Immunosuppression for the Transplant Surgical Patient

2020 ◽  
Author(s):  
Bharath R. Ravichandran ◽  
Tracy M. Sparkes ◽  
Jillian P. Casale ◽  
Sara Hammad ◽  
Jacqueline E. Clark ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Clinical Status ◽  
Solid Organ Transplantation ◽  
Patient Specific ◽  
Surgical Patient ◽  
Solid Organ ◽  
Key Words Immunosuppression ◽  
Related Factors ◽  
Therapeutic Goals ◽  
Patient’S History

Immunosuppression brings with it many additional challenges in the management of the surgical patient already fraught with complexity. Given advances in surgery and medicine, transplantation has become a therapeutic option for patients once considered too ill. In the medical management of these patients, it is always most important to take into account the clinical status of the patient to balance the risk of infection and rejection. The management of immunosuppression in the surgical patient is challenging depending on the clinical scenario. In addition to patient-specific factors, there are many medication-related factors to consider, including toxicity, interactions, and pharmacokinetics. It is always important to consult a transplant specialist prior to initiating or reinitiating immunosuppression in these patients as the therapeutic goals are likely to be modified. Additionally, consideration of the patient’s history as it pertains to infection, rejection, and malignancy is highly pertinent in their immunosuppression management. Appropriate management and augmentation of immunosuppression are critical to the success of these patients, both at the time of transplantation and in the years that follow. The goal of this review is to provide a basis for the understanding of the complexities of immunosuppression in the surgical transplant patient. This review contains 5 figures, 7 tables, and 54 references.  Key Words: immunosuppression; infection; rejection; solid-organ transplantation

The Immunocompromised Surgical Patient

2015 ◽  
Author(s):  
Rhiannon Deierhoi Reed ◽  
Brittany Shelton ◽  
Jayme E. Locke
Keyword(s):  
Opportunistic Infections ◽  
Solid Organ Transplantation ◽  
Cancer Recurrence ◽  
Preoperative Assessment ◽  
The United States ◽  
Surgical Patient ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Suspected Infection ◽  
Management Algorithms

General surgeons are encountering an increasing number of cases involving immunosuppressed patients due to a number of factors, including the improvement in treatment for HIV, increased survival following solid-organ transplantation, and more aggressive chemotherapy. These groups of patients present unique challenges for the surgeon and often require more comprehensive preoperative assessment and perioperative monitoring. This review addresses the surgical management of these immunocompromised populations, with specific recommendations for each type of patient. Tables outline opportunistic infections and antibiotic prophylaxis; common immunosuppressive medications, posttransplantation drug levels, and side effects for renal transplant recipients; components of preoperative workup involving suspected infection in immunocompromised patients; and anesthetics and demonstrated impact on immune response and cancer recurrence. Graphs display the number of AIDS diagnoses and deaths and people living with AIDS and HIV in the United States over time, and compare percentages of death certificates reporting opportunistic infection versus chronic disease in the HIV-infected population. Management algorithms outline approaches to patients with defects in host defenses and candidates for transplantation to be deliberately immunosuppressed. This review contains 2 graphs, 2 management algorithms, 4 tables, 157 references, and 5 annotated key references.

The Immunocompromised Surgical Patient

2015 ◽  
Author(s):  
Rhiannon Deierhoi Reed ◽  
Brittany Shelton ◽  
Jayme E. Locke
Keyword(s):  
Opportunistic Infections ◽  
Solid Organ Transplantation ◽  
Cancer Recurrence ◽  
Preoperative Assessment ◽  
The United States ◽  
Surgical Patient ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Suspected Infection ◽  
Management Algorithms

General surgeons are encountering an increasing number of cases involving immunosuppressed patients due to a number of factors, including the improvement in treatment for HIV, increased survival following solid-organ transplantation, and more aggressive chemotherapy. These groups of patients present unique challenges for the surgeon and often require more comprehensive preoperative assessment and perioperative monitoring. This review addresses the surgical management of these immunocompromised populations, with specific recommendations for each type of patient. Tables outline opportunistic infections and antibiotic prophylaxis; common immunosuppressive medications, posttransplantation drug levels, and side effects for renal transplant recipients; components of preoperative workup involving suspected infection in immunocompromised patients; and anesthetics and demonstrated impact on immune response and cancer recurrence. Graphs display the number of AIDS diagnoses and deaths and people living with AIDS and HIV in the United States over time, and compare percentages of death certificates reporting opportunistic infection versus chronic disease in the HIV-infected population. Management algorithms outline approaches to patients with defects in host defenses and candidates for transplantation to be deliberately immunosuppressed. This review contains 2 graphs, 2 management algorithms, 4 tables, 157 references, and 5 annotated key references.

Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation

2019 ◽  
Vol 28 (3) ◽  
pp. 450-462 ◽  
Author(s):  
MICHELLE W. MCQUINN ◽  
LAURA L. KIMBERLY ◽  
BRENDAN PARENT ◽  
J. RODRIGO DIAZ-SISO ◽  
ARTHUR L. CAPLAN ◽  
...  
Keyword(s):  
Patient Selection ◽  
Gunshot Wound ◽  
Selection Process ◽  
Therapeutic Option ◽  
Solid Organ Transplantation ◽  
Significant Risk ◽  
Gunshot Wounds ◽  
Solid Organ ◽  
Facial Transplantation ◽  
Overall Evaluation

Abstract:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation.

scholarly journals Infections in solid-organ transplant recipients.

1997 ◽  
Vol 10 (1) ◽  
pp. 86-124 ◽  
Author(s):  
R Patel ◽  
C V Paya
Keyword(s):  
Organ Transplantation ◽  
Bacterial Infections ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Therapeutic Option ◽  
Solid Organ Transplantation ◽  
Mycelial Fungi ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Salmonella Spp

Solid-organ transplantation is a therapeutic option for many human diseases. Infections are a major complication of solid-organ transplantation. All candidates should undergo a thorough infectious-disease screening prior to transplantation. There are three time frames, influenced by surgical factors, the level of immunosuppression, and environmental exposures, during which infections of specific types most frequently occur posttransplantation. Most infections during the first month are related to surgical complications. Opportunistic infections typically occur from the second to the sixth month. During the late posttransplant period (beyond 6 months), transplantation recipients suffer from the same infections seen in the general community. Opportunistic bacterial infections seen in transplant recipients include those caused by Legionella spp., Nocardia spp., Salmonella spp., and Listeria monocytogenes. Cytomegalovirus is the most common cause of viral infections. Herpes simplex virus, varicella-zoster virus, Epstein-Barr virus and others are also significant pathogens. Fungal infections, caused by both yeasts and mycelial fungi, are associated with the highest mortality rates. Mycobacterial, pneumocystis, and parasitic diseases may also occur.

The Immunocompromised Surgical Patient

2017 ◽  
Author(s):  
Rhiannon Deierhoi Reed ◽  
Brittany Shelton ◽  
Jayme E. Locke
Keyword(s):  
Opportunistic Infections ◽  
Solid Organ Transplantation ◽  
Cancer Recurrence ◽  
Preoperative Assessment ◽  
The United States ◽  
Surgical Patient ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Suspected Infection ◽  
Management Algorithms

General surgeons are encountering an increasing number of cases involving immunosuppressed patients due to a number of factors, including the improvement in treatment for HIV, increased survival following solid-organ transplantation, and more aggressive chemotherapy. These groups of patients present unique challenges for the surgeon and often require more comprehensive preoperative assessment and perioperative monitoring. This review addresses the surgical management of these immunocompromised populations, with specific recommendations for each type of patient. Tables outline opportunistic infections and antibiotic prophylaxis; common immunosuppressive medications, posttransplantation drug levels, and side effects for renal transplant recipients; components of preoperative workup involving suspected infection in immunocompromised patients; and anesthetics and demonstrated impact on immune response and cancer recurrence. Graphs display the number of AIDS diagnoses and deaths and people living with AIDS and HIV in the United States over time, and compare percentages of death certificates reporting opportunistic infection versus chronic disease in the HIV-infected population. Management algorithms outline approaches to patients with defects in host defenses and candidates for transplantation to be deliberately immunosuppressed. This review contains 2 graphs, 2 management algorithms, 4 tables, 157 references, and 5 annotated key references.

Hand Transplantation: The State-of-the-Art

2007 ◽  
Vol 32 (1) ◽  
pp. 2-17 ◽  
Author(s):  
F. SCHUIND ◽  
D. ABRAMOWICZ ◽  
S. SCHNEEBERGER
Keyword(s):  
State Of The Art ◽  
Therapeutic Option ◽  
Graft Loss ◽  
Solid Organ Transplantation ◽  
Psychological Status ◽  
Solid Organ ◽  
Psychological Benefits ◽  
Hand Transplantation ◽  
Key Issues ◽  
Specific Tolerance

The feasibility of hand transplantation has been demonstrated, both surgically and immunologically. Levels of immunosuppression comparable to regimens used in solid organ transplantation are proving sufficient to prevent graft loss. Many patients have achieved discriminative sensibility and recovery of intrinsic muscle function. In addition to restoration of function, hand transplantation offers considerable psychological benefits. The recipient’s pre-operative psychological status, his motivation and his compliance with the intense rehabilitation programme are key issues. While the induction of graft specific tolerance represents a hope for the future, immunosuppression currently remains necessary and carries significant risks. Hand transplantation should, therefore, only be considered a therapeutic option for a carefully selected group of patients.

scholarly journals Clinical Manifestations and Outcomes in Immunocompetent and Immunocompromised Patients With Blastomycosis

2020 ◽  
Author(s):  
Joseph A McBride ◽  
Alana K Sterkel ◽  
Eduard Matkovic ◽  
Aimee T Broman ◽  
Suzanne N Gibbons-Burgener ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Clinical Features ◽  
Solid Organ Transplantation ◽  
Clinical Manifestations ◽  
Severe Infection ◽  
Immune Defense ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Dimorphic Fungus ◽  
Related Factors

Abstract Background Blastomyces is a dimorphic fungus that infects persons with or without underlying immunocompromise. To date, no study has compared the clinical features and outcomes of blastomycosis between immunocompromised and immunocompetent persons. Methods A retrospective study of adult patients with proven blastomycosis from 2004–2016 was conducted at the University of Wisconsin. Epidemiology, clinical features, and outcomes were analyzed among solid-organ transplantation (SOT) recipients, persons with non-SOT immunocompromise (non-SOT IC), and persons with no immunocompromise (NIC). Results A total of 106 cases met the inclusion criteria including 74 NIC, 19 SOT, and 13 non-SOT IC (malignancy, HIV/AIDS, idiopathic CD4+ lymphopenia). The majority of patients (61.3%) had at least 1 epidemiologic risk factor for acquisition of Blastomyces. Pneumonia was the most common manifestation in all groups; however, immunocompromised patients had higher rates of acute pulmonary disease (P = .03), more severe infection (P = .007), respiratory failure (P = .010), and increased mortality (P = .02). Receipt of SOT primarily accounted for increased severity, respiratory failure, and mortality in immunosuppressed patients. SOT recipients had an 18-fold higher annual incidence of blastomycosis than the general population. The rate of disseminated blastomycosis was similar among NIC, SOT, and non-SOT IC. Relapse rates were low (5.3–7.7%). Conclusions Immunosuppression had implications regarding the acuity, severity, and respiratory failure. The rate of dissemination was similar across the immunologic spectrum, which is in sharp contrast to other endemic fungi. This suggests that pathogen-related factors have a greater influence on dissemination for blastomycosis than immune defense.

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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