Long-term management of patients taking immunosuppressive drugs

Hsu, Denise C.; Katelaris, Constance H.

doi:10.18773/austprescr.2009.035

Cited by 41 publications

(33 citation statements)

References 5 publications

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“…In 60 to 93 percent of patients treated with MTX, there have been a number of adverse reactions, including nonproductive cough, dyspnea, fever, pneumonitis, interstitial lung disease, and pulmonary fibrosis (5). Most of these reactions are dosedependent in nature and are not life-threatening, but up to 30 percent of patients treated with MTX for more than five years discontinue the therapy because of unacceptable toxicity (6).…”

Section: Introductionmentioning

confidence: 99%

Protective Effects of Erythropoietin and N-Acetylcysteine on Methotrexate-Induced Lung Injury in Rats

Kahraman¹,

Kurutaş²,

Tokur³

et al. 2013

Balkan Med J

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Objective: Dexmedetomidine has been reported to produce analgesia after intrathecal administration. In the present study the α2-adrenoceptor agonist dexmedetomidine was evaluated for its potential spinal neurotoxic effects.Material and Methods: Three days after intrathecal cannulation, rats were administered either dexmedetomidine (3 μg/30 μL, i.t.) or saline (30 μL, i.t.). Antinociceptive, sedative and motor effects of intrathecal administrations of dexmedetomidine or saline were evaluated during 90 min. The tail-flick and hot plate tests were used to assess the thermal nociceptive threshold. Seven days after drug administration, animals were sacrified and spinal cords were evaluated for histopathological changes by light microscopy.Results: Dexmedetomidine administered intrathecally produced antinociception. Antinociception was accompanied by immediate sedation and loss of placing-stepping reflexes that lasted over 40 min in all dexmedetomidine administered rats. In all rats, microscopic examination revealed mild gliosis and minimal infiltration of inflamatory r cells in posterior white matter. Mild (total score 4-6) histopathologic lesions were seen in four animals in dexmedetomidine adminisered rats, but there was no statistically significant difference when compared with the saline administered rats. Conclusion:We observed that intrathecal injections of dexmedetomidine at the dose of 3 μg/30 μL produce antinociception but did not cause any histopathological sign of injury in the spinal cord.

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Section: Introductionmentioning

confidence: 99%

Protective Effects of Erythropoietin and N-Acetylcysteine on Methotrexate-Induced Lung Injury in Rats

Kahraman¹,

Kurutaş²,

Tokur³

et al. 2013

Balkan Med J

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“…Arguably, the largest concern with immunosuppressive therapies in this context is the increased chance of malignancy 26. Younger patients have a higher chance of developing a malignancy than older transplant recipients 1.…”

Section: Hand Transplantation In Childrenmentioning

confidence: 99%

Transplants for non-lethal conditions: a case against hand transplantation in minors

Hedges

Rosoff

2018

J Med Ethics

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Human allografts for life-threatening organ failure have been demonstrated to be lifesaving and are now considered to be standard of care for many conditions. Transplantation of non-vital anatomic body parts has also been accomplished. Hand transplantation after limb loss in adults has been shown to offer some promising benefits in both functional and psychological measures in preliminary studies. It has been suggested to expand eligibility criteria to include minors, with one such operation having already been performed. With this in mind, we examine the current state of hand transplantation research in the context of available alternatives. We examine the ethics of carrying out these operations in minors, including under the protections of clinical research. We argue that children should not be considered for this surgery due to the substantial risks of immunosuppressive medication, the likelihood that the graft will need to be replaced during the patient's lifetime and the lack of significant compensatory advantages over modern prosthetics.

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“…A number of strategies has been developed to overcome immune rejection, such as gene knockout of the α‐1,3‐galactosyltransferase enzyme to produce αGal‐deficient islets, transgenic overexpression of human complement regulatory proteins and encapsulation of transplanted porcine islets to shield them physically from an influx of host immune cells . However, these strategies have had limited success in achieving long‐term graft survival and have not removed the need to administer lifelong high‐dose immunosuppressant medications to xenotransplant recipients, which in itself causes accelerated vascular disease and increased rates of cancer …”

Section: Xenotransplantationmentioning

confidence: 99%

Gene editing advance re‐ignites debate on the merits and risks of animal to human transplantation

Fung

Kerridge

2016

Internal Medicine Journal

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In Australia, and internationally, the shortage of organ and tissue donors significantly limits the number of patients with critical organ or tissue failure who are able to receive a transplant each year. The rationale for xenotransplantation – the transplantation of living cells, tissues or organs from one species to another – is to meet this shortfall in human donor material. While early clinical trials showed promise, particularly in patients with type I diabetes whose insulin dependence could be temporarily reversed by the transplantation of porcine islet cells, these benefits have been balanced with scientific, clinical and ethical concerns revolving around the risks of immune rejection and the potential transmission of porcine endogenous retroviruses or other infectious agents from porcine grafts to human recipients. However, the advent of CRISPR/Cas9, a revolutionary gene editing technology, has reignited interest in the field with the possibility of genetically engineering porcine organs and tissues that are less immunogenic and have virtually no risk of transmission of porcine endogenous retroviruses. At the same time, CRISPR/Cas9 may also open up a myriad of possibilities for tissue engineering and stem cell research, which may complement xenotransplantation research by providing an additional source of donor cells, tissues and organs for transplantation into patients. The recent international symposium on gene editing, organised by the US National Academy of Sciences, highlights both the enormous therapeutic potential of CRISPR/Cas9 and the raft of ethical and regulatory challenges that may follow its utilisation in transplantation and in medicine more generally.

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Long-term management of patients taking immunosuppressive drugs

Cited by 41 publications

References 5 publications

Protective Effects of Erythropoietin and N-Acetylcysteine on Methotrexate-Induced Lung Injury in Rats

Protective Effects of Erythropoietin and N-Acetylcysteine on Methotrexate-Induced Lung Injury in Rats

Transplants for non-lethal conditions: a case against hand transplantation in minors

Gene editing advance re‐ignites debate on the merits and risks of animal to human transplantation

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