scholarly journals Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
N. Thao Galván ◽  
Kayla Kumm ◽  
Michael Kueht ◽  
Cindy P. Ha ◽  
Dor Yoeli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Transplant Patient ◽  
Solid Organ Transplantation ◽  
Kidney Transplant Patient ◽  
Solid Organ ◽  
Takotsubo Syndrome ◽  
Transplant Patients

Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo’s Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure.

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 Choice of Study Populations for Vaccines

2020 ◽  
Vol 221 (Supplement_1) ◽  
pp. S128-S134
Author(s):  
Paul Griffiths ◽  
Brenna Hughes
Keyword(s):  
Natural History ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Clinical Trial Design ◽  
Active Immunization ◽  
Solid Organ ◽  
Cell Transplant ◽  
Natural Immunity ◽  
Childbearing Age ◽  
Transplant Patients

Abstract The natural history of cytomegalovirus (CMV) infection is complex. Individuals may experience primary infection, reactivation of latent infection, or reinfection with a new strain despite natural immunity. The ability of this virus to continue to replicate despite substantial immune responses is attributable to the many immune evasion genes encoded within its genome. Given this complex natural history and immunology, the design of clinical trials of CMV vaccines may require components not usually found in trials of vaccines designed to protect against viruses that cause only acute infections. In this article, we focus on specific aspects of clinical trial design that could be adopted to address the complexities of CMV infections. We consider women of childbearing age, toddlers, recipients of solid organ transplantation, and stem cell transplant patients, emphasizing the parallels between women and solid organ transplantation that could allow vaccines to be developed in parallel in both these patient groups. We emphasize the potential for studies of passive immunity to inform the selection of immunogens as candidates for active immunization and vice versa. We also illustrate how application of whole-genomic sequencing could document whether vaccines protect against reactivation or reinfection of CMV or both.

Approaching a Consensus: Psychosocial Support Services for Solid Organ Transplantation Programs

2001 ◽  
Vol 11 (3) ◽  
pp. 163-168 ◽  
Author(s):  
Christine E. Skotzko ◽  
Judith A. Stowe ◽  
Carol Wright ◽  
Kay Kendall ◽  
Mary Amanda Dew
Keyword(s):  
United States ◽  
Organ Transplantation ◽  
Support Services ◽  
Psychosocial Support ◽  
Solid Organ Transplantation ◽  
The United States ◽  
Solid Organ ◽  
Psychosocial Needs ◽  
Psychosocial Services ◽  
Transplant Patients

Background— Solid organ transplantation has become an accepted treatment for individuals with end-stage organ dysfunction. Criteria are being developed in the United States to determine medical eligibility for transplant candidates and competencies for transplant centers and physicians. To date, similar criteria for psychosocial services have not been developed. Design and Setting— We queried participants in a specialty psychosocial transplant meeting to determine their views of which psychosocial services are essential to the comprehensive care of transplant patients in the United States. Results— There was broad based multidisciplinary support for proactive pretransplant screening to discern individual psychosocial needs; focused pretransplant interventions to improve candidacy and future compliance; and posttransplant programs that address psychosocial, rehabilitation, and financial issues. Conclusion— Among psychosocial providers of solid organ transplantation services, there is support for expanding routine screening and support services to individuals who are candidates for and undergo solid organ transplantation.

scholarly journals Do Liver Transplant Recipients Have a Higher Risk for Cryptococcosis Than Non-liver Transplant Recipients?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S87-S87
Author(s):  
Hsin-Yun Sun ◽  
Aristine Cheng ◽  
Cheng-Maw Ho ◽  
Rey-Heng Hu ◽  
Nai-Kuan Chou ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Tertiary Hospital ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
European Organization ◽  
Increased Risk ◽  
Liver Transplant Recipients

Abstract Background Patients with liver cirrhosis have an increased risk for cryptococcosis. However, it is unknown whether they remain at a higher risk for cryptococcosis after liver transplantation. Methods Patients undergoing solid organ transplantation at a tertiary hospital in Taiwan were included for analysis. Cryptococcosis was defined based on criteria proposed by the European Organization for Research and Treatment in Cancer and the Mycoses Study Group. Only Nystatin oral suspension but no systemic anti-fungal agents was prescribed routinely post-transplant. Results From 2001 to 2016, in total, 1576 patients underwent solid organ transplantation, including 756 kidney, 411 liver, 336 heart, 61 lung, and 12 multi-organ transplantation. Cryptococcosis developed in 20 patients (1.3%), including cryptococcemia in 9, pulmonary/urine in 6, meningitis in 3, and surgical site infection in 2. Its incidence was 3.2% (13/411) in liver, 1.5% (5/336) in heart, and 0.3% (2/756) in kidney transplant recipients. Compared with 1165 non-liver transplant recipients, 441 liver transplant recipients had a significant higher incidence of cryptococcosis (3.1% vs. 0.6%, P < 0.01) and developed the disease with a shorter median duration after transplantation (75 vs. 213 days). Cryptococcosis with very-early onset (<30 days after transplantation) developed in 38.5% (5/13) of liver transplant recipients with cryptococcosis, but only 14.3% (1/7) in non-liver transplant recipients. Six patients (30%) died after a median follow-up duration of 399 days, and only two deaths were related to cryptococcosis. Conclusion Our findings showed that liver transplant recipients still had a higher risk for cryptococcosis, and the disease developed earlier after transplantation than non-liver transplant recipients. Disclosures All authors: No reported disclosures.

scholarly journals Strategy to achieve biomarker-driven immunosuppression after solid organ transplantation by an academic-industry partnership within the European BIO-DrIM consortium

2016 ◽  
Vol 1 (1) ◽  
pp. 12
Author(s):  
Hans-Dieter Volk ◽  
Bernhard Banas ◽  
Frederike Bemelman ◽  
Oriol Bestard ◽  
Sophie Brouard ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Transplant Patients ◽  
End Stage

Solid organ transplantation has emerged as the “gold standard” therapy for end-stage organ failure as it improves both quality of life and survival. Despite the progress in short-term graft survival, that is closely associated with the impressive reduction of acute rejections within the first year, long-term graft and patient survival remain almost un-changed and unsatisfactory. Incomplete control of chronic allograft injury but particularly the adverse effects of long-term immunosuppression, such as graft toxicity, diabetes, cardiovascular events, infections, and tumours continue to challenge the long-term success. In general, immunosuppression is applied as one-size-fits-all strategy. This can result in over- and under-immunosuppression of patients with low and high alloresponsiveness, respectively. Trial- and -error strategies to minimize or even completely wean of immunosuppression have a high failure rate. Consequently, there is an unmet medical need to develop biomarkers allowing objective risk stratification of transplant patients. To achieve this goal, we engaged in an academic-industrial partnership. The central focus of the European-wide BIO-DrIM consortium (BIOmarker-Driven IMmmunosuppression) is the implementation of biomarker-guided strategies for personalizing immunosuppression to improve the long-term outcome and to decrease the adverse effects and costs of chronic immunosuppression in solid organ transplant patients. The concept includes four innovative investigator-driven clinical trials designed by the consortium.

scholarly journals Varicella-Zoster Gastritis in a Liver Transplant Patient: A Call to Attention

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Víctor Escrich ◽  
◽  
Ángela Martinez ◽  
Berta Lapeña ◽  
Marta Mayorga ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Transplant Patient ◽  
Solid Organ Transplantation ◽  
Gastrointestinal Symptoms ◽  
Solid Organ ◽  
Liver Transplant Patient ◽  
Cutaneous Manifestations ◽  
Varicella Zoster ◽  
Acute Gastritis ◽  
Histologic Changes

The reactivation of the Varicella-zoster virus (VZV) is a rare cause of acute gastritis in adults. About 30 cases have been reported in the literature, mostly with immunocompromised patients and mainly after bone marrow transplantation or during the development of malignant hematological diseases. Clinically, it is usually accompanied by cutaneous manifestations. Here, we studied a case of VZV gastritis in a liver transplant (LT) patient. We described the main symptoms, endoscopic findings, histologic changes, and treatment of VZV gastritis. Till now, no case of acute gastritis due to the reactivation of VZV after solid organ transplantation had been reported [2–5]. This was the first reported case of acute gastritis by the reactivation of VZV after LT without cutaneous vesicular eruption. Gastrointestinal symptoms usually develop a week before the onset of fever and cutaneous manifestations. However, in some cases, like this one, vesicular rashes may be absent, making the diagnosis quite challenging. In conclusion, through this case, we suggest including VZV gastritis in the differential diagnosis of gastrointestinal symptoms after transplantation and informing about the response of VZV gastritis to treatment with oral acyclovir.

The interactive effect of parent personality and medication knowledge on adherence in children awaiting solid organ transplantation.

2017 ◽  
Vol 36 (5) ◽  
pp. 445-448 ◽  
Author(s):  
Jennifer L. Lee ◽  
Cyd K. Eaton ◽  
Kristin Loiselle Rich ◽  
Bonney Reed-Knight ◽  
Rochelle S. Liverman ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Interactive Effect ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Medication Knowledge ◽  
Parent Personality
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