476
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Takaya S, Bronsther O, Todo S, Abu-Elmagd K, Jain A, Alessiani M, Madariaga J, Marino IR, Selby R, Fung JJ. Retransplantation of liver: a comparison of FK 506- and cyclosporine-treated patients. Transplant Proc 1991; 23:3026-8. [PMID: 1721348 PMCID: PMC3154773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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477
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Demetris AJ, Fung JJ, Todo S, McCauley J, Jain A, Takaya S, Alessiani M, Abu-Elmagd K, Van Thiel DH, Starzl TE. FK 506 used as rescue therapy for human liver allograft recipients. Transplant Proc 1991; 23:3005-6. [PMID: 1750088 PMCID: PMC3008423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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478
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Cooper MH, Gregory SH, Thomson AW, Fung JJ, Starzl TE, Wing EJ. Evaluation of the influence of FK 506, rapamycin, and cyclosporine on processing and presentation of particulate antigen by macrophages: assessment of a drug "carry-over" effect. Transplant Proc 1991; 23:2957-8. [PMID: 1721326 PMCID: PMC2958665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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479
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Felser I, Wagner S, Depee J, Johnson N, Staschak S, Jain A, Fung JJ, Starzl TE. Changes in quality of life following conversion from CyA to FK 506 in orthotopic liver transplant patients. Transplant Proc 1991; 23:3032-4. [PMID: 1721350 PMCID: PMC2958703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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480
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Valdivia LA, Fung JJ, Demetris AJ, Starzl TE. Differential survival of hamster-to-rat liver and cardiac xenografts under FK 506 immunosuppression. Transplant Proc 1991; 23:3269-71. [PMID: 1721432 PMCID: PMC3026139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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481
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Abu-Elmagd K, Van Thiel D, Jegasothy BV, Ackerman CD, Todo S, Fung JJ, Thomson AW, Starzl TE. FK 506: a new therapeutic agent for severe recalcitrant psoriasis. Transplant Proc 1991; 23:3322-4. [PMID: 1721449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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482
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Wu YM, Venkataramanan R, Suzuki M, Zhu Y, Abdallah H, Emeigh J, Burckart GJ, Warty VS, Fung JJ, Todo S. Interaction between FK 506 and cyclosporine in dogs. Transplant Proc 1991; 23:2797-9. [PMID: 1721281 PMCID: PMC2975952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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483
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Roat MI, Thoft RA, Thomson AW, Jain A, Fung JJ, Starzl TE. Treatment of Cogan's syndrome with FK 506: a case report. Transplant Proc 1991; 23:3347. [PMID: 1721457 PMCID: PMC2993316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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484
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McCauley J, Fung JJ, Todo S, Jain A, Deballi P, Starzl TE. Changes in renal function after liver transplantation under FK 506. Transplant Proc 1991; 23:3143-5. [PMID: 1721385 PMCID: PMC3022442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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485
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Todo S, Tzakis A, Reyes J, Abu-Elmagd K, Casavilla A, Nour BM, Selby R, Fung JJ, Van Thiel D, Starzl TE. Clinical small bowel or small bowel plus liver transplantation under FK 506. Transplant Proc 1991; 23:3093-5. [PMID: 1721369 PMCID: PMC2952529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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486
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Cooper MH, Hartman GG, Starzl TE, Fung JJ. The induction of pseudo-graft-versus-host disease following syngeneic bone marrow transplantation using FK 506. Transplant Proc 1991; 23:3234-5. [PMID: 1721419 PMCID: PMC2987742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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487
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Rao P, Sun H, Snyder J, Fung JJ, Starzl TE. Effect of FK 506 on FK-binding protein and transforming growth factor beta gene expression. Transplant Proc 1991; 23:2873-4. [PMID: 1721301 PMCID: PMC3018877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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488
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Jain AB, Fung JJ, Tzakis AG, Venkataramanan R, Abu-Elmagd K, Alessiani M, Reyes J, Irish W, Warty V, Mehta S. Comparative study of cyclosporine and FK 506 dosage requirements in adult and pediatric orthotopic liver transplant patients. Transplant Proc 1991; 23:2763-6. [PMID: 1721270 PMCID: PMC2981795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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489
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Mieles LA, Fung JJ, Yokoyama I, McCauley J, Singh N, Todo S, Gordon RD, Starzl TE. Liver transplantation of American veterans under FK 506 immunosuppression: a preliminary report. Transplant Proc 1991; 23:3016-8. [PMID: 1721344 PMCID: PMC2974314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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490
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Abu-Elmagd KM, Fung JJ, Alessiani M, Jain A, Takaya S, Venkataramanan R, Warty VS, Shannon W, Todo S, Tzakis A. Strategy of FK 506 therapy in liver transplant patients: effect of graft function. Transplant Proc 1991; 23:2771-4. [PMID: 1721272 PMCID: PMC2974307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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491
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Starzl TE, Abu-Elmagd K, Fung JJ, Todo S, Tzakis AG, McCauley J, Demetris AJ. [Clinical experience with FK 506]. Presse Med 1991; 20:1967-73. [PMID: 1722311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
FK 506 is a superior immunosuppressive agent that should improve patient survival after the commonly performed transplant procedures, make feasible transplantations that have been previously impractical, allow immune intervention for serious autoimmune diseases, and create a better spin-off understanding of basic biologic processes including signal transduction.
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492
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Markus PM, Cai X, Ming W, Demetris AJ, Fung JJ, Starzl TE. Prevention of graft-versus-host disease following allogeneic bone marrow transplantation in rats using FK506. Transplantation 1991; 52:590-4. [PMID: 1718063 PMCID: PMC2975544 DOI: 10.1097/00007890-199110000-00002] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
FK506 and cyclosporine were used for the prevention of acute graft-versus-host disease. Acute GVHD was induced in Lewis rats by total-body irradiation and subsequent reconstitution with allogeneic (ACI) bone marrow and spleen cells (BMTx). GVHD was assessed by both clinical and histologic parameters during the experiment duration of 60 days, and longer for selected animals. All untreated BM recipients died within 26 days from severe acute GVHD. GVHD was prevented with CsA during the period of immunosuppressive therapy, but it appeared within a few days afterward. FK506-treated BM recipients were also protected, but they had a markedly prolonged GVHD-free period after therapy was discontinued. Most such animals eventually developed GVHD but with notable exceptions. Maintenance therapy with doses of FK506 as low as 0.1 mg/kg every other day (1/20 of daily induction dose) was infallible insurance against delayed GVHD. The relevance of these findings to GVHD caused by lymphoid-containing solid organs such as the intestine was discussed.
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493
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494
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Markus PM, Cai X, Ming W, Demetris AJ, Fung JJ, Starzl TE. FK 506 reverses acute graft-versus-host disease after allogeneic bone marrow transplantation in rats. Surgery 1991; 110:357-63; discussion 363-4. [PMID: 1713358 PMCID: PMC2956606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Severe graft-versus-host disease was induced by transplantation of ACI rat bone marrow and spleen cells into irradiated Lewis rat recipients. Treatment with FK 506 or cyclosporine A (CsA) was started after clinical and histologic evidence of acute GVHD was present. A 14-day course of FK 506 at 1.0 mg/kg/day could rescue 100% of the animals suffering from GVHD. In contrast only one half of the animals treated with CsA at a high dose of 25 mg/kg/day recovered. After cessation of immunosuppressive therapy, FK 506-treated animals displayed a marked prolonged disease-free interval as compared to CsA-treated bone marrow recipients. Recurrence of the disease in these animals could be prevented when FK 506 treatment was continued after the induction period with a low maintenance dose of 0.1 mg/kg/day every other day.
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495
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Abu-Elmagd K, Fung JJ, Alessiani M, Jain A, Venkataramanan R, Warty VS, Takaya S, Todo S, Shannon WD, Starzl TE. The effect of graft function on FK506 plasma levels, dosages, and renal function, with particular reference to the liver. Transplantation 1991; 52:71-7. [PMID: 1713365 PMCID: PMC2978661 DOI: 10.1097/00007890-199107000-00015] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Plasma FK506 was studied in 49 liver, 13 heart, 3 double-lung or heart-lung, and 21 kidney recipients. The levels were correlated with the drug doses used, kidney function, and liver function. In all varieties of recipients, there was an early rise in the FK506 plasma levels that occurred at the time of intravenous administration of the drug. At the same time or shortly after, there were increases in serum creatinine that were transitory except in liver recipients with continuing suboptimal graft function. The quality of hepatic function dominated all aspects of FK506 management in the liver recipients. Those who received well-functioning grafts could be given about the same drug doses as recipients of kidneys and the thoracic organs. Liver recipients with defective grafts had astronomical rises in plasma FK506, a high incidence of renal failure, and probably increased neurotoxicity. In kidney transplant recipients, the FK506 plasma levels and doses were essentially the same in patients with prompt versus delayed renal function. These studies have highlighted the necessity, first, of close pharmacologic monitoring of patients who are given FK506 in the presence of abnormal liver function, and second, of using smaller intravenous induction doses than in past practice.
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496
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Van Thiel DH, Carr B, Iwatsuki S, Tzakis A, Fung JJ, Starzl TE. Liver transplantation for alcoholic liver disease, viral hepatitis, and hepatic neoplasms. Transplant Proc 1991; 23:1917-21. [PMID: 2063427 PMCID: PMC3229280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In closing, it is important to note that the indications for liver transplantation are not static but rather are remarkably dynamic and capable of change over time. Thus yesterday's major indications can become relative contraindications, while yesterday's absolute contraindications have become today's nuisances. The goal for physicians who care for individuals with problems such as alcoholic liver disease, viral hepatitis, and hepatic cancer should be to develop new strategies of care that will ultimately eliminate these diseases as problems, rather than eliminating individuals with such health problems from currently available health options. In other words, physicians who accept the responsibility for a patient's life should be searching for the best form of therapy available for their patient rather than examining the reasons that exist for limiting one's choice in health care.
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497
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Fung JJ, Todo S, Tzakis A, Alessiani M, Abu-Elmagd K, Jain A, Bronster O, Martin M, Gordon R, Starzl TE. Current status of FK 506 in liver transplantation. Transplant Proc 1991; 23:1902-5. [PMID: 1712133 PMCID: PMC2955871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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498
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Starzl TE, Todo S, Tzakis A, Alessiani M, Casavilla A, Abu-Elmagd K, Fung JJ. The many faces of multivisceral transplantation. SURGERY, GYNECOLOGY & OBSTETRICS 1991; 172:335-44. [PMID: 2028370 PMCID: PMC2655210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The transplantation of multiple abdominal viscera, including liver-duodenum-pancreas, liver-stomach-duodenum-pancreas and liver-intestine, is being performed with increasing frequency and success. These procedures and other variations are derived from a seldom used multivisceral operation in which all of the foregoing organs are transplanted en bloc. It is described herein how the full multivisceral transplantation and its less extensive derivatives are based on the same principles of procurement, preservation and postoperative management. With all of these multiple organ permutations and with intestinal transplantation alone, management is complicated by inclusion in the grafts of a large lymphoreticular component that is capable of causing graft versus host disease (GVHD). Because of a systematic error in therapeutic philosophy, past efforts have been directed at altering or damaging the lymphoreticular cells by pretreatment of the donor or of the organs with drugs, irradiation or other means. From recent observations, the alternative approach is suggested of keeping these lymphoid depots intact, which then become the site of two way cell traffic after transplantation. With the use of powerful immunosuppression, such as that provided with FK 506, the donor lymphoreticular cells can circulate in the recipient without causing clinical GVHD, and the lymphoreticular cells in the graft become those of the recipient (local chimerism) without causing rejection. Even with avoidance of rejection and GVHD, metabolic interrelations between the grafted organs, and also between the graft organs and retained recipient viscera can affect the fate of the individual transplanted organs or retained recipient organs. The best delineated of these metabolic influences are mediated by the endogenous splanchnic hepatotrophic factors, of which insulin has been the most completely studied. An understanding of these various immunologic and nonimmunologic factors combined with more potent immunosuppression that is now available is sure to stimulate efforts at transplantation of abdominal organs and particularly of the hollow viscera that have resisted such clinical efforts.
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499
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Todo S, Demetris AJ, Van Thiel D, Teperman L, Fung JJ, Starzl TE. Orthotopic liver transplantation for patients with hepatitis B virus-related liver disease. Hepatology 1991. [PMID: 2010156 DOI: 10.1002/hep.1840130402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifty-nine patients with prior hepatitis B virus infection underwent orthotopic liver transplantation. During the first 2 mo, mortality was not significantly different in the hepatitis B virus-infected group (25.5%) vs. a hepatitis B virus-immune control group (21%). Beyond 2 mo, the mortality, rate of graft loss, need for retransplantation and incidence of abnormal liver function were significantly higher in the hepatitis B virus-infected group. Treatment of the hepatitis B virus infection was attempted with passive immunization, combined active and passive immunization, alpha-interferon or nothing. The clinical outcome was not significantly influenced by any of these therapies. However, of the patients who lived more than 60 days, 6 of 22 treated with active plus passive immunization were cleared of HBsAg, something achieved once in 16 patients treated with alpha-interferon, never in 3 patients with passive immunization only and once in 4 patients with no therapy. In patients with recurrent hepatitis B virus infection, the pace of hepatitis development in the graft appeared to be accelerated, and this was particularly striking in patients who underwent multiple retransplantations at progressively shorter intervals. None of the patients who became HBsAg-negative had HBeAg preoperatively.
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500
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Markus PM, Van den Brink MR, Luchs BA, Fung JJ, Starzl TE, Hiserodt JC. Effects of in vivo treatment with FK506 on natural killer cells in rats. Transplantation 1991; 51:913-5. [PMID: 1707562 PMCID: PMC2963998 DOI: 10.1097/00007890-199104000-00037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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