scholarly journals Rapid Disease Progression of Liver Metastases following Resection in a Liver-Transplanted Patient with Probable Lynch Syndrome – A Case Report and Review of the Literature

2017 ◽  
Vol 10 (1) ◽  
pp. 244-251 ◽  
Author(s):  
Noelle Suemi Wassano ◽  
Francisco  Sergi ◽  
Gustavo Ferro ◽  
Tércio Genzini ◽  
Renata D’Alpino Peixoto
Keyword(s):  
Case Report ◽  
Lynch Syndrome ◽  
Immunosuppressive Therapy ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Life Saving ◽  
Microbial Infections ◽  
End Stage ◽  
Risk Of Cancer

Solid organ transplantation provides life-saving therapy for patients with end-stage organ disease, and its outcomes have been improving dramatically over the past few decades. However, substantial morbidity results from chronic immunosuppressive therapy administered to prevent graft rejection. It predisposes patients to several life-threatening complications, such as opportunistic microbial infections and the development of different types of cancers. Here, we presented the case of a young man with probable Lynch syndrome, who developed an aggressive colon carcinoma after long-term immunosuppressive therapy due to a prior liver transplantation. Based on this case report, we attempt to find an answer to the question about the risk of cancer development or recurrence in patients with familial syndromes receiving long-term immunosuppressive therapy and to find out how it can be minimized. Answering these questions is particularly important, given the facts that disease course is substantially more aggressive among transplanted patients and that prognosis is poor due to lack of immunocompetence, especially in the setting of Lynch syndrome.

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 Takrolimuszterápia vesetranszplantáció után. A koncentráció/dózis arány aktuális kérdései

2019 ◽  
Vol 160 (30) ◽  
pp. 1178-1183
Author(s):  
Ádám Varga ◽  
Károly Kalmár Nagy ◽  
Péter Szakály
Keyword(s):  
Immunosuppressive Therapy ◽  
Solid Organ Transplantation ◽  
Long Term Results ◽  
Solid Organ ◽  
Individual Variations ◽  
Risk Patients ◽  
Patient Groups ◽  
Higher Doses

Abstract: Tacrolimus is an important part of immunosuppressive therapy after solid organ transplantation. The therapeutic range of the drug from the calcineurin inhibitor group is narrow. Adjustment of the blood concentration can be very complicated but to be able to avoid the occurrence of side effects or ineffective immunosuppression it is inevitable. This article summarizes the properties of tacrolimus pharmacokinetics, pharmacogenetics and pharmacodynamics. We will focus on individual variations of cytochrome enzymes. In the following part, a new method for screening high risk patients will be introduced. We will present the publications of the determination of the concentration/dose (C/D) ratio. By determining the C/D ratio, researchers identify fast and slow metabolizing patient groups. Fast metabolizers require higher doses in general and the occurrence of complications is also more frequent in this group. Long-term results are lagging behind the slow metabolizing group. The long-term results of renal transplantation nowadays contribute to the postoperative period and the later years rather than the surgery itself. It includes the proper management of previous illnesses (e.g., hypertension, diabetes, endocrinological problems), detection of complications (e.g., infections, malignancies), and the precise regulation of immunosuppressive therapy. Orv Hetil. 2019; 160(30): 1178–1183.

scholarly journals When Operating on Dead People Saves Lives: Benefits of Surgical Organ Donor Intensivists

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Kristin Long ◽  
Cynthia Talley ◽  
Rebecca B. Yarrison ◽  
Andrew Bernard
Keyword(s):  
Ethical Issues ◽  
Solid Organ Transplantation ◽  
Organ Donor ◽  
Time Frame ◽  
Solid Organ ◽  
Organ Donors ◽  
Life Saving ◽  
Decompressive Laparotomy ◽  
End Stage ◽  
Aggressive Interventions

Solid organ transplantation has emerged as a life-saving treatment for many patients suffering from end-stage organ failure. Organs have been successfully recovered after a variety of aggressive interventions. We propose that decompressive laparotomy, when clinically indicated, should be considered in the aggressive resuscitation of potential organ donors. A thorough literature review examining aggressive interventions on potential organ donors was conducted after experience with a unique case at this institution. Articles were reviewed for the types of interventions performed as well as the time frame in relation to organ donation. In our case, several ethical issues were raised when considering decompressive laparotomy in a patient pronounced dead by neurologic criteria. We propose that having a surgical intensivist involved in the management of potential donors will further increase the salvage rate, as more invasive resuscitation options are possible.

scholarly journals Transplant Critical Care: Is There A Need for Sub-specialized Units? — A Perspective

2018 ◽  
Vol 4 (3) ◽  
pp. 83-89
Author(s):  
Sujit Vijay Sakpal ◽  
Suresh Kumar Agarwal ◽  
Hector Saucedo-Crespo ◽  
Christopher Auvenshine ◽  
Robert N. Santella ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Solid Organ Transplantation ◽  
Multidisciplinary Care ◽  
Solid Organ ◽  
Operative Morbidity ◽  
Critical Care Units ◽  
Contemporary Perspective ◽  
End Stage

Abstract The critical care involved in solid-organ transplantation (SOT) is complex. Pre-, intra- and post-transplant care can significantly impact both – patients’ ability to undergo SOT and their peri-operative morbidity and mortality. Much of the care necessary for medical optimization of end-stage organ failure (ESOF) patients to qualify and then successfully undergo SOT, and the management of peri-operative and/or long-term complications thereafter occurs in an intensive care unit (ICU) setting. The current literature specific to critical care in abdominal SOT patients was reviewed. This paper provides a contemporary perspective on the potential multifactorial advantages of sub-specialized transplant critical care units in providing efficient, comprehensive, and collaborative multidisciplinary care.

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.

High-Risk Kidney Transplantation

2019 ◽  
pp. 449-458
Author(s):  
Ilias P. Gomatos ◽  
Susan Lerner ◽  
Madhav C. Menon
Keyword(s):  
High Risk ◽  
End Stage Renal Disease ◽  
Solid Organ Transplantation ◽  
Surgical Techniques ◽  
Solid Organ ◽  
Antiviral Therapies ◽  
Stage Renal Disease ◽  
End Stage

Outcomes after solid organ transplantation have improved dramatically with the development of better surgical techniques and effective therapies for rejection. As a result, higher numbers of end-stage renal disease patients with hepatitis C, HIV, cardiovascular disease, and pretransplant tumor history are listed for a potential kidney transplant, posing increasing challenges for the transplant team. Modifying cardiovascular risk factors while awaiting or after transplantation, novel antiviral therapies, close follow-up, and tailored management of posttransplant malignancies are imperative to further improve long-term graft and patient survival in high-risk kidney transplants.

Cell Therapy in Solid Organ Transplantation

2019 ◽  
Vol 19 (2) ◽  
pp. 71-80 ◽  
Author(s):  
Songjie Cai ◽  
Anil Chandraker
Keyword(s):  
Cell Therapy ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Suppressor Cells ◽  
Immunosuppressive Drugs ◽  
Solid Organ ◽  
Antigen Specificity ◽  
Tolerogenic Dendritic Cells ◽  
End Stage ◽  
Risk Of Cancer

Transplantation is the only cure for end-stage organ failure. Current immunosuppressive drugs have two major limitations: 1) non antigen specificity, which increases the risk of cancer and infection diseases, and 2) chronic toxicity. Cell therapy appears to be an innovative and promising strategy to minimize the use of immunosuppression in transplantation and to improve long-term graft survival. Preclinical studies have shown efficacy and safety of using various suppressor cells, such as regulatory T cells, regulatory B cells and tolerogenic dendritic cells. Recent clinical trials using cellbased therapies in solid organ transplantation also hold out the promise of improving efficacy. In this review, we will briefly go over the rejection process, current immunosuppressive drugs, and the potential therapeutic use of regulatory cells in transplantation.

Darmtransplantatie: van een experimentele procedure tot een levensreddende behandelingsoptie voor patiënten met gecompliceerd darmfalen

2021 ◽  
Author(s):  
L.J. CEULEMANS ◽  
T. VANUYTSEL ◽  
E. CANOVAI ◽  
M. HIELE ◽  
D. MONBALIU ◽  
...  
Keyword(s):  
Small Bowel Transplantation ◽  
Solid Organ Transplantation ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Long Term Results ◽  
Solid Organ ◽  
Life Saving ◽  
Life Threatening ◽  
International Data

Bowel transplantation: from an experimental procedure to a life-saving treatment option for patients with complicated bowel failure Intestinal transplantation is the rarest form of solid organ transplantation, probably due to the important immunobiological challenges linked to the procedure, resulting in the need for high levels of immunosuppression and in life-threatening complications like infections, malignancies and renal failure. These factors explain the poor long-term results after small bowel transplantation and the fact that this procedure has always been reserved as the sole life-saving option for patients with severely complicated intestinal failure due to loss of vascular access, infections, or liver failure induced by total parenteral nutrition. In the last decade, an improvement in patient survival and prevention of rejection is observed. This is the result of a better understanding of the immune response and the development of immunomodulatory protocols, like the Leuven protocol, that aims to lower the level of immunosuppression. This review summarizes the current experience and the most recent evolutions in the field of bowel transplantation, describes the Leuven and the Belgian results and compares them to the international data.

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.

Sign in / Sign up

Export Citation Format

Share Document