Effectiveness of aggressive prophylatic and preemptive therapies targeted against cytomegaloviral and Epstein–Barr viral disease after human intestinal transplantation

Farmer, Douglas G.; McDiarmid, Sue V.; Winston, D J; Yersiz, Hasan; Cortina, Galen; Dry, Sarah M.; Maxfield, Anne; Vandenbogaart, B.; Corrêa, Maria Clara Medina; Kroeber, Alexander; Geevarghese, Sunil K.; Busuttil, Ronald W.

doi:10.1016/s0041-1345(02)02710-0

Cited by 24 publications

(6 citation statements)

References 5 publications

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“…Excessive therapy with ATG likely contributed to this complication. It is also possible that inadequate ganciclovir levels contributed to the risk of PTLD in these animals since prophylactic ganciclovir has been reported to be successful in preventing PTLD in established clinical transplantation programs including liver, pancreas, and intestine transplantation (42)(43)(44)(45). Finally these experiments also lacked the benefit of PCR monitoring for CMV and EBV, which clinical transplantation programs employ in high-risk patients to direct preemptive measures (46).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Xenotransplantation: Progress Toward the Clinic

McGregor¹,

Teotia

Byrne

et al. 2004

Transplantation

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The median survival of 76 days in this group of heterotopic porcine-to-baboon cardiac xenografts represents a major advance over the median 27-day survival reported in the literature. Cellular rejection may not constitute a direct major barrier to xenotransplantation. A median survival of 90 days may be achievable with better control of BCMV infection. If further studies in the orthotopic position replicate these outcomes, criteria considered appropriate for clinical application of cardiac xenotransplantation would be approached.

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Section: Discussionmentioning

confidence: 99%

Cardiac Xenotransplantation: Progress Toward the Clinic

McGregor¹,

Teotia

Byrne

et al. 2004

Transplantation

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“…A monitoring protocol using a blood polymerase chain reaction for CMV and Epstein-Barr virus was also initiated with samples collected weekly early on after ITx, followed by monthly during the intermediate phase, and quarterly for long-term survivors. Based on the results of these polymerase-chain reaction testing, preemptive therapy with ganciclovir and/or CMV Ig (CMV-IVIG, Cytogam; CSL Behring) was applied as previously described (23). …”

Section: Methodsmentioning

confidence: 99%

Incidence, Timing, and Significance of Early Hypogammaglobulinemia After Intestinal Transplantation

et al. 2013

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Background Despite recent advances in intestinal transplantation (ITx), infection (INF) and acute cellular rejection (ACR) remain major causes of patient and graft loss. Studies in other solid-organ transplantations indicate that low levels of serum immunoglobulin G (IgG) negatively impact outcomes. To date, there have been no studies on IgG after ITx. Methods A retrospective review of an IgG measurement protocol in primary ITx recipients between 2007 and 2011 was undertaken. IgG levels were measured at the time of evaluation, transplantation, and at weekly intervals for 2 months. Hypogammaglobulinemia (HGG) was defined as IgG levels below the lower limit of the 95% confidence interval for age. Associations between HGG, INF, and ACR were tested, and the incidence and timing of INF and ACR were compared. Results Thirty-four patients were transplanted at a mean (SD) age of 12.4 (17.2) years. Most were Latino children with gastroschisis who received multivisceral grafts. Relative to pre-ITx levels, a statistically significant decrease in IgG levels was observed after ITx (PG0.05). Twenty patients (59%) developed HGG during the post-ITx period at a mean (SD) of 9.8 days. No significant associations were identified between HGG and INF or ACR. Conclusions This is the first study to describe serum IgG levels after ITx. A marked decrease in serum IgG levels was observed early on, in most patients. The etiology is potentially related to immunotherapy. HGG was not associated with INF or ACR, possibly related to the sample size and our practice of exogenous intravenous immunoglobulin replacement.

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“…13 EBV viremia was treated similarly with ganciclovir, valganciclovir, and/or CMV immunoglobulin. Prior to 2000, EBV PCRs were monitored using a qualitative assay, and starting in 2000 were monitored using a quantitative assay.…”

Section: Management Protocolsmentioning

confidence: 99%

“…Based on the results of PCR testing, asymptomatic CMV viremia was treated with pre-emptive therapy (to prevent the development of symptoms or signs of CMV, CMV syndrome, and end-organ disease) with ganciclovir, valganciclovir, and/or CMV immunoglobulin as previously described. 13 EBV viremia was treated similarly with ganciclovir, valganciclovir, and/or CMV immunoglobulin. Reduction of immunosuppression was also implemented if deemed clinically appropriate.…”

Section: Management Protocolsmentioning

confidence: 99%

Clinical characteristics and outcomes of PTLD following intestinal transplantation

Wozniak

Mauer

Venick

et al. 2018

Clinical Transplantation

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Post-transplant lymphoproliferative disease (PTLD) has the highest incidence following intestinal transplantation (ITx). Our center has seen a recent increase in PTLD. Our aim was to review a single-center PTLD experience with a focus on clinical characteristics and outcomes. We completed a retrospective review of biopsy-proven PTLD cases using a prospectively maintained database of 115 ITx recipients transplanted between 1991 and 2014. Nineteen (17%) ITx recipients developed 25 PTLD cases during a median follow-up time of 6.4 (1.6-14.6) years. The incidence of early PTLD was 6% (n = 7). There was a trend toward increased risk of PTLD in children compared with adults (P = .11) and a significantly increased risk of PTLD in re-ITx compared with primary ITx recipients (P = .03). Most PTLD cases were diagnosed between 2010 and 2014 (n = 14). All early PTLD cases were EBV+ on in situ hybridization. Overall graft and patient survival are 68% and 74%, respectively. Second episodes of PTLD were diagnosed in 43% of surviving pediatric patients. Our program has a low incidence of early PTLD with overall excellent graft and patient survival following diagnosis. However, we have also seen a rising incidence of late PTLD. The cause of the increase is unknown as no major changes in immunosuppression protocols have occurred since 1999.

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Effectiveness of aggressive prophylatic and preemptive therapies targeted against cytomegaloviral and Epstein–Barr viral disease after human intestinal transplantation

Cited by 24 publications

References 5 publications

Cardiac Xenotransplantation: Progress Toward the Clinic

Cardiac Xenotransplantation: Progress Toward the Clinic

Incidence, Timing, and Significance of Early Hypogammaglobulinemia After Intestinal Transplantation

Clinical characteristics and outcomes of PTLD following intestinal transplantation

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