, TB diagnosis is often delayed by the atypical presentation of the disease and difficulties related to the anti-TB drugs toxicity and the interaction with immunosuppressive drugs. This review includes relevant articles published in the last 20 years and also takes into account the current Brazilian recommendations for the diagnosis and therapeutic management of TB in solid organ transplant (SOT) recipients. It also attempts to provide useful recommendations to assist physicians as to the patient care, and presents the main limitations for a better approach upon considering the Brazilian scenario.

Cytomegalovirus in Solid Organ Transplant Recipients: Clinical Updates, Challenges and Future Directions

2020 ◽  
Vol 26 (28) ◽  
pp. 3497-3506
Author(s):  
Raymund R. Razonable
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Future Directions ◽  
Prevention And Treatment ◽  
Solid Organ Transplant Recipients

Cytomegalovirus is the classic opportunistic infection after solid organ transplantation. This review will discuss updates and future directions in the diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients. Antiviral prophylaxis and pre-emptive therapy are the mainstays of CMV prevention, but they should not be mutually exclusive and each strategy should be considered depending on a specific situation. The lack of a widely applicable viral load threshold for diagnosis and preemptive therapy is emphasized as a major factor that should pave the way for an individualized approach to prevention. Valganciclovir and intravenous ganciclovir remain as drugs of choice for CMV management, and strategies for managing drug-resistant CMV infection are enumerated. There is increasing use of CMV-specific cell-mediated immune assays to stratify the risk of CMV infection after solid organ transplantation, and their potential role in optimizing CMV prevention and treatment efforts is discussed.

scholarly journals Exploring the Epidemiology of Cancer after Solid Organ Transplantation (EpCOT): an observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043731
Author(s):  
Adnan Sharif ◽  
Javeria Peracha ◽  
David Winter ◽  
Raoul Reulen ◽  
Mike Hawkins
Keyword(s):  
Organ Transplantation ◽  
Record Linkage ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Study Cohort ◽  
Solid Organ ◽  
Post Transplantation ◽  
Increased Risk ◽  
Risk Of Cancer

IntroductionSolid organ transplant patients are counselled regarding increased risk of cancer (principally due to their need for lifelong immunosuppression) and it ranks as one of their biggest self-reported worries. Post-transplantation cancer is common, associated with increased healthcare costs and emerging as a leading cause of post-transplant mortality. However, epidemiology of cancer post-transplantation remains poorly understood, with limitations including translating data from different countries and national data being siloed across different registries and/or data warehouses.Methods and analysisStudy methodology for Epidemiology of Cancer after Solid Organ Transplantation involves record linkage between the UK Transplant Registry (from NHS Blood and Transplant), Hospital Episode Statistics (for secondary care episodes from NHS Digital), National Cancer Registry (from cancer registration data hosted by Public Health England) and the National Death Registry (from NHS Digital). Deterministic record linkage will be conducted by NHS Digital, with a fully anonymised linked dataset available for analysis by the research team. The study cohort will consist of up to 85 410 solid organ transplant recipients,who underwent a solid organ transplant in England between 1 January 1985 and 31 December 2015, with up-to-date outcome data.Ethics and disseminationThis study has been approved by the Confidentiality Advisory Group (reference: 16/CAG/0121), Research Ethics Committee (reference: 15/YH/0320) and Institutional Review Board (reference: RRK5471). The results of this study will be presented at national and international conferences, and manuscripts with results will be submitted for publication in high-impact peer-reviewed journals. The information produced will also be used to develop national evidence-based clinical guidelines to inform risk stratification to enable risk-based clinical follow-up.Trial registration numberNCT02991105.

Barcelona Consensus on Biomarker-Based Immunosuppressive Drugs Management in Solid Organ Transplantation

2016 ◽  
Vol 38 ◽  
pp. S1-S20 ◽  
Author(s):  
Mercè Brunet ◽  
Maria Shipkova ◽  
Teun van Gelder ◽  
Eberhard Wieland ◽  
Claudia Sommerer ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Immunosuppressive Drugs ◽  
Solid Organ

scholarly journals Regulatory T Cells and Kidney Transplantation

2018 ◽  
Vol 13 (11) ◽  
pp. 1760-1764 ◽  
Author(s):  
Paloma Leticia Martin-Moreno ◽  
Sudipta Tripathi ◽  
Anil Chandraker
Keyword(s):  
T Cells ◽  
Regulatory T Cells ◽  
Organ Transplantation ◽  
Tissue Repair ◽  
Solid Organ Transplantation ◽  
Immunosuppressive Drugs ◽  
Solid Organ ◽  
Effective Expansion ◽  
Conventional Immunosuppression

The ability of the immune system to differentiate self from nonself is critical in determining the immune response to antigens expressed on transplanted tissue. Even with conventional immunosuppression, acceptance of the allograft is an active process often determined by the presence of regulatory T cells (Tregs). Tregs classically are CD4+ cells that constitutively express high levels of the IL-2 receptor α chain CD25, along with the transcription factor Foxp3. The use of Tregs in the field of solid organ transplantation is related specifically to the objective of achieving tolerance, with the goal of reducing or eliminating immunosuppressive drugs as well as maintaining tissue repair and managing acute rejection. A key issue in clinical use of Tregs is how to effectively expand the number of Tregs, either through increasing numbers of endogenous Tregs or by the direct infusion of exogenously expanded Tregs. In order to realize the benefits of Treg therapy in solid organ transplantation, a number of outstanding challenges need to be overcome, including assuring an effective expansion of Tregs, improving long-term Treg stability and reduction of risk-related to off-target, nonspecific, immunosuppressive effects related specially to cancer.

scholarly journals Neurological Complications of Solid Organ Transplantation

2013 ◽  
Vol 3 (3) ◽  
pp. 152-166 ◽  
Author(s):  
Amy A. Pruitt ◽  
Francesc Graus ◽  
Myrna R. Rosenfeld
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Neurological Complications ◽  
Solid Organ
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