Immunosuppressive therapy post-transplantation in children: what the clinician needs to know.

Immunosuppressive therapy post-transplantation in children: what the clinician needs to know. Expert Rev Clin Immunol. 2020 Jan 17;: Authors: Tönshoff B Abstract Introduction: The goal of immunosuppressive therapy post-transplantation in pediatric renal transplant recipients is to prevent acute and chronic rejection while minimizing drug side effects. Most therapies alter immune response mechanisms but are not immunologically specific, and a careful balance is required to find the dose that prevents rejection of the graft, while minimizing the risks of over-immunosuppression leading to infection and cancer.Areas covered: This review article focuses on immunosuppressive therapy in pediatric renal transplant recipients, but many aspects can be applied on pediatric recipients of other solid organ transplants such as liver and heart. The major maintenance immunosuppressive agents currently used in various combination regimens are tacrolimus, cyclosporine, mycophenolate mofetil, azathioprine, everolimus, sirolimus, and glucocorticoids.Expert opinion: Although data from adult renal transplantation trials are used to help guide management decisions in pediatric patients, immunosuppressive therapy in pediatric renal transplant recipients often must be modified because of the unique dosage requirements and clinical effects of these agents in children, including their impact on growth and development. The optimal immunosuppressive therapy post-transplant is no...
Source: Expert Review of Clinical Immunology - Category: Allergy & Immunology Tags: Expert Rev Clin Immunol Source Type: research

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SummaryImmunosuppression (IS) is administered to kidney transplant recipients to prevent rejection episodes and loss of the renal allograft. Most centers rely on a triple IS after induction with either interleukin ‑2 receptor antibodies or antithymocyte globulin. The most frequently used substances for maintenance IS are glucocorticoids, antimetabolites, mTOR inhibitors (mTORi), calcineurin inhibitors (CNI) and the costimulation blocker belatacept. Guidelines recommend a triple combination consisting of CNI s, antimetabolites and corticosteroids for the majority of patients. The long-term risk for malignancy in general i...
Source: Memo - Magazine of European Medical Oncology - Category: Cancer & Oncology Source Type: research
In conclusion, circulating MDSCs are measurable, functional and have a G-MDSC phenotype in lung transplant patients. Their frequency is increased in stable patients, decreased during post-transplant complications, and related to level of immunosuppression. This study may pave the way for further investigations of MDSC in the context of lung transplantation. Introduction From a transplant immunological point of view, graft acceptance is the fundamental element in allograft survival. Graft acceptance is realized by blocking the immune system with immunosuppression preventing host immune cells to recognized and attack...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
In this study, we compare the ability of suboptimal doses of freshly sorted and in vitro expanded human CD127loCD25+CD4+ Tregs to promote human skin allograft survival and demonstrate that higher effectiveness of expanded Tregs can be compensated by transient activation of freshly isolated Tregs. Recently-activated Tregs are characterized by an increased expression of Treg functional markers and better in vitro and in vivo survival, correlating with an increased expression of anti-apoptotic BCL-XL. The ability to enhance Treg function without long in vitro culture may be of value in the treatment of specific immunopatholog...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Eva Miko1,2*, Matyas Meggyes1,2, Katalin Doba1, Aliz Barakonyi1,2 and Laszlo Szereday1,2 1Department of Medical Microbiology and Immunology, Medical School, University of Pécs, Pécs, Hungary 2Janos Szentagothai Research Centre, Pécs, Hungary Immune checkpoint molecules, like CTLA-4, TIM-3, PD-1, are negative regulators of immune responses to avoid immune injury. Checkpoint regulators are thought to actively participate in the immune defense of infections, prevention of autoimmunity, transplantation, and tumor immune evasion. Maternal-fetal immunotolerance represents a real immunological chal...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Qiancheng Deng1, Yangyang Luo1,2, Christopher Chang3, Haijing Wu1, Yan Ding4* and Rong Xiao1* 1Hunan Key Laboratory of Medical Epigenetics, Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China 2Department of Dermatology, Hunan Children's Hospital, Changsha, China 3Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, United States 4Department of Dermatology, Hainan Provincial Dermatology Disease Hospital, Haikou, China Autoimmune diseases are usually complex and multifactorial, characterized by aberrant produc...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion As a critical regulator of inflammation and cell survival, the NFκB pathway is a promising target for diagnosing and treating kidney diseases. For modulation of the NFκB pathway in the clinic, a number of molecules can effectively inhibit NFκB signaling by targeting the receptors, associated adaptors, IKKs, IκBs and transcriptional regulators (144). There is further clinical evidence on small-molecule inhibitors of IKKα and NIK from recent trials on anti-cancer therapies (145). These clinical trials showed that the cancer-selective pharmacodynamic response of DTP3, the co-inhibitor...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion: Mesenchymal stem cell transplantation could be use as a potential treatment for PHLF. Introduction Partial hepatectomy is an important treatment for benign and malignant liver diseases. Although the liver can be completely regenerated after partial excision or injury, at least 1/3 of the liver should be retained in most of the patients, and 40–50% should be retained in patients with parenchymal liver disease (Adams et al., 2013; Cieslak et al., 2014). Postoperative complications, such as acute post-hepatectomy liver failure (PHLF) or small liver syndrome, may occur when the scope of excision is to...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more. This content is...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Authors: Phillips PK, Caldis MW, Hristov AD, Lee AS, Lucey MR Abstract The manufacture and consumption of alcohol are ubiquitous and as old as time. Alcohol use disorder (AUD) is defined as a problematic pattern of alcohol use leading to clinically significant impairment. The physical injuries that result from excessive alcohol consumption are varied including end-organ damage to liver (alcohol-associated liver disease or ALD), pancreas, brain and heart, and systemic consequences including several forms of cancer. Liver transplantation (LT) remains the treatment of last resort for life-threatening liver disease. LT...
Source: Minerva Gastroenterologica e Dietologica - Category: Gastroenterology Tags: Minerva Gastroenterol Dietol Source Type: research
Opening a new frontier in transplant surgery, Texas doctors have done the world's first partial skull and scalp transplant to help a man who suffered a large head wound from cancer treatment. Doctors from Houston Methodist Hospital and MD Anderson Cancer Center did the operation two weeks ago. The recipient - Jim Boysen, a 55-year-old software developer from Austin, Texas - expects to leave the hospital Thursday with a new kidney and pancreas along with the scalp and skull grafts. He said he was stunned at how well doctors matched him to a donor with similar skin and hair coloring. "It's kind of shocking, really, h...
Source: Science - The Huffington Post - Category: Science Source Type: news
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