Başkent Üniversitesi Yayınları

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search.filters.applied.f.language: search.filters.language.en_USSubject: search.filters.subject.immunosuppression

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    Novel Treatment with Rituximab of Oropharyngeal Posttransplant Lymphoproliferative Disorder after Heart Transplantation
    (Başkent Üniversitesi, 2005-12) Kaczmarek, Ingo; Beiras-Fernandez, Andres; Sadoni, Sebastian; Bengel, Dominik; Deutsch, Marcus-Andre; Meiser, Bruno; Reichart, Bruno
    Posttransplant lymphoproliferative disorders are severe complications that arise after solid organ transplantation, which are often related to Epstein-Barr virus. Reports are anecdotal, and a standardized therapy does not exist. We report a case of a 36-year-old man who developed posttransplant lymphoproliferative disorder of the oropharynx 1 year after receiving a heart transplant. A short review of the literature is presented, after which a new therapeutic approach that combines antiviral therapy, monoclonal antibodies, and a sirolimus-based maintenance immunosuppression regimen with reduced target trough levels of tacrolimus is introduced. The patient achieved complete remission and was free from recurrence 18 months after the therapy was initiated.
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    Mycophenolic Acid Plasma Trough Level: Correlation with Clinical Outcome
    (Başkent Üniversitesi, 2005-12) Barbari, A.; Stephan, A.; Masri, M A.; Kamel, G.; Karam, A.; Mourad, N.; Kilani, H.; El-Ghoul, B.
    Objectives: Assess the relationship between clinical diagnosis, state of immunosuppression, mycophenolic acid (MPA) plasma trough levels (MPACmin), and mycophenolate mofetil (MMF) dosage in renal transplant recipients. Materials and Methods: MPACmin were determined in 30 kidney transplant patients, of whom 7 exhibited biopsy-proven acute rejection. The remaining 23 had normal graft function. Graft outcome, defined by clinical diagnosis and serum creatinine level, was compared according to MPACmin, MMF dosage, and total lymphocyte count (LC). Results: Patients with acute rejection had similar MPACmin (2.4 ± 1.7 µg/mL), MMF dosages (1.7 ± 0.5 g), and LCs (0.001165 ± 0.0040 x 109/L) when compared with normal patients (2.2 ± 0.7 µg/mL, 1.7 ± 0.4 g and 0.001160 ± 0.00527 x 109/L) respectively. Rejection rates were comparable irrespective of MPACmin ranges and higher in those receiving the 1-g dose (30%) when compared with those receiving 1.5-g and 2-g doses (12.5% and 11.7%). No relationship was observed between MPACmin and MMF doses, and neither parameter correlated with LC. Conclusions: These results suggest that MPACmin is a poor correlate of clinical outcome and state of immunosuppression. Although the usually recommended dosage of MMF (2 g) may be associated with acute rejection, low-dose MMF (1 g) seems to constitute a higher risk.
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    Sirolimus: A Current Perspective
    (Başkent Üniversitesi, 2003-06) Yakupoğlu, K. Yarkin; D. Kahan, Barry
    Sirolimus, a macrocyclic lactone that displays a novel mechanism of immunosuppressive action, is a critical-dose drug requiring therapeutic drug monitoring for optimal outcomes. The compound was documented in two multicenter, blinded clinical trials to reduce the incidence of acute rejection episodes when used in combination with cyclosporine and steroids vs. azathioprine or placebo comparators. Furthermore, studies utilizing cyclosporine withdrawal documented a long-term benefit on renal function of chronic sirolimus therapy, albeit with a modestly enhanced incidence of acute rejection episodes. Although this application may be useful in selected cases, we believe that minimal initial cyclosporine exposures de novo mitigate the need for eventual withdrawal for chronic nephropathy, while preserving the immunosuppressive synergy during the maintenance phase. Recipients treated de novo with a sirolimuscyclosporine combination tolerate steroid withdrawal at 1 month after living-donor or at 3 to 6 months after cadaveric kidney transplantation with only a 5% risk of acute rejection episodes and 6% incidence of chronic reactions within 3 years. However, sirolimus exacerbates the hypertriglyceridemic and hypercholesterolemic proclivities of transplant recipients, as well as exerts myelosuppressive effects, which are augmented by concomitant therapy with azathioprine or, particularly, with mycophenolate mofetil. Due to its apparent lack of nephrotoxicity, sirolimus has been employed for induction therapy in a calcineurin antag-onist-free regimen in combination with either basiliximab or rabbit antilymphocyte sera for weak or strong immune responders, respectively, followed by introduction of a calcineurin antagonist upon resolution of the ischemia-reperfusion injury. Therefore, sirolimus proffers a potent and unique platform for new immunosuppressive strategies in organ transplantation.