Besides orthotopic liver transplantation (OLT) there is no long-term and effective replacement therapy for severe liver failure. Artificial extracorporeal liver supply devices are able to reduce blood toxin levels, but do not replace any synthetic function of the liver. Molecular adsorbent recirculating system (MARS) is one of the methods that can be used to treat fulminant acute liver failure (ALF) or acute on chronic liver failure (AoCLF). The primary non-function (PNF) of the newly transplanted liver manifests in the clinical settings exactly like acute liver failure. MARS treatment can reduce the severity of complications by eliminating blood toxins, so that it can help hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and the high rate mortality of cerebral herniation. This might serve as a bridging therapy before orthotopic liver retransplantation (reOLT). Three patients after a first liver transplantation became candidate for urgent MARS treatment as a bridging solution prior to reOLT in our center. Authors report these three cases, fo-cusing on indications, MARS sessions, clinical courses, and final outcomes.
A szervtranszplantáció ötvenéves történetében az immunszuppresszív terápia fejlődésének köszönhetően egyre jobb szerv-és betegtúlélési eredményekről számoltak be világszerte, azonban a bázisgyógyszereknek minősülő kalcineurin inhibitorok káros mellékhatásait, elsősorban a nephrotoxicitast mellőző vegyületek kifejlesztése csak az elmúlt két évtizedben zajlott. A gazdaszervezet számára idegennek minősülő implantált szerv a recipiensből komplex immunválaszt vált ki. A dolgozatban az immunválasz vázlatos áttekintését követően a szerzők bemutatják az új, eltérő tá-madáspontokon ható gyógyszereket. Ezek vagy már gyakorlati alkalmazásban lévő, vagy rövid időn belül esetlegesen forgalomba kerülő vegyületek, amelyek távlati lehetőségeket nyújtanak a kalcineurin inhibitorok leváltására. Kiemelt hangsúlyt kap a kostimulációs blokádon keresztül ható belatacept és az elmúlt években egyre nagyobb kutatási teret nyerő toleranciaindukció, mint jövőbeli lehetőség. Orv. Hetil., 2012Hetil., , 153, 1294Hetil., -1301. Kulcsszavak: szervátültetés, immunszuppresszió, kalcineurin inhibitor, kostimulációs blokád, toleranciaindukció Recent options in drug therapy after solid organ transplantationSolid organ transplantation has shown improvement in patient and graft survival rates due to the development of immunosuppression in the last fi fty years; however only the last two decades led to the development of new, baseline immunosuppressive drugs that avoid the unlikely side effects of calcineurin inhibitors, especially nephrotoxicity. The transplanted organ is foreign to the host and, therefore, it induces a complex immune response of the recipient. In this review, a brief outline of immune response is given, followed by the introduction of new immunosuppressive drugs acting via variant pathways. These are compounds which are already in use or becoming shortly available and are potential future alternatives for the calcineurin inhibitors. This paper highlights the role of co-stimulation blockade with belatacept and the recently even more intensively studied fi eld of tolerance induction. Orv. Hetil., 2012, 153, 1294-1301 Keywords: organ transplantation, immunosuppression, calcineurin inhibitor, co-stimulation blockade, tolerance induction (Beérkezett: 2012. február 12.; elfogadva: 2012. június 17.) Rövidítések APC = (antigen presenting cell) antigén-bemutató sejt; BKV = BK-vírus; CD = (cluster of differentiation) sejtfelszíni fehérjék jelölése; CMV = cytomegalovirus; CNI = kalcineurin inhibitor; CTLA4 = citotoxikus T-lymphocyta-antigén-4; DC = dentritikus sejt; EBV = Epstein-Barr-vírus; FDA = Food and Drug Administration; FKBP12 = (FK-binding protein 12) FK-kötő fehérje 12; FOXP3 = forkhead boksz p3, egyike a transzkripciós regulátor fehérjéknek; γ-IFN = gamma-interferon; GVH = graft versus host; HUS = hemolitikus urémiás szindróma; IDO = indolamin-2,3-dioxigenáz; IL = interleukin; IL-2R = interleukin-2-receptor; JAK3 = Janus activated kinase 3, citokinreceptorokhoz kötődő tirozinkinázok egyike; LFA-1 = limphocytafunkció-asszociált anti...
Our prospective research included all of the patients who were admitted to the Surgical Department of St. John Hospital diagnosed with a malignant gastrointestinal tumor. Demographic (gender, age) and morphologic Abstract: Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality. However, there are limited data on the nutritional status of surgical patients and the effects of prehabilitation on the outcomes of surgery. Methods A prospective analysis was conducted on all patients surgically-treated for malignant gastrointestinal tumors at St. John Hospital during a two-year period. The patient's gender, age, body weight, height, BMI and weight loss were registered, then a risk score was determined by the MUST survey. Measurement of the triceps and thigh skin-fold thickness and the circumference of the upper arm and thigh were done to calculate muscle area and muscle index, respectively. The body composition was assessed using an OMRON-BF511 device. Muscle function was evaluated based on hand clamping force measurement and activity tests. Patients who were diagnosed as being at-risk received preoperative prehabilitation, which included physiotherapy and nutritional therapy. Results A total of 231 patients (133 males/98 females) were analyzed. They had a mean age of 68.9 years (18~98). Seventy-four patients (32%) lost weight, with an average loss of 7 kilograms (3~15 kg). Anthropometric data showed an average upper-arm circumference of 27.4 cm (14.3~38.1) and thigh circumference of 44.7 cm (19.3~60.1), so the median muscle index was 1.29. The mean BMI was 26, which is above normal, and the elevated BMI was consistent documented in each patient subgroup stratified by age and tumor type. A body composition analysis was performed for 75 patients (44 male/31 female), who had a median age of 68 (37~88 y). The average BMI of these patients was 25.7 y and their average MUST score was 1.12. The total body fat percentage (of the total body mass) was 29.5%, total muscle was 30.1% and visceral fat was 10%. Thirty patients (40%) had sarcopenia, with a mean BMI of 28.7, fat comprising 34.2% of the body mass, visceral-fat 11%, and muscle 27.1 %, and their median MUST score was 1.23. Patients who received preoperative training (physiotherapy) showed improvements in physical function ranging from 12%~33%. Conclusion Gastrointestinal tumor patients have a higher than normal BMI regardless of age or tumor type. Patients with sarcopenia show measurable improvement after two weeks of prehabilitation.
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