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Frontiers in Endocrinology 2023Post-transplant diabetes mellitus (PTDM) is a common complication among cardiac transplant recipients, causing diabetes-related complications and death. While certain...
INTRODUCTION
Post-transplant diabetes mellitus (PTDM) is a common complication among cardiac transplant recipients, causing diabetes-related complications and death. While certain maintenance immunosuppressive drugs increase PTDM risk, it is unclear whether induction immunosuppression can do the same. Therefore, we evaluated whether induction immunosuppression with IL-2 receptor antagonists, polyclonal anti-lymphocyte antibodies, or Alemtuzumab given in the peri-transplant period is associated with PTDM.
METHODS
We used the Scientific Registry of Transplant Recipients database to conduct a cohort study of US adults who received cardiac transplants between January 2008-December 2018. We excluded patients with prior or multiple organ transplants and those with a history of diabetes, resulting in 17,142 recipients. We created propensity-matched cohorts (n=7,412) using predictors of induction immunosuppression and examined the association between post-transplant diabetes and induction immunosuppression by estimating hazard ratios using Cox proportional-hazards models.
RESULTS
In the propensity-matched cohort, the average age was 52.5 (SD=13.2) years, 28.7% were female and 3,706 received induction immunosuppression. There were 867 incident cases of PTDM during 26,710 person-years of follow-up (32.5 cases/1,000 person-years). There was no association between induction immunosuppression and post-transplant diabetes (Hazard Ratio= 1.04, 95% confidence interval 0.91 - 1.19). Similarly, no associations were observed for each class of induction immunosuppression agents and post-transplant diabetes.
CONCLUSION
The use of contemporary induction immunosuppression in cardiac transplant patients was not associated with post-transplant diabetes.
Topics: Adult; Humans; Female; Middle Aged; Male; Cohort Studies; Immunosuppressive Agents; Immunosuppression Therapy; Antilymphocyte Serum; Diabetes Mellitus
PubMed: 37929038
DOI: 10.3389/fendo.2023.1248940 -
Best Practice & Research. Clinical... Nov 2014The clinical literature notes that pregnancy has become an expected benefit of solid organ transplant. Establishing "best practices" in the management of this particular...
The clinical literature notes that pregnancy has become an expected benefit of solid organ transplant. Establishing "best practices" in the management of this particular transplant population requires careful consideration of the ethical dimensions, broadly speaking, of posttransplant pregnancies and these women's lived experiences. In this article, we present the current clinical and social science posttransplant pregnancy research. We specifically address the psychosocial and ethical issues surrounding preconception counseling and posttransplant health quality of life and mothering and suggest areas for future research.
Topics: Female; Humans; Immunosuppression Therapy; Monitoring, Physiologic; Organ Transplantation; Preconception Care; Pregnancy; Pregnancy, High-Risk; Quality of Life; Women's Health
PubMed: 25151472
DOI: 10.1016/j.bpobgyn.2014.07.016 -
Veterinary Journal (London, England :... Aug 2015Surgical removal of primary tumours can help in the treatment of cancer but carries the risk of triggering the proliferation of dormant micrometastases. Many... (Review)
Review
Surgical removal of primary tumours can help in the treatment of cancer but carries the risk of triggering the proliferation of dormant micrometastases. Many experimental and clinical studies have demonstrated that anti-angiogenic mechanisms and immune surveillance are essential to inhibit metastatic tumour cells from growing. As surgical stress often induces a reduction in anti-angiogenic factors in parallel with increases in angiogenic factors and suppression of immune surveillance during the post-operative period, new strategies for peri-operative immunostimulation and chemotherapy are required. This review summarises the factors and proposed mechanisms underlying the effects of surgery on immunosuppression and angiogenesis.
Topics: Animals; Immunosuppression Therapy; Neoplasms; Neovascularization, Pathologic; Stress, Physiological
PubMed: 25956342
DOI: 10.1016/j.tvjl.2015.04.009 -
Cell Communication and Signaling : CCS May 2020Efferocytosis is a physiologic phagocytic clearance of apoptotic cells, which modulates inflammatory responses and the immune environment and subsequently facilitates... (Review)
Review
Efferocytosis is a physiologic phagocytic clearance of apoptotic cells, which modulates inflammatory responses and the immune environment and subsequently facilitates immune escape of cancer cells, thus promoting tumor development and progression. Efferocytosis is an equilibrium formed by perfect coordination among "find-me", "eat-me" and "don't-eat-me" signals. These signaling pathways not only affect the proliferation, invasion, metastasis, and angiogenesis of tumor cells but also regulate adaptive responses and drug resistance to antitumor therapies. Therefore, efferocytosis-related molecules and pathways are potential targets for antitumor therapy. Besides, supplementing conventional chemotherapy, radiotherapy and other immunotherapies with efferocytosis-targeted therapy could enhance the therapeutic efficacy, reduce off-target toxicity, and promote patient outcome. Video abstract.
Topics: Animals; Apoptosis; Disease Progression; Humans; Immunosuppression Therapy; Inflammation; Neoplasms; Phagocytosis; Regulated Cell Death; Tumor Escape
PubMed: 32370748
DOI: 10.1186/s12964-020-00542-9 -
Advanced Drug Delivery Reviews Dec 2023The prevalence of immune-mediated disorders, including autoimmune conditions and allergies, is steadily increasing. However, current therapeutic approaches are often... (Review)
Review
The prevalence of immune-mediated disorders, including autoimmune conditions and allergies, is steadily increasing. However, current therapeutic approaches are often non-specific and do not address the underlying pathogenic condition, often resulting in impaired immunity and a state of generalized immunosuppression. The emergence of technologies capable of selectively inhibiting aberrant immune activation in a targeted, antigen (Ag)-specific manner by exploiting the body's intrinsic tolerance pathways, all without inducing adverse side effects, holds significant promise to enhance patient outcomes. In this review, we will describe the body's natural mechanisms of central and peripheral tolerance as well as innovative delivery strategies using cells and biomaterials targeting innate and adaptive immune cells to promote Ag-specific immune tolerance. Additionally, we will discuss the challenges and future opportunities that warrant consideration as we navigate the path toward clinical implementation of tolerogenic strategies to treat immune-mediated diseases.
Topics: Humans; Biocompatible Materials; Immune Tolerance; Antigens; Immunosuppression Therapy; Hypersensitivity
PubMed: 37980950
DOI: 10.1016/j.addr.2023.115141 -
International Journal of Surgery... Nov 2015Neural cell transplantation has long been considered as an option for the treatment of neurodegenerative disorders. To date, several patients with Parkinson's and... (Review)
Review
Neural cell transplantation has long been considered as an option for the treatment of neurodegenerative disorders. To date, several patients with Parkinson's and Huntington's diseases have been treated with human fetal-derived neurons with disparate results. However, the limited efficacy to date combined with the scarce availability of human fetal tissues and ethical concerns render this procedure inapplicable to a wide population scale. With a view to overcoming these shortcomings, transplantation of pig-derived cell precursors has been proposed and applied in preclinical and clinical trials. Recently long-term survival (more than 18 months) associated with clinical efficacy has been reported following transplantation of genetically engineered porcine neural precursors in fully immunosuppressed primate recipients. Despite the promising results obtained to date, several questions remain unanswered. In particular, the ideal xenogeneic cell-products to transplant, the extent of the immune response against the implanted xenograft and the most suitable therapeutic strategies to improve engraftment are all issues that still need to be thoroughly addressed. The present review describes the current knowledge in the pig-to-primate xenotransplantation field. In this context, recent data on human-to-nonhuman primate xenogeneic stem cell-based treatments for neurological disorders are discussed.
Topics: Animals; Humans; Immunosuppression Therapy; Neurodegenerative Diseases; Neurons; Primates; Swine; Transplantation, Heterologous
PubMed: 26403068
DOI: 10.1016/j.ijsu.2015.09.052 -
Transplant Infectious Disease : An... Dec 2022Xenotransplantation of organs from swine in immunosuppressed human recipients poses many of the same challenges of allotransplantation relative to the risk for... (Review)
Review
Xenotransplantation of organs from swine in immunosuppressed human recipients poses many of the same challenges of allotransplantation relative to the risk for infection, malignancy, or graft rejection in proportion to the degree of immunosuppression and epidemiologic exposures. The unique features of xenotransplantation from pigs relative to infectious risk center on the potential for unusual organisms derived from swine causing productive infection, "xenosis" or "xenozoonosis," in the host. Based on experience in allotransplantation, the greatest hazard is due to viruses, due to the relative lack of information regarding the behavior of these potential pathogens in humans, the absence of validated serologic and molecular assays for swine-derived pathogens, and uncertainty regarding the efficacy of therapeutic agents for these organisms. Other known, potential pathogens (i.e., bacteria, fungi, parasites) tend to be comparable to those of humans. Concerns remain for unknown organisms in swine that may replicate in immunosuppressed humans. Clinical trials of genetically modified organs sourced from swine in immunosuppressed humans with organ failure are under development. Such trials require informed consent regarding potential infectious risks to the recipient, determination of breeding characteristics of swine, assessments of potential risks to the public and healthcare providers, consideration of ethical issues posed by this novel therapy, and defined strategies to monitor and address infectious episodes that may be encountered by healthcare teams. Clinical trials in xenotransplantation will allow improved definition of potential infectious risks.
Topics: Animals; Humans; Swine; Transplantation, Heterologous; Infections; Immunosuppression Therapy; Immunocompromised Host; Neoplasms
PubMed: 35870125
DOI: 10.1111/tid.13909 -
Transplant Immunology Oct 2023ABO incompatibility has long been considered an absolute contraindication for kidney transplantation. However, with the increasing number of patients with ESRD in recent... (Review)
Review
ABO incompatibility has long been considered an absolute contraindication for kidney transplantation. However, with the increasing number of patients with ESRD in recent years, ABO-incompatible kidney transplantation (ABOi-KT) has expanded the types of donors by crossing the blood group barrier through preoperative desensitization therapy. At present, the desensitization protocols consist of removal of preexisting ABO blood group antibody titers and prevention of ABO blood group antibody return. Studies have suggested similar patient and graft survival among ABOi-KT and ABOc-KT recipients. In this review, we will summarize the effective desensitization regimens of ABOi-KT, aiming to explore effective ways to improve the success rate and the long-term survival rate of ABOi-KT recipients.
Topics: Humans; Kidney Transplantation; ABO Blood-Group System; Immunosuppression Therapy; Antibodies; Blood Group Incompatibility; Living Donors; Graft Survival; Graft Rejection
PubMed: 37433394
DOI: 10.1016/j.trim.2023.101899 -
Seminars in Nephrology Jan 2022Cancer remains a significant cause of morbidity and mortality in kidney transplant recipients, due to long-term immunosuppression. Salient issues to consider in... (Review)
Review
Cancer remains a significant cause of morbidity and mortality in kidney transplant recipients, due to long-term immunosuppression. Salient issues to consider in decreasing the burden of malignancy among kidney transplant recipients include pretransplant recipient evaluation, post-transplant screening and monitoring, and optimal treatment strategies for the kidney transplant recipients with cancer. In this review, we address cancer incidence and outcomes, approaches to cancer screening and monitoring pretransplant and post-transplant, as well as treatment strategies, immunosuppressive management, and multidisciplinary approaches in the kidney transplant recipients with cancer.
Topics: Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Neoplasms
PubMed: 35618396
DOI: 10.1016/j.semnephrol.2022.01.003 -
Cell Reports. Medicine Nov 2023In this issue, Pang and colleagues identify the protease legumain as a potential immunotherapy target in glioblastoma that drives tumor-associated macrophages in...
In this issue, Pang and colleagues identify the protease legumain as a potential immunotherapy target in glioblastoma that drives tumor-associated macrophages in response to hypoxia.
Topics: Humans; Glioblastoma; Cysteine Endopeptidases; Immunosuppression Therapy; Hypoxia
PubMed: 37992680
DOI: 10.1016/j.xcrm.2023.101293