Drug Therapy in the Heart Transplant Recipient

Lindenfeld, Jo Ann; Miller, Geraldine G.; Shakar, Simon F.; Zolty, Ronald; Lowes, Brian D.; Wolfel, Eugene E.; Mestroni, Luisa; Page, Robert L.; Kobashigawa, Jon A.

doi:10.1161/01.cir.0000150332.42276.69

Cited by 211 publications

(158 citation statements)

References 61 publications

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“…Drugs that inhibit T cell activation (calcineurin inhibitors) are the basis of immunosuppressive therapy; In recent years we have preferred the use of tacrolimus over ciclosporin, given the lower toxicity of the former, especially gingival hyperplasia and hirsutism 28 . We have also replaced the use of azathioprine with mycophenolate, since it has a more selective action on the proliferation of T lymphocytes at the medullary level 29 .…”

Section: Discussionmentioning

confidence: 99%

Resultados de un programa nacional de trasplante cardiaco pediátrico: fortalezas y debilidades

Becker

Besa

Riveros

et al. 2017

Rev. chil. pediatr.

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Introduction: Pediatric heart transplantation is an effective therapy to treat advanced heart failure in children. Objectives: To analyze the immediate and mid-term results of pediatric patients listed for heart transplantation. Material and Methods: Registration of patients admitted to our transplant protocol between October 2001 and July 2016 were reviewed, analyzing demographic data, diagnosis, status at the time of listing, waiting time until transplantation, donor data, use of ventricular assist device, hemodynamic data, complications and global mortality. Results: Thirthy patients where included with a mean age of 9.4 years (1 month to 15 years). The most frequent diagnosis was dilated cardiomyopathy in 24 patients (80%). The status was I (urgency) in 19 cases and II in 11 cases. Ten patients died on the waiting list (33,3%) at an average of 52 days (13-139 days). Fourteen were transplanted (46.7%), with a waiting time of 199.6 days (4-586 days). Nine patients required mechanical support (30%). All patients received triple association of immunosuppression. One patient died 16 days post transplant due to primary graft failure (7.1%). The average follow-up was 43 months (0.5-159 months). Two patients died later on (82 and 55 months), both due to secondary rejection because of voluntary cessation of immunosuppressive therapy. Survival at 1 and 5 years was 93% and 74%, respectively. Conclusions: Our program has successfully transplanted 50% of patients enrolled, with good medium-term survival. A significant proportion of patients were listed urgently and 34.5% died on the waiting list.

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Section: Discussionmentioning

confidence: 99%

Resultados de un programa nacional de trasplante cardiaco pediátrico: fortalezas y debilidades

Becker

Besa

Riveros

et al. 2017

Rev. chil. pediatr.

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“…Esta interação resulta na ativação da calcineurina, uma fosfatase presente no citoplasma das células T. A calcineurina desfosforila o fator de transcrição denominado fator nuclear das células T ativadas (NF-AT ), permitindo sua entrada no núcleo da célula e ligação com áreas promotoras da interleucina 2 (IL-2) e outras citocinas. As interleucinas 2 secretadas ativam receptores da IL-2 na superfície da célula, e assim, estimulam a expansão clonal das células T e outras células do sistema imune, desencadeando um processo inflamatório, com possível dano ao enxerto 5 .…”

Section: Lista De Figurasunclassified

“…incluindo a NF-AT (fator nuclear das células T ativadas). O NF-AT desfosforilado se transloca para o núcleo, onde se une a sítios específicos do DNA, nas regiões promotoras de vários genes de citocinas, inibindo a transcrição da interleucina-2 e outras citocinas 5 .…”

Section: Imunossupressãounclassified

“…O objetivo da sua administração é obter uma mielossupressão leve, mantendo o número total de leucócitos entre 4.000/ml e 12.000/ml [4][5] .…”

Section: Agentes Antiproliferativosunclassified

“…Observa-se menor taxa de rejeição e menor taxa de proliferação da íntima das artérias coronárias com associação de micofenolato e inibidor da calcineurina em relação ao uso da azatioprina com inibidor da calcineurina 5 .…”

Section: Agentes Antiproliferativosunclassified

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