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Parlakpinar H, Gunata M. Transplantation and immunosuppression: a review of novel transplant-related immunosuppressant drugs. Immunopharmacol Immunotoxicol 2021; 43:651-665. [PMID: 34415233 DOI: 10.1080/08923973.2021.1966033] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunosuppressive drugs used in the transplantation period are generally defined as induction and maintenance therapy. The use of immunosuppressants, which are particularly useful and have fewer side effects, decreased both mortality and morbidity. Many drugs such as steroids, calcineurin inhibitors (cyclosporine-A, tacrolimus), antimetabolites (mycophenolate mofetil, azathioprine), and mTOR inhibitors (sirolimus, everolimus) are used as immunosuppressive agents. Although immunosuppressant drugs cause many side effects such as hypertension, infection, and hyperlipidemia, they are the agents that should be used to prevent organ rejection. This shows the importance of individualized drug use. The optimal immunosuppressive therapy post-transplant is not established. Therefore, discovering less toxic but more potent new agents is of great importance, and new experimental and clinical studies are needed in this regard.Our review discussed the mechanism of immunosuppressants, new agents' discovery, and current therapeutic protocols in the transplantation.
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Affiliation(s)
- Hakan Parlakpinar
- Department of Medical Pharmacology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Gunata
- Department of Medical Pharmacology, Faculty of Medicine, Inonu University, Malatya, Turkey
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Han SR, Cho MH, Moon JS, Ha IS, Cheong HI, Kang HG. Life-Threatening Extrarenal Manifestations in an Infant with Atypical Hemolytic Uremic Syndrome Caused by a Complement 3-Gene Mutation. Kidney Blood Press Res 2019; 44:1300-1305. [PMID: 31522186 DOI: 10.1159/000502289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/22/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment caused by uncontrolled activation of the complement system. About 20% of patients show extrarenal manifestations, with central nervous system involvement being the most frequent. We described the clinical course and management of aHUS in an infant, that was caused by a complement 3 (C3) gene mutation with severe extrarenal manifestations. CASE PRESENTATION A 4-month-old girl visited our hospital for jaundice and petechiae. Laboratory tests revealed microangiopathic hemolytic anemia, thrombocytopenia, and hyperazotemia. She was diagnosed with aHUS with a C3 p.E1160K mutation. Daily fresh-frozen plasma (FFP) therapy was administered; however, she experienced the severe extrarenal manifestations of pulmonary hemorrhage and gastrointestinal bleeding. With aggressive treatment, supportive care, and daily FFP transfusion, the patient recovered and was discharged after 72 days of hospital stay, on a regular FFP transfusion. Four months after diagnosis, she was switched to eculizumab treatment. Twenty months have passed since then and she has been relapse-free until now. CONCLUSION aHUS is rare but has a devastating course if not properly treated. Severe extrarenal manifestations, such as pulmonary hemorrhage and gastrointestinal bleeding, can develop in aHUS caused by a C3 mutation. In our case, long-term management with eculizumab resulted in relapse-free survival.
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Affiliation(s)
- Sa Ra Han
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea, .,Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea,
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Raina R, Krishnappa V, Blaha T, Kann T, Hein W, Burke L, Bagga A. Atypical Hemolytic-Uremic Syndrome: An Update on Pathophysiology, Diagnosis, and Treatment. Ther Apher Dial 2018; 23:4-21. [PMID: 30294946 DOI: 10.1111/1744-9987.12763] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/25/2018] [Indexed: 12/25/2022]
Abstract
Atypical hemolytic uremic syndrome (aHUS), a rare variant of thrombotic microangiopathy, is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment. The condition is associated with poor clinical outcomes with high morbidity and mortality. Atypical HUS predominantly affects the kidneys but has the potential to cause multi-organ system dysfunction. This uncommon disorder is caused by a genetic abnormality in the complement alternative pathway resulting in over-activation of the complement system and formation of microvascular thrombi. Abnormalities of the complement pathway may be in the form of mutations in key complement genes or autoantibodies against specific complement factors. We discuss the pathophysiology, clinical manifestations, diagnosis, complications, and management of aHUS. We also review the efficacy and safety of the novel therapeutic agent, eculizumab, in aHUS, pregnancy-associated aHUS, and aHUS in renal transplant patients.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General and Akron Children's Hospital, Akron, OH, USA.,Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, OH, USA
| | - Vinod Krishnappa
- Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, OH, USA.,Northeast Ohio Medical University, Rootstown, OH, USA
| | - Taryn Blaha
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Taylor Kann
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - William Hein
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Linda Burke
- Atypical Hemolytic Uremic Syndrome Alliance, Cape Elizabeth, ME, USA
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, Werthmann PG, Moher D, Rison RA, Shamseer L, Koch CA, Sun GH, Hanaway P, Sudak NL, Kaszkin-Bettag M, Carpenter JE, Gagnier JJ. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol 2017; 89:218-235. [PMID: 28529185 DOI: 10.1016/j.jclinepi.2017.04.026] [Citation(s) in RCA: 814] [Impact Index Per Article: 116.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Well-written and transparent case reports (1) reveal early signals of potential benefits, harms, and information on the use of resources; (2) provide information for clinical research and clinical practice guidelines, and (3) inform medical education. High-quality case reports are more likely when authors follow reporting guidelines. During 2011-2012, a group of clinicians, researchers, and journal editors developed recommendations for the accurate reporting of information in case reports that resulted in the CARE (CAse REport) Statement and Checklist. They were presented at the 2013 International Congress on Peer Review and Biomedical Publication, have been endorsed by multiple medical journals, and translated into nine languages. OBJECTIVES This explanation and elaboration document has the objective to increase the use and dissemination of the CARE Checklist in writing and publishing case reports. ARTICLE DESIGN AND SETTING Each item from the CARE Checklist is explained and accompanied by published examples. The explanations and examples in this document are designed to support the writing of high-quality case reports by authors and their critical appraisal by editors, peer reviewers, and readers. RESULTS AND CONCLUSION This article and the 2013 CARE Statement and Checklist, available from the CARE website [www.care-statement.org] and the EQUATOR Network [www.equator-network.org], are resources for improving the completeness and transparency of case reports.
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Affiliation(s)
- David S Riley
- Integrative Medicine Institute, 2437A NW Overton Street, Portland, OR 97210, USA; Helfgott Research Institute, 2220 SW 1st Ave, Portland, OR 97201, USA.
| | - Melissa S Barber
- Integrative Medicine Institute, 2437A NW Overton Street, Portland, OR 97210, USA
| | - Gunver S Kienle
- Senior Research Scientist, University of Freiburg, Fahnenbergplatz, 79085 Freiburg im Breisgau, Germany; Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - Jeffrey K Aronson
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Tido von Schoen-Angerer
- Department of Pediatrics, Centre médical de La Chapelle, Chemin de Compostelle 7, 1212 Grand-Lancy, Genève, Switzerland; ACIM Institute, Filderklinik, Im Haberschlai 7, 70794 Filderstadt-Bonlanden, Germany
| | - Peter Tugwell
- Department of Medicine University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada K1H 8M5
| | - Helmut Kiene
- Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - Mark Helfand
- Departmenty of Medical Informatics and C linical Epidemiology, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Douglas G Altman
- University of Oxford, Center for Statistics - Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Harold Sox
- Professor Medicine and of The Dartmouth Institute, Geisel School of Medicine at Dartmouth, 31 Faraway Lane, West Lebanon, NH 03784-4401, USA
| | - Paul G Werthmann
- Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - David Moher
- Senior Scientist, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smythe Road, Ottawa, ON, Canada K1H 8L6
| | - Richard A Rison
- PIH Health Hospital-Whittier, Neurology Consultants Medicine Group, University of Southern California Keck School of Medicine, 12291 Washington Blvd # 303, Whittier, CA 90606, USA
| | - Larissa Shamseer
- Senior Scientist, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smythe Road, Ottawa, ON, Canada K1H 8L6
| | - Christian A Koch
- Professor of Medicine, Director - Endocrinology at the University of Mississippi Medical Center, 2500 N. State Street, Jacson, MS 39216, USA
| | - Gordon H Sun
- Medical Director of Inpatient Services at Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Highway, Downey, CA 90242, USA
| | - Patrick Hanaway
- Cener for Functional Medicine, Cleveland Clinic, Mail Code H-18, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Nancy L Sudak
- Essentia Health - Duluth, 420 East First Street, Duluth, MN 55805-1951, USA
| | | | - James E Carpenter
- Department Chair, Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA; Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
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