A Contraindication for Transplantation? Consequences of Frailty on Immunity and Immunosuppression
AbstractPurpose of ReviewFrailty has gained clinical relevance. While the condition may negatively impact outcomes, organ transplantation may also improve frailty. Notably, available assessment tools are broad and have not allowed for a detailed analysis or prognosis.Recent FindingsFrailty has been linked to adverse surgical outcomes while imparting on immune competency. Immunosuppressive treatment may therefore require modifications in frail patients, and effects on drug metabolism may need consideration. Moreover, cognitive impairment may impact compliance. Here, we provide a comprehensive update on clinical features, diagnostics, consequences on immunity and immunosuppression, and clinical outcomes.SummaryClinical studies have shown promising outcomes for some frail transplant recipients. Relevant open questions include patient selection, adaptation of immunosuppression, potential to improve frailty, compliance, and transplant outcomes.
ConclusionsProlonged use of cyclosporine may expose to several dose-related adverse events and may contribute to the development of allograft dysfunction but it does not necessarily cause relentless, progressive transplant failure if patients are carefully and consistently monitored during the follow-up.
Authors: Didier K, Robbins A, Antonicelli F, Pham BN, Giusti D, Servettaz A Abstract Systemic sclerosis is a rare connective tissue disease characterized by skin and several internal organ fibrosis, systemic vasculopathy and immune abnormalities. Even if fibroblasts and endothelial cells dysfunction, as well as lymphocytes and other immune cells implication are now well described, the exact origin and chronology of the disease pathogenesis remain unclear. Oxidative stress, influenced by genetic and environmental factors, seems to play a key role. Indeed, it seems to be implicated in the early phases of fibrosis dev...
This editorial explores the most recent advances in the approaches to nutrition for CKD patients.Nephrology Dialysis Transplantation
Authors: Adhyapak SM, Parachuri VR Abstract Advances in revascularization techniques along with its timeliness has significantly prolonged survival in Coronary Artery Disease. Progressive heart failure is one of the complications which persists in a large scale. The challenges of surgical revascularization in such patients with left ventricular dysfunction are daunting, necessitating short cross-clamp and cardio-pulmonary bypass times. Associated co-morbidities like renal dysfunction, low cardiac output state and pulmonary vascular obstructive disease are additional significant deterrents to surgical success. In th...
Conclusions: This case suggests that even when the latest RBC antibody screen is negative after immunosuppression, clinicians should consider the possibility of the prior positive result. Emphasizing those results by the system would be supportive for safer patient management. PMID: 31304695 [PubMed - as supplied by publisher]
ConclusionsRates of ODD utilization in lung transplantation have increased in accordance with the opioid epidemic, but there remains a significant pool of ODD pulmonary allografts with favorable characteristics that are discarded. With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate and pulmonary allografts should not be discarded based solely on ODD status.
Whether as a bridge to a transplant or a permanent course of care, ventricular assist devices (VADs) present an essential but challenging tool for nurses, who must learn VAD operation and maintenance while also helping heart failure patients transfer from hospital to home care. Critical- and progressive-care nurses’ comfort and experience with VADs varies widely, The post Knowledge Gap at the Heart of VAD Care appeared first on Johns Hopkins Nursing Magazine.
Authors: Golchin A, Shams F, Kangari P, Azari A, Hosseinzadeh S Abstract Cellular-based therapies have drawn a great deal of attention thanks to their regenerative medicine approaches to treat incurable diseases and specific injuries. In this regard, injectable cell delivery systems could actualize the therapeutically beneficial outcomes of cell-based therapeutic products. These systems have found considerable clinical uses. Hence, the recent studies have focused on developing injectable bio-constructs to protect transplanted cells during delivery and stimulating endogenous regeneration through interactions of thes...
Condition: Lymphoma, Large B-Cell, Diffuse Intervention: Drug: Chidamide, Rituximab, Gemcitabine,Oxaliplatin Sponsor: Sun Yat-sen University Not yet recruiting
Condition: Lymphoma, Large B-Cell, Diffuse Intervention: Drug: gemcitabine, vinorelbine and doxorubicin liposome, with or without rituximab Sponsor: Sun Yat-sen University Not yet recruiting