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Einstein (Sao Paulo, Brazil) 2015Heart transplantation is currently the definitive gold standard surgical approach in the treatment of refractory heart failure. However, the shortage of donors limits... (Review)
Review
Heart transplantation is currently the definitive gold standard surgical approach in the treatment of refractory heart failure. However, the shortage of donors limits the achievement of a greater number of heart transplants, in which the use of mechanical circulatory support devices is increasing. With well-established indications and contraindications, as well as diagnosis and treatment of rejection through defined protocols of immunosuppression, the outcomes of heart transplantation are very favorable. Among early complications that can impact survival are primary graft failure, right ventricular dysfunction, rejection, and infections, whereas late complications include cardiac allograft vasculopathy and neoplasms. Despite the difficulties for heart transplantation, in particular, the shortage of donors and high mortality while on the waiting list, in Brazil, there is a great potential for both increasing effective donors and using circulatory assist devices, which can positively impact the number and outcomes of heart transplants.
Topics: Brazil; Chagas Cardiomyopathy; Graft Rejection; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Immunosuppression Therapy; Neoplasms; Opportunistic Infections; Postoperative Complications; Primary Graft Dysfunction; Tissue Donors
PubMed: 26154552
DOI: 10.1590/S1679-45082015RW3154 -
Nature Reviews. Immunology Nov 2019
Topics: Immunosuppression Therapy; Skin
PubMed: 31467404
DOI: 10.1038/s41577-019-0216-6 -
Dermatologic Clinics Jan 2023Patients with immunosuppressive conditions experience an increased frequency and severity of cutaneous malignancies. This article highlights management of keratinocyte... (Review)
Review
Patients with immunosuppressive conditions experience an increased frequency and severity of cutaneous malignancies. This article highlights management of keratinocyte carcinoma, melanoma, Merkel cell carcinoma, and Kaposi sarcoma in the setting of lymphoproliferative disorders, acquired immunodeficiencies, and organ transplantation. Advances in the safety of organ transplant recipient immunosuppression, early identification of risk factors, and new targeted therapies are improving skin cancer outcomes in immunocompromised populations.
Topics: Humans; Immunocompromised Host; Skin; Skin Neoplasms; Carcinoma, Merkel Cell; Immunosuppression Therapy
PubMed: 36410975
DOI: 10.1016/j.det.2022.07.012 -
Kidney360 Dec 2022
Topics: Immunosuppression Therapy; Immunosuppressive Agents
PubMed: 36591358
DOI: 10.34067/KID.0005652022 -
Multiple Sclerosis and Related Disorders May 2020Prolonged and significant alterations of the immune system by immunosuppression makes multiple sclerosis (MS) patients susceptible to opportunistic infections and... (Review)
Review
IMPORTANCE
Prolonged and significant alterations of the immune system by immunosuppression makes multiple sclerosis (MS) patients susceptible to opportunistic infections and malignancies over long periods of treatment.
OBSERVATIONS
A reasonable clinical and practical definition of immunosuppression is a temporary or permanent alteration of the body's immune system and subsequent lack of ability to fight infections and malignancies. Immunosurveillance is the sine qua non of the immune system. Immunosurveillance is the constant process by which the immune system looks for and recognizes foreign pathogens such as bacteria and viruses or pre-cancerous or cancerous cells in the body. Immunomodulation (a decrease or increase in pitch or tone - in this case a decrease) maintains immunosurveillance. Immunosuppression (quashing, stamping out) impedes immunosurveillance by one mechanism or another. Immunosuppressive agents need to be administered continually in order to maintain effectiveness. In contrast, immune reconstitution therapies (IRTs) are short course agents that are initially immunosuppressive but ultimately immunomodulatory and can provide significant decreased disease activity over time without retreatment.
CONCLUSIONS AND RELEVANCE
The goal of disease modifying therapies in MS is effectiveness over long periods of time with minimal risk. The preservation, reduction or elimination of immunosurveillance should be an important consideration in deciding on the optimal disease modifying treatments (DMT) for an individual MS patient. IRTs have the advantage of providing long term control of disease activity with short term immunosuppression followed by long term immunomodulation without retreatment. For most MS patients with mild or modest disease activity, initial immunomodulation followed by IRT for breakthrough disease may be the best option. In MS, immunosuppression may be passé.
Topics: Humans; Immune System; Immunologic Factors; Immunosuppression Therapy; Multiple Sclerosis
PubMed: 32007655
DOI: 10.1016/j.msard.2020.101967 -
Transplantation Reviews (Orlando, Fla.) Dec 2023Kidney transplant (KT) recipients of HLA identical siblings (HLAid) have lower immunological risk, but there are no specific recommendations for immunosuppression. Our... (Review)
Review
BACKGROUND
Kidney transplant (KT) recipients of HLA identical siblings (HLAid) have lower immunological risk, but there are no specific recommendations for immunosuppression. Our aim was to analyze evidence about results from HLAid living-donor recipients under different immunosuppression in the current era of immunological risk assessment.
METHODS
Systematic review of studies describing associations between outcomes of HLAid living-donor KT recipients according to their immunological risk and applied immunosuppression.
RESULTS
From 1351 studies, 16 (5636 KT recipients) were included in the analysis. All studies were retrospective, ten comparing immunosuppression strategies, and six immunological risk strata. Of those ten, six studies were published in 1990 or earlier and only three included tacrolimus. The evidence is poor, and the inclusion of calcineurin inhibitors does not demonstrate better results. Furthermore, only few studies describe different immunosuppression regimens according to the patient immunological risk and, in general, they do not include the assessment with new solid phase assays.
CONCLUSIONS
There are no studies analyzing the association of outcomes of HLAid KT recipients with current immunological risk tools. In the absence of evidence, no decision or proposal of immunosuppression adapted to modern immunological risk assessment can be made currently by the Descartes Working Group.
Topics: Humans; Kidney Transplantation; Living Donors; Retrospective Studies; Graft Survival; Graft Rejection; Immunosuppression Therapy; Transplant Recipients; Immunosuppressive Agents; HLA Antigens
PubMed: 37657355
DOI: 10.1016/j.trre.2023.100787 -
Hematology/oncology and Stem Cell... Dec 2017Allotransplantation cures patients by cytoreduction and the graft-versus-tumor (leukemia; graft-versus-leukemia [GVL]) alloresponse; both eliminate residual disease. The... (Review)
Review
Allotransplantation cures patients by cytoreduction and the graft-versus-tumor (leukemia; graft-versus-leukemia [GVL]) alloresponse; both eliminate residual disease. The spectrum of conditioning intensity influences toxicities and non-relapse mortality. The spectrum of tumor sensitivity to the GVL response influences relapse. Balancing tolerable toxicities (influenced by patients' performance status and comorbidities) is also influenced by the graft. Intense immunosuppression (for engraftment and graft-versus-host disease prevention) may constrain the immunologic potency of the graft and limit the antineoplastic capacity of the transplant, thus requiring more intense or more effective conditioning regimens to limit the risks of relapse and permit satisfactory disease-free survival.
Topics: Allografts; Graft Survival; Graft vs Host Disease; Graft vs Tumor Effect; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppression Therapy; Neoplasms; Transplantation Conditioning
PubMed: 28641099
DOI: 10.1016/j.hemonc.2017.05.002 -
Xenotransplantation Sep 2018There is currently a significant disparity between the number of patients who need lifesaving transplants and the number of donated human organs. Xenotransplantation is... (Review)
Review
There is currently a significant disparity between the number of patients who need lifesaving transplants and the number of donated human organs. Xenotransplantation is a way to address this disparity and attempts to enable the use of xenogeneic tissues have persisted for centuries. While immunologic incompatibilities have presented a persistent impediment to their use, encapsulation may represent a way forward for the use of cell-based xenogeneic therapeutics without the need for immunosuppression. In conjunction with modern innovations such as the use of bioprinting, incorporation of immune modulating molecules into capsule membranes, and genetic engineering, the application of xenogeneic cells to treat disorders ranging from pain to liver failure is becoming increasingly realistic. The present review discusses encapsulation in the context of xenotransplantation, focusing on the current status of clinical trials, persistent issues such as antigen shedding, oxygen availability, and donor selection, and recent developments that may address these limitations.
Topics: Animals; Graft Survival; Humans; Immune Tolerance; Immunosuppression Therapy; Tissue and Organ Procurement; Transplantation, Heterologous; Transplants
PubMed: 29732615
DOI: 10.1111/xen.12399 -
Current Opinion in Pharmacology Aug 2017
Topics: Antineoplastic Agents; Humans; Immunosuppression Therapy; Myeloid Cells; Neoplasms; Tumor Microenvironment
PubMed: 29241832
DOI: 10.1016/j.coph.2017.11.002 -
The Veterinary Quarterly Dec 2023Certain pathogens, due to their adverse effects on the immune reaction, aggravate the course of concomitant heterologous infections. Here we summarize mechanisms by... (Review)
Review
Certain pathogens, due to their adverse effects on the immune reaction, aggravate the course of concomitant heterologous infections. Here we summarize mechanisms by which circoviruses, including the most studied porcine circovirus 2, and other mammalian and avian circoviruses, trigger their own replication and confound the hosts' immune response. At different stages of infection, from latent state to disease induction, these viruses markedly influence the cellular signaling pathways. Circoviruses have been found to interfere with interferon and proinflammatory cytokine producing and responsive pathways. Apoptotic processes, altered cellular transport and constraint of the mitotic phase all support the viral replication. The cytokine imbalance and lymphocyte depletion, thus the impaired immunity, favors invasion of super- or co-infecting agents, which in concert with circoviruses induce illnesses with increased severity. The information summarized in this review point out the diversity of host and viral factors involved in the mechanisms of disease progression during circovirus infections.
Topics: Swine; Animals; Circovirus; Circoviridae Infections; Virus Replication; Immunosuppression Therapy; Cytokines; Swine Diseases; Mammals
PubMed: 37431709
DOI: 10.1080/01652176.2023.2234430