126 research outputs found
The SPARK Study: a phase II randomized blinded controlled trial of the effect of furosemide in critically ill patients with early acute kidney injury
Report of the first international liver transplantation society expert panel consensus conference on renal insufficiency in liver transplantation
No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64330/1/21877_ftp.pd
LMP-420, a small molecular inhibitor of TNF-α, prolongs islet allograft survival by induction of suppressor of cytokine signaling-1: synergistic effect with cyclosporin-A
Pig-to-Nonhuman Primates Pancreatic Islet Xenotransplantation: An Overview
The therapy of type 1 diabetes is an open challenging problem. The restoration of normoglycemia and insulin independence in immunosuppressed type 1 diabetic recipients of islet allotransplantation has shown the potential of a cell-based diabetes therapy. Even if successful, this approach poses a problem of scarce tissue supply. Xenotransplantation can be the answer to this limited donor availability and, among possible candidate tissues for xenotransplantation, porcine islets are the closest to a future clinical application. Xenotransplantation, with pigs as donors, offers the possibility of using healthy, living, and genetically modified islets from pathogen-free animals available in unlimited number of islets. Several studies in the pig-to-nonhuman primate model demonstrated the feasibility of successful preclinical islet xenotransplantation and have provided insights into the critical events and possible mechanisms of immune recognition and rejection of xenogeneic islet grafts. Particularly promising results in the achievement of prolonged insulin independence were obtained with newly developed, genetically modified pigs islets able to produce immunoregulatory products, using different implantation sites, and new immunotherapeutic strategies. Nonetheless, further efforts are needed to generate additional safety and efficacy data in nonhuman primate models to safely translate these findings into the clinic
Minimization protocols in pancreas transplantation
Diagnosis of immunologic injury (acute and chronic) is much more difficult in
pancreas transplants when compared with transplants of other organs. Currently,
the immunosuppressive regimen for induction involves calcineurin
inhibitors (CNI), antimetabolites and corticosteroids (Cs). This strong and
nonspecific regimen does not take into consideration pancreas specificities (i.e.
the need to avoid diabetogenic compounds). For obvious reasons, CNI might
be calling for review, if permanently indicated in recipients of solitary pancreas
with mild renal dysfunction. CNI as well as corticosteroids may induce hyperglycemia
and contribute to differential diagnosis of a rejection process. However,
in spite of the benefits accruing from withdrawal of above
immunosuppressive agents, minimization or avoidance of these drugs could be
dangerous and may end up with graft loss (i.e. antibody-mediated process).
Long-term results of pancreas transplantation are now achieving comparable
survival rates similar to the transplant of traditional organs such as kidney and
liver. As a consequence, the physicians’ objectives are to prolong the patient’s
quality of life and organ function as long as possible. Weaning strategies in
regard to CNI and steroids are tested. Sirolimus, everolimus, CTLA-4 Ig, etc,
are agents known to be either both nonnephrotoxic and nondiabetogenic or
less so when compared with CNI. Their impact on pancreas transplantation is
beginning to be evaluated. Large randomized trials in all pancreas categories,
with long-term clinical and histologic results, are mandatory to establish new
guidelines for immunosuppressive regimens for pancreas transplantation
A Multicenter, Prospective and Randomized Trial Comparing Pancreas versus Islet Transplantation: Should We Do It Now?
International audienc
Liraglutide in whole-pancreas transplant patients with impaired glucose homoeostasis: A case series
International audienceHyperglycaemia may develop after whole-pancreas transplantation (PTX) in patients with type 1 diabetes mellitus (T1DM), but the efficacy and tolerability of GLP-1 receptor agonists have not been assessed in this population. This report is a 6-month prospective follow-up of six T1DM recipients of PTX (mean time after PTX: 68.8 ± 45.7 months), all of whom had an HbA 1c > 6.5% (48 mmol/mol) [mean: 7.1% (54 mmol/mol)] after initiation of liraglutide alone at 0.6 mg once daily titrated to 1.2 mg once daily at week 1. Gastrointestinal disorders were reported in three of the six patients, with discontinuation of liraglutide in only one patient. HbA 1c improved in the five remaining patients, with a median decrease of 0.8% (0.0-2.7%) at 6 months, and the median decrease in body weight was 2.0 kg. Immunosuppressive treatments remained unchanged with liraglutide. Thus, liraglutide appears to be an effective and well-tolerated option in PTX patients with impaired glucose homoeostasis, regardless of the cause
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