tacrolimus and Communicable-Diseases

Introduction of calcineurin-inhibitor (CNI) has made transplantation a miracle in the past century. However, the side effects of long-term use of CNI turn out to be one of the major challenges in the current century. Among these, renal dysfunction attracts more and more attention. Herein, we undertook a meta-analysis to evaluate the efficacy and safety of calcineurin-inhibitor (CNI) minimization protocols in liver transplant recipients with CNI-related renal dysfunction.. We included randomized trials with no year and language restriction. All data were analyzed using random effect model by Review Manager 5.0. The primary endpoints were glomerular filtration rate (GFR), serum creatinine level (sCr) and creatinine clearance rate (CrCl), and the secondary endpoints were acute rejection episodes, incidence of infection and patient survival at the end of follow-up.. GFR was significantly improved in CNI minimization group than in routine CNI regimen group (Z = 5.45, P<0.00001; I(2) = 0%). Likely, sCr level was significantly lower in the CNI minimization group (Z = 2.84, P = 0.005; I(2) = 39%). However, CrCl was not significantly higher in the CNI minimization group (Z = 1.59, P = 0.11; I(2) = 0%). Both acute rejection episodes and patient survival were comparable between two groups (rejection: Z = 0.01, P = 0.99; I(2) = 0%; survival: Z = 0.28, P = 0.78; I(2) = 0%, respectively). However, current CNI minimization protocols may be related to a higher incidence of infections (Z = 3.06, P = 0.002; I(2) = 0%).. CNI minimization can preserve or even improve renal function in liver transplant patients with renal impairment, while sharing similar short term acute rejection rate and patient survival with routine CNI regimen.

Topics: Calcineurin; Calcineurin Inhibitors; Communicable Diseases; Cyclosporine; Female; Glomerular Filtration Rate; Graft Rejection; Humans; Incidence; Kidney; Kidney Function Tests; Liver Transplantation; Male; Randomized Controlled Trials as Topic; Survival Analysis; Tacrolimus; Time Factors

Immunosuppressive drugs lead to an enhanced risk for infection. The impact of these drugs on the immune system can be broad (eg, corticosteroids) or targeted (eg, rituximab). Infections can have serious consequences, particularly if there is a delay in diagnosis. It is hoped that a knowledge of the type of immune defects that are induced by these drugs and the specific infections that have been reported will guide clinicians in the appropriate use of prophylactic regimens and diagnostic considerations in the event of pneumonia.

Topics: Aspergillosis; Communicable Diseases; Cyclosporine; Glucocorticoids; Humans; Immunosuppressive Agents; Lung Diseases; Methotrexate; Pneumonia, Pneumocystis; Purine Nucleosides; Tacrolimus; Tuberculosis; Tumor Necrosis Factor-alpha

Topics: Adolescent; Adult; Aged; Antilymphocyte Serum; CD3 Complex; Child; Communicable Diseases; Cyclosporine; Drug Therapy, Combination; Female; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Muromonab-CD3; Mycophenolic Acid; Postoperative Complications; Prospective Studies; Survival Rate; T-Lymphocyte Subsets; Tacrolimus

Topics: Communicable Diseases; Follow-Up Studies; Graft Rejection; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Liver Transplantation; Mycophenolic Acid; Postoperative Complications; Prednisone; Tacrolimus

Following primary liver transplantation, immunosuppressive efficacy of Neoral and Prograf was similar and superior to that of Sandimmune. Rejection incidence was statistically increased with Sandimmune therapy. Incidence of hypertension, posttransplant diabetes mellitus, and infectious complications was not statistically different. Although early compromise in renal function was associated with Sandimmune, Neoral, and Prograf immunosuppression, no progressive renal dysfunction was identified.

Topics: Adult; Analysis of Variance; Azathioprine; Communicable Diseases; Creatinine; Cyclosporine; Diabetes Mellitus; Drug Therapy, Combination; Graft Rejection; Humans; Hypertension; Immunosuppressive Agents; Incidence; Kidney Function Tests; Liver Transplantation; Methylprednisolone Hemisuccinate; Postoperative Complications; Regression Analysis; Retrospective Studies; Tacrolimus

Topics: Adult; Antilymphocyte Serum; Azathioprine; Communicable Diseases; Coronary Disease; Cyclosporine; Drug Therapy, Combination; Follow-Up Studies; Heart Transplantation; Humans; Hypertension; Immunosuppressive Agents; Incidence; Muromonab-CD3; Prednisone; Survival Rate; Tacrolimus; Time Factors; Transplantation, Homologous

This report describes the clinical characteristics and demographics of patients enrolled into this rescue trial for patients experiencing refractory rejection after liver transplantation. Actuarial graft and patient survival at 12 months postconversion was 50% and 72%, respectively. Actual treatment success at 3 months postconversion was 70%. Karnofsky scores and liver function tests were significantly improved for patients continuing on therapy indicating clinical benefit in these patients. The safety profile of FK 506 is acceptable for such a high-risk group of patients. These preliminary clinical results support the conclusion that FK 506 can effectively control and reverse refractory rejection in a majority of liver transplantation patients.

Topics: Acute Disease; Acute Kidney Injury; Adrenal Cortex Hormones; Bilirubin; Chronic Disease; Communicable Diseases; Cyclosporine; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection; Graft Survival; Humans; Liver Function Tests; Liver Transplantation; Male; Muromonab-CD3; Renal Dialysis; Survival Analysis; Tacrolimus; Time Factors

Evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) for renal transplantation (RT) is still limited, but maintaining a dose of <2 g could result in worse clinical outcomes in terms of acute rejection (AR). This study aimed to determine the association between AR and infectious and noninfectious complications after RT with a dose of 1.5 g vs 2 g of MMF. A prospective cohort study was performed with a 12-month follow-up of recipients of RT from living donors with low (1.5 g/day) or standard (2 g/day) doses of MMF. The association between adverse effects and complications and doses of MMF was examined using Cox proportional hazard models, and survival free of AR, infectious diseases, and noninfectious complications was evaluated using the Kaplan-Meier test. At the end of the follow-up, the incidence of infectious diseases was 52% versus 50% (P = .71) and AR was 5% versus 5% (P = .86), respectively. The survival rate free of gastrointestinal (GI) complications requiring medical attention was higher in the low-dose group than in the standard-dose dose (88% vs 45%, respectively; P < .001). The use of 1.5 g/day of MMF confers a reduction in GI complications without an increase in infectious diseases or the risk of AR.

Topics: Communicable Diseases; Drug Therapy, Combination; Graft Rejection; Graft Survival; Hospitals; Humans; Immunosuppressive Agents; Kidney Transplantation; Mexico; Mycophenolic Acid; Prospective Studies; Tacrolimus

Following liver transplantation, acute kidney injury (AKI) and chronic kidney disease occur in 20%-50% and 30%-90% of patients, respectively. Basiliximab, a chimeric monoclonal antibody, is highly effective to prevent rejection in organ transplant recipients, particularly among patients with renal dysfunction who benefit from delayed introduction of calcineurin inhibitors.. The objective of this study was to measure the immunosuppressive effect of basiliximab and its impact on renal failure, lengths of hospital and intensive care unit (ICU) stays and prevalence of infection.. From January 2010 through December 2011, we performed a controlled, nonrandomized study comparing two different immunosuppressive regimens: Group I, 36 transplantation on 34 patients, tacrolimus and corticosteroids de novo with mycophenolate mofetil in cases of renal failure; and Group II, 33 transplantation in 33 patients, corticosteriods and mycophenolate mofetil de novo with basiliximab on day 0 and day 4, and inception of tacrolimus on day 3.. Basiliximab patients (Group II) showed a significantly lower incidence of renal failure requiring replacement therapy (3.03% vs 25%; P = .014). The incidence of acute cellular rejection episodes treated with corticosteriod boluses was also significantly lower (3.03% vs 25%; P = .014). Bacterial, fungal, and cytomegalovirus infection rates were lower in Group II, although the differences were not significant. Similarly, Group II patients had an insignificantly shorter average stay in the hospital (25.9 vs 40.06 days) and the ICU (5.9 vs 8.17 days).. Basiliximab administration with delayed introduction of calcineurin inhibitors may be an effective strategy to reduce post-liver transplantation AKI requiring renal replacement therapy.

Topics: Acute Kidney Injury; Adrenal Cortex Hormones; Antibodies, Monoclonal; Basiliximab; Calcineurin Inhibitors; Chi-Square Distribution; Communicable Diseases; Drug Therapy, Combination; Female; Graft Rejection; Humans; Immunosuppressive Agents; Incidence; Intensive Care Units; Length of Stay; Liver Transplantation; Logistic Models; Male; Middle Aged; Multivariate Analysis; Mycophenolic Acid; Recombinant Fusion Proteins; Risk Factors; Tacrolimus; Time Factors; Treatment Outcome

Posttransplant infection after lung transplantation is a common feature due to the immunodeficiency induced by the immunosuppressive load.. To assess B-cell subsets in lung transplant recipients suffering at least one episode of infection within the first year posttransplantation.. Twenty-eight lung transplant recipients were enrolled in the study. Their overall mean age was 56.6 ± 10.7 years and 10 were women (35.7%). All recipients were treated with steroids, tacrolimus, and mycophenolate mofetil. B-cell subset levels were measured in peripheral blood before as well as 7, 14, 30, 60, 90, and 180 days posttransplantation.. No difference in the absolute number of B-cell subsets was observed within the first year of follow-up. However, pre-germinal center-activated naïve B cells (Bm2'), defined as IgD(+)CD38(++), were increased among patients displaying infections within the first year. The increased Bm2' subset was accompanied by a decrease in the double negative (CD27(-)IgD(-)) B-cell population.. Infections in lung transplant recipients were associated with an increase in the Bm2' subset even before transplantation. It is possible that Bm2' cells have a role in response to infection in lung transplantation.

Topics: ADP-ribosyl Cyclase 1; Aged; B-Lymphocytes; Biomarkers; Communicable Diseases; Drug Therapy, Combination; Female; Humans; Immunoglobulin D; Immunosuppressive Agents; Lung Transplantation; Lymphocyte Count; Lymphocyte Subsets; Male; Membrane Glycoproteins; Middle Aged; Mycophenolic Acid; Prospective Studies; Steroids; Tacrolimus; Time Factors; Treatment Outcome; Tumor Necrosis Factor Receptor Superfamily, Member 7

Orthotopic liver transplantation (OLT) is a successful therapy for patients with end-stage liver disease, and infection remains a significant cause of morbidity and mortality for patients undergoing this procedure. To assess humoral and cellular immunity markers as potential risk factors for development of infection, 46 consecutive liver transplant recipients (hepatitis C virus cirrhosis [n=17], alcoholic liver disease [n=15], hepatocellular carcinoma [n=9], autoimmune hepatitis [n=2], and other [n=3]) performed at a single center were prospectively studied. Maintenance therapy included tacrolimus (n=37) or cyclosporine (n=9) and prednisone. During follow-up, 27 patients had at least 1 episode of infection (58.7%). Pre-OLT immunoglobulin G (IgG) hypergammaglobulinemia (relative risk [RR] 2.78; 95% confidence interval [CI], 1.17-6.60, P=0.02), pre-OLT IgA hypergammaglobulinemia (RR 2.77, CI=1.24-6.19, P=0.012), and pre-OLT C3 hypocomplementemia (RR 3.02, CI=1.21-7.55, P=0.018) were associated with an increased risk for development of infection. Monitoring of Ig and complement levels might help to identify the risk of developing infection in OLT.

Topics: Adult; Aged; Anti-Inflammatory Agents; Antibody Formation; Biomarkers; Communicable Diseases; Complement C3; Cyclosporine; Female; Follow-Up Studies; Graft Rejection; Humans; Immunity, Cellular; Immunoglobulins; Immunosuppression Therapy; Immunosuppressive Agents; Liver Failure; Liver Transplantation; Lymphocyte Count; Male; Middle Aged; Monitoring, Immunologic; Postoperative Complications; Prednisone; Prognosis; Prospective Studies; Risk Factors; Spain; Survival Analysis; T-Lymphocytes; Tacrolimus

To prospectively evaluate the safety of tacrolimus in active rheumatoid arthritis (RA) in elderly patients with insufficient response to disease-modifying antirheumatic drugs (DMARDs).. Fifty-seven patients aged > or =65 yr with RA for > or =6 months were enrolled in an open-label, non-controlled study. All DMARDs were discontinued and tacrolimus was administered orally once daily after the evening meal for 28 weeks. Tacrolimus, initiated at 1.5 mg/day, was increased to 3 mg/day after 6 weeks if no abnormal changes developed. Existing NSAID and oral corticosteroid (< or =7.5 mg/day prednisolone equivalent) therapy could be continued during the study. Safety was evaluated as clinical symptoms, abnormal changes in laboratory values and the development of infection. Treatment response was determined using the American College of Rheumatology (ACR) criteria for improvement. Whole blood concentrations of tacrolimus 12 h after administration were measured by high-performance liquid chromatography and tandem mass spectrometry.. Clinical adverse events developed in 25 patients (46.3%). Abnormal changes in laboratory values occurred in 25 patients (46.3%). Ten patients (18.5%) developed infection. An ACR20 response was achieved by 50.0% of efficacy-evaluable patients and ACR20 success rates (the proportion of patients achieving ACR20 response and completing the study) was 46.3%. The ACR50 response rate was 18.5% of evaluable patients. Mean blood concentration of tacrolimus was 3.3 and 5.3 ng/ml in patients receiving 1.5 and 3.0 mg daily, respectively. No relationship between its concentration and adverse reactions was observed.. In elderly patients with insufficient response to DMARD therapy, tacrolimus at 1.5-3.0 mg/day is safe and well-tolerated and provides clinical benefit.

Topics: Administration, Oral; Aged; Arthritis, Rheumatoid; Communicable Diseases; Creatinine; Humans; Immunosuppressive Agents; Prospective Studies; Tacrolimus; Treatment Outcome

Topics: Administration, Oral; Adult; Azathioprine; Communicable Diseases; Female; Follow-Up Studies; Graft Rejection; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Methylprednisolone; Muromonab-CD3; Postoperative Complications; Retrospective Studies; Tacrolimus; Time Factors

Topics: Adolescent; Child; Child, Preschool; Colon; Communicable Diseases; Follow-Up Studies; Humans; Immunosuppressive Agents; Intestine, Small; Liver Transplantation; Postoperative Complications; Retrospective Studies; Tacrolimus; Time Factors; Transplantation, Homologous

Topics: Anti-Bacterial Agents; Communicable Diseases; Cyclosporins; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications; Tacrolimus; Time Factors

Topics: Anti-Bacterial Agents; Communicable Diseases; Humans; Immunosuppressive Agents; Liver Transplantation; Postoperative Complications; Prospective Studies; Tacrolimus; Wound Infection