ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The use of molecular tests for the diagnosis of viral infections in solid organ transplant recipients is increasing, in part because of the increased sensitivity and rapid turnaround time of these tests. A variety of molecular methods are now available for the detection and quantification of viral pathogens, including polymerase chain reaction, nucleic acid sequence based amplification, transcription mediated amplification, hybrid capture, and branched DNA. A key challenge facing clinicians when diagnosing herpesvirus infections with molecular assays is distinguishing latent from active infection. Methods to improve the clinical specificity of molecular assays have been developed and are reviewed. A major limitation to the widespread use of molecular assays for the diagnosis and monitoring of viral infections in solid organ transplant recipients is the lack of standardized assays. The availability of such assays will allow the establishment of interpretive guidelines that can be broadly applied in clinical practice.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Multiple risk factors place the organ transplant recipient at an increased risk for fungal infection. Some of the risk factors for fungal infection are similar to those observed in comparable nontransplant abdominal, cardiothoracic, and genitourinary surgery in immunocompetent patients. However, the changing patterns of newer immunosuppressive agents, complex surgical techniques and artificial devices, and donor considerations all have contributed to the intrinsic risk for fungal infection in organ recipients. Fungal pathogens, some previously unknown or considered saprophytes, have gradually changed the complexion of fungal disease in solid organ recipients. Consequently, a heightened clinical suspicion for both traditional and emerging fungal pathogens is warranted. The early recognition of these fungal pathogens and the wide array of associated clinical presentations, in conjunction with the identification of at-risk organ recipients, are essential requirements in reducing morbidity and mortality.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A wealth of clinical and experimental evidence exists indicating the interaction of cytomegalovirus (CMV) infection and rejection in cardiac allografts. Acute inflammatory response after transplantation leads to release of proinflammatory cytokines that may activate latent CMV infection. In a reciprocal situation, CMV infection leads to up-regulation of transplant antigens and, thereby, to increased immunogenicity and acute rejection. The activation of intragraft mononuclear inflammatory cells and increased mRNA expression of various cytokines and growth factors results in acceleration of the development of chronic rejection. Thus, the effect of CMV infection on cardiac allograft dysfunction isbidirectionalandbiphasic. These two effects of CMV on allograft dysfunction emphasize the need for precise diagnosis of CMV infection in transplant recipients and pre-emptive or prophylactic antiviral therapy. The benefits of this strategy may be evident not only during the early post-transplant period but also, in particular, 5 to 10 years after transplantation as better graft survival.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Immunotherapy approaches have been increasingly used to treat relapsed malignancy and viral infections after solid organ or hematopoietic stem cell transplant. Adoptive cellular immunotherapy with donor T lymphocytes or cytotoxic T cells has proven effective therapy for Epstein-Barr virus lymphoma and some relapsed leukemias after allogeneic stem cell transplantation, and the use of autologous or haploidentical Epstein-Barr virus–specific cytotoxic T lymphocyte lines is being explored after solid organ transplant. More recently, the humanized CD20 antibody rituximab has shown efficacy in the therapy of post-transplant lymphoma. Other antibodies are in trials to treat relapsed malignancy and other viral infections.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Three new human herpesviruses (HHVs) have been discovered over the last 14 years. Two of these, HHV-6 and HHV-7, are widespread with infection usually acquired in early childhood. The third, HHV-8, is less prevalent and is etiologically associated with the malignancies Kaposi’s sarcoma (KS), multicentric Castleman’s disease, and primary effusion lymphoma. As with other herpesviruses, each has the potential to be pathogenic in the post-transplant period. HHV-6 has been associated with a range of clinical disease in solid organ and bone marrow transplant recipients, including encephalitis, bone marrow suppression, and graft rejection. HHV-7 has been associated with an increased risk of cytomegalovirus disease following renal transplantation. Although HHV-8 is relatively uncommon in transplant recipients, iatrogenic immunosuppression increases the incidence of KS, particularly following renal transplantation. Reactivation can occur in persons with prior infection or HHV-8 may potentially be acquired through the donor allograft. Other risk factors for transplant-associated KS include ethnic origin, and the type and degree of therapy-induced immunosuppression.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Polyomavirus infection in immunosuppressed transplant patients is in most cases an asymptomatic reactivation of a latent infection that can, however, progress to manifest disease. JC virus causes progressive multifocal leukoencephalopathy, a rare complication with poor outcome. BK virus infection has been associated with hemorrhagic cystitis of late onset in bone marrow recipients and with ureteral stenosis in renal allograft recipients. More recently, BK virus has been identified in renal transplant recipients as the cause of progressive graft dysfunction and loss. The diagnosis of BK virus nephropathy requires allograft biopsy, revealing typical viral intranuclear inclusion bodies, and, in typical cases, damage of tubules. Urine cytology and the detection of BK virus DNA in plasma helps to identify and manage patients with BK virus nephropathy. Because of the lack of effective antiviral therapy, current treatment attempts aim at lowering the degree of immunosuppression in order to regain control over polyomavirus replication.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Transplantation of HIV-infected patients is complicated by practical as well as ethical considerations. However, advances in the treatment of HIV-infected patients that have resulted in improved survival may also improve outcome following transplantation. Recent reports indicate potential detrimental effects of specific immunosuppressive agents in the HIV-infected transplant patient, as well as potential positive effects of others. Similarly, new information about the activity of certain antiretroviral agents suggests that they may be optimal for first-line management of HIV infection in this setting. Careful monitoring of patients treated with these agents plus other drugs commonly used in the transplant setting, as well as carefully conducted prospective trials, will be necessary to ultimately determine optimal treatment protocols.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The success of solid organ transplantation has paradoxically led to the progressive shortage of donor organs. The increasing demand and relatively static supply has led to the use of expanded criteria donors. This article reviews the recent literature on the use of expanded criteria donors in renal, pancreatic, heptatic, and cardiac transplantation. The available data suggest that, whereas expanded criteria donor organs are associated with outcomes inferior to those achievable with optimal donor organs, there are ways of improving the outcomes associated with their use. The other important issue to consider is that the outcomes of transplantation with these organs may in fact be superior to those associated with not undergoing transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID