mercaptopurine and Postoperative-Complications

Preoperative immunosuppressive use among patients with Crohn's disease or ulcerative colitis may lead to an increased risk of postoperative complications. There is limited information on the preoperative safety profile of methotrexate (MTX) in inflammatory bowel disease (IBD).. A retrospective study of patients who underwent abdominal surgery for IBD between 1993 and 2012 was performed and records abstracted, including preoperative use of MTX, azathioprine/6-mercaptopurine, antitumor necrosis factor, and corticosteroids. Early postoperative complications, including death, septic, and nonseptic complications were identified. A meta-analysis was also performed on the use of preoperative MTX in patients with IBD or rheumatoid arthritis.. A total of 180 patients with IBD underwent abdominal surgery. A total of 15 patients received MTX either monotherapy or in combination therapy. Total early postoperative complications were identified in 71 (39%) patients, specifically 5 patients on oral MTX. A total of 51 cases (28%) of septic complications and 20 (11%) nonseptic. No significant association between the use of MTX and early postoperative complications was found. The odds ratio (OR) of complications versus no complications associated with MTX was 0.75 (95% CI, 0.25-2.29) and with azathioprine/6-mercaptopurine, OR 1.48 (95% CI, 0.77-2.84). The odds of a septic complication associated with MTX were 0.58 (95% CI, 0.09-3.73), and higher in azathioprine/6-mercaptopurine, OR 3.97 (95% CI, 1.03-15.3). Our meta-analysis also did not reveal an increased risk of postoperative complications in IBD or rheumatoid arthritis on preoperative MTX (OR 0.62, 95% CI, 0.34-1.15).. Preoperative MTX use does not seem to be associated with early postoperative complications in IBD.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Azathioprine; Colitis, Ulcerative; Crohn Disease; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Methotrexate; Middle Aged; Odds Ratio; Postoperative Complications; Preoperative Period; Retrospective Studies; Sepsis; Tumor Necrosis Factor-alpha; Young Adult

This systematic review examined the use of immunomodulators and the risk of postoperative complications after abdominal surgery in patients with inflammatory bowel disease.. Electronic databases (PubMed, Embase, Ingenta, Zetoc and Ovid) were searched and the reference lists in all articles identified were hand-searched for further relevant papers. Studies were included if they evaluated postoperative complications and defined exposure to individual immunomodulators.. All 11 studies that met the inclusion criteria were observational studies; two were reported only in abstract form. Five studies reported risks associated with azathioprine, five reported risks associated with cyclosporin and three reported risks associated with infliximab. None showed an increased risk of either total or infectious complications associated with immunomodulator use. However, subgroup analysis in one study, published as an abstract, suggested increased rates of anastomotic complications and reoperation associated with azathioprine.. Available evidence does not suggest an increased rate of postoperative complications associated with immunomodulator use.

Topics: Aged; Antibodies, Monoclonal; Azathioprine; Cyclosporine; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Infliximab; Mercaptopurine; Middle Aged; Postoperative Complications; Risk Factors

Pulmonary toxicity due to antitumor agents, chiefly bleomycin pulmonary toxicity including clinical feature, histopathology, pathophysiology, biochemical changes, common clinical settings (risk factors), and prevention was reviewed. Moreover, pulmonary toxicity from methotrexate, busulfan, cyclophosphamide, mitomycin C, 6-mercaptopurine, nitrosourea and procarbazine was reviewed.

Topics: Animals; Antineoplastic Agents; Bleomycin; Busulfan; Cyclophosphamide; Humans; Lung; Mercaptopurine; Methotrexate; Mitomycin; Mitomycins; Nitrosourea Compounds; Postoperative Complications; Procarbazine

Topics: Adolescent; Adult; Antilymphocyte Serum; Azathioprine; Dactinomycin; Female; Histocompatibility Testing; Humans; Hydrocortisone; Immunosuppressive Agents; Lung Diseases; Lung Transplantation; Male; Mediastinum; Mercaptopurine; Methods; Middle Aged; Pneumonia; Postoperative Complications; Prednisolone; Respiration; Respiratory Insufficiency; Thymus Gland; Time Factors; Tissue Donors; Transplantation Immunology; Transplantation, Homologous

Topics: Adrenal Cortex Hormones; Adult; Allopurinol; Autoimmune Diseases; Azathioprine; Bone Diseases; Diabetes Mellitus; Drug Synergism; Duodenal Ulcer; Embolism, Fat; Glomerulonephritis; Histocompatibility; Humans; Hypertension, Renal; Immunosuppressive Agents; Infections; Kidney Glomerulus; Kidney Transplantation; Malabsorption Syndromes; Male; Mercaptopurine; Neoplasm Transplantation; Neoplasms; Obesity; Osteoporosis; Pancreatitis; Peptic Ulcer Hemorrhage; Phenylbutazone; Postoperative Complications; Proteinuria; Transplantation, Homologous

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Biliary Atresia; Bone Marrow; Cyclophosphamide; Cytarabine; Daunorubicin; Dexamethasone; Fatal Outcome; Female; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Infant; Leukemia, T-Cell; Liver Transplantation; Lung Transplantation; Lymph Nodes; Male; Mercaptopurine; Methotrexate; Postoperative Complications; Prednisone; Remission Induction; Vincristine

Combination therapy of thiopurines and anti-tumor necrosis factor alpha (TNF-α) antibodies is the most effective medical treatment of Crohn's disease (CD). Data on thiopurines and anti-TNF-α antibodies in preventing surgical recurrence (need for re-resection) of CD are scarce. Therefore, we analyzed which factors were involved in surgical recurrence of CD in a large cohort of patients with CD operated in a regional and a university hospital.. This is a retrospective cohort study of 567 patients who underwent surgery for CD. Clinical data and risk factors for surgical recurrence were analyzed, focusing on medical therapy and hospital type.. Overall, 237 (41.8%) patients developed a surgical recurrence, after a median of 70 (2-482) months. Before surgical recurrence, 235 patients (41.4%) and 116 patients (20.5%) used thiopurines and anti-TNF-α antibodies, respectively. Multivariate analysis identified 3 independent risk factors associated with surgical recurrence of CD. A higher risk was seen in patients with colonic disease compared with patients with ileal disease (hazard ratio, 1.56; 95% confidence interval, 1.10-2.21; P = 0.012) and in patients using multiple types of medication (hazard ratio, 1.38; 95% confidence interval, 1.25-1.54; P < 0.001). However, a lower risk was seen in patients using thiopurines (hazard ratio, 0.51; 95% confidence interval, 0.34-0.77; P = 0.001).. Thiopurines are effective in preventing surgical recurrence of CD. The role of anti-TNF-α antibodies seems promising as well. Combination therapy of thiopurines and anti-TNF-α antibodies for prevention of surgical recurrence of CD should be studied in a randomized trial.

Topics: Academic Medical Centers; Adolescent; Adult; Antibodies, Monoclonal; Azathioprine; Combined Modality Therapy; Crohn Disease; Cross-Sectional Studies; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Mercaptopurine; Postoperative Complications; Prognosis; Retrospective Studies; Secondary Prevention; Survival Rate; Tumor Necrosis Factor-alpha; Young Adult

Ileal pouch-anal anastomosis continues to be confounded by Crohn's disease-like complications after surgery. Such patients experience significant morbidity and often require either pouch excision or diversion. This study evaluated the effectiveness in our hands of infliximab and/or azathioprine/6-mercaptopurine in treating this patient population.. We conducted a retrospective chart review of all patients who underwent IPAA who experienced Crohn's disease-like complications (pouch fistulas, stricturing small-bowel disease, or pouchitis unresponsive to antibiotics) after ileostomy closure. Patients were segregated according to treatment (azathioprine/6-mercaptopurine only, infliximab only, or both azathioprine/6-mercaptopurine and infliximab) and evaluated for clinical response defined by significant symptomatic improvement and avoidance of stoma.. Of 382 IPAAs, 32 (8.4%) patients developed Crohn's disease-like complications a mean of 17 months after stoma closure. Of these, 22 were treated with azathioprine/6-mercaptopurine and/or infliximab with one lost to follow-up. Overall mean follow-up was 97 ± 11.8 months. Failure rate (requiring stomas) was highest in the fistula group treated with infliximab and azathioprine/6-mercaptopurine (6/13, 46%). Patients with stricturing disease (6) or severe pouchitis (2) were all effectively treated with azathioprine/6-mercaptopurine (5/6) or infliximab (1 patient allergic to azathioprine/6-mercaptopurine) and none of these patients required stomas. In the group not receiving stomas, bowel frequency improved from 8.3 ± 1 to 5.7 ± 0.5 per day (P < .05).. Fistulizing disease after IPAA has the highest failure/stoma rate (46%) despite treatment with infliximab and/or azathioprine/6-mercaptopurine. IPAA patients with stricturing disease and/or antibiotic resistant pouchitis were successfully treated without stomas and all had resolution of symptoms, which suggests that fistulous disease after IPAA should be treated with infliximab, but stricturing disease and antibiotic resistant pouchitis may be effectively treated with azathioprine/6-mercaptopurine only. Such a protocol will potentially minimize the risks associated with infliximab in this difficult group of patients.

Topics: Adult; Anastomosis, Surgical; Antibodies, Monoclonal; Azathioprine; Colitis, Ulcerative; Colonic Pouches; Crohn Disease; Female; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Male; Mercaptopurine; Postoperative Complications; Proctocolectomy, Restorative; Retrospective Studies; Treatment Outcome

Lymphoma can rarely present as an ovarian tumor in children. We describe the unusual case of a 14-year-old adolescent with a locally disseminated ovarian anaplastic large-cell lymphoma, treated with surgery followed by chemotherapy, and who remains disease free at 2 years after diagnosis.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Disease-Free Survival; Doxorubicin; Female; Humans; Long QT Syndrome; Lymph Node Excision; Lymphoma, Large-Cell, Anaplastic; Mercaptopurine; Methotrexate; Omentum; Ovarian Neoplasms; Ovariectomy; Postoperative Complications; Prednisone; Remission Induction; Sepsis; Tumor Lysis Syndrome; Vincristine

A 28-year-old woman with acute lymphoblastic leukemia developed fever and unilateral pleural based pulmonary infiltrate during prolonged chemotherapy induced neutropenia. CT-guided lung biopsy confirmed the diagnosis of pulmonary mucormycosis and liposomal amphotericin B therapy was started. A few days after the initial symptoms, the patient developed convulsions and a brain abscess was detected in computerized tomography and magnetic resonance imaging. Fungal hyphae detected in histopathological examination of a brain biopsy had identical morphology with those seen in previous lung biopsies. The patient was treated with liposomal amphotericin B for five months and cytotoxic chemotherapy was successfully completed during antifungal therapy. Pulmonary infiltrates and the brain abscess resolved and the patient received an allogeneic bone marrow transplantation from a matched, unrelated donor. Antifungal therapy was continued for one additional month after bone marrow transplantation to prevent a relapse of invasive mucormycosis. Follow-up of the patient revealed no signs of relapse of invasive mucormycosis but two months after successful bone marrow transplantation the patient developed lethal cytomegalovirus pneumonitis which was confirmed by autopsy. No signs of mucormycosis were detected at post-mortem.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bone Marrow Transplantation; Brain Abscess; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Daunorubicin; Dexamethasone; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Liposomes; Lung Diseases, Fungal; Mercaptopurine; Mitoxantrone; Mucormycosis; Pneumonia, Viral; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Transplantation, Homologous; Vincristine

Many patients with inflammatory bowel disease receive corticosteroids and 6-mercaptopurine/azathioprine during elective bowel surgery. We investigated the postoperative infection risk for patients undergoing elective bowel surgery who were receiving corticosteroids and/or 6-mercaptopurine/azathioprine before surgery compared with patients not receiving these medications.. A retrospective cohort study was conducted on 159 patients with inflammatory bowel disease who underwent elective bowel surgery. There were 56 patients receiving corticosteroids alone, 52 patients receiving 6-mercaptopurine/azathioprine alone or with corticosteroids, and 51 patients receiving neither corticosteroids nor 6-mercaptopurine/azathioprine. Postoperative infectious complications to time of discharge were categorized into major and minor complications.. Patients receiving corticosteroids had an adjusted odds ratio for any and major infectious complications of 3.69 (95% confidence interval [CI], 1.24-10.97) and 5.54 (95% CI, 1.12-27.26), respectively. The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively.. Preoperative use of corticosteroids in patients with inflammatory bowel disease who are undergoing elective bowel surgery is associated with an increased risk of postoperative infectious complications. 6-Mercaptopurine/azathioprine alone and the addition of 6-mercaptopurine/azathioprine for patients receiving corticosteroids was not found to significantly increase the risk of postoperative infectious complications.

Topics: Adjuvants, Immunologic; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Azathioprine; Cohort Studies; Female; Humans; Infections; Inflammatory Bowel Diseases; Length of Stay; Male; Mercaptopurine; Middle Aged; Postoperative Complications; Retrospective Studies; Risk

Topics: Adjuvants, Immunologic; Azathioprine; Humans; Infections; Inflammatory Bowel Diseases; Mercaptopurine; Postoperative Complications

To determine whether the use of azathioprine/6-mercaptopurine before colectomy is associated with an increased rate of postoperative complications.. All patients who underwent colectomy with ileal pouch-anal anastomosis for ulcerative colitis between 1997 and 1999 were identified. Medical records were abstracted for demographics, extent and duration of disease, dose and duration of corticosteroids and azathioprine/6-mercaptopurine, albumin, and Truelove/Witts score. Early (30-day) and late (6-month) complications were identified. Noncorticosteroid immunosuppressive use was coded as none, azathioprine/6-mercaptopurine within 1 week of surgery, or therapy with other immunosuppressive agents within 1 month of surgery. A logistic regression analysis assessed the association between these variables and complications.. Early complications occurred in 49 of 151 (32%) patients not treated with immunosuppressive agents, 12 of 46 (26%) azathioprine/6-mercaptopurine-treated patients, and 4 of 12 (33%) patients treated with other immunosuppressive agents (p = 0.71). Late complications occurred in 72 of 148 (49%), 20 of 46 (43%), and 8 of 12 (67%) patients in these same groups, respectively. Intravenous or oral steroids at doses of 40 mg/d or greater (p < 0.01) and severe or fulminant disease (p = 0.0094) were associated with greater early complication rates.. Early complications after restorative proctocolectomy for ulcerative colitis are associated with high dose steroids and severe disease but not use of azathioprine/6-mercaptopurine.

Topics: Adolescent; Adult; Aged; Anal Canal; Anastomosis, Surgical; Azathioprine; Child; Colitis, Ulcerative; Colonic Pouches; Female; Humans; Ileum; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Postoperative Complications; Preoperative Care; Proctocolectomy, Restorative; Retrospective Studies; Risk Factors

Topics: Adult; Histiocytosis, Langerhans-Cell; Humans; Liver Transplantation; Magnetic Resonance Imaging; Male; Mercaptopurine; Postoperative Complications; Prednisolone; Recurrence; Time Factors; Vinblastine

Topics: Acenocoumarol; Anticoagulants; Aortic Valve; Coronary Artery Bypass; Drug Interactions; Female; Humans; Mercaptopurine; Middle Aged; Postoperative Complications; Thrombosis

Azathioprine-induced myelosuppression is the most important side effect observed in kidney transplantation. We report a case of severe neutropenia after kidney transplantation due to a thiopurine methyltransferase deficiency. This cause of azathioprine-induced myelotoxicity is rare, but its infectious consequences may be severe. Thiopurine methyltransferase deficiency must therefore be suspected when early and severe leukopenia occurs during azathioprine therapy. Erythrocyte thiopurine methyltransferase activity measurement confirms the diagnosis. Azathioprine and 6-mercaptopurine must afterwards be definitively avoided.

Topics: Azathioprine; Contraindications; Female; Glomerulonephritis, Membranoproliferative; Graft Rejection; Homozygote; Humans; Kidney Failure, Chronic; Kidney Transplantation; Leukopenia; Mercaptopurine; Methyltransferases; Middle Aged; Postoperative Complications; Transplantation, Homologous

We have evaluated the feasibility of using polyanhydride disks containing hydrophobic antiproliferative agents for controlled drug release after glaucoma filtration surgery. Taxol and VP-16 were the most potent inhibitors of fibroblast proliferation tested, with ID50s of 3 ng/mL and 200 ng/mL, respectively. In vitro release of taxol occurred at concentrations exceeding its ID50 for at least 100 days; VP-16 was released for 31 days. The media into which the drugs were released were able to inhibit fibroblast proliferation in vitro, indicating that the bioactivity of the drugs withstood incorporation into, and release from, the polyanhydride. Polyanhydride disks containing taxol and VP-16 merit testing in animal models of glaucoma filtration surgery.

Topics: Alkaloids; Cell Division; Cells, Cultured; Decanoic Acids; Delayed-Action Preparations; Dicarboxylic Acids; Drug Implants; Etoposide; Fibroblasts; Floxuridine; Fluorouracil; Glaucoma; Humans; Mercaptopurine; Paclitaxel; Polymers; Postoperative Complications; Vincristine

We report the cases of two renal transplant recipients suffering from idopathic portal hypertension, a condition characterised by increased portal venous pressure in the absence of both histological lesion of the liver and obstruction of the portal vein. In these two patients, perisnusoidal fibrosis, invisible by light microscopy, was demonstrated by electron microscopy; it is suggested that partial obstruction of hepatic sinusoids by perisinusoidal fibrosis could be the mechanism for increased portal venous pressure in all the patients with idiopathic portal hypertension. In these two patients, who received 6-mercaptopurine and azathioprine, perisinusoidal fibrosis might be the consequence of prolonged administration of these drugs.

Topics: Adult; Azathioprine; Humans; Hypertension, Portal; Kidney Transplantation; Liver; Male; Mercaptopurine; Microscopy, Electron; Postoperative Complications; Transplantation, Homologous

Topics: Animals; Dogs; Graft Rejection; Lung Transplantation; Mercaptopurine; Postoperative Complications; Transplantation, Autologous; Transplantation, Homologous

Topics: Adolescent; Appendicitis; Child; Child, Preschool; Gastrointestinal Diseases; Humans; Hypersplenism; Infant; Intestinal Obstruction; Intussusception; Leukemia; Leukemia, Erythroblastic, Acute; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Mercaptopurine; Pancreatitis; Postoperative Complications; Prednisone; Thrombocytopenia; Time Factors

Topics: Adult; Choriocarcinoma; Female; Humans; Hysterectomy; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Postoperative Complications; Pregnancy

Topics: Adult; Choriocarcinoma; Female; Humans; Hydatidiform Mole; Hysterectomy; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Postoperative Complications; Pregnancy; Remission, Spontaneous; Thoracic Neoplasms; Uterine Neoplasms

Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Aspartate Aminotransferases; Bacteroides; Chemical and Drug Induced Liver Injury; Diagnosis, Differential; Enterococcus faecalis; Female; Humans; Hyperbilirubinemia; Jaundice; Liver; Liver Diseases; Liver Function Tests; Male; Mercaptopurine; Postoperative Complications; Pseudomonas; Sepsis; Staphylococcus; Streptococcus; Tetracycline; Transfusion Reaction

Topics: Acute Kidney Injury; Azathioprine; Cobalt Isotopes; Drug Therapy; Immune Tolerance; Immunosuppressive Agents; Kidney Transplantation; Mercaptopurine; Pathology; Postoperative Complications; Radiation Effects; Renal Insufficiency; Statistics as Topic; Toxicology; Transplantation Immunology; Transplantation, Homologous

Topics: Embolectomy; Glomerulonephritis; Heart, Artificial; Imidazoles; Kidney Function Tests; Kidney Transplantation; Mercaptopurine; Postoperative Complications; Prednisone; Pulmonary Embolism; Transplantation, Homologous; Vascular Surgical Procedures