#06#
Revisiones-Clínica-Pronóstico
*** Reviews-Clinical-Prognosis
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: - Clinical practice
guidelines for managing dyslipidemias in kidney transplant patients: a report
from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the
National Kidney Foundation Kidney Disease Outcomes Quality Initiative.
REVISTA
/ JOURNAL: - Am J Transplant 2004;4 Suppl 7:13-53.
●●
Enlace al texto completo (gratuito o de pago) 1111/j.1600-6135.2004.0355.x
AUTORES
/ AUTHORS: - Kasiske B; Cosio FG; Beto J; Bolton K;
Chavers BM; Grimm R Jr; Levin A; Masri B; Parekh R; Wanner C; Wheeler DC;
Wilson PW
RESUMEN
/ SUMMARY: - The incidence of cardiovascular disease
(CVD) is very high in patients with chronic kidney (CKD) disease and in kidney
transplant recipients. Indeed, available evidence for these patients suggests
that the 10-year cumulative risk of coronary heart disease is at least 20%, or
roughly equivalent to the risk seen in patients with previous CVD. Recently,
the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative
(K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias
in patients with CKD, including transplant patients. It was the conclusion of
this Work Group that the National Cholesterol Education Program Guidelines are
generally applicable to patients with CKD, but that there are significant
differences in the approach and treatment of dyslipidemias in patients with CKD
compared with the general population. In the present document we present the
guidelines generated by this workgroup as they apply to kidney transplant
recipients. Evidence from the general population indicates that treatment of
dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests
that judicious treatment can be safe and effective in improving dyslipidemias.
Dyslipidemias are very common in CKD and in transplant patients. However, until
recently there have been no adequately powered, randomized, controlled trials
examining the effects of dyslipidemia treatment on CVD in patients with CKD.
Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results
of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been
presented and published. Based on information from randomized trials conducted
in the general population and the single study conducted in kidney transplant
patients, these guidelines, which are a modified version of the K/DOQI
dyslipidemia guidelines, were developed to aid clinicians in the management of
dyslipidemias in kidney transplant patients. These guidelines are divided into
four sections. The first section (Introduction) provides the rationale for the
guidelines, and describes the target population, scope, intended users, and
methods. The second section presents guidelines on the assessment of
dyslipidemias (guidelines 1-3), while the third section offers guidelines for
the treatment of dyslipidemias (guidelines 4-5). The key guideline statements
are supported mainly by data from studies in the general population, but there
is an urgent need for additional studies in CKD and in transplant patients.
Therefore, the last section outlines recommendations for research.
----------------------------------------------------
[2]
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
----------------------------------------------------
[3]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of Transplantation,
University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Early outcome after
sirolimus-eluting stent implantation in patients with acute coronary syndromes:
insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital
(RESEARCH) registry.
REVISTA
/ JOURNAL: - J Am Coll Cardiol 2003 Jun
4;41(11):2093-9.
AUTORES
/ AUTHORS: - Lemos PA; Lee CH; Degertekin M; Saia F;
Tanabe K; Arampatzis CA; Hoye A; van Duuren M; Sianos G; Smits PC; de Feyter P;
van der Giessen WJ; van Domburg RT; Serruys PW
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiology, Thoraxcenter,
Erasmus Medical Center, Dr Molewaterplein 40, NL-3015 GD Rotterdam, the
Netherlands.
RESUMEN
/ SUMMARY: - OBJECTIVES: This study evaluated the early
outcomes of patients with acute coronary syndromes (ACS) treated with
sirolimus-eluting stents (SES). BACKGROUND: The safety of SES implantation in
patients with a high risk for early thrombotic complications is currently
unknown. METHODS: Sirolimus-eluting stents have been utilized as the device of
choice for all percutaneous procedures in our institution, as part of the
Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH)
registry. After four months of enrollment, 198 patients with ACS had been
treated exclusively with SES (64% of those treated in the period) and were
compared with a control group composed of 301 consecutive patients treated with
bare stents in the same time period immediately before this study. The
incidence of major adverse cardiac events (MACE) during the first month was
evaluated (death, nonfatal myocardial infarction [MI], or re-intervention).
RESULTS: Compared with control patients, patients treated with SES had more
primary angioplasty (95% vs. 77%; p < 0.01), more bifurcation stenting (13%
vs. 5%; p < 0.01), less previous MI (28% vs. 45%; p < 0.01), and less
glycoprotein IIb/IIIa inhibitor utilization (27% vs. 42%; p < 0.01). The
30-day MACE rate was similar between both groups (SES 6.1% vs. control patients
6.6%; p = 0.8), with most complications occurring during the first week. Stent
thrombosis occurred in 0.5% of SES patients and in 1.7% of control patients (p
= 0.4). In multivariate analysis, SES utilization did not influence the
incidence of MACE (odds ratio 1.0 [95% confidence interval: 0.4 to 2.2]; p =
0.97). CONCLUSIONS: Sirolimus-eluting stent implantation for patients with ACS
is safe, with early outcomes comparable with bare metal stents. N. Ref:: 25
----------------------------------------------------
[5]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients
representing 0.84% of all reported malignancies. We identified 7 renal
transplant recipients with bladder cancer at our institution. Invasive
transitional cell carcinoma developed in 5 patients at a median of 2.8 years
after transplant. Three patients underwent uncomplicated radical cystectomy and
preservation of the renal allograft. Overall survival at 48 months was 60%.
CONCLUSIONS: Bladder cancer after renal transplantation is not common. For
patients who present with invasive disease, traditional extirpative surgery
should be considered. Moreover, the allograft is rarely the source of
transitional cell carcinoma and can be preserved. In our experience the cancer
and urinary outcomes compare favorably with nontransplant patient outcomes
after treatment. N.
Ref:: 21
----------------------------------------------------
[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: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[9]
TÍTULO / TITLE: - Cell survival and
clinical outcome following intrastriatal transplantation in Parkinson disease.
REVISTA
/ JOURNAL: - J Neuropathol Exp Neurol 2001
Aug;60(8):741-52.
AUTORES
/ AUTHORS: - Hagell P; Brundin P
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Neuroscience,
University Hospital, Lund University, Sweden.
RESUMEN
/ SUMMARY: - Intrastriatal transplantation of embryonic
dopaminergic neurons is currently explored as a restorative cell therapy for
Parkinson disease (PD). Clinical results have varied, probably due to
differences in transplantation methodology and patient selection. In this
review, we assess clinical trials and autopsy findings in grafted PD patients
and suggest that a minimum number of surviving dopaminergic neurons is required
for a favorable outcome. Restoration of [18F]-fluorodopa uptake in the putamen
to about 50% of the normal mean seems necessary for moderate to marked clinical
benefit to occur. Some studies indicate that this may require mesencephalic
tissue from 3-5 human embryos implanted into each hemisphere. The volume,
density and pattern of fiber outgrowth and reinnervation, as well as functional
integration and dopamine release. are postulated as additional important
factors for an optimal clinical outcome. For neural transplantation to become a
feasible therapeutic alternative in PD, graft survival must be increased and
the need for multiple donors of human embryonic tissue substantially decreased
or alternate sources of donor tissue developed. Donor cells derived from alternative
sources should demonstrate features comparable to those associated with
successful implantation of human embryonic tissue before clinical trials are
considered. N. Ref:: 62
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
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.
----------------------------------------------------
[12]
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.
----------------------------------------------------
[13]
TÍTULO / TITLE: - Prediction of an
HLA-DR-binding peptide derived from Wilms’ tumour 1 protein and demonstration
of in vitro immunogenicity of WT1(124-138)-pulsed dendritic cells generated
according to an optimised protocol.
REVISTA
/ JOURNAL: - Cancer Immunol Immunother 2002
Jul;51(5):271-81. Epub 2002 Apr 26.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00262-002-0278-2
AUTORES
/ AUTHORS: - Knights AJ; Zaniou A; Rees RC; Pawelec G;
Muller L
INSTITUCIÓN
/ INSTITUTION: - University of Tubingen, Section for
Transplantation Immunology and Immunohaematology, Second Department of Internal
Medicine, Zentrum fur Medizinische Forschung ZMF, Waldhornlestrasse 22, 72072
Tubingen, Germany.
RESUMEN
/ SUMMARY: - The Wilms’ tumour 1 (WT1) protein is over-expressed
in several types of cancer including leukaemias and might therefore constitute
a novel target for immunotherapy. Recently, human leucocyte antigen (HLA) class
I-binding WT1 peptides have been identified and shown to stimulate CD8(+) T
cells in vitro. For maximal CD8 cell efficacy, CD4(+) helper T cells responding
to major histocompatibility complex (MHC) class II-binding epitopes are
required. Here, we report that scanning the WT1 protein sequence using an
evidence-based predictive computer algorithm (SYFPEITHI) yielded a peptide
WT1(124-138) predicted to bind the HLA-DRB1*0401 molecule with high affinity.
Moreover, synthetic WT1(124-138)-peptide-pulsed dendritic cells (DC), generated
according to a protocol optimised in the present study, sensitised T cells in
vitro to proliferate and secrete interferon-gamma (IFN-gamma) when rechallenged
with specific peptide-pulsed DC, but not with peripheral blood mononuclear
cells (PBMC). These results suggest that the WT1 protein may yield epitopes
immunogenic to CD4 as well as CD8 T cells, and therefore constitute a novel
potential target for specific immunotherapy.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Pregnancy outcome after
cyclosporine therapy during pregnancy: a meta-analysis.
REVISTA
/ JOURNAL: - Transplantation 2001 Apr 27;71(8):1051-5.
AUTORES
/ AUTHORS: - Bar Oz B; Hackman R; Einarson T; Koren G
INSTITUCIÓN
/ INSTITUTION: - The Motherisk Program, Division of
Clinical Pharmacology/Toxicology, The Hospital for Sick Children, Toronto,
Ontario, Canada.
RESUMEN
/ SUMMARY: - BACKGROUND: Cyclosporine (CsA) therapy
must often be continued during pregnancy to maintain maternal health in such
conditions as organ transplantation and autoimmune disease. This meta-analysis
was performed to determine whether CsA exposure during pregnancy is associated
with an increased risk of congenital malformations, preterm delivery, or low
birthweight. METHODS: Various health science databases were searched to
identify relevant articles. Articles selected for inclusion in the study were
required to be free of any apparent selection bias and report outcomes in at
least 10 newborns exposed to CsA in utero, specifically commenting on the
presence or absence of congenital malformations. Article selection and data
extraction were performed by two independent reviewers, with adjudication in
cases of disagreement. To assess risks of CsA exposure, a summary odds ratio
was calculated. Prevalence of malformations was calculated as a rate for all cyclosporine-exposed
live births and for the subgroups identified. Ninety-five percent confidence
intervals were constructed for both the odds ratio and prevalence rates.
RESULTS: Fifteen studies (6 with control groups of transplant without use of
cyclosporine; total patients: 410) met the inclusion criteria for major
malformations, 10 for preterm delivery (4 with control groups; total patients:
379) and 5 for low birth weight (1 with control groups; total number of
patients: 314). The calculated odds ratio of 3.83 for malformations did not
achieve statistical significance (CI 0.75-19.6). The overall prevalence of
major malformations in the study population (4.1%) also did not vary
substantially from that reported in the general population. OR for prematurity [1.52
(CI 1.00-2.32)] did not reach statistical significance although the overall
prevalence rate was 56.3%. The OR for low birth weight [1.5 (CI 0.95-2.44 based
on 1 study)]. CONCLUSIONS: CsA does not appear to be a major human teratogen.
It may be associated with increased rates of prematurity. More research is
needed to evaluate whether cyclosporine increases teratogenic risk.
----------------------------------------------------
[15]
TÍTULO / TITLE: - Protocol core needle
biopsy and histologic Chronic Allograft Damage Index (CADI) as surrogate end
point for long-term graft survival in multicenter studies.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):773-9.
AUTORES
/ AUTHORS: - Yilmaz S; Tomlanovich S; Mathew T;
Taskinen E; Paavonen T; Navarro M; Ramos E; Hooftman L; Hayry P
INSTITUCIÓN
/ INSTITUTION: - Data Analysis Center, Division of
Transplantation, Department of Surgery, University of Calgary, Alberta, Canada.
RESUMEN
/ SUMMARY: - This study is an investigation of whether
a protocol biopsy may be used as surrogate to late graft survival in
multicenter renal transplantation trials. During two mycophenolate mofetil
trials, 621 representative protocol biopsies were obtained at baseline, 1 yr,
and 3 yr. The samples were coded and evaluated blindly by two pathologists, and
Chronic Allograft Damage Index (CADI) score was constructed. At 1 yr, only 20%
of patients had elevated (>l.5 mg/100 ml) serum creatinine, whereas 60% of
the biopsies demonstrated an elevated (>2.0) CADI score. The mean CADI score
at baseline, 1.3 +/- 1.1, increased to 3.3 +/- 1.8 at 1 yr and to 4.1 +/- 2.2
at 3 yr. The patients at 1 yr were divided into three groups, those with CADI
<2, between 2 and 3.9, and >4.0, the first two groups having normal (1.4
+/- 0.3 and 1.5 +/- 0.6 mg/dl) and the third group pathologic (1.9 +/- 0.8
mg/dl) serum creatinine. At 3 yr, there were no lost grafts in the low CADI
group, six lost grafts (4.6%) in the in the elevated CADI group, and 17 lost
grafts (16.7%) in the high CADI group (P < 0.001). One-year histologic CADI
score predicts graft survival even when the graft function is still normal.
This observation makes it possible to use CADI as a surrogate end point in
prevention trials and to identify the patients at risk for intervention trials.
----------------------------------------------------
[16]
TÍTULO / TITLE: - Pulmonary infiltrates
in the non-HIV-infected immunocompromised patient: etiologies, diagnostic
strategies, and outcomes.
REVISTA
/ JOURNAL: - Chest. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.chestjournal.org/
●●
Cita: Chest: <> 2004 Jan;125(1):260-71.
AUTORES
/ AUTHORS: - Shorr AF; Susla GM; O’Grady NP
INSTITUCIÓN
/ INSTITUTION: - Pulmonary and Critical Care Medicine
Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. afshorr@dnamail.com
RESUMEN
/ SUMMARY: - Pulmonary complications remain a major
cause of both morbidity and mortality in immunocompromised patients. When such
individuals present with radiographic infiltrates, the clinician faces a
diagnostic challenge. The differential diagnosis in this setting is broad and
includes both infectious and noninfectious processes. Rarely are the
radiographic findings classic for one disease, and most potential etiologies
have overlapping clinical and radiographic appearances. In recent years,
several themes have emerged in the literature on this topic. First, an
aggressive approach to identifying a specific etiology is necessary; as a
corollary, diagnostic delay increases the risk for mortality. Second, the
evaluation of these infiltrates nearly always entails bronchoscopy.
Bronchoscopy allows identification of some etiologies with certainty, and often
allows for the exclusion of infectious agents even if the procedure is
otherwise unrevealing. Third, early use of CT scanning regularly demonstrates
lesions missed by plain radiography. Despite these advances, initial
therapeutic interventions include the use of broad-spectrum antibiotics and
other anti-infectives in order to ensure that the patients is receiving
appropriate therapy. With the results of invasive testing, these treatments are
then narrowed. Frustratingly, outcomes for immunocompromised patients with
infiltrates remain poor. N.
Ref:: 58
----------------------------------------------------
[17]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.13 Analysis of patient and graft survival.
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 4:60-7.
RESUMEN
/ SUMMARY: - GUIDELINES: A. It is important for a
transplant unit to follow-up on the results of their transplant activities. In
order to achieve correct reports on graft and patient outcome in all patients,
it is necessary to have sufficient resources, such as a computerized database,
and continuous updates of patient information. All data collected should be
subjected to validation procedures to ensure completeness and accuracy. B.
Improved outcomes following implementation of new protocols, based on
evaluation of clinical multi-centre trials, should be verified at local
transplant centres since centres often include a range of patients different
from those selected for the trial. C. The most widely accepted descriptor of
outcome is the Kaplan-Meier probability estimate of patient and graft survival.
Survival estimates should be calculated at intervals of time after
transplantation and should always be expressed with their 95% confidence
intervals. D. Kaplan-Meier survival estimates may be calculated in three ways.
(i) ‘Patient survival’ should be calculated from the date of transplantation to
the date of death or the date of the last follow-up. (ii) ‘Graft survival’
(non-censored for death) should be calculated from the date of transplantation
to the date of irreversible graft failure signified by return to long-term dialysis
(or retransplantation) or the date of the last follow-up during the period when
the transplant was still functioning or to the date of death. Here, death with
graft function is treated as graft failure. (iii) ‘Graft survival censored for
death with a functioning graft’ (death-censored graft survival) should be
calculated from the date of transplantation to the date of irreversible graft
failure signified by return to long-term dialysis (or retransplantation) or the
date of last follow-up during the period when the transplant was still
functioning. In the event of death with a functioning graft, the follow-up
period is censored at the date of death. E. The outcome of transplants carried
out at a centre should be compared with those achieved across a range of data
from centres collated by national and international multi-centre registries.
Interpretation of a centre’s performance should take into account the number of
transplants performed and the prevalence of major risk factors. F. Major risk
factors that influence transplant outcome are identifiable by applying
multivariate analytical methods to large multi-centre follow-up databases.
Although these major risk factors may not be identifiable in individual centre
data, they should nonetheless be taken into account in patient management. G.
When designing a clinical trial or evaluating data from a recent trial, the
expected improvement in graft survival resulting from a reduction in acute
rejection may be estimated from a knowledge of the rejection and graft survival
rates that existed prior to the introduction of the new therapeutic regimen. H.
When designing or evaluating a clinical trial, it is important to analyse the
power of the study to verify statistically the difference (in graft survival)
that might be expected and its statistical significance. A study resulting in
absence of statistically significant differences between two treatment groups
with insufficient statistical power to verify a difference at the expected
level should not be taken as evidence of absence of a true difference.
----------------------------------------------------
[18]
TÍTULO / TITLE: - Renal function as a
predictor of long-term graft survival in renal transplant patients.
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 May;18 Suppl 1:i3-6.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - Research and Development, Fujisawa
Healthcare, Inc., Deerfield, IL 60015, USA. roy_first@fujisawa.com
RESUMEN
/ SUMMARY: - Acute rejection is a major risk factor for
kidney graft failure. However, as acute rejection has been progressively
reduced by recent immunosuppressive regimens, other risk factors are becoming
increasingly important. Evidence is accumulating that early renal function
predicts long-term outcome. A recent registry survey of more than 100 000
kidney transplants found that 6- and 12-month serum creatinine levels, as well
as the change between 6 and 12 months, are strongly associated with long-term
graft survival. A survey of paediatric renal transplant recipients showed that
poor creatinine clearance (<50 ml/min) as early as 30 days post-transplant
predicted an annual rate of graft loss of 13% compared with <3% in patients
with 30-day clearance >50 ml/min. This association between early renal
function and long-term outcome was confirmed in multicentre studies. Renal
transplant recipients (n=572) with 6-month serum creatinine levels >1.5
mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients with
levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving
tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with
cyclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study
(n=436) found that while glomerular filtration rate (GFR) at 6 months
post-transplant had remained stable over the last decade, the rate of loss of
renal function had decreased. A lower rate of GFR loss was associated with
absence of rejection, use of mycophenolate mofetil rather than azathioprine and
use of tacrolimus rather than cyclosporin (P<0.01). In conclusion, early
measures of renal function allow identification of those patients at highest
risk of graft failure and provide an invaluable tool for improving outcomes by
tailored immunosuppression. The choice of such immunosuppression should be
guided not only by its ability to prevent rejection, but also by its impact on
renal function. N.
Ref:: 11
----------------------------------------------------
[19]
TÍTULO / TITLE: - Hematopoietic cell
transplantation for inherited metabolic diseases: an overview of outcomes and
practice guidelines.
REVISTA
/ JOURNAL: - Bone Marrow Transplant 2003
Feb;31(4):229-39.
●●
Enlace al texto completo (gratuito o de pago) 1038/sj.bmt.1703839
AUTORES
/ AUTHORS: - Peters C; Steward CG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, University of
Minnesota School of Medicine, Minneapolis, 55455, USA.
RESUMEN
/ SUMMARY: - For the past two decades, hematopoietic
cell transplantation (HCT) has been used as effective therapy for selected
inherited metabolic diseases (IMD) including Hurler (MPS IH) and Maroteaux-Lamy
(MPS VI) syndromes, childhood-onset cerebral X-linked adrenoleukodystrophy
(X-ALD), globoid-cell leukodystrophy (GLD), metachromatic leukodystrophy (MLD),
alpha-mannosidosis, osteopetrosis, and others. Careful pre-HCT evaluation is
critical and coordinated, multidisciplinary follow-up is essential in this
field of transplantation. The primary goals of HCT for these disorders have
been to promote long-term survival with donor-derived engraftment and to
optimize the quality of life. Guidelines for HCT and monitoring are provided; a
brief overview of long-term results is also presented. N. Ref:: 131
----------------------------------------------------
[20]
TÍTULO / TITLE: - Clinical outcomes and
insulin secretion after islet transplantation with the Edmonton protocol.
REVISTA
/ JOURNAL: - Diabetes. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://diabetes.diabetesjournals.org/
●●
Cita: Diabetes: <> 2001 Apr;50(4):710-9.
AUTORES
/ AUTHORS: - Ryan EA; Lakey JR; Rajotte RV; Korbutt GS;
Kin T; Imes S; Rabinovitch A; Elliott JF; Bigam D; Kneteman NM; Warnock GL;
Larsen I; Shapiro AM
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Surgical Medical
Research Institute, University of Alberta, Edmonton, Canada. edmond.ryan@ualberta.ca
RESUMEN
/ SUMMARY: - Islet transplantation offers the prospect
of good glycemic control without major surgical risks. After our initial report
of successful islet transplantation, we now provide further data on 12 type 1
diabetic patients with brittle diabetes or problems with hypoglycemia previous
to 1 November 2000. Details of metabolic control, acute complications
associated with islet transplantation, and long-term complications related to
immunosuppression therapy and diabetes were noted. Insulin secretion, both
acute and over 30 min, was determined after intravenous glucose tolerance tests
(IVGTTs). The median follow-up was 10.2 months (CI 6.5-17.4), and the longest
was 20 months. Glucose control was stable, with pretransplant fasting and meal
tolerance-stimulated glucose levels of 12.5+/-1.9 and 20.0+/-2.7 mmol/l,
respectively, but decreased significantly, with posttransplant levels of
6.3+/-0.3 and 7.5+/-0.6 mmol/l, respectively (P < 0.006). All patients have
sustained insulin production, as evidenced by the most current baseline
C-peptide levels 0.66+/-0.06 nmol/l, increasing to 1.29+/-0.25 nmol/l 90 min
after the meal-tolerance test. The mean HbA1c level decreased from 8.3+/-0.5%
to the current level of 5.8+/-0.1% (P < 0.001). Presently, four patients
have normal glucose tolerance, five have impaired glucose tolerance, and three
have post-islet transplant diabetes (two of whom need oral hypoglycemic agents
and low-dose insulin (<10 U/day). Three patients had a temporary increase in
their liver-function tests. One patient had a thrombosis of a peripheral branch
of the right portal vein, and two of the early patients had bleeding from the
hepatic needle puncture site; but these technical problems were resolved. Two
patients had transient vitreous hemorrhages. The two patients with elevated
creatinine levels pretransplant had a significant increase in serum creatinine
in the long term, although the mean serum creatinine of the group was
unchanged. The cholesterol increased in five patients, and lipid-lowering
therapy was required for three patients. No patient has developed
cytomegalovirus infection or disease, posttransplant lymphoproliferative
disorder, malignancies, or serious infection to date. None of the patients have
been sensitized to donor antigen. In 11 of the 12 patients, insulin
independence was achieved after 9,000 islet equivalents (IEs) per kilogram were
transplanted. The acute insulin response and the insulin area under the curve
(AUC) after IVGTT were consistently maintained over time. The insulin AUC from
the IVGTT correlated to the number of islets transplanted, but more closely
correlated when the cold ischemia time was taken into consideration (r = 0.83,
P < 0.001). Islet transplantation has successfully corrected labile type 1
diabetes and problems with hypoglycemia, and our results show persistent
insulin secretion. After a minimum of 9,000 IEs per kilogram are provided,
insulin independence is usually attained. An elevation of creatinine appears to
be a contraindication to this immunosuppressive regimen. For the subjects who
had labile type 1 diabetes that was difficult to control, the risk-to-benefit
ratio is in favor of islet transplantation.
----------------------------------------------------
[21]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.1. Organization of follow-up of transplant patients
after the first year.
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 4:3-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All renal transplant
recipients should undergo regular laboratory check-ups (at least every 2 or 3
months) and regular medical visits as out-patients (at least every 4-6 months)
after the first year post-transplant. B. All renal transplant recipients should
be seen at least once a year in the transplant centre where the transplantation
has been performed or referred to a closer transplant centre for a complete
annual evaluation.
----------------------------------------------------
[22]
TÍTULO / TITLE: - Cyclosporin trough
levels: is monitoring necessary during short-term treatment in psoriasis? A
systematic review and clinical data on trough levels.
REVISTA
/ JOURNAL: - Br J Dermatol 2002 Jul;147(1):122-9.
AUTORES
/ AUTHORS: - Heydendael VM; Spuls PI; Ten Berge IJ;
Opmeer BC; Bos JD; de Rie MA
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Academic
Medical Center, University of Amsterdam, PO Box 22660, the Netherlands.
RESUMEN
/ SUMMARY: - BACKGROUND: Cyclosporin is an effective
treatment for severe plaque psoriasis. Unfortunately, its use may be limited by
time- and dose-related nephrotoxicity. Serum trough levels may be useful for
monitoring the risk of nephrotoxicity. OBJECTIVES: To determine whether
monitoring of trough levels is necessary in psoriasis patients undergoing
short-term treatment with cyclosporin. METHODS: A computerized and manual
literature search identified studies on adults with plaque-type psoriasis
treated with cyclosporin < or = 5 mg kg-1 daily, in which trough levels were
measured in whole blood. Number of patients, treatment duration, formulation
and dosage, renal function tests and trough levels were extracted. The
association between renal function and trough levels was investigated.
Additionally, in a randomized controlled trial on cyclosporin vs. methotrexate
in moderate to severe psoriasis, cyclosporin trough levels were measured
frequently in 20 patients during 12 weeks of treatment. The Pearson correlation
coefficient between serum creatinine and cyclosporin trough levels was
calculated. RESULTS: Fifty-six articles were found concerning cyclosporin
trough level measurements in psoriasis patients, of which eight were analysed.
Many studies were excluded due to inappropriate cyclosporin dosages used. As
data were heterogeneous and lacked various key parameters, a correlation study
and a meta-analysis could not be performed. Instead, a quantitative description
of the literature was given. No high mean trough levels or elevations of serum
creatinine were described. In our clinical study, all the mean trough levels in
17 patients treated with cyclosporin 3 mg kg-1 daily were within the
therapeutic range (< 200 ng mL-1). Elevated trough levels were found in two
of three patients treated with cyclosporin 3-5 mg kg-1 daily. No signs of renal
dysfunction were seen. CONCLUSIONS: The literature does not provide a
definitive answer on whether monitoring cyclosporin trough levels in patients
with psoriasis should be standard practice. Our own data show no need for
cyclosporin trough level monitoring during short-term treatment with
cyclosporin 3 mg kg-1 daily. However, when cyclosporin doses are > 3 mg kg-1
daily, monitoring may be indicated. N.
Ref:: 32
----------------------------------------------------
[23]
TÍTULO / TITLE: - Prospects for treatment
of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for
better prediction of outcome: a systematic review.
REVISTA
/ JOURNAL: - Qjm. Acceso gratuito al texto completo a
partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://qjmed.oupjournals.org/
●●
Cita: QJM: <> 2003 Nov;96(11):809-24.
AUTORES
/ AUTHORS: - Eddleston M; Wilks MF; Buckley NA
INSTITUCIÓN
/ INSTITUTION: - Centre for Tropical Medicine, Nuffield
Department of Clinical Medicine, University of Oxford, UK. eddlestonm@eureka.lk
RESUMEN
/ SUMMARY: - BACKGROUND: Acute paraquat self-poisoning
is a significant problem in parts of Asia, the Pacific and the Caribbean.
Ingestion of large amounts of paraquat results in rapid death, but smaller
doses often cause a delayed lung fibrosis that is usually fatal.
Anti-neutrophil (‘immunosuppressive’) treatment has been recommended to prevent
lung fibrosis, but there is no consensus on efficacy. Aim: To review the
evidence for the use of immunosuppression in paraquat poisoning, and to
identify validated prognostic systems that would allow the use of data from
historical control studies and the future identification of patients who might
benefit from immunosuppression. DESIGN:Systematic review. METHODS: We searched
PubMed, Embase and Cochrane databases for ‘paraquat’ together with ‘poisoning’
or ‘overdose’. We cross-checked references and contacted experts, and searched
on [www.google.com] and [www.yahoo.com] using ‘paraquat’, ‘cyclophosphamide’,
‘methylprednisolone’ and ‘prognosis’. RESULTS: We found ten clinical studies of
immunosuppression in paraquat poisoning. One was a randomized controlled trial
(RCT). Seven used historical controls only; the other two were small (n = 1 and
n = 4). Mortality in controls and patients varied markedly between studies.
Three of the seven non-RCT controlled studies measured plasma paraquat;
analysis using Proudfoot’s or Hart’s nomograms did not suggest that
immunosuppression increased survival in these studies. Of 16 prognostic systems
for paraquat poisoning, none has been independently validated in a large
cohort. DISCUSSION: The authors of the RCT have performed valuable and
difficult research, but their results are hypothesis-forming rather than
conclusive; elsewhere, the use of historical controls is problematic. In the
absence of a validated prognostic marker, a large RCT of immunosuppression
using death as the primary outcome is required. This RCT should also
prospectively test and validate the available prognostic methods, so that
future patients can be selected for this and other therapies on admission. N. Ref:: 57
----------------------------------------------------
[24]
TÍTULO / TITLE: - A benefit-risk
assessment of basiliximab in renal transplantation.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2004;27(2):91-106.
AUTORES
/ AUTHORS: - Boggi U; Danesi R; Vistoli F; Del Chiaro
M; Signori S; Marchetti P; Del Tacca M; Mosca F
INSTITUCIÓN
/ INSTITUTION: - Division of General Surgery and
Transplants, Department of Oncology, Transplants and Advanced Technologies in
Medicine, University of Pisa, Pisa, Italy. uboggi@med.unipi.it
RESUMEN
/ SUMMARY: - Interleukin-2 (IL-2) and its receptor
(IL-2R) play a central role in T lymphocyte activation and immune response
after transplantation. Research on the biology of IL-2R allowed the
identification of key signal transduction pathways involved in the generation
of proliferative and antiapoptotic signals in T cells. The alpha-chain of the
IL-2R is a specific peptide against which monoclonal antibodies have been
raised, with the aim of blunting the immune response by means of inhibiting
proliferation and inducing apoptosis in primed lymphocytes. Indeed,
basiliximab, one of such antibodies, has proved to be effective in reducing the
episodes of acute rejection after kidney and pancreas transplantation. The use
of basiliximab was associated with a significant reduction in the incidence of
any treated rejection episodes after kidney transplantation in the two major
randomised studies (placebo 52.2% vs basiliximab 34.2% at 6 months, European
study; placebo 54.9% vs basiliximab 37.6% at 1 year, US trial). Basiliximab and
equine antithymocyte globulin (ATG) administration resulted in a similar rate
of biopsy-proven acute rejection at 6 months (19% for both) and at 12 months
(19% and 20%, respectively). The use of basiliximab appears not to be
associated with an increased incidence of adverse events as compared with
placebo in immunosuppressive regimens, including calcineurin inhibitors,
mycophenolate mofetil or azathioprine and corticosteroids, and its safety
profile is superior to ATG. Moreover, a similar occurrence of infections is
noted in selected studies (65.5% after basiliximab vs 65.7% of controls),
including cytomegalovirus infection (17.3% vs 14.5%), and cytokine-release
syndrome is not observed. Finally, economic analysis demonstrated lower costs of
overall treatment in patients treated with basiliximab. Therefore, the use of
basiliximab entails a very low risk, allows safe reduction of corticosteroid
dosage and reduces the short- and mid-term rejection rates. However, the
improvement in the long-term survival of kidney grafts in patients treated
according to modern immunosuppressive protocols is still to be demonstrated.
These conclusions are based on a systematic review of the scientific
literature, indexed on Medline database, concerning the mechanism of action,
therapeutic activity, safety and pharmacoeconomic evaluation of basiliximab in
renal transplantation. N.
Ref:: 62
----------------------------------------------------
[25]
TÍTULO / TITLE: - Longitudinal profile of
bronchoalveolar lavage cell characteristics in patients with a good outcome
after lung transplantation.
REVISTA
/ JOURNAL: - Am J Respir Crit Care Med. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajrccm.atsjournals.org/
●●
Cita: Am J. of Respir & Crit Care Med: <> 2002 Feb 15;165(4):501-7.
AUTORES
/ AUTHORS: - Slebos DJ; Scholma J; Boezen HM; Koeter
GH; van der Bij W; Postma DS; Kauffman HF
INSTITUCIÓN
/ INSTITUTION: - Department of Pulmonary Diseases,
University Hospital, University of Groningen, The Netherlands. D.Slebos@int.azg.nl
RESUMEN / SUMMARY: - Bronchoalveolar lavage fluid (BALF) analysis is used in patients after lung transplantation (LTX) to obtain more insight into pathological conditions such as acute and chronic allograft rejection. Information on the normal course of BALF cell characteristics in patients with “good outcome” after LTX is limited. Therefore we analyzed 169 BALF samples from 63 well-defined “good outcome” patients after LTX (no acute or chronic transplant dysfunction, bacterial, fungal, or viral infections at the time of BAL). Total cell count decreased from