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Best Practice & Research. Clinical... 2021
Topics: Gastroenterology; Gastrointestinal Tract; Humans; Immunosuppression Therapy
PubMed: 34874847
DOI: 10.1016/j.bpg.2021.101766 -
Nature Immunology Nov 2022
Topics: Humans; Immunosuppression Therapy; Immune Tolerance; Immunologic Deficiency Syndromes; Immunosuppressive Agents
PubMed: 36333609
DOI: 10.1038/s41590-022-01362-4 -
Best Practice & Research. Clinical... 2021In recent years, the clinician has a more diverse approach to immunosuppression. Now, for many conditions, such as solid organ transplantation or treatment of some... (Review)
Review
In recent years, the clinician has a more diverse approach to immunosuppression. Now, for many conditions, such as solid organ transplantation or treatment of some autoimmune diseases, the consequences of immunosuppression becomes a greater risk than organ failure from immune-mediated disease. Some of the consequences of immunosuppression can be prevented by prophylaxis, immunisation, surveillance and pharmacological intervention. Infections and malignancy are major causes of morbidity and mortality in the immunosuppressed. Screening for evidence of latent infection and immunisation prior to introduction of immunosuppression (where possible and appropriate) will help reduce the risk of infection. Surveillance for those cancers that are increased in association with immunosuppression (especially skin cancers, melanoma, anal canal, Kaposi, post-transplant lymphoproliferative disease) will allow early detection and intervention and, where appropriate, alteration of agent.
Topics: Gastroenterology; Humans; Immune Tolerance; Immunosuppression Therapy; Organ Transplantation; Skin Neoplasms
PubMed: 34874842
DOI: 10.1016/j.bpg.2021.101758 -
Gastroenterology Nov 2020
Topics: Frailty; Humans; Immunosuppression Therapy; Inflammatory Bowel Diseases
PubMed: 32946899
DOI: 10.1053/j.gastro.2020.07.062 -
Best Practice & Research. Clinical... Nov 2014Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during... (Review)
Review
Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during pregnancy and breast-feeding. This article reviews case and series reports regarding breast-feeding in those taking transplant medications. Avoidance of breast-feeding has been the customary advice because of the potential adverse effects of immunosuppressive exposure on the infant. Subsequent studies have demonstrated that not all medication exposure translates to risk for the infant, that the exposure in utero is greater than via breast milk and that no lingering effects due to breast-feeding have been found to date in infants who were breast-fed while their mothers were taking prednisone, azathioprine, cyclosporine, and/or tacrolimus. Thus, except for those medications where clinical information is inadequate (mycophenolic acid products, sirolimus, everolimus, and belatacept), the recommendation for transplant recipients regarding breast-feeding has evolved into one that is cautiously optimistic.
Topics: Breast Feeding; Evidence-Based Medicine; Female; Guidelines as Topic; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Infant; Infant, Newborn; Milk, Human; Organ Transplantation; Pregnancy; Risk Factors
PubMed: 25271063
DOI: 10.1016/j.bpobgyn.2014.09.001 -
Clinical Journal of the American... Dec 2021Cardiovascular disease remains a leading cause of death and morbidity in kidney transplant recipients and a common reason for post-transplant hospitalization. Several...
Cardiovascular disease remains a leading cause of death and morbidity in kidney transplant recipients and a common reason for post-transplant hospitalization. Several traditional and nontraditional cardiovascular risk factors exist, and many of them present pretransplant and worsened, in part, due to the addition of immunosuppression post-transplant. We discuss optimal strategies for identification and treatment of these risk factors, including the emerging role of sodium-glucose cotransporter 2 inhibitors in post-transplant diabetes and cardiovascular disease. We present common types of cardiovascular disease observed after kidney transplant, including coronary artery disease, heart failure, pulmonary hypertension, arrhythmia, and valvular disease. We also discuss screening, treatment, and prevention of post-transplant cardiac disease. We highlight areas of future research, including the need for goals and best medications for risk factors, the role of biomarkers, and the role of screening and intervention.
Topics: Humans; Cardiovascular Diseases; Diabetes Mellitus; Risk Factors; Kidney Transplantation; Immunosuppression Therapy
PubMed: 34556500
DOI: 10.2215/CJN.00520121 -
The Nursing Clinics of North America Dec 2018Current donor pool utilization is unable to meet the high demand for kidney transplants. Donor pool expansion using expanded-criteria donors and dual kidney... (Review)
Review
Current donor pool utilization is unable to meet the high demand for kidney transplants. Donor pool expansion using expanded-criteria donors and dual kidney transplantation are viable options. Advances in diagnosing antibody-mediated rejection and targeting immunosuppression increase long-term transplantation success. Further exploration of minimally invasive surgical techniques, kidney bioengineering, and artificial-implantable renal devices hold promise for the future.
Topics: Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Transplantation; Minimally Invasive Surgical Procedures; Robotic Surgical Procedures; Tissue Donors
PubMed: 30388978
DOI: 10.1016/j.cnur.2018.07.003 -
Cells Oct 2023Type 1 Diabetes (T1D) is an autoimmune destruction of pancreatic beta cells. The development of the Edmonton Protocol for islet transplantation in 2000 revolutionized... (Review)
Review
Type 1 Diabetes (T1D) is an autoimmune destruction of pancreatic beta cells. The development of the Edmonton Protocol for islet transplantation in 2000 revolutionized T1D treatment and offered a glimpse at a cure for the disease. In 2022, the 20-year follow-up findings of islet cell transplantation demonstrated the long-term safety of islet cell transplantation despite chronic immunosuppression. The Edmonton Protocol, however, remains limited by two obstacles: scarce organ donor availability and risks associated with chronic immunosuppression. To overcome these challenges, the search has begun for an alternative cell source. In 2006, pluripotency genomic factors, coined "Yamanaka Factors," were discovered, which reprogram mature somatic cells back to their embryonic, pluripotent form (iPSC). iPSCs can then be differentiated into specialized cell types, including islet cells. This discovery has opened a gateway to a personalized medicine approach to treating diabetes, circumventing the issues of donor supply and immunosuppression. In this review, we present a brief history of allogenic islet cell transplantation from the early days of pancreatic remnant transplantation to present work on encapsulating stem cell-derived cells. We review data on long-term outcomes and the ongoing challenges of allogenic islet cell and stem cell-derived islet cell transplant.
Topics: Humans; Islets of Langerhans Transplantation; Diabetes Mellitus, Type 1; Islets of Langerhans; Insulin-Secreting Cells; Immunosuppression Therapy
PubMed: 37887267
DOI: 10.3390/cells12202423 -
Current Opinion in Organ Transplantation Dec 2017Cardiac xenotransplantation has entered an exciting era, marked by numerous considerable advances in the field, and continues to be of great interest because of its... (Review)
Review
PURPOSE OF REVIEW
Cardiac xenotransplantation has entered an exciting era, marked by numerous considerable advances in the field, and continues to be of great interest because of its potential ability in ameliorating the current constraints of limited allograft availability. This review aims to examine recent progress in this rapidly changing discipline.
RECENT FINDINGS
Although several hurdles remain, the use of rapidly evolving transgenic technology, in combination with novel immunosuppression regimens, has the potential to address current allogenic donor pool constraints and mechanical circulatory system device limitations. Furthermore, innovative uses of biomarker tools, such as miRNA, serve as a method for improved monitoring of xenograft status. These tools may allow for more targeted immunosuppressive strategies as well as earlier interventions to mitigate xenograft rejection. Finally, coinciding with these remarkable advances, preliminary consideration of the clinical application for cardiac xenotransplantation has begun, particularly regarding specific patient criteria for these initial clinical trials.
SUMMARY
The studies in this review highlight efforts in multiple disciplines to optimize perioperative and postxenotransplant outcomes. In examining these individual topics, this article reflects the exciting and ongoing progress in the field of cardiac xenotransplantation.
Topics: Animals; Graft Survival; Heart Transplantation; Humans; Immunosuppression Therapy; Transplantation, Heterologous
PubMed: 29099728
DOI: 10.1097/MOT.0000000000000461 -
British Journal of Anaesthesia Mar 2024Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) is a clinical endotype of chronic critical illness. PICS consists of a self-perpetuating cycle... (Review)
Review
Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) is a clinical endotype of chronic critical illness. PICS consists of a self-perpetuating cycle of ongoing organ dysfunction, inflammation, and catabolism resulting in sarcopenia, immunosuppression leading to recurrent infections, metabolic derangements, and changes in bone marrow function. There is heterogeneity regarding the definition of PICS. Currently, there are no licensed treatments specifically for PICS. However, findings can be extrapolated from studies in other conditions with similar features to repurpose drugs, and in animal models. Drugs that can restore immune homeostasis by stimulating lymphocyte production could have potential efficacy. Another treatment could be modifying myeloid-derived suppressor cell (MDSC) activation after day 14 when they are immunosuppressive. Drugs such as interleukin (IL)-1 and IL-6 receptor antagonists might reduce persistent inflammation, although they need to be given at specific time points to avoid adverse effects. Antioxidants could treat the oxidative stress caused by mitochondrial dysfunction in PICS. Possible anti-catabolic agents include testosterone, oxandrolone, IGF-1 (insulin-like growth factor-1), bortezomib, and MURF1 (muscle RING-finger protein-1) inhibitors. Nutritional support strategies that could slow PICS progression include ketogenic feeding and probiotics. The field would benefit from a consensus definition of PICS using biologically based cut-off values. Future research should focus on expanding knowledge on underlying pathophysiological mechanisms of PICS to identify and validate other potential endotypes of chronic critical illness and subsequent treatable traits. There is unlikely to be a universal treatment for PICS, and a multimodal, timely, and personalised therapeutic strategy will be needed to improve outcomes for this growing cohort of patients.
Topics: Animals; Humans; Critical Illness; Syndrome; Immunosuppression Therapy; Inflammation; Chronic Disease; Research
PubMed: 38177003
DOI: 10.1016/j.bja.2023.11.052