Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon

Interferon alfa-2b (IFN-α) therapy has been shown to be effective in the treatment of viral hepatitis B (HBV) or viral hepatitis C (HCV) in patients who did not undergo transplantation. However, in allograft recipients, treatment with IFN-α often leads to allograft rejection. The aim of the present study was to determine if IFN-α therapy increases the incidence or severity of acute rejection in human liver allograft recipients. One hundred five orthotopic liver transplant (OLT) recipients with HBV (n = 32), HCV (n = 58), or Non A Non B Non C (n = 15) viral infections were treated with a 6-month course of IFN-α, 5 million U subcutaneously three times a week, which began 2 to 97 months after transplantation. The mean hepatitis activity index (HAI) at the beginning of the therapy was 10.1 ± 3.0. The baseline immunosuppression was achieved by tacrolimus in 77 patients and by cyclosporine A (CyA) in 28 patients. Contemporaneous controls consisted of 132 OLT patients (100 who received tacrolimus and 32 who received CyA) who did not receive IFN-α. A retrospective analysis was performed on this group of patients. The incidence of rejection and the baseline immunosuppression were compared. All biopsies were reviewed without knowledge of clinical data and scored for HAI and for rejection activity index (RAI). The biochemical response to IFN-α was also examined. The mean baseline maintenance dose of prednisone was greater by 2 mg daily in patients who received IFN-α with tacrolimus compared with control patients who did not receive IFN-α with tacrolimus (IFN-α 5.3 ± 5.2 mg daily v controls 3.3 ± 4.9 mg daily; P ≤ .05). Similarly, the mean maintenance dose of prednisone was greater by 2.5 mg daily in patients who received IFN-α compared with controls who received CyA-based immunosuppression (IFN-α 9.8 ± 3.1 mg daily v controls 7.3 ± 3.3 mg daily; P = .01). Acute rejection episodes were detected in 10.5% (n = 11) of IFN-α-treated patients compared with 8.8% of controls for the similar time period from OLT and period of exposure to risk of rejection. Mean RAI was 2.0 ± 2.4 for the IFN-α- treated group and 2.1 ± 1.7 for controls. Rejection episodes with IFN-α treatment were mild and responded to steroid therapy. In OLT recipients, the risk of acute rejection was not increased by the introduction of IFN-α. However, in this study, patients were exposed to greater levels of immunosuppression

Review of Economic Instruments in Risk Reduction

Economic instruments (EI), such as subsidies, taxes and insurance-related options are at the heart of discussions regarding novel approaches for managing risk and adapting to climate change, including in the context of multi-stakeholder partnerships (MSP) between the private and public sectors. Although the attractiveness of reducing and managing disasters has long been demonstrated, there is underinvestment into disaster risk management (DRM). A number of factors, such as lack of comprehensive information and cognitive biases are important. In particular, financial constraints and moral hazard, i.e. adverse incentives provided by current arrangements for dealing with disasters rule high. In this line of thinking, instruments that provide a price signal for risk management and incentivize behavioural change hold high appeal to policymakers including the EU. Yet, little is known about such economic instruments, their mechanics, links to risk management and concrete application in the field of disaster risk management (and climate adaptation). Knowledge gaps exist particularly for conditions that create enabling environments for innovative market based EI. Among these are, e.g., the attractiveness for stakeholders in the context of MSP or institutional settings that are required to successfully and efficiently apply the EI. This report reviews key EI according to their potential for managing and incentivising risk management in the context of the ENHANCE project. The guiding questions for this review are: What economic instruments exist for managing disaster risk? How do they contribute to risk management? What innovative options re being discussed? How do case studies plan to discuss and assess economic instruments? The overall aim of this report is to develop an inventory of EI as they support risk management generally and their anticipated uptake in the ENHANCE cases studies. This report first discusses the methodology and the mechanics of EI. Next it presents the market-based and risk financing instruments; finally it concludes with a synthesis of our findings and next steps for the case studies, which are being carried out as part of the ENHANCE project

Urban Climate Action. The urban content of the NDCs: Global review 2022

This report was prepared by United Nations Human Settlement Programme (UN-Habitat) and the UNESCO Chair on Urban Resilience at the University of Southern Denmark (SDU.Resilience). It offers a global analysis of the urban content of 193 Nationally Determined Contributions (NDCs) submitted to the Secretariat of the United Nations Framework Convention on Climate Change (UNFCCC) before the 19th of June 2022. For this report, more than 200 indicators were used to analyse external data (e.g., Human Development Index and income categorisation) and data within the NDCs, including climate mitigation and adaptation challenges and responses, as well as specific sectors. This analysis is instrumental to supporting Parties’ efforts in further integrating national climate policies and urban climate actions, which is considered fundamental to raising ambition and developing adequate and timely actions as required by the current climate emergency. This review can be instrumental for advocacy and direct support to countries by partner organisations. The work was supported by a group of experts from bilateral and multilateral organisations and academia. Three expert group meetings were convened, and a peer review was organised for the final report