摘要:

Purpose of reviewRecent publications have focused on the results of phase I and phase II everolimus clinical trials in renal transplantation. This review will focus both on the pharmacokinetics of everolimus and on its use as an immunosuppressive agent in phase III clinical trials in solid multiorgan transplantation.Recent findingsPhase III clinical trials with long-term follow-up (3 years) have demonstrated that everolimus is a potent immunosuppressive agent. It appears to be well tolerated, with a good safety profile, and has been shown to be effective in solid multiorgan transplant recipients; it has also been effective in cyclosporine-sparing protocols. Everolimus has also been demonstrated to inhibit smooth muscle proliferation, obliterative arteriopathy, transplant arteriosclerosis, and posttransplant lymphoproliferative disorder-derived cellsin vitroandin vivo.SummaryEverolimus, like sirolimus, appears to allow for calcineurin inhibitor minimization, which may allow less nephrotoxicity without compromising efficacy. It appears to protect against CMV infection, and the potential antitumor and antiproliferative activity in in-stent neointimal growth may have significant clinical benefits.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewOutcomes after lung transplantation are poor, largely because of chronic rejection. Increasing immunosuppression to control rejection frequently results in toxicity and opportunistic infection. Aerosol cyclosporine was developed with the rationale that high concentrations of cyclosporine delivered to the lung by aerosol inhalation would result in improved rejection control with limited systemic cyclosporine exposure. Here we describe the developmental history of inhaled cyclosporine and review our ongoing trials to evaluate its use as a promising new therapy for lung transplant recipients.Recent findingsAfter demonstrating safety and efficacy in animal transplant models, clinical trials using rescue open-label, inhaled cyclosporine in human lung transplant recipients with bronchiolitis obliterans and refractory acute rejection demonstrated improvement in pulmonary function and survival. A therapeutic response was dependent on the absolute quantity of cyclosporine measured within the allograft. In 1998, a randomized, placebo-controlled trial was initiated using inhaled cyclosporine in addition to oral immunosuppression. An interim analysis showed that lung function was superior in patients randomized to inhaled cyclosporine who deposited at least 5 mg in the allograft compared with placebo aerosol.SummaryInhaled cyclosporine was safe and improved outcomes in lung transplant recipients with refractory acute and chronic rejection. An interim analysis of a placebo-controlled, randomized trial showed that inhaled cyclosporine improves lung function compared with placebo aerosol. Inhaled cyclosporine should become a standard treatment after lung transplantation if a final analysis of this recently completed trial demonstrates a reduction in the incidence of chronic rejection.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of the reviewThis article examines the trends in consent for organ donations from deceased donors and to give an ethical analysis of why informed consent from donors should be respected for the good of the donor, recipients, and society as a whole.Recent findingsA number of initiatives have been proposed to increase organ donation in the United States such as presumed consent, required response, financial incentives, preferred status, and conscription. However, after reviewing all of these approaches from both a social and an ethical perspective, it appears that the one approach that could work is the present one based on altruism and voluntarism with a few modifications.SummaryDonor authorization would allow competent adults to decide whether they wish to be an organ donor without the added step of seeking surrogate or family consent after death. An individual could register as an organ donor through the Department of Motor Vehicles or have a valid organ donor card that is signed and witnessed. To verify that an individual is an organ donor, there could be the creation of a national organ registry, which would be available around the clock. If an individual is recognized as a legal organ donor, then the transplant coordinator would inform the surrogate or family members of the individual's wish to be a donor and then explain the harvesting process to them. The donor authorization approach would not only respect the individual's right of autonomy and justice, but would be beneficial to recipients and society as a whole.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewOrgans procured from donors with positive viral serology are currently underused. Defining the risk of transmission will enhance the use of such organs.Recent findingsRecent data point to the overall safety of using such organs. Prophylaxis and prevention of reactivation of the viruses have been looked at, and more studies are underway. However, one needs to define the criteria and the population suitable to receive organs from hepatitis-positive donors.SummaryIn this article, we attempt to get to the basics by discussing the antigens and antibodies as they relate to the transplant surgeons. Analysis of the current data from individual centers and the United Network of Organ Sharing database is used to delineate some guidelines. Judicious judgment will allow many of these organs with positive viral serology to be transplanted into appropriate recipients with minimal incremental risk.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID