... linear models, linear regression, tacrolimus, renal transplantation Background Tacrolimus, a calcineurin inhibitor, remains the centerpiece of the maintenance treatment scheme in renal transplant ... combination of a calcineurin inhibitor (tacrolimus) with a purine inhibitor (mycophenolate mofetil or azathioprine) and a steroid (prednizolone). Tacroli-mus was given twice a day in individually ... determine the impact of CYP3A5*1 and CYP3A5*3 on the kinetics of tacrolimus inrenaltransplant recipients. Material and methods: Forty kidney recipients were selected to participate. Maintenance...
... regimens including pyrazin-amide, 31% received drug regimens including a fluoro-quinolone, and 17% received drug regimens includingstreptomycin. Induction drug regimens consisted of 2drugs in 5% ... MTB infection was defined as includinglung or mediastinal lymph node involvement. We de-fined multiorgan (ie, miliary) MTB infection as involve-ment of 2 or more organs (lymph nodes draining in- fected ... positive tubercu-lin skin test (TST) result in the absence of symptoms orclinical findings suggestive of active infection. In ana-lyzing LTBI treatment, we included studies reporting 10or more...
... Medicine > Chapter 126. InfectionsinTransplant Recipients Infections inTransplant Recipients: Introduction The evaluation of infectionsintransplantrecipients involves consideration of ... corneal transplants. eT. gondii usually causes disease in the brain. In hematopoietic stem cell Chapter 126. Infectionsin Transplant Recipients (Part 1) Harrison's Internal Medicine ... recipient of the transplanted organ. Infections following transplantation are complicated by the use of drugs that are necessary to enhance the likelihood of survival of the transplanted organ...
... 126. Infectionsin Transplant Recipients (Part 2) In many transplantation centers, transmission of infections that may be latent or clinically inapparent in the donor organ has resulted in ... latent infections already. Nevertheless, most infections occur in a predictable time frame after transplantation (Table 126-2). Table 126-2 Common Sources of Infections after Hematopoietic ... and Trypanosoma cruzi (the latter particularly in Latin America). Clinicians caring for prospective organ donors should also consider assessing stool for parasites, should ...
... becomes available. Promising new drugs that are now being assessed in clinical trials include maribavir, a benzimidazole ribonucleoside that inhibits a viral protein kinase activity (UL97). ... ulcerations occur in both the lower and the upper gastrointestinal tract, and it may be difficult to distinguish diarrhea due to GVHD from that due to CMV infection. The finding of CMV in the liver ... abnormalities. It is interesting that the ocular and neurologic manifestations of CMV infections are uncommon in these patients. Management of CMV disease in HSCT recipients includes strategies...
... disease. Treatment of CMV pneumonia in HSCT recipients (unlike that in other clinical settings) involves both IV immune globulin (IVIg) and ganciclovir. In patients who cannot tolerate ganciclovir, ... Chapter 126. Infectionsin Transplant Recipients (Part 5) Like prophylaxis, preemptive treatment, which targets patients with polymerase chain reaction (PCR) evidence of ... recipients is 0.6–1%, which contrasts with figures of ~5% for renaltransplantrecipients and up to 20% for cardiac transplant patients. In all cases, EBV-LPD is more likely to occur with high-dose,...
... the Chapter 126. Infectionsin Transplant Recipients (Part 6) PCR can be used to monitor EBV production after hematopoietic stem cell transplantation. High or increasing viral loads predict ... critical in an assessment of posttransplantation infections. to have activity against the different forms of latent EBV infection. Preventing lytic replication in these patients would theoretically ... resulted in disease in HSCT recipients, although some cases of virus-associated marrow aplasia have been reported in the peritransplantation period. The relatively low seroprevalence of KSHV in the...
... therapy (when indicated), and rapid diagnosis and treatment of infections can be lifesaving in SOT recipients, who, unlike most HSCT recipients, continue to be immunosuppressed. SOT recipients ... acute infectionsinrecipients of SOT are different from those that infect HSCT recipients because SOT recipients do not go through a period of neutropenia. As the transplantation procedure involves ... (Chap. 177). Intranasal pleconaril, a capsid-binding agent, is being studied for the treatment of enterovirus infection. Rhinoviruses and coronaviruses are frequent co-pathogens in HSCT recipients; ...
... 126. Infectionsin Transplant Recipients (Part 8) Kidney Transplantation (See Table 126-4) Table 126-4 Common Infections after Kidney Transplantation Period after Transplantation Infection ... of InfectionsinTransplantRecipients Risk Factor Organism Prophylactic Antibiotics Examination(s)a Travel to or residence in area with known risk of fungal infection Coccidioides, ... Nocardia; invasive fungi Central nervous system Listeria (meningitis); Toxoplasma gondii CMV disease; Listeria (meningitis); Cryptococcus (meningitis); Table 126-5 Prophylaxis of Infections...
... Chapter 126. Infectionsin Transplant Recipients (Part 9) Middle-Period Infections Because of continuing immunosuppression, kidney transplantrecipients are predisposed to lung infections ... Legionella pneumophila infection (Chap. 141) led to the closing of renaltransplant units in hospitals with endemic legionellosis. About 50% of all renaltransplantrecipients presenting with fever ... JC virus (polyomavirus hominis types 1 and 2) have been cultured from the urine of kidney transplantrecipients (as they have from that of HSCT recipients) in the setting of profound immunosuppression....
... 126. Infectionsin Transplant Recipients (Part 10) Kidney transplantrecipients are also subject to infections with other intracellular organisms. These patients may develop pulmonary infections ... cause pulmonary infiltrates or disseminated disease. Late Infections Late infections (>6 months after kidney transplantation) may involve the CNS and include CMV retinitis as well as ... bacteremia ≥1 month after renal transplantation and should be seriously considered inrenaltransplant recipients presenting with fever and headache. Kidney transplantrecipients may develop...
... lung transplantrecipients with symptomatic CMV disease have pneumonia. Difficulty in distinguishing the radiographic picture of CMV infection from other Chapter 126. Infectionsin Transplant ... Cryptococcus. Mediastinitis may occur at an even higher rate among lung transplant recipients than among heart transplantrecipients and most commonly develops within 2 weeks of surgery. In the absence ... against CMV and is also active against HSV. The prophylaxis of CMV infection with IV ganciclovir—or increasingly with valganciclovir, the oral alternative—is recommended for lung transplant recipients. ...
... these findings may suggest graft rejection, rejection is typically accompanied by marked elevation of Chapter 126. Infectionsin Transplant Recipients (Part 12) Late Infections The incidence ... but also in the spleen, pericolic area, and pelvis. Treatment includes antibiotic administration and drainage as necessary. Liver transplant patients have a high incidence of fungal infections, ... Middle-Period Infections The development of postsurgical biliary stricture predisposes patients to cholangitis. The incidence of strictures is increased in LDLT (~17% of liver transplant recipients) ;...