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Tanni KA, Qian J. Comparative safety of generic versus brand calcineurin inhibitors in solid organ transplant patients: a systematic review and meta-analysis. J Am Pharm Assoc (2003) 2023; 63:709-719. [PMID: 36863965 DOI: 10.1016/j.japh.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Although generic ciclosporin-A (CsA) and tacrolimus (TAC) have been used for the prophylaxis of organ rejection in transplant patients for decades, evidence in their safety profile compared to reference listed drugs (RLDs) in real-world transplant patients remains limited. OBJECTIVES To compare safety outcomes of generic CsA and TAC with the reference-listed drugs in solid organ transplant patients. METHODS We systematically searched MEDLINE, International Pharmaceutical Abstracts, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature from inception until March 15, 2022, to select randomized and observational studies comparing safety profiles of generic versus brand CsA and TAC in de novo and/or stable solid organ transplant patients. Primary safety outcomes were changes in serum creatinine (Scr) and glomerular filtration rate (GFR). Secondary outcomes included incidences of infection, hypertension, diabetes, other serious adverse events (AEs), hospitalization, and death. Mean difference (MD) and relative risk (RR) with 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. RESULTS Of 2612 publications identified, 32 studies met inclusion criteria. Seventeen studies had a moderate risk of bias. Scr was statistically significantly lower in patients using generic CsA compared to brand at 1 month (MD = -0.07; 95% CI: -0.11, -0.04), while there were no statistically significant differences at 4 months, 6 months, and 12 months. No differences were detected in Scr (MD = -0.04; 95% CI: -0.13, 0.04) and estimated GFR (MD = -2.06; 95% CI: -8.89, 4.77) between patients using generic and brand TAC at 6 months. No statistically significant differences between generic CsA and TAC with their RLDs were observed for secondary outcomes. CONCLUSION Findings support similarity in safety outcomes between generic and brand CsA and TAC in real-world solid organ transplant patients.
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A case of giant cell myocarditis mimicking cardiac sarcoidosis successfully maintained by prednisolone and tacrolimus. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Milane A, Abou-Abbas L, Osmani L, Saber N, Mefleh N, Barbari A. Association Between Blood and Lymphocyte Levels of Cyclosporin A and Infectious Complications in Renal Transplant Patients. Dose Response 2021; 19:15593258211042169. [PMID: 34675757 PMCID: PMC8524715 DOI: 10.1177/15593258211042169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This study aims to investigate a potential association between whole blood
and lymphocyte Cyclosporin A (CyA) levels and the occurrence and frequency
of infectious complications in kidney transplant patients. Methods The study involves 130 kidney transplant recipients who received CyA in
addition to Mycophenolate Mofetil and steroids. CyA whole blood trough and
maximum level (CyA BL0 and CyA BLm) as well as the corresponding
levels in the lymphocytes (CyA L0 and CyA Lm) were measured for
6 months post-transplantation. Results Cytomegalovirus (CMV) as well as urinary tract infections (UTIs) were the
most commonly diagnosed with an incidence of 24.6% and 26.2%, respectively.
Only CyA L0 showed a significant association with CMV infection
occurrence (adjusted OR = 1.051, 95% CI .997–1.025, P-value
0.046). A positive linear correlation was found between CyA BL0,
CyA BLm and CyA Lm and the number of CMV episodes per patient. Conclusion We showed an association between the CMV infections occurrence and the trough
lymphocyte level of CyA (CyA L0). Both lymphocyte CyA levels also
correlated with the frequency of CMV infections. Further studies are needed
to establish the optimal range of both CyA blood and lymphocyte levels and
decrease the risk of opportunistic infections in high risk patients.
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Affiliation(s)
- Aline Milane
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Lara Osmani
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Naja Saber
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Nadine Mefleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Antoine Barbari
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Glowacka P, Rudnicka L, Warszawik-Hendzel O, Sikora M, Goldust M, Gajda P, Stochmal A, Blicharz L, Rakowska A, Olszewska M. The Antiviral Properties of Cyclosporine. Focus on Coronavirus, Hepatitis C Virus, Influenza Virus, and Human Immunodeficiency Virus Infections. BIOLOGY 2020; 9:biology9080192. [PMID: 32731331 PMCID: PMC7463439 DOI: 10.3390/biology9080192] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
This review updates current knowledge regarding the risk of viral infections, including COVID-19, in patients treated with cyclosporine. We also shortly refer to bacterial infections and parasitic infestations in patients treated with cyclosporin. Cyclosporine is an immunosuppressive drug, which is widely used in medicine, including in the treatment of autoimmune skin diseases in dermatology, rheumatology, ophthalmology and nephrology, and in organ transplantation. A usual concern associated with immunosuppressive treatment is the potential risk of infections. Interestingly, several data indicate a relatively low risk of infections, especially viral infections, in patients receiving cyclosporine. It was shown that cyclosporine exerts an inhibitory effect on the replication of some viruses, or may have a potentially beneficial effect on the disease course in infections. These include hepatitis C, influenza virus, rotavirus, human immunodeficiency virus and coronavirus infections. Available data indicate that cyclosporine may have a beneficial effect on COVID-19, which is caused by the coronavirus SARS-COV2.
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Affiliation(s)
- Paulina Glowacka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
- Correspondence:
| | - Olga Warszawik-Hendzel
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Mariusz Sikora
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Mohamad Goldust
- Department of Dermatology, G. Marconi University of Rome, 00193 Rome, Italy;
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany
- Department of Dermatology, University Hospital Basel, 4031 Basel, Switzerland
| | - Patrycja Gajda
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Anna Stochmal
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
| | - Malgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (P.G.); (O.W.-H.); (M.S.); (P.G.); (A.S.); (L.B.); (A.R.); (M.O.)
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Scherger S, Mathur S, Bajrovic V, Johnson SC, Benamu E, Ramanan P, Wolfel G, Levi ME, Abidi MZ. Cytomegalovirus myocarditis in solid organ transplant recipients: A case series and review of literature. Transpl Infect Dis 2020; 22:e13282. [PMID: 32232951 DOI: 10.1111/tid.13282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Abstract
Cytomegalovirus (CMV) is a DNA virus of the Herpesviridae family and is estimated to affect 15%-30% of high-risk solid organ transplant recipients. Typical manifestations of CMV end-organ disease in this population include colitis, esophagitis, and pneumonitis, and myocarditis is a rarely reported manifestation. We describe two cases of CMV myocarditis in solid organ transplant recipients and review the literature regarding previously published cases of CMV myocarditis.
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Affiliation(s)
- Sias Scherger
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Swati Mathur
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Valida Bajrovic
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Steven C Johnson
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Esther Benamu
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Poornima Ramanan
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Gene Wolfel
- Division of Cardiology, University of Colorado Denver, Aurora, CO, USA
| | - Marilyn E Levi
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
| | - Maheen Z Abidi
- Division of Infectious Disease, University of Colorado Denver, Aurora, CO, USA
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Lin YC, Tsai CS, Li IH, Tsai YT, Huang TY, Lee KF, Lin CS, Shih JH, Kao LT. Transplant Recipients Using Tacrolimus Had Higher Utilization of Healthcare Services Than Those Receiving Cyclosporine in Taiwan. Front Pharmacol 2019; 10:1074. [PMID: 31607922 PMCID: PMC6761300 DOI: 10.3389/fphar.2019.01074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/23/2019] [Indexed: 12/27/2022] Open
Abstract
To date, population-based studies on the healthcare service utilization among stable heart, kidney, and liver transplant recipients with different calcineurin inhibitors are still scarce. Therefore, we used the Taiwan National Health Insurance Research Database to conduct a nationwide cross-sectional study to estimate the healthcare utilization of stable transplant recipients with tacrolimus or cyclosporine (n = 3,482). The sampled patients in this study comprised 377 heart, 1,693 kidney, and 1,412 liver transplant recipients between 1 January 2011 and 31 December 2011. Each subject was followed for a 1-year period to evaluate his/her healthcare service utilization. Outcome variables of the healthcare service utilization were stated as below: numbers of outpatient visits, outpatient costs, numbers of inpatient days, inpatients costs, and total costs of all healthcare services. As for all healthcare service utilization, stable transplant recipients on tacrolimus had significantly more outpatient visits (40.7 vs. 38.6), outpatient costs (US$10,383 vs. US$8,155), and total costs (US$12,516 vs. US$10,372) of all healthcare services than those on cyclosporine during the 1-year follow-up period. Additionally, further analysis showed that heart transplant recipients receiving tacrolimus incurred 1.7-fold higher inpatient costs compared to patients receiving cyclosporine. We concluded that transplant recipients using tacrolimus had significantly higher utilization of all healthcare services than those receiving cyclosporine as immunosuppressive therapy.
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Affiliation(s)
- Yi-Chang Lin
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Hsun Li
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ting Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kwai-Fong Lee
- Biobank Management Center, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sheng Lin
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Jui-Hu Shih
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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Santhanakrishnan K, Yonan N, Callan P, Karimi E, Al-Aloul M, Venkateswaran R. The use of CMVIg rescue therapy in cardiothoracic transplantation: A single‐center experience over 6 years (2011‐2017). Clin Transplant 2019; 33:e13655. [DOI: 10.1111/ctr.13655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Affiliation(s)
| | - Nizar Yonan
- Transplant Department Wythenshawe Hospital Manchester UK
| | - Paul Callan
- Transplant Department Wythenshawe Hospital Manchester UK
| | - Ebrahim Karimi
- Transplant Department Wythenshawe Hospital Manchester UK
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8
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Jewani PK, Pouch SM, Kissling KT. Incidence of cytomegalovirus in cardiac transplant recipients receiving induction immunosuppression with antithymocyte globulin. Clin Transplant 2018; 32:e13420. [PMID: 30290013 DOI: 10.1111/ctr.13420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a major cause of morbidity and mortality in cardiac transplant recipients. Use of induction immunosuppression in cardiac transplantation may have an impact on the incidence of CMV, but literature is limited. METHODS Single-center, retrospective cohort study comparing the risk of CMV infection and disease in cardiac transplant patients receiving antithymocyte globulin (ATG) induction therapy to those receiving no antibody induction. RESULTS A total of 75 patients were included in our analysis, 50 who received ATG induction and 25 who did not. CMV infection occurred in 10 (20%) and 5 (20%) patients in the ATG and No ATG groups, respectively (P > 0.99). CMV disease occurred in 10 (20%) and 4 (16%) patients in the ATG and No ATG groups, respectively (P = 0.763). The median time from transplant to CMV infection was 200.0 [142.5, 364.5] days in the ATG group vs 221.0 [192.0, 299.0] days in the No ATG group (P = 0.723). The median time from end of CMV prophylaxis to CMV infection was 94.5 [66.5, 151.0] days in the ATG group vs 53.0 [41.0,149.5] days in the No ATG group (P = 0.202). Freedom from CMV infection was highest in the D+/R+ group and lowest in the D+/R- group. CONCLUSION In cardiac transplant recipients, ATG induction was not associated with an increased incidence of CMV infection or disease in the setting of valganciclovir prophylaxis and an initial maintenance immunosuppression regimen of primarily steroids, mycophenolate mofetil, and tacrolimus.
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Affiliation(s)
- Poonam K Jewani
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kevin T Kissling
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Bond MMK, Bond MMK, Sehn A, Dias VH, Said TL, Dos Santos CC, Finger MA, Santos AMG, Neto JMR. Cyclosporine Versus Tacrolimus: Which Calcineurin Inhibitor Has Influence on Cytomegalovirus Infection in Cardiac Transplantation? Transplant Proc 2018; 50:809-814. [PMID: 29661443 DOI: 10.1016/j.transproceed.2018.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cytomegalovirus (CMV) infection is a relevant cause of morbidity and mortality in transplantation patients. Its major incidence is in the first year and viral replication is related to acute rejection, survival reduction, and graft vascular disease. OBJECTIVE This study aims to evaluate retrospectively whether a high dose of calcineurin inhibitors correlates with CMV-positive polymerase chain reaction (PCR), need for treatment, and death in cardiac transplantation patients. METHODS This is a case-control study including patients who underwent transplantation between 2014 and 2016. They were separated into two groups (positive or negative PCR) and evaluated for dosage serum levels of cyclosporine and tacrolimus. Patients were classified with adequate dose of immunosuppressant or high dose, and was analyzed that there was any association with those and positive CMV-PCR, need for treatment for CMV, and deaths. For statistical analysis, the Student t test was used for the quantitative variables and the Fisher's Exact Test for qualitative variables. To show CMV-free survival, the Kaplan-Meier curve was used. The level of significance was set at 5%. RESULTS CMV-positive PCR in the sample was 72% for a total of 50 individuals. Positive PCR correlated with a high dose of calcineurin inhibitors in a statistically significant way (P = .002), as did a high dose of cyclosporine (P = .004); however, a high dose of tacrolimus had no such association (P = .17). When a high dose was assessed with a need for treatment, the chance of needing treatment increased more than eight times (P = .024; odds ratio = 8.25; 95% CI = 1.33 to 51.26), which was different from results found with high-dose tacrolimus (P = 1.0). However, no significant association was found in relation to deaths. CONCLUSIONS Tacrolimus serum levels showed no association with CMV-PCR, which was different from serum cyclosporine, which showed association with CMV-PCR positivity, increasing the need for treatment approximately 8-fold, without association with death.
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Affiliation(s)
| | - Marisa M K Bond
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Sehn
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - V H Dias
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - T L Said
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - C C Dos Santos
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - M A Finger
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - A M G Santos
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - J M R Neto
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
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Abstract
Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R-). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation.
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Deuse T, Bara C, Barten MJ, Hirt SW, Doesch AO, Knosalla C, Grinninger C, Stypmann J, Garbade J, Wimmer P, May C, Porstner M, Schulz U. The MANDELA study: A multicenter, randomized, open-label, parallel group trial to refine the use of everolimus after heart transplantation. Contemp Clin Trials 2015; 45:356-363. [DOI: 10.1016/j.cct.2015.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
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