#04#
Revisiones-Clínica-Epidemiología,
Higiene & Prevención *** Reviews-Clinical-Epidemiology, Hygiene &
Prevention
INMUNOSUPRESIÓN
*** IMMUNOSUPPRESSION
(Conceptos
/ Keywords: Immunosuppression; Immunosuppressive ag.; Transpl. immunol.; GVH;
Antirejection therapy; Lymphocyte depletion; Transpl. conditioning; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Nystatin prophylaxis
and treatment in severely immunodepressed patients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2002;(4):CD002033.
AUTORES
/ AUTHORS: - Gotzsche PC; Johansen HK
INSTITUCIÓN
/ INSTITUTION: - The Nordic Cochrane Centre,
Rigshospitalet, Dept. 7112, Blegdamsvej 9, Copenhagen O, Denmark, 2100. p.c.gotzsche@cochrane.dk
RESUMEN
/ SUMMARY: - BACKGROUND: Nystatin is sometimes used
prophylactically in patients with severe immunodeficiency or in the treatment
of fungal infection in such patients, although the effect seems to be
equivocal. OBJECTIVES: To study whether nystatin decreases morbidity and
mortality when given prophylactically or therapeutically to patients with
severe immunodeficiency. SEARCH STRATEGY: MEDLINE and The Cochrane Library
using a comprehensive search strategy, date of last search November 2001.
Contacted industry and scanned reference lists. SELECTION CRITERIA: Randomised
trials comparing nystatin with placebo, an untreated control group, fluconazole
or amphotericin B. DATA COLLECTION AND ANALYSIS: Data on mortality, invasive
fungal infection and colonisation were extracted by both authors independently.
A random effects model was used unless p>0.10 for the test of heterogeneity.
MAIN RESULTS: We included 12 trials (1,464 patients). The drugs were given
prophylactically in ten trials and as treatment in two. Seven trials were in
acute leukaemia, two in cancer, one in liver transplant patients, one in
critically ill surgical and trauma patients, and one in AIDS patients. Nystatin
had been compared with placebo in three trials and with fluconazole in nine;
the dose varied from 1.5 MIE to 72 MIE daily. The effect of nystatin was
similar to that of placebo on fungal colonisation (relative risk 0.85, 95%
confidence interval 0.65 to 1.13). There was no statistically significant
difference between fluconazole and nystatin on mortality (relative risk 0.76,
0.49 to 1.18) whereas fluconazole was more effective in preventing invasive
fungal infection (relative risk 0.37, 0.15 to 0.91) and colonisation (relative
risk 0.49, 0.34 to 0.70). The results were very similar if the three studies
which were not performed in cancer patients were excluded. REVIEWER’S
CONCLUSIONS: Nystatin cannot be recommended for prophylaxis or treatment of
Candida infections in immunodepressed patients. N. Ref:: 22
----------------------------------------------------
[2]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Novel therapeutic
molecular targets for prostate cancer: the mTOR signaling pathway and epidermal
growth factor receptor.
REVISTA
/ JOURNAL: - J Urol 2004 Feb;171(2 Pt 2):S41-3;
discussion S44.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000108100.53239.b7
AUTORES
/ AUTHORS: - Tolcher AW
INSTITUCIÓN
/ INSTITUTION: - Director Clinical Research, Institute for
Drug Development Cancer Therapy and Research Center, San Antonio, Texas, USA.
RESUMEN
/ SUMMARY: - PURPOSE: The scientific rationale and
existing evidence for the use of novel molecular targets in the chemoprevention
of cancer are reviewed, with special attention to prostate cancer. MATERIALS
AND METHODS: A search for relevant literature on basic science and clinical
trials was conducted using PubMed/MEDLINE. RESULTS: The emergence of
molecularly targeted therapies for advanced malignancies creates an important
opportunity to examine these agents for the chemoprevention of prostate cancer.
Two critical targets in the proliferation and malignant transformation of
normal cells, the PI3/Akt signal transduction pathway and the epidermal growth
factor receptor, are currently the focus of several novel investigational
therapies that are in late stage phase II and phase III studies. CONCLUSIONS:
Research to date supports consideration of these novel molecular targets as
future agents in the chemoprevention of prostate cancer. N. Ref:: 28
----------------------------------------------------
[4]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[5]
TÍTULO / TITLE: - Depletion of host
reactive T cells by photodynamic cell purging and prevention of graft versus
host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Nov;44(11):1871-9.
AUTORES
/ AUTHORS: - Goggins TF; Chao N
INSTITUCIÓN
/ INSTITUTION: - Hematology-Oncology, Duke University
Medical Center, 2400 Pratt Street, Ste. 1100, Durham, NC 27710, USA. goggi002@mc.duke.edu
RESUMEN
/ SUMMARY: - Graft versus Host Disease (GVHD) is the
principal cause of morbidity and mortality in patients undergoing allogeneic
stem cell transplant. T cell depletion has been recognized as a method of
reducing the incidence of GVHD in allogeneic transplants. Until recently, most
T cell depletion methods were non-selective in reducing lymphocytes. Rhodamine
purging is one method, which selectively reduces alloreactive T cells
preventing GVHD. We review here the methods of non-selective and selective T
cell depletion, particularly the newer method of photodynamic purging utilizing
rhodamine. N. Ref:: 129
----------------------------------------------------
[6]
TÍTULO / TITLE: - Patient and graft
survival following liver transplantation for hepatitis C: much ado about
something.
REVISTA
/ JOURNAL: - Gastroenterology 2002 Apr;122(4):1162-5.
AUTORES
/ AUTHORS: - Charlton M N. Ref:: 20
----------------------------------------------------
[7]
TÍTULO / TITLE: - Fulminant hepatic
failure secondary to acetaminophen poisoning: a systematic review and
meta-analysis of prognostic criteria determining the need for liver
transplantation.
REVISTA
/ JOURNAL: - Crit Care Med 2003 Jan;31(1):299-305.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.CCM.0000034674.51554.4C
AUTORES
/ AUTHORS: - Bailey B; Amre DK; Gaudreault P
INSTITUCIÓN
/ INSTITUTION: - Division of Emergency Medicine, Department
of Pediatrics, Hopital Ste-Justine, Universite de Montreal, Quebec, Canada. baileyb@med.umontreal.ca
RESUMEN
/ SUMMARY: - OBJECTIVES: To summarize and compare
different prognostic criteria used to determine need for liver transplantation
in patients with fulminant hepatic failure secondary to acetaminophen
poisoning. DATA SOURCES: Studies published in the literature that investigated
criteria for hepatic transplantation secondary to acetaminophen-induced liver
failure as identified by a preestablished MEDLINE strategy (1966 through
October 2001). STUDY SELECTION: Studies were included if 2 x 2 tables could be
reconstructed and if they did not assume that patients undergoing transplantation
would have eventually died had they not received the transplant. DATA
EXTRACTION: Relevant articles were reviewed by two authors independently.
Discrepancies or disagreements, if any, on the inclusion or exclusion of
studies were resolved by consulting the third author. DATA SYNTHESIS: King’s
criteria (pH < 7.30 or prothrombin time of >100 secs plus creatinine of
>300 micromol/L plus encephalopathy grade of > or =3) were evaluated in
nine studies, pH < 7.30 in four, prothrombin time of >100 secs in three,
prothrombin time of >100 secs plus creatinine of >300 micromol/L plus
encephalopathy grade of > or =3 in three, creatinine of >300 micromol/L
in two, and one each for increase in prothrombin time day 4, factor V of
<10%, Acute Physiology and Chronic Health Evaluation (APACHE) II score of
>15, and Gc-globulin of <100 mg/L. King’s criteria were more sensitive
than pH: 69% (95% confidence interval, 63-75) vs. 57% (95% confidence interval,
44-68). Their specificities were, however, comparable: 92% (95% confidence
interval, 81-97) vs. 89% (95% confidence interval, 62-97). APACHE II score of
>15 had the highest positive likelihood ratio (16.4) and the lowest negative
likelihood ratio (0.19) but was evaluated in only one study. The accuracy
measures of all other criteria were lower than that of King’s criteria or pH
< 7.30. CONCLUSIONS: Presently, available criteria are not very sensitive
and may miss patients requiring transplantation. Future studies should further
evaluate the efficacy of the APACHE II criteria. N. Ref:: 33
----------------------------------------------------
[8]
TÍTULO / TITLE: - Suppression of
graft-versus-host disease by naturally occurring regulatory T cells.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S9-S11.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106475.38978.11
AUTORES
/ AUTHORS: - Zeng D; Lan F; Hoffmann P; Strober S
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology and Immunology,
Department of Medicine, Stanford University School of Medicine, Stanford, CA
94305, USA.
RESUMEN
/ SUMMARY: - Studies of graft-versus-host disease after
allogeneic bone marrow transplantation have shown that there are subsets of freshly
isolated donor T cells that induce the disease and subsets that suppress the
disease. The balance of subsets in the graft determines disease severity. The
authors’ work on the nature of the regulatory-suppressor T cells and their
mechanisms of action is summarized in this article. N. Ref:: 24
----------------------------------------------------
[9]
TÍTULO / TITLE: - Diagnosis and therapy
of coronary artery disease in renal failure, end-stage renal disease, and renal
transplant populations.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):214-27.
AUTORES
/ AUTHORS: - Logar CM; Herzog CA; Beddhu S
INSTITUCIÓN
/ INSTITUTION: - Renal Section, Salt Lake VA Healthcare
System, Department of Medicine, University of Utah School of Medicine, Salt
Lake City, USA.
RESUMEN
/ SUMMARY: - Even though cardiovascular disease is the
leading cause of death in patients with CRF and end-stage renal disease (ESRD),
ill-conceived notions have led to therapeutic nihilism as the predominant
strategy in the management of cardiovascular disease in these populations. The
recent data clearly support the application of proven interventions in the
general population, such as angiotensin-converting enzyme inhibitors and
statins to patients with CRF and ESRD. The advances in coronary stents and
intracoronary irradiation have decreased the restenosis rates in renal failure
patients. Coronary artery bypass with internal mammary graft might be the
procedure of choice for coronary revascularization in these patients. The role
of screening for asymptomatic coronary disease is established as a
pretransplant procedure, but it is unclear whether this will be applicable to
all patients with ESRD. Future studies need to focus on unraveling the
mechanisms by which uremia leads to increased cardiovascular events to design
optimal therapies targeted toward these mechanisms and improve cardiovascular
outcomes. N. Ref:: 125
----------------------------------------------------
[10]
TÍTULO / TITLE: - Drug-eluting stents in
vascular intervention.
REVISTA
/ JOURNAL: - Lancet 2003 Jan 18;361(9353):247-9.
AUTORES
/ AUTHORS: - Fattori R; Piva T
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Cardiovascular
Unit, University Hospital S Orsola, 40138, Bologna, Italy. ross@med.unibo.it
RESUMEN
/ SUMMARY: - CONTEXT: Restenosis is the most important
long-term limitation of stent implantation for coronary artery disease,
occurring in 15-60% of patients. In-stent restenosis, a refractory coronary
lesion resulting from neointimal hyperplasia, challenges both vascular
biologist and interventional cardiologist. Various drugs and devices have been
used tried to overcome restenosis but are not particularly successful. Over
1500000 percutaneous coronary interventions are done annually. Restenosis is
not only important clinically but also for its impact on health-care costs.
STARTING POINT: Growth and migration of vascular smooth-muscle cells result in
neointimal proliferation after vascular injury and are the key mechanism of
in-stent restenosis. The rationale of the most recent approaches to restenosis
(eg, brachytherapy and immunosuppressive agents) arises from the similarity
between tumour-cell growth and the benign tissue proliferation which
characterises intimal hyperplasia. Several immunosuppressants have been tested
for their potential to inhibit restenosis, with the novel strategy of
administering the drug via a coated stent platform. Local drug delivery
achieves higher tissue concentrations of drug without systemic effects, at a
precise site and time. The first multicentre trial with stents coated with
sirolimus was by Marie-Claude Morice and colleagues (N Engl J Med 2002; 346:
1773-80). In a trial of 238 patients, restenosis of 50% or more at 6 months was
0% and 27% with sirolimus or normal stents (p<0.001), respectively, after
percutaneous revascularisation. Muzaffer Degertekin and colleagues (Circulation
2002; 106: 1610-13) present data on 2-year follow-up of 15 patients who had
been implanted with the sirolimus stent in another study, and confirm
persistent inhibition of restenosis and an absence of unexpected adverse
events. WHERE NEXT? Local application of antiproliferative agents is a
promising technique and research is developing. Other agents with potential
benefits (eg, statins, local gene-therapy, adenovirus-mediated arterial
gene-transfer, L-arginine, abciximab, angiopeptin, recombinant pegylated
hirudin, and hiloprost) as well as improvements in polymer technology
(biodegradable smart polymers, coatings for multiple-drug release) are under
evaluation. The clinical impact of the elimination of restenosis may influence
the approach to coronary artery disease, the future of cardiac surgery, and
health-care economics in cardiology. N.
Ref:: 22
----------------------------------------------------
[11]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma,
antiviral treatment with acyclovir, valacyclovir or ganciclovir may be initiated
for at least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[12]
TÍTULO / TITLE: - Regulatory (suppressor)
T cells in peripheral allograft tolerance and graft-versus-host reaction.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S5.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107184.18562.FC
AUTORES
/ AUTHORS: - Rifle G; Herve P
INSTITUCIÓN
/ INSTITUTION: - UPRES EA563, Faculte de Medecine, Universite
de Bourgogne and Department of Nephrology-Intensive Care-Transplantation,
Hopital du Bocage, Dijon, France. gerard.rifle@chu-dijon.fr.
RESUMEN
/ SUMMARY: - Among the mechanisms capable of inducing peripheral
tolerance, regulatory (suppressor) T cells (Treg) probably play a key role in
the control of both reactivity to self-antigens and alloimmune response.
Augmentation or manipulation of Treg could improve organ allograft survival or
control graft-versus-host disease, thus resulting in operational tolerance. The
role of this immunomanipulation as one method of inducing tolerance has yet to
be clearly defined. N.
Ref:: 14
----------------------------------------------------
[13]
TÍTULO / TITLE: - Nystatin prophylaxis
and treatment in severely immunodepressed patients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2002;(2):CD002033.
AUTORES
/ AUTHORS: - Gotzsche PC; Johansen HK
INSTITUCIÓN
/ INSTITUTION: - The Nordic Cochrane Centre, Rigshospitalet,
Dept. 7112, Blegdamsvej 9, Copenhagen O, Denmark, 2100. p.c.gotzsche@cochrane.dk
RESUMEN
/ SUMMARY: - BACKGROUND: Nystatin is sometimes used
prophylactically in patients with severe immunodeficiency or in the treatment
of fungal infection in such patients, although the effect seems to be
equivocal. OBJECTIVES: To study whether nystatin decreases morbidity and
mortality when given prophylactically or therapeutically to patients with
severe immunodeficiency. SEARCH STRATEGY: MEDLINE and The Cochrane Library
using a comprehensive search strategy, date of last search November 2001.
Contacted industry and scanned reference lists. SELECTION CRITERIA: Randomised
trials comparing nystatin with placebo, an untreated control group, fluconazole
or amphotericin B. DATA COLLECTION AND ANALYSIS: Data on mortality, invasive
fungal infection and colonisation were extracted by both authors independently.
The outcomes were weighted by the inverse variance. A random effects model was
used unless p>0.10 for the test of heterogeneity. MAIN RESULTS: We included
12 trials (1,464 patients). The drugs were given prophylactically in ten trials
and as treatment in two. Seven trials were in acute leukaemia, two in cancer,
one in liver transplant patients, one in critically ill surgical and trauma
patients, and one in AIDS patients. Nystatin had been compared with placebo in
three trials and with fluconazole in nine; the dose varied from 1.5 MIE to 72
MIE daily. The effect of nystatin was similar to that of placebo on fungal
colonisation (relative risk 0.85, 95% confidence interval 0.65 to 1.13). There
was no statistically significant difference between fluconazole and nystatin on
mortality (relative risk 0.76, 0.49 to 1.18) whereas fluconazole was more
effective in preventing invasive fungal infection (relative risk 0.37, 0.15 to
0.91) and colonisation (relative risk 0.49, 0.34 to 0.70). The results were
very similar if the three studies which were not performed in cancer patients
were excluded. REVIEWER’S CONCLUSIONS: Nystatin cannot be recommended for
prophylaxis or treatment of Candida infections in immunodepressed
patients. N. Ref:: 21
----------------------------------------------------
[14]
TÍTULO / TITLE: - Treatment of chronic
granulomatous disease with myeloablative conditioning and an unmodified
hemopoietic allograft: a survey of the European experience, 1985-2000.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2002 Dec 15;100(13):4344-50. Epub 2002 Aug 8.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-02-0583
AUTORES
/ AUTHORS: - Seger RA; Gungor T; Belohradsky BH;
Blanche S; Bordigoni P; Di Bartolomeo P; Flood T; Landais P; Muller S; Ozsahin
H; Passwell JH; Porta F; Slavin S; Wulffraat N; Zintl F; Nagler A; Cant A;
Fischer A
INSTITUCIÓN
/ INSTITUTION: - European Group for Blood and Marrow
Transplantation (EBMT) and the European Society for Immunodeficiencies (ESID),
Division of Immunology/Hematology, University Children’s Hospital, Zurich,
Switzerland. reinhard.seger@kispi.unizh.ch
RESUMEN
/ SUMMARY: - Treatment of chronic granulomatous disease
(CGD) with myeloablative bone marrow transplantation is considered risky. This
study investigated complications and survival according to different risk
factors present at transplantation. The outcomes of 27 transplantations for
CGD, from 1985 to 2000, reported to the European Bone Marrow Transplant
Registry for primary immunodeficiencies were assessed. Most transplant
recipients were children (n = 25), received a myeloablative busulphan-based
regimen (n = 23), and had unmodified marrow allografts (n = 23) from human
leukocyte antigen (HLA)-identical sibling donors (n = 25). After myeloablative
conditioning, all patients fully engrafted with donor cells; after
myelosuppressive regimens, 2 of 4 patients fully engrafted. Severe (grade 3 or
4) graft-versus-host disease (GVHD) disease developed in 4 patients: 3 of 9
with pre-existing overt infection, 1 of 2 with acute inflammatory disease.
Exacerbation of infection during aplasia was observed in 3 patients;
inflammatory flare at the infection site during neutrophil engraftment in 2:
all 5 patients belonged to the subgroup of 9 with pre-existing infection.
Overall survival was 23 of 27, with 22 of 23 cured of CGD (median follow-up, 2
years). Survival was especially good in patients without infection at the
moment of transplantation (18 of 18). Pre-existing infections and inflammatory
lesions have cleared in all survivors (except in one with autologous
reconstitution). Myeloablative conditioning followed by transplantation of
unmodified hemopoietic stem cells, if performed at the first signs of a severe
course of the disease, is a valid therapeutic option for children with CGD
having an HLA-identical donor. N.
Ref:: 30
----------------------------------------------------
[15]
TÍTULO / TITLE: - Valacyclovir provides
optimum acyclovir exposure for prevention of cytomegalovirus and related
outcomes after organ transplantation.
REVISTA
/ JOURNAL: - J Infect Dis. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://www.journals.uchicago.edu/
●●
Cita: J. of Infectious Diseases: <> 2002 Oct 15;186 Suppl 1:S110-5.
AUTORES
/ AUTHORS: - Fiddian P; Sabin CA; Griffiths PD
INSTITUCIÓN
/ INSTITUTION: - Royal Free and University College Medical
School (Royal Free Campus), London NW3 2PF, United Kingdom. paul.fiddian@which.net
RESUMEN
/ SUMMARY: - A meta-analysis of 12 randomized trials
(1574 patients) examined herpesvirus and related outcomes following organ
transplantation over a range of acyclovir exposures (including valacyclovir).
Overall, cytomegalovirus (CMV) infection (odds ratio [OR], 0.44; 95% confidence
interval [CI], 0.34-0.57; P<.001), CMV disease (OR, 0.41; 95% CI, 0.31-0.54;
P<.001), death (OR, 0.60; 95% CI, 0.40-0.90; P=.01), opportunistic infection
(OR, 0.70; 95% CI, 0.53-0.91; P=.009), acute graft rejection (OR, 0.67; 95% CI,
0.52-0.86; P<.001), herpes simplex virus disease (OR, 0.17; 95% CI,
0.12-0.24; P<.001), and varicella-zoster virus disease (OR, 0.06; 95% CI,
0.01-0.25; P<.001) were significantly reduced. Increased acyclovir exposure
influenced more end points: Maximum efficacy resulted from valacyclovir (8
g/day). Increasing acyclovir exposure to that achieved with valacyclovir
extends benefits of prophylaxis to include impact on graft rejection and
opportunistic infections.
----------------------------------------------------
[16]
TÍTULO / TITLE: - The history and future
of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic
hematopoietic stem cell transplantation.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2001 Dec 1;98(12):3192-204.
AUTORES
/ AUTHORS: - Ho VT; Soiffer RJ
INSTITUCIÓN
/ INSTITUTION: - Department of Adult Oncology, Dana-Farber
Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA, USA. N. Ref:: 244
----------------------------------------------------
[17]
TÍTULO / TITLE: - Immunisations in
solid-organ transplant recipients.
REVISTA
/ JOURNAL: - Lancet 2002 Mar 16;359(9310):957-65.
AUTORES
/ AUTHORS: - Stark K; Gunther M; Schonfeld C; Tullius
SG; Bienzle U
INSTITUCIÓN
/ INSTITUTION: - Institute of Tropical Medicine, Charite,
Humboldt University, Berlin, Germany. starkk@rki.de
RESUMEN
/ SUMMARY: - Solid-organ transplant recipients are at
increased risk of various infectious diseases, some of which are vaccine
preventable mmunisations are among the most efficient interventions available.
Solid-organ tranplant recipients would greatly benefit from effective
immunisations, provided the recommendations are based on a careful risk-benefit
analysis in which the effectiveness of the vaccine is weighed against possible
adverse reactions, including graft rejection. In this review, we summarise the
data from studies on relevant immunisations in solid-organ transplant
recipients. The major issues are the immunogenicity and safety of immunisations,
the factors associated with poor immune response, and recommendations for
immunisation schemes. N.
Ref:: 94
----------------------------------------------------
[18]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular
mammography, according to national recommendations where available. N. All
renal transplant recipients should undergo a faecal occult-blood testing as a
screening for colorectal cancer and other (pre-malignant) lesions, according to
national recommendations where available. O. In all these conditions, it is
recommended to reduce immunosuppression whenever possible.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Survival after
HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation
for hematologic malignancies: meta-analysis of randomized controlled trials.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Aug;32(3):293-8.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1704112
AUTORES
/ AUTHORS: - Horan JT; Liesveld JL; Fernandez ID; Lyman
GH; Phillips GL; Lerner NB; Fisher SG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Rochester School of Medicine and Dentistry, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - The impact of peripheral blood stem cell
transplantation (PBSCT) on survival relative to bone marrow transplantation
(BMT) remains poorly defined. Several randomized controlled trials (RCTs)
comparing HLA-matched related PBSC- and BMT for patients with hematologic
malignancies have been published, yielding differing results. We conducted a
meta-analysis of published RCTs to more precisely estimate the effect of PBSCT
on survival. Seven trials that assessed survival were identified and included
in our analysis. Using a fixed effects model, and combining the results of all
seven trials, the summary odds ratio for mortality after PBSCT was 0.81 (95%
CI, 0.62-1.05) when compared to BMT. Subgroup analysis revealed no association
between the median PBSCT 34+ cell dose and relative risk for morality after
PBSCT. However, there was an association between the proportion of patients
enrolled with advanced-stage disease and the summary odds ratio for mortality.
The pooled estimate was 0.64 for studies where patients with
intermediate/advanced disease comprised at least 25% of enrollment, and was
1.07 for the studies enrolling a smaller proportion. This finding substantiates
results from previously published studies that have demonstrated a survival
advantage with PBSCT limited to patients with advanced disease.
----------------------------------------------------
[20]
TÍTULO / TITLE: - One-year survival in
patients with acute myocardial infarction and a saphenous vein graft culprit
treated with primary angioplasty.
REVISTA
/ JOURNAL: - Am J Cardiol 2003 May 15;91(10):1250-4.
AUTORES
/ AUTHORS: - Nguyen TT; O’Neill WW; Grines CL; Stone
GW; Brodie BR; Cox DA; Grines LL; Boura JA; Dixon SR
INSTITUCIÓN
/ INSTITUTION: - William Beaumont Hospital, Royal Oak,
Michigan 48073, USA.
----------------------------------------------------
[21]
TÍTULO / TITLE: - Guidelines for
preventing opportunistic infections among hematopoietic stem cell transplant
recipients. Recommendations of CDC, the Infectious Disease Society of America,
and the American Society of Blood and Marrow Transplantation.
REVISTA
/ JOURNAL: - Cytotherapy 2001;3(1):41-54.
●●
Enlace al texto completo (gratuito o de pago) 1080/146532401753156403
----------------------------------------------------
[22]
TÍTULO / TITLE: - Calcium channel
blockers for preventing acute tubular necrosis in kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003421.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003421.pub2
AUTORES
/ AUTHORS: - Shilliday I; Sherif M
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Monklands Hospital, Monkscourt
Avenue, Airdrie, UK, ML6 0JS.
RESUMEN
/ SUMMARY: - BACKGROUND: The incidence of delayed graft
function in cadaveric grafts has increased over the last few years due in part
to the large demand for cadaveric kidneys necessitating the use of kidneys from
marginal donors. Calcium channel blockers have the potential to reduce the
incidence of post-transplant acute tubular necrosis (ATN) if given in the
peri-operative period. However, there is controversy surrounding their use in
this situation with no consensus as to their efficacy. OBJECTIVES: To evaluate
the benefits and harms of using calcium channel blockers in the peri-transplant
period in patients at risk of ATN following cadaveric kidney transplantation.
SEARCH STRATEGY: We searched the Cochrane Renal Group’s specialised register,
the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane
Library issue 2, 2003) MEDLINE (1966 to January 2003) and EMBASE (1980 -
January 2003). The Trials Search Coordinator was contacted to develop the
search strategy. SELECTION CRITERIA: Randomised controlled trials comparing
calcium channel blockers given in the peri-transplant period with controls were
included. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS:
Data was extracted and quality assessed independently by two reviewers, with
differences resolved by discussion. Dichotomous outcomes are reported as
relative risk (RR) and measurements on continuous scales are reported as
weighted mean differences (WMD) with 95% confidence intervals (CI). MAIN
RESULTS: Nine trials were suitable for inclusion. Treatment with calcium
channel blockers in the peri-transplant period was associated with a
significant decrease in the incidence of post transplant ATN (RR 0.57, 95%CI
0.40 to 0.82) and delayed graft function (RR 0.44, 95% CI 0.28 to 0.69). There
was no difference between control and treatment groups in graft loss,
mortality, requirement for haemodialysis. There was insufficent information to
comment on adverse events. REVIEWER’S CONCLUSIONS: These results suggest that
calcium channel blockers given in the peri-operative period may reduce the
incidence of ATN post-transplantation. The result should be treated with
caution due to the heterogeneity of the trials which made comparison of studies
and pooling of data difficult.
----------------------------------------------------
[23]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[24]
TÍTULO / TITLE: - Induction of immune
tolerance by dendritic cells: implications for preventative and therapeutic
immunotherapy of autoimmune disease.
REVISTA
/ JOURNAL: - Immunol Cell Biol 2002 Dec;80(6):509-19.
AUTORES
/ AUTHORS: - Thompson AG; Thomas R
INSTITUCIÓN
/ INSTITUTION: - Centre for Immunology and Cancer Research,
Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.
RESUMEN
/ SUMMARY: - Dendritic cells (DC) have a key role in
controlling the immune response, by determining the outcome of antigen
presentation to T cells. Through costimulatory molecules and other factors, DC
are involved in the maintenance of peripheral tolerance through modulation of
the immune response. This modulation occurs both constitutively, and in
inflammation, in order to prevent autoimmunity and to control established
immune responses. Dendritic cell control of immune responses may be mediated
through cytokine or cell-contact dependent mechanisms. The molecular and
cellular basis of these controls is being understood at an increasingly more
complex level. This understanding is reaching a level at which DC-based
therapies for the induction of immune regulation in autoimmunity can be tested
in vivo. This review outlines the current state of knowledge of DC in immune
tolerance, and proposes how DC might control both T cell responses, and
themselves, to prevent autoimmunity and maintain peripheral tolerance. N. Ref:: 135
----------------------------------------------------
[25]
TÍTULO / TITLE: - The treatment of
glomerular disease—a compromise between the standard and the individual
approach.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v31-3.
AUTORES
/ AUTHORS: - Kiperova B
INSTITUCIÓN
/ INSTITUTION: - Medical University of Sofia, University
Hospital Alexandrovska, Clinic of Nephrology, Sofia, Bulgaria. bkiperova@yahoo.com
RESUMEN
/ SUMMARY: - Chronic glomerulonephritis (GN) is one of
the leading causes of end-stage renal disease (ESRD). The possibilities for
successful treatment in the earliest stages are still limited.
Immunosuppressive treatment leads to complete or partial remission only in some
patients. Even then, a non-immunological evolution to chronic renal
insufficiency often enters a progressive course. By applying a consistent
strategy for their individual evaluation and management, it is possible to
improve the outcome of patients with GN. The early referral to a nephrologist
and an early histomorphological diagnosis; the precise assessment of the type
of injury, i.e. proliferative or non-proliferative; the indices of activity and
chronicity; and the prognostic indicators are helpful for the therapeutic
approach. The goal of the management of GN has to be to suppress the disease
with minimum side effects of the treatment. Many unanswered questions and
controversies remain concerning the immunosuppressive therapy. A precise distinction
is needed between the problematic assertions and evidence-based protocols. A
common task for the treatment of all types of chronic GN should be the
protection of renal structure and function: control of blood pressure, action
on renal haemodynamics and proteinuria via pharmacological inhibition of the
renin-angiotensin system, control of hyperlipidaemia and limitation of
fibrosis. Some novel and promising pharmacological approaches to extracellular
matrix accumulation and chronic interstitial fibrosis are in progress. N. Ref:: 15
----------------------------------------------------
[26]
TÍTULO / TITLE: - Mycophenolate mofetil
versus azathioprine therapy is associated with a significant protection against
long-term renal allograft function deterioration.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1341-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062833.14843.4B
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Steffen BJ; Hochberg
AM; Gordon RD; Liebman MN; Morris JA; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Florida College of Medicine, Gainesville, FL 32610-0224, USA. meierhu@medicine.ufl.edu.
RESUMEN
/ SUMMARY: - BACKGROUND: To evaluate the association of
long-term continuous mycophenolate mofetil (MMF) versus azathioprine (AZA)
therapy and renal allograft function, as measured by the slope of reciprocal
creatinine, we analyzed 49,666 primary renal allograft recipients reported to
the United States Renal Data System between October 31, 1988 and June 30, 1998.
METHODS: The primary study endpoint was defined as a greater than 20% decrease
below a 6-month baseline of 1/serum creatinine (SCr) (slope of reciprocal
creatinine) at or beyond 1 year after transplantation. A secondary endpoint was
defined as reaching an SCr value greater than 1.6 mg/dL. Univariate
Kaplan-Meier analysis and multivariate Cox proportional hazard models were used
to investigate the risk of reaching the study endpoints. Multivariate analyses
were corrected for potential confounding covariates. RESULTS: According to the
Cox proportional hazard model, 12-month continued therapy of MMF versus AZA was
associated with a protective effect against declining renal function, as
measured by the slope of reciprocal creatinine (relative risk [RR]=0.84,
confidence interval 0.78-0.91, P<0.001). For 24-month continued therapy of
MMF versus AZA, MMF was associated with a further decreased risk for a decline
in renal function (RR=0.66, confidence interval=0.57-0.77, P<0.001).
Furthermore, MMF was associated with a protective effect against reaching the
SCr threshold of 1.6 mg/dL (RR=0.80, P<0.001) beyond 12 months
posttransplantation. CONCLUSIONS: Continuous use of MMF versus AZA was
associated with a protective effect against declining renal function beyond 1
year after transplantation. Further study is needed to confirm that continued
MMF therapy is protective against long-term deterioration in renal function.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Evaluation of
thalidomide for treatment or prevention of chronic graft-versus-host disease.
REVISTA
/ JOURNAL: - Leuk Lymphoma 2003 Jul;44(7):1141-6.
AUTORES
/ AUTHORS: - Flowers ME; Martin PJ
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Research, Fred
Hutchinson Cancer Research Center, 1100 Fairview Avenue N., DS-290, PO Box
19024, Seattle, WA 98109-1024, USA. mflowers@fhcrc.org
RESUMEN
/ SUMMARY: - During the past 5 years, better
understanding of immunomodulatory and anti-angiogenesis properties of
thalidomide has increased interest in the use of this agent for a wider variety
of clinical applications. This article reviews the clinical evaluation of
thalidomide for treatment or prevention of chronic
graft-versus-host-disease. N.
Ref:: 38
----------------------------------------------------
[28]
TÍTULO / TITLE: - Dry eye as a major
complication associated with chronic graft-versus-host disease after
hematopoietic stem cell transplantation.
REVISTA
/ JOURNAL: - Cornea 2003 Oct;22(7 Suppl):S19-27.
AUTORES
/ AUTHORS: - Ogawa Y; Kuwana M
INSTITUCIÓN / INSTITUTION: - Institute for Advanced Medical Research, and Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. yoko@sc.itc.ke