scholarly journals General Principles of Modern Immunosuppressive Therapy

2021 ◽  
pp. 101-114
Author(s):  
O. S. Nykonenko
Keyword(s):  
Side Effects ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
De Novo ◽  
Hla Antibodies ◽  
Before And After ◽  
Therapeutic Problem ◽  
Therapy Treatment

Immunosuppressive therapy is the most important component of drug treatment after organ transplantation. The goal of immunosuppression is to prevent acute and chronic rejection while maximizing patient survival, and long-term graft survival remains a major therapeutic challenge before and after organ transplantation. However, the benefits of immunosuppressive therapy must be balanced against the side effects and underlying toxicity of the drugs used.Immunosuppressants can be classified as induction agents, maintenance therapy, treatment of acute rejection and chronic rejection, and antibody directed therapy. Although induction therapy remains a subject of debate in the field of organ transplantation, it is still used in most transplant centers. Protocols for maintenance immunosuppressive therapy are more or less standardized and include, as a rule, three drugs, a calcineurin inhibitor, an antimetabolite, and a glucocorticoid. The presence of HLA antibodies in transplantation candidates and the development of de novo antibodies after transplantation remain a serious therapeutic problem before and after organ transplantation. In this lecture, we will look at the drugs used to induce and maintain immunosuppression, as well as their effectiveness in preventing side effects.

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.

Secondary Long-Term Prophylaxis in Severe Patients with von Willebrand’s Disease: An Italian Cohort Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1782-1782 ◽  
Author(s):  
Augusto B. Federici ◽  
Francesca Gianniello ◽  
Maria T. Canciani ◽  
Pier M. Mannucci
Keyword(s):  
Cohort Study ◽  
Side Effects ◽  
Von Willebrand's Disease ◽  
Packed Red Blood Cells ◽  
Von Willebrand’S Disease ◽  
On Demand ◽  
Before And After ◽  
Type 3 ◽  
Design And Methods

Abstract Background and Objectives. Patients with severe forms of von Willebrand’s disease (VWD) may have frequent episodes of mucocutaneous bleeding and also of hemarthrosis or hematomas. However, little retrospective or prospective data on secondary long term prophylaxis in VWD are available. Aim of this study was to evaluate the efficacy and safety of fixed regimens of prophylaxis with factor VIII/VWF concentrates in our cohort of VWD patients with recurrent joint and gastrointestinal (GI) bleeds. Design and Methods. This is a cohort study on 452 VWD patients regularly followed up at our Center for at least three years. 89/452 cases (20%) were treated with FVIII/VWF concentrates during the last two years because of one or more bleedings and 11/89 (12%) were included in a long term prophylaxis program because of frequent recurrence of bleeds at the same sites. All patients were characterized by a bleeding severity score derived from a detailed history of 11 symptoms. Since concentrates available in Italy are still labelled in FVIII IU, patients were given 40 FVIII IU/Kg of high- (Alphanate, Fanhdi) or intermediate-purity (Haemate-P) concentrates, two times a week (joint bleeds) or every other day (GI bleeds) to maintain FVIII/VWF levels higher than baseline during prophylaxis. Effectiveness of prophylaxis was based on resolution/reduction of bleeding as well as on numbers of transfused packed red blood cells (PRBC) and days of hospitalization. Safety was measured by monitoring side effects and FVIII levels before and after every injection during the first three weeks of prophylaxis. Results. All the 11 patients were severe, as shown by high bleeding scores (> 20) and VWF:RCo baseline levels <10 U/dL. Prophylaxis was started because of GI bleeds in 7 patients with VWD type 3 (n=1), 2A (n=4), 2M (n=1) and 1 (n=1) and for joint bleeds only in VWD type 3 (n= 4). Prophylaxis could stop bleeding in 8 patients and largely reduced hospitalization for PRBC transfusions in the remaining 3. When prophylaxis was compared with previous on demand regimen in all 11 cases, the annual total FVIII IU (x 1000) of concentrate (a) as well as number of PRBC used (b) and days of hospitalization (c) were significantly reduced (mean ± SD, with * p < 0.01): a * = 239±207 versus 385±247; b* = 9±11 versus 3±4; c* = 18±13 versus 4±3. As far as safety, FVIII levels were always <180 U/dL in all VWD and no side effects, including thrombosis, were observed. Interpretations and Conclusions. Secondary long-term prophylaxis by high-and intermediate purity FVIII/VWF concentrates is effective and safe in severe forms of VWD. Cost-effectiveness of these prophylaxis regimens versus on demand therapy should be further investigated in large prospective studies.

scholarly journals Warm compresses to decrease dysmenorrhea among adolescents

2020 ◽  
Vol 3 (2) ◽  
pp. 110-114
Author(s):  
Dian Nurafifah ◽  
Ihda Mauliyah ◽  
Atiul Impartina
Keyword(s):  
Data Analysis ◽  
Treatment Group ◽  
Side Effects ◽  
Young Women ◽  
Control Group ◽  
Not Given ◽  
Menstrual Pain ◽  
Before And After ◽  
Experience Pain

Dysmenorrhea is one of discomfort experienced by adolescent during menstruation. A Survey of 10 young women at University of Muhammadiyah Lamongan found 90% had dysmenorrhea. To reduce pain, they take pain relievers. However, the use of drugs can cause side effects, especially if long-term use can lead to addiction or dependence. Research design using Quasy Eksperiment (pretest-posttest). The study was conducted on adolescents who are experiencing dysmenorrhea. They were divided into two groups namely control and treament groups. The study began by assessing pain levels in both groups. The treatment group was given warm compresses but the control group was not given any treatment, after that reassess the level of pain. The study analyzes changes in pain levels and compares pain change in the two groups. The results showed that in the control group most of the adolescents did not experience pain changes during dysmenorrhea (86.7%), whereas in the treatment group most of the adolescents experienced a decrease in pain (93.3%). Data analysis using the Mann Whitney test showed p=0.000 where p0.05 so it can be concluded that there are differences in dysmenorrhea before and after treatment between the warm compress group and the control group. The results of this study are expected to be used as consideration in developing plans to reduce discomfort in the form of menstrual pain in a non-pharmacological manner.

Gastrointestinal Side Effects of Post-Transplant Therapy

2016 ◽  
Vol 25 (3) ◽  
pp. 367-373 ◽  
Author(s):  
Valerian Ciprian Lucan ◽  
Luisa Berardinelli
Keyword(s):  
Side Effects ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Post Transplant ◽  
Medication Side ◽  
Gastrointestinal Side Effects ◽  
Inflammatory Drugs ◽  
The Impact

Modern immunosuppressive therapy has produced a real revolution in renal and organ transplantation but it comes with the price of multiple side effects. There are many gastrointestinal (GI) complications that are the consequence of transplant immunosuppressant medication. In fact, for any immunosuppressant therapy, certain standardized precepts and attitudes that aim to reduce the incidence and the impact of the medication side effects must be applied. Many patients undergo renal transplantation and the physicians have to be aware of the advantages and the risks associated. This article reviews the main GI complications that may arise as a consequence of immunosuppressive therapy after solid organ transplantation, focusing on renal and renal/pancreas transplantation, as well as the ways in which the incidence of these complications can be reduced. Management of the post-transplant therapy is mandatory in order to increase not only the grafts’ and the patients’ survival, but also their quality of life by the occurrence of fewer complications. Abbreviations: Aza: azathioprine; CMV: cytomegalovirus; CsA: cyclosporine A; GI: gastrointestinal; MMF: mycophenolate mofetil; NSAID: non-steroidal anti-inflammatory drugs; Tac: tacrolimus.

Glucocorticoid-induced osteoporosis

2011 ◽  
pp. 754-759
Author(s):  
Gherardo Mazziotti ◽  
Andrea Giustina ◽  
Ernesto Canalis ◽  
John P. Bilezikian
Keyword(s):  
Side Effects ◽  
Bone Loss ◽  
Organ Transplantation ◽  
Gastrointestinal Diseases ◽  
Glucocorticoid Therapy ◽  
Skeletal Health ◽  
Effective Strategies ◽  
New Knowledge ◽  
Synthetic Glucocorticoids

Synthetic glucocorticoids are used in a wide variety of disorders including autoimmune, pulmonary, and gastrointestinal diseases, as well as in patients following organ transplantation and with malignancies. Although the indications for glucocorticoids in these various conditions are clear, their use is fraught with a host of potential side effects. In particular, glucocorticoids are detrimental to bone and glucocorticoid-induced osteoporosis (GIO) is the most common form of secondary osteoporosis (1). Despite the fact that glucocorticoids can cause bone loss and fractures, many patients receiving or initiating long-term glucocorticoid therapy are not evaluated for their skeletal health. Furthermore, patients often do not receive specific preventive or therapeutic agents when indicated. New knowledge of the pathophysiological mechanisms underlying GIO has been accompanied by the availability of effective strategies to prevent and treat GIO (1).

scholarly journals Teacrine Does Not Enhance Physical Performance or Training Status Over 8 Weeks

2021 ◽  
Author(s):  
Henrique Santa Capita Cerqueira ◽  
Hugo Tourinho Filho ◽  
Marcos Corrêa Junior ◽  
Carlos Eduardo Martinelli Junior
Keyword(s):  
Side Effects ◽  
Physical Performance ◽  
Training Status ◽  
Training Performance ◽  
Igf I ◽  
Before And After ◽  
Physical Tests ◽  
The Individual ◽  
Igfbp 3

Abstract Background: Fatigue is a condition that may affect physical performance during training sessions. Consequently, this will impact training performance, moreover in the performance of the individual in long-term. Caffeine is broadly utilized to this purpose, however contains several side effects. Thus, teacrine emerges as an alternative to the use of caffeine, providing the same benefits without the side effects. Thus, the current work had as an objective to investigate the effects of 8 weeks of supplementation with teacrine on physical performance and the training status of young amateur athletes. Methods: 22 subjects were divided into two groups – Teacrine Group (T) and Placebo Group (P) – and evaluated before and after the intervention period. Evaluations included physical tests and hormonal doses of IGF-I and IGFBP-3, utilized as markers of training status. Results: Results demonstrated that teacrine was not capable of promoting benefits in relation to physical performance of the subjects. Neither produced effects on serum secretion of IGF-I and its binding protein, IGFBP-3.Conclusion: Therefore, the findings of the present study do not support the use of teacrine for the purpose of increasing physical performance.

scholarly journals Anti-HLA Antibodies before and after Lung Transplantation: A Role on Medium-Long Term Outcomes?

2019 ◽  
Vol 38 (4) ◽  
pp. S404
Author(s):  
E. Benazzi ◽  
L. Morlacchi ◽  
A. Cannavò ◽  
L. Rosso ◽  
A. Palleschi ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Long Term Outcomes ◽  
Hla Antibodies ◽  
Before And After
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