Reduction of the Incidence of Rejection by Adjunct Immunosuppression With Photochemotherapy After Heart Transplantation

Bm, Meiser; Kur, F.; Reichenspurner, Hermann; Wagner, Florian; Ks, Boos; Vielhauer, Stefan; Weiss, M; Rohrbach, Helmut; Kreuzer, E.; Überführ, P.

doi:10.1097/00007890-199402000-00015

Cited by 89 publications

(20 citation statements)

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“…A T-tube drainage at OLT has traditionally been used to provide easy access to the biliary tree and lower the pressure in the biliary system, which may be elevated in the case of stenosis at the anastomotic site or due to sphincter of Oddi dysfunction [7, 9, 85]. Additionally it aids monitoring of the quality and output of bile and may reduce the incidence of late anastomotic biliary strictures [9,86,87,88,89,90] (table 5) and the need for their surgical repair [9, 89, 91]. Biliary drains, however, may increase complication rates by frequently observed leaks following bile drain removal, its dislodgement, cholangitis and biliary obstruction [5, 8, 90, 92, 93].…”

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 99%

“…Transcystic or internal endobiliary stents, as well as routine interventional radiologic procedures have also been proposed to overcome these problems [11, 100,102,103,104]. Many groups have abandoned the use of a T-tube at whole-organ OLT, which has been shown to be safe, efficacious, and cost-effective, as compared to biliary reconstruction over a T-tube [86, 87, 105, 106]. This practice conforms with the results from two prospective, randomized trials showing no advantage of biliary drainage at whole-organ OLT [88, 90].…”

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 99%

“…Anastomotic strictures that appear early in the postoperative period are usually related to errors in the surgical technique, whereas later onset most likely indicates fibrotic healing due to ischemia at the end of the donor or recipient bile duct [107, 108, 121]. According to some series of whole-organ OLT, they are reported to be more common after hepaticojejunostomy than after direct duct-to-duct anastomosis [5, 8, 13], as well as following duct-to-duct anastomosis in non-T-tube recipients, as compared to the anastomosis over a T-tube (table 5) [9,86,87,88,89,90]. In right lobe living-donor transplants, the incidence of duct-to-duct anastomotic strictures has been consistently higher, as compared to recipients of whole liver grafts [24, 25, 32, 34, 44].…”

Section: Biliary Stricturesmentioning

confidence: 99%

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Biliary Tract Complications after Liver Transplantation: A Review

Wójcicki¹,

Milkiewicz²,

2008

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Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10–30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.

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Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 99%

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 99%

Section: Biliary Stricturesmentioning

confidence: 99%

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Biliary Tract Complications after Liver Transplantation: A Review

Wójcicki¹,

Milkiewicz²,

2008

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“…20 After this initial success, recent trials in humans have similarly shown the reversal of acute cardiac allograft rejection. 21,22 This range of indications for photopheresis has now been expanded to include prophylactic treatment immediately after heart transplantation [23][24][25] and rescue therapy for severe racalcitrant cardiac allograft rejection. 26 In addition, we and others have recently shown the efficacy of photopheresis in the reversal of both renal 27,28 and pulmonary allograft rejection.…”

Section: Discussionmentioning

confidence: 99%

Successful Reversal of Recalcitrant Hepatic Allograft Rejection by Photopheresis

Lehrer

Ruchelli

Olthoff

et al. 2000

Liver Transplantation

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Extracorporeal photopheresis (ECP) is an immunologic modality that has shown efficacy in the treatment of clonal T-cell diseases, including Sézary syndrome and allograft rejection. In this case report, we expand on this observation to include recalcitrant hepatic allograft rejection. A 14-year-old boy with hepatic allograft rejection refractory to high-dose corticosteroid and lymphocytolytic therapy was treated with 4 sessions of ECP over a 6-week period. After 2 sessions, a liver biopsy showed complete reversal of acute cell-mediated rejection. No opportunistic infections or other adverse events were noted. Photopheresis appears to be a safe and effective modality for the treatment of refractory hepatic allograft rejection. (Liver Transpl 2000;6:644-647.)

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“…The role of photopheresis in the management of patients who received heart or lung transplants has been recently studied in various clinical situations. Meiser et al demonstrated that photochemotherapy plus three immunosuppressive drugs were superior than drugs alone to reduce the number of biopsy proven acute rejection episodes following heart transplantation [14]. More recently, a randomized pilot study con®rmed that the addition of photopheresis to triple-drug immunosuppressive therapy signi®cantly reduced the risk of cardiac transplant rejection in 60 patients [4].…”

Section: Effect Of the Instrument Usedmentioning

confidence: 99%

Characteristics of photopheresis treatments for the management of rejection in heart and lung transplant recipients

Khuu

Desmond

Huang

et al. 2002

J of Clinical Apheresis

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Photopheresis has been used in the management of rejection of heart and/or lung transplants. Although its mechanism of action remains unknown, irradiated T-helper cell-induced immunosuppression is the main theory. Since transplant recipients are often lymphopenic and lymphocytes are the target cells in phototherapy, we performed this study to determine which factors affect the cellular yield to undergo irradiation. We reviewed the records of all photophereses performed in our institution between July 1998 and April 2000 using the UVAR (first generation) or XTS (second generation) instruments (Therakos, Exton, PA). Our data included patient's blood volume, absolute lymphocyte count and hematocrit, catheter type, flow rate of collection cycles and centrifuge bowl size, as well as volume, hematocrit, and lymphocyte count of the cell suspension. With a mixed model multivariate analysis we sought to determine which variables predicted the lymphocyte yield. A total of 406 procedures in 25 adult patients was analyzed. There was no significant difference between the lymphocyte yield among the procedures performed with the first- and the second-generation instruments. The patient's absolute lymphocyte count was the only parameter, which positively correlated with the total number of lymphocytes collected for irradiation (P < 0.0001). Indeed, based on the mixed model, the total number of lymphocytes for irradiation can be predicted from the pre-procedure lymphocyte count. Additional studies are necessary to correlate the number of treated cells with patient outcome.

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Reduction of the Incidence of Rejection by Adjunct Immunosuppression With Photochemotherapy After Heart Transplantation

Cited by 89 publications

References 0 publications

Biliary Tract Complications after Liver Transplantation: A Review

Biliary Tract Complications after Liver Transplantation: A Review

Successful Reversal of Recalcitrant Hepatic Allograft Rejection by Photopheresis

Characteristics of photopheresis treatments for the management of rejection in heart and lung transplant recipients

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