115 research outputs found
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
Immunosuppression minimization in kidney transplantation
Kidney transplantation is considered the best
treatment for patients with end-stage renal failure, even in
extreme age-groups. Immunosuppression for “life” is,
however, mandatory. This chronic, somewhat unselected,
inhibition of the host immune system may induce
complications, such as cancer and infection, that could
counterbalance the benefits achieved by the transplant. In
addition, all currently used immunosuppressors have
several side-effects, impeding their long-term use.
Consequently, drug associations are frequently tested by
different centres according to their own practices, resulting
in different survival and tolerance profiles. Corticosteroids
and calcineurin inhibitors are the cornerstones of current
immunosuppressive regimens. However, they are also the
main culprits of adverse-events and side-effects
encountered after transplantation. Lowering the doses of
each drug, or even eliminating them from the
immunosuppressive menu, has been evaluated by many
groups over the last two decades. This review summarises a
huge number of studies dealing with corticosteroid and
calcineurin inhibitor minimization, including withdrawal
and avoidance trials. It is hard today to propose any
practical guidelines on such a controversial topic. Good
results are achieved by some groups and bad results by
others. The lack of long-term follow-up in randomized
studies contributes to this debate. Nevertheless, it seems
possible and safe to avoid corticosteroids and/or calcineurin
inhibitors in many patients. The application of protocol
biopsies as well as new immunological tests to determine
the degree of immunosuppression will certainly help
transplant physicians to provide more personalized
treatment strategies
First global forum on education on organ donation and transplantation for schools.
The Transplantation Society, in collaboration with the Canadian Society of Transplantation, organized a forum on education on ODT for schools. The forum included participants from around the world, school boards, and representatives from different religions. Participants presented on their countries' experience in the area of education on ODT. Working groups discussed about technologies for education, principles for sharing of resources globally, and relationships between education, and health authorities and non-governmental organizations. The forum concluded with a discussion about how to best help existing programs and those wishing to start educational programs on ODT
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