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Pregnancy outcomes in female patientsexposed to cyclosporin versus tacrolimus as primary immunosuppression after liver/kidney transplantation:a systematic review and meta-analysis

Pregnancy outcomes in female patientsexposed to cyclosporin ...

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2022第27届广东省药师周大会

作者： Xiaojiao Gong Jingjie Li Jiajia Yan Rui Dai Longshan Liu Pan Chen Xiao Chen Department of Pharmacy the First Affiliated HospitalSun Yat-sen University Institute of Clinical Pharmacology School of Pharmaceutical SciencesSun Yat-sen University Reproductive medicine center the Sixth Affiliated HospitalSun Yat-sen University Organ transplant Center the First Affiliated HospitalSun Yat-sen University

What is known and objective:Pregnancy after transplantation is a challenge due to high risk of adverse maternal and fetal outcomes,and immunosuppressant may further impact the *** systematically reviewed and meta-analyzedobservational studies to compare the influences of tacrolimus and cyclosporin on pregnancy outcomes for female transplant ***:Relevant studies comparing pregnancy outcomesof tacrolimus and cyclosporin head to head were searched from PubMed,EMBASE,and Web of Science(from January 1,2000 to March 20,2020).Weighted mean difference and odds ratio(OR) was calculated to compare continuous and dichotomous variables respectively with 95% confidence intervals(CIs).Publication bias was estimated by funnel *** of study was assessed according to the modified Newcastle-Ottawa *** and discussion:10 observational studies including a total of 1080 post-liver or kidneytransplantpregnancieswere ***-treated recipients experienced lower risk of gestational hypertension(28.0%;OR:1.74;95% CI,1.27-2.39;Psection(40.3%;OR:0.62;95% CI,0.46-0.82;Psectionandhigherincidenceoflive ***-analysis specifically on this topic has not been reported *** findings may provide a reference for clinicians in their clinical monitoring and obstetric care for post-transplant pregnancies.

关键词： Tacrolimus cyclosporine transplantation pregnancy outcomes immunosuppression

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Cardiac risk stratification of the liver transplant candidate:A comprehensive review

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World Journal of transplantation 2022年第7期12卷 142-156页

作者： Sanjana Nagraj Spyros Peppas Maria Gabriela Rubianes Guerrero Damianos G Kokkinidis Felipe I Contreras-Yametti Sandhya Murthy Ulrich P Jorde Department of Medicine Jacobi Medical Center/Albert Einstein College of MedicineNew York CityNY 10461United States Department of Gastroenterology Athens Naval HospitalAthens 11521Greece section of Cardiovascular Medicine Yale University School of MedicineYale New Haven HospitalNew HavenCT 06510United States Department of Medicine Wellstar Atlanta Medical CenterAtlantaGA 30312United States Division of Cardiology Montefiore Medical CenterAlbert Einstein College of MedicineNew York CityNY 10467United States

Cardiovascular diseases(CVD)form a principal consideration in patients with end-stage liver disease(ESLD)undergoing evaluation for liver transplant(LT)with prognostic implications in the peri-and post-transplant *** the predominant etiology of ESLD continues to evolve,addressing CVD in these patients has become increasingly ***,as the number of LTs increase by the year,the proportion of older adults on the waiting list with competing comorbidities increase,and the demographics of LT candidates evolve with parallel increases in their CVD risk *** primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri-and post-transplant *** complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform *** review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient *** hope that this will reinforce the importance of cardiovascular optimization prior to LT,prevent futile LT in those with advanced CVD beyond the stage of optimization,and thereby use the finite resources prudently.

关键词： Cardiovascular risk Liver transplantation End stage liver disease Liver cirrhosis Cardiovascular diseases Cardiovascular diagnostic techniques

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清髓性同种异体造血细胞移植术后的血清胆红素水平与死亡率

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世界核心医学期刊文摘（胃肠病学分册） 2005年第6期1卷 50-51页

作者： Gooley T.A. Rajvanshi P. Schoch H.G. McDonald G.B. 杨瑗 Gastroenterology/Hepatology section Fred Hutchinson Cancer Res. Center 1100 Fairview Avenue North Seattle WA 98109-1024 United States Dr.

Many patients who undergo hematopoietic cell transplantation experience liver injury. We examined the association of serum bilirubin levels with nonrelapse mortality by day +200, testing the hypothesis that the duration of jaundice up to a given point in time provides more prognostic information than either the maximum bilirubin value or the value at that point in time. We studied 1,419 consecutive patients transplanted from allogeneic donors. Total serum bilirubin values up to day +100, death, or relapse were retrieved -along with nonrelapse mortality by day +200 as an outcome measure -using Cox regression models with each bilirubin measure modeled as a time-dependent covariate. The bilirubin value at a particular point in time provided the best fit to the model for mortality. With bilirubin at a point in time modeled as an 8th-degree polynomial, an increase in bilirubin from 1 to 3 mg/dL is associated with a mortality hazard ratio of 6.42. An increase from 4 to 6 mg/dL yields a hazard ratio of 2.05, and an increase from 10 to 12 mg/dL yields a hazard ratio of 1.17. Among patients who were deeply jaundiced, survival was related to the absence of multiorgan failure and to higher platelet counts. In conclusion, the value of total serum bilirubin at a particular point in time after transplant carries more informative prognostic information than does the maximum or average value up to that point in time. The increase inmortality for a given increase in bilirubin value is larger when the starting value is lower.

关键词：清髓性造血细胞胆红素值移植术肝损伤预后信息给定时间黄疸持续时间共变量多脏器衰竭

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肝脏结合盒转运子G5和G8的表达与肝移植后胆汁中胆固醇分泌无关

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世界核心医学期刊文摘（胃肠病学分册） 2006年第5期2卷 44-45页

作者： Geuken E. Visser D.S. Leuvenink H.G.D. R.J. Porte 孟欣颖 Department of Surgery Section Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center Groningen P.O. Box 30.001 9700 RB Groningen Netherlands Dr.

The adenosine triphosphate (ATP) binding cassette (ABC) transporters ABCG5 and ABCG8 have been shown to mediate hepatic and intestinal excretion of cholesterol. In various (genetically modified) murine models, a strong relationship was found between hepatic expression of ABCG5/ABCG8 and biliary cholesterol content. Our study aimed to relate levels of hepatic expression of ABCG5 and ABCG8 to biliary excretion of cholesterol in man. From 24 patients who had received a liver transplant, bile samples were collected daily after transplantation over a 2-week period to determine biliary composition. Expression of ABCG5, ABCG8, MDR3, and BSEP was assessed by real-time polymerase chain reaction (PCR) in liver biopsy specimens collected before and after transplantation. Levels of hepatic ABCG5, ABCG8, and MDR3 messenger RNA (mRNA) were strongly correlated. After transplantation, the biliary secretion rate of cholesterol continuously increased, coinciding with gradual increases in bile salt and phospholipid secretion. In contrast, hepatic levels of ABCG5 and ABCG8 mRNA remained unchanged. Surprisingly, no correlation was found between the hepatic expression of ABCG5 and ABCG8 and rates of biliary cholesterol secretion, normalized for biliary phospholipid secretion. As expected, the concentration of biliary phospholipids correlated well with MDR3 expression. In conclusion, the strong relationship between ABCG5 and ABCG8 gene expression is consistent with the coordinate regulation of both genes, and in line with heterodimerization of both proteins into a functional transporter. Hepatic ABCG5/ABCG8 expression, at least during the early phase after transplantation, is not directly related to biliary cholesterol secretion in humans. This finding suggests the existence of alternative pathways for the hepatobiliary transport of cholesterol that are not controlled by ABCG5/ABCG8.

关键词：胆汁标本人肝脏胆固醇分泌率移植后转运子三磷酸腺苷(ATP) mRNA水平 ABCG8 ABCG5

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软质和硬质二尖瓣环治疗充血性心力衰竭的比较:修复耐久性差异

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世界核心医学期刊文摘（心脏病学分册） 2007年第1期3卷 20-21页

作者： Spoor M.T. Geltz A. Bolling S.F 徐永城 section of Cardiac Surgery University of Michigan University of Michigan Hospitals 1500 E Medical Center Drive Ann Arbor MI 48109-0348 United States.Dr

背景:对于伴有局部缺血和扩张性心肌病的充血性心力衰竭(CHF)患者来说,外科手术日益成为重要的治疗手段。患者左心室(LV)的几何变形可导致二尖瓣反流(MR)。但是对于伴有心室几何变形所致MR的CHF患者,何种类型的二尖瓣环最适宜尚不清楚... 详细信息

背景:对于伴有局部缺血和扩张性心肌病的充血性心力衰竭(CHF)患者来说,外科手术日益成为重要的治疗手段。患者左心室(LV)的几何变形可导致二尖瓣反流(MR)。但是对于伴有心室几何变形所致MR的CHF患者,何种类型的二尖瓣环最适宜尚不清楚。本研究回顾了伴有心脏几何变形M R的CH F患者使用两种完整二尖瓣环的比较结果:软质二尖瓣环和硬质二尖瓣环。

关键词：二尖瓣环充血性心力衰竭几何变形心肌病左心室射血分数二尖瓣反流局部缺血外科手术二尖瓣

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BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

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World Journal of transplantation 2016年第3期6卷 472-504页

作者： Darlene Vigil Nikifor K Konstantinov Marc Barry Antonia M Harford Karen S Servilla Young Ho Kim Yijuan Sun Kavitha Ganta Antonios H Tzamaloukas Nephrology section Medicine Service Raymond G. Murphy VA Medical Center and Department of Medicine University of New Mexico School of Medicine Department of Medicine University of Minnesota School of Medicine Department of Pathology University of New Mexico School of Medicine Division of Nephrology Department of Medicine University of New Mexico School of Medicine Division of Nephrology University of North Carolina School of Medicine

Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy(BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.

关键词： BK viral infection BK nephropathy Cardiac transplant Bone marrow transplant Liver transplant Pancreatic transplant Lung transplant

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Essential concept of transplant immunology for clinical practice

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World Journal of transplantation 2013年第4期3卷 113-118页

作者： Damodar Kumbala Rubin Zhang section of Nephrology Department of MedicineTulane University School of MedicineNew OrleansLA 70112United States

Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitization and to detect pre-existing donor-specific antibodies(DSA) in pre-transplant crossmatch. After a transplant, pre-existing or de novo DSA are increasingly monitored to guide clinical management. Therefore, it is important for clinicians to understand the basic concepts and key components of transplant immunology as well as be familiarized with the modern immunological techniques used in kidney transplantation.

关键词： Alloimmune response Major histocompatibility complex Human leukocyte antigens Co-stimulation pathway Panel reactive antibody Donor specific antibody Non-human leukocyte antigens antibody Crossmatch

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WJSC 6^(th) Anniversary Special Issues(1):Hematopoietic stem cell transplantation Allogeneic hematopoietic cell transplant for acute myeloid leukemia:Current state in 2013 and future directions

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World Journal of Stem Cells 2014年第2期6卷 69-81页

作者： Abraham S Kanate Marcelo C Pasquini Parameswaran N Hari Mehdi Hamadani Osborn Hematopoietic Malignancy and transplantation program Section of Hematology/OncologyWest Virginia University Division of Hematology and Oncology Medical College of Wisconsin

Acute myeloid leukemia(AML)represents a heterogeneous group of high-grade myeloid neoplasms of the elderly with variable *** remissioninduction is an important first step in the management of AML,additional treatment strategies are essential to ensure long-term disease-free *** pivotal advances in understanding the genetics and molecular biology of AML have allowed for a risk-adapted approach in its management based on *** hematopoietic cell transplantation(allo-HCT)represents an effective therapeutic strategy in AML providing the possibility of cure with potent graft-versus-leukemia reactions,with a demonstrable survival advantage in younger patients with intermediate-or poor-risk *** we review the published data regarding the role of allo-HCT in adults with *** searched MEDLINE/PubMed and EMBASE/*** addition,we searched reference lists of relevant articles,conference proceedings and ongoing trial *** discuss the role of allo-HCT in AML patients stratified by cytogenetic-and molecular-risk in first complete remission,as well as allo-HCT as an option in relapsed/refractory *** the conventional sibling and unrelated donor allografts,we review the available data and recent advances for alternative donor sources such as haploidentical grafts and umbilical cord *** also discuss conditioning regimens,including reduced intensity conditioning which has broadened the applicability of *** we explore recent advances and future possibilities and directions of allo-HCT in *** therapeutic recommendations have been made where possible based on available data and expert opinion.

关键词： Acute myeloid leukemia Allogeneic hematopoietic cell transplantation Reduced intensity conditioning Myeloablative conditioning Haploidentical Umbilical cord blood

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Clinical and pathological features of kidney transplant patients with concurrent polyomavirus nephropathy and rejection-associated endarteritis

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World Journal of transplantation 2015年第4期5卷 292-299页

作者： Stephanie M McGregor W James Chon Lisa Kim Anthony Chang Shane M Meehan Department of Pathology University of Chicago Hospitals Department of Medicine Section of NephrologyUniversity of Chicago Hospitals Hawaii Pathologists’ Laboratory Sharp Memorial Hospital

AIM: To describe the clinicopathologic features of concurrent polyomavirus nephropathy(PVN) and endarteritis due to rejection in renal ***: We searched our electronic records database for cases with transplant kidney biopsies demonstrating features of both PVN and acute rejection(AR). PVN was defined by the presence of typical viral cytopathic effect on routine sections and positive polyomavirus SV40 large-T antigen immunohistochemistry. AR was identified by endarteritis(v1 by Banff criteria). All cases were subjected to chart review in order to determine clinical presentation, treatment course and outcomes. Outcomes were recorded with a length of follow-up of at least one year or time to nephrectomy. RESULTS: Of 94 renal allograft recipients who developed PVN over an 11-year period at our institution, we identified 7(7.4%) with viral cytopathic changes, SV40 large T antigen staining, and endarteritis in the same biopsy specimen, indicative of concurrent PVN and AR. Four arose after reduction of immunosuppression(IS)(for treatment of PVN in 3 and tuberculosis in 1), and 3 patients had no decrease of IS before developing simultaneous concurrent disease. Treatment consisted of reduced oral IS and leflunomide for PVN, and antirejection therapy. Three of 4 patients who developed endarteritis in the setting of reduced IS lost their grafts to rejection. All 3 patients with simultaneous PVN and endarteritis cleared viremia and were stable at 1 year of follow up. Patients with endarteritis and PVN arising in a background of reduced IS had more severe rejection and poorer ***: Concurrent PVN and endarteritis may be more frequent than is currently appreciated and may occur with or without prior reduction of IS.

关键词： Acute rejection BK polyomavirus Kidney transplant Polyomavirus nephropathy

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Surgical relevance of anatomic variations of the right hepatic vein

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World Journal of transplantation 2021年第6期11卷 231-243页

作者： Shamir O Cawich Vijay Naraynsingh Neil W Pearce Rahul R Deshpande Robbie Rampersad Michael T Gardner Fawwaz Mohammed Roma Dindial Tanzilah Afzal Barrow Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Radiology University of the West IndiesSt.Augustine 000000Trinidad and Tobago Department of Radiology Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of Radiology University of the West IndiesSt Augustine 000000Trinidad and Tobago

BACKGROUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons,interventional radiologists,and other medical practitioners who treat liver *** drainage patterns of the right hepatic veins(RHVs)are particularly relevant to transplantation *** The aim was to identify variations of the patterns of venous drainage from the right side of the *** the best of our knowledge,there have been no reports on RHV variations in in a Caribbean *** Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral *** outflow patterns were observed and RHV variants were described as:(1)Tributaries of the RHV;(2)Variations at the hepatocaval junction(HCJ);and(3)Accessory *** A total of 118 scans met the inclusion *** 39%of the scans found conventional anatomy of the main hepatic *** RHVs were present 49.2%and included a well-defined inferior RHV draining segment VI(45%)and a middle RHV(4%).At the HCJ,83 of the 118(70.3%)had a superior RHV that received no tributaries within 1 cm of the junction(Nakamura and Tsuzuki type I).In 35 individuals(29.7%)there was a short superior RHV with at least one variant *** to the Nakamura and Tsuzuki classification,there were 24 type II variants(20.3%),six type III variants(5.1%)and,five type IV variants(4.2%).CONCLUSION There was significant variation in RHV patterns in this population,each with important relevance to liver *** radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

关键词： Liver Variant Hepatic Vein Anomaly Venous,Drainage,Vena cava

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