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Clinical Infectious Diseases : An... Oct 2021Successful solid organ transplantation reflects meticulous attention to the details of immunosuppression, balancing risks for graft rejection against risks for... (Review)
Review
Successful solid organ transplantation reflects meticulous attention to the details of immunosuppression, balancing risks for graft rejection against risks for infection. The "net state of immune suppression" is a conceptual framework of all factors contributing to infectious risk. Assays that measure immune function in the immunosuppressed transplant recipient relative to infectious risk and allograft function are lacking. The best measures of integrated immune function may be quantitative viral loads to assess the individual's ability to control latent viral infections. Few studies address adjustment of immunosuppression during active infections; thus, confronted with infection in solid organ recipients, the management of immunosuppression is based largely on clinical experience. This review examines known measures of immune function and the immunologic effects of common immunosuppressive drugs and available studies reporting modification of drug regimens for specific infections. These data provide a conceptual framework for the management of immunosuppression during infection in organ recipients.
Topics: Graft Rejection; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Infections; Organ Transplantation
PubMed: 32803228
DOI: 10.1093/cid/ciaa1189 -
Clinical Journal of the American... Aug 2021The long-term management of maintenance immunosuppression in kidney transplant recipients remains complex. The vast majority of patients are treated with the calcineurin... (Review)
Review
The long-term management of maintenance immunosuppression in kidney transplant recipients remains complex. The vast majority of patients are treated with the calcineurin inhibitor tacrolimus as the primary agent in combination with mycophenolate, with or without corticosteroids. A tacrolimus trough target 5-8 ng/ml seems to be optimal for rejection prophylaxis, but long-term tacrolimus-related side effects and nephrotoxicity support the ongoing evaluation of noncalcineurin inhibitor-based regimens. Current alternatives include belatacept or mammalian target of rapamycin inhibitors. For the former, superior kidney function at 7 years post-transplant compared with cyclosporin generated initial enthusiasm, but utilization has been hampered by high initial rejection rates. Mammalian target of rapamycin inhibitors have yielded mixed results as well, with improved kidney function tempered by higher risk of rejection, proteinuria, and adverse effects leading to higher discontinuation rates. Mammalian target of rapamycin inhibitors may play a role in the secondary prevention of squamous cell skin cancer as conversion from a calcineurin inhibitor to an mammalian target of rapamycin inhibitor resulted in a reduction of new lesion development. Early withdrawal of corticosteroids remains an attractive strategy but also is associated with a higher risk of rejection despite no difference in 5-year patient or graft survival. A major barrier to long-term graft survival is chronic alloimmunity, and regardless of agent used, managing the toxicities of immunosuppression against the risk of chronic antibody-mediated rejection remains a fragile balance.
Topics: Abatacept; Adrenal Cortex Hormones; Calcineurin Inhibitors; Drug Therapy, Combination; Graft Rejection; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; MTOR Inhibitors; Maintenance Chemotherapy; Mycophenolic Acid; Tacrolimus; Time Factors
PubMed: 33853841
DOI: 10.2215/CJN.15040920 -
International Maritime Health 2017Given a better quality of life and extended life expectancy in patients with immune suppression, the number of immunocompromised travellers is constantly growing. The... (Review)
Review
Given a better quality of life and extended life expectancy in patients with immune suppression, the number of immunocompromised travellers is constantly growing. The aim of the article is to discuss travel-related health problems in immunocompromised patients, their most common destinations and reasons to travel, as well as complications associated with travel to regions with harsh environmental conditions. The article focuses on selected groups of immunocompromised travellers (ICTs), i.e., cancer patients, transplant patients receiving immunosuppressant agents, splenectomised patients and HIV-infected individuals. The most common infections and complications, including traveller's diarrhoea, vector-borne diseases (yellow fever, malaria, leishmaniasis, dengue, chikungunya), respiratory infections (including tuberculosis), and dermatoses were taken into account. Preventive measures dedicated to ICTs (pre-travel consultation, vaccinations, malaria chemoprophylaxis, prevention during travelling) have been also characterised.
Topics: Communicable Disease Control; HIV Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Neoplasms; Organ Transplantation; Splenectomy; Travel; Travel Medicine; Vaccination
PubMed: 29297574
DOI: 10.5603/IMH.2017.0041 -
Ophthalmology Feb 2018The uveitides are a collection of more than 30 diseases characterized by intraocular inflammation. Many cases of juvenile idiopathic arthritis-associated uveitis, many... (Review)
Review
The uveitides are a collection of more than 30 diseases characterized by intraocular inflammation. Many cases of juvenile idiopathic arthritis-associated uveitis, many cases of intermediate uveitis, and most cases of posterior and panuveitides requiring treatment are treated with corticosteroids and immunosuppression. Disease-specific, time-updated modeling of clinical data for several uveitides suggests superior prevention of ocular complications and visual outcomes with immunosuppression. These studies also suggest that oral corticosteroids at doses low enough for safe long-term therapy (i.e., <7.5 mg/day) are ineffective, implying that immunosuppression should be part of the initial regimen. The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study was a randomized comparative effectiveness trial comparing systemic therapy with oral corticosteroids and immunosuppression with regional corticosteroid treatment. It demonstrated that, when used properly, oral corticosteroids and immunosuppression can be given safely for up to 7 years with no evident increased risk of systemic side effects compared with regional corticosteroid therapy, except for greater antibiotic use for infections. The Systemic Treatment for Eye Diseases (SITE) Cohort Study suggested long-term safety for this approach, when the immunosuppressive agents were antimetabolites or calcineurin inhibitors. Thus, oral corticosteroids and immunosuppression may be a preferred initial therapy for many noninfectious, intermediate, posterior, and panuveitides. Nonalkylating-agent immunosuppression has a low rate of sustained, drug-free remissions, <10%/year. Nonalkylating-agent immunosuppression for >3 years with control of the inflammation for >2 years is associated with a decreased risk of relapse after discontinuing immunosuppression. Alkylating agents can induce sustained drug-free remissions but likely increase the lifetime risk of cancer. Biologics, which target specific cytokines and pathways, hold promise for the future. Monoclonal antibodies directed against tumor necrosis factor (TNF)-α have been studied most often, and one, adalimumab, is U.S. Food and Drug Administration approved for the treatment of noninfectious, intermediate, posterior, and panuveitides.
Topics: Humans; Immunosuppression Therapy; Immunosuppressive Agents; Uveitis; Visual Acuity
PubMed: 28942074
DOI: 10.1016/j.ophtha.2017.08.007 -
Kidney360 Dec 2022
Topics: Immunosuppression Therapy; Immunosuppressive Agents
PubMed: 36591358
DOI: 10.34067/KID.0005652022 -
Transplant International : Official... Aug 2015
Topics: Graft Rejection; Humans; Immune Tolerance; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Transplantation Tolerance
PubMed: 26178312
DOI: 10.1111/tri.12624 -
British Journal of Hospital Medicine... May 2017Medical care for patients following liver transplantation is complex and requires a holistic approach to management. Patients and clinicians are faced with multiple... (Review)
Review
Medical care for patients following liver transplantation is complex and requires a holistic approach to management. Patients and clinicians are faced with multiple challenges: immunosuppressive regimens must be optimized to avoid and treat graft rejection, the risk and atypical features of sepsis in the immunocompromised patient must be recognized, steps are required to reduce the recurrence of liver disease and the long-term increased risks of malignancy, renal failure and metabolic complications need managing. Despite the benefits of liver transplantation there are additional concerns regarding the impact upon quality of life. This review will focus upon the care of patients following liver transplantation. As these patients will present to a broad range of clinicians, an understanding of the common drugs used post-transplantation and general approach to management of these patients will be of benefit to the general clinical audience.
Topics: Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Transplantation; Postoperative Care; Postoperative Complications; Quality of Life
PubMed: 28489436
DOI: 10.12968/hmed.2017.78.5.278 -
Frontiers in Immunology 2019In solid organ transplantation lifelong immunosuppression exposes transplant recipients to life-threatening complications, such as infections and malignancies, and to... (Review)
Review
In solid organ transplantation lifelong immunosuppression exposes transplant recipients to life-threatening complications, such as infections and malignancies, and to severe side effects. Cellular therapy with mesenchymal stromal cells (MSC) has recently emerged as a promising strategy to regulate anti-donor immune responses, allowing immunosuppressive drug minimization and tolerance induction. In this review we summarize preclinical data on MSC in solid organ transplant models, focusing on potential mechanisms of action of MSC, including down-regulation of effector T-cell response and activation of regulatory pathways. We will also provide an overview of available data on safety and feasibility of MSC therapy in solid organ transplant patients, highlighting the issues that still need to be addressed before establishing MSC as a safe and effective tolerogenic cell therapy in transplantation.
Topics: Adaptive Immunity; Animals; B-Lymphocytes; Cell Compartmentation; Cellular Microenvironment; Graft Rejection; Humans; Immune Tolerance; Immunity, Innate; Immunosuppression Therapy; Immunosuppressive Agents; Macrophages; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Organ Transplantation; T-Lymphocytes; Time Factors; Transplantation Tolerance
PubMed: 31231393
DOI: 10.3389/fimmu.2019.01287 -
Cellular & Molecular Immunology Apr 2019Vascularized composite allotransplants (VCAs) have unique properties because of diverse tissue components transplanted en mass as a single unit. In addition to surgery,... (Review)
Review
Vascularized composite allotransplants (VCAs) have unique properties because of diverse tissue components transplanted en mass as a single unit. In addition to surgery, this type of transplant also faces enormous immunological challenges that demand a detailed analysis of all aspects of alloimmune responses, organ preservation, and injury, as well as the immunogenicity of various tissues within the VCA grafts to further improve graft and patient outcomes. Moreover, the side effects of long-term immunosuppression for VCA patients need to be carefully balanced with the potential benefit of a non-life-saving procedure. In this review article, we provide a comprehensive update on limb and face transplantation, with a specific emphasis on the alloimmune responses to VCA, established and novel immunosuppressive treatments, and patient outcomes.
Topics: Adaptive Immunity; Graft Rejection; Graft Survival; Humans; Immune Tolerance; Immunity, Innate; Immunosuppression Therapy; Immunosuppressive Agents; Risk Factors; Skin; Skin Transplantation; Vascularized Composite Allotransplantation
PubMed: 30842628
DOI: 10.1038/s41423-019-0215-3 -
Ugeskrift For Laeger Jan 2021Patients in immunosuppressive treatment may have increased risk of post-operative infections and wound-healing complications. Perioperative management of... (Review)
Review
Patients in immunosuppressive treatment may have increased risk of post-operative infections and wound-healing complications. Perioperative management of immunosuppressive treatment is challenging due to the variety of medications and differences in surgical procedures across surgical specialities. This review examines the literature regarding the effect of immunosuppressive treatment on post-operative infections and wound-healing complications.
Topics: Humans; Immunosuppression Therapy; Immunosuppressive Agents; Postoperative Complications; Surgical Wound Infection; Wound Healing
PubMed: 33491626
DOI: No ID Found