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Konda P, Golamari R, Eisen HJ. Novel Immunosuppression in Solid Organ Transplantation. Handb Exp Pharmacol 2022; 272:267-285. [PMID: 35318509 DOI: 10.1007/164_2021_569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Solid organ transplantation and survival has improved tremendously in the last few decades, much of the success has been attributed to the advancements in immunosuppression. While steroids are being replaced and much of the immunosuppressive strategies focus on steroid free regimens, novel agents have introduced in the induction, maintenance, and treatment of acute rejection phase. MTOR inhibitors have helped with the renal sparing side effect from the calcineurin inhibitors, newer agents such as rituximab have decreased the incidence of donor-specific antibodies which led to decreased incidence of acute rejection reactions. In this chapter we discuss the newer therapies directed specifically for solid organ transplantation.
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Affiliation(s)
- Prasad Konda
- Heart and Vascular Institute, Pennsylvania State University/Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Reshma Golamari
- Department of Hospital Medicine, Pennsylvania State University/Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Howard J Eisen
- Heart and Vascular Institute, Pennsylvania State University/Milton S. Hershey Medical Center, Hershey, PA, USA.
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Ajlan A, Aleid H, Ali TZ, Joharji H, Almeshari K, Nazmi AM, Shah Y, Devol E, Alkortas D, Alabdulkarim Z, Broering D, Alahmadi I, Ullah A, Alotaibi A, Aljedai A. Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial. Trials 2021; 22:414. [PMID: 34167567 PMCID: PMC8223264 DOI: 10.1186/s13063-021-05253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated. AIMS To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol. METHODS Prospective, randomized, double blind, non-inferiority, controlled clinical trial EXPECTED OUTCOMES: 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2. SECONDARY OUTCOMES a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) TRIAL REGISTRATION: The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.
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Affiliation(s)
- Aziza Ajlan
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Pharmaceutical Care Division MBC 11, Riyadh, Saudi Arabia.
| | - Hassan Aleid
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Tariq Zulfiquar Ali
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Hala Joharji
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Pharmaceutical Care Division MBC 11, Riyadh, Saudi Arabia
| | - Khalid Almeshari
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Ahmed Mohammed Nazmi
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Yaser Shah
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Edward Devol
- Biostats, Epidemiology and Scientific Computing Department, Riyadh, Saudi Arabia
| | - Dalal Alkortas
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Pharmaceutical Care Division MBC 11, Riyadh, Saudi Arabia
| | - Zinah Alabdulkarim
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Pharmaceutical Care Division MBC 11, Riyadh, Saudi Arabia
| | - Dieter Broering
- Organ Transplant Centre of Excellence- Riyadh, OTC, Riyadh, Saudi Arabia
| | - Ibrahim Alahmadi
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Asad Ullah
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Kidney & Pancreas Health Centre - Riyadh, KPT, Riyadh, Saudi Arabia
| | - Anwar Alotaibi
- Biostats, Epidemiology and Scientific Computing Department, Riyadh, Saudi Arabia
| | - Ahmed Aljedai
- King Faisal Specialist Hospital and Research Centre (KFSHRC), Pharmaceutical Care Division MBC 11, Riyadh, Saudi Arabia.,Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
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3
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Ariyamuthu VK, Amin AA, Drazner MH, Araj F, Mammen PPA, Ayvaci M, Mete M, Ozay F, Ghanta M, Mohan S, Mohan P, Tanriover B. Induction regimen and survival in simultaneous heart-kidney transplant recipients. J Heart Lung Transplant 2017; 37:587-595. [PMID: 29198930 DOI: 10.1016/j.healun.2017.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Induction therapy in simultaneous heart-kidney transplantation (SHKT) is not well studied in the setting of contemporary maintenance immunosuppression consisting of tacrolimus (TAC), mycophenolic acid (MPA), and prednisone (PRED). METHODS We analyzed the Organ Procurement and Transplant Network registry from January 1, 2000, to March 3, 2015, for recipients of SHKT (N = 623) maintained on TAC/MPA/PRED at hospital discharge. The study cohort was further stratified into 3 groups by induction choice: induction (n = 232), rabbit anti-thymoglobulin (r-ATG; n = 204), and interleukin-2 receptor-α (n = 187) antagonists. Survival rates were estimated using the Kaplan-Meier estimator. Multivariable inverse probability weighted Cox proportional hazard regression models were used to assess hazard ratios associated with post-transplant mortality as the primary outcome. The study cohort was censored on March 4, 2016, to allow at least 1-year of follow-up. RESULTS During the study period, the number of SHKTs increased nearly 5-fold. The Kaplan-Meier survival curve showed superior outcomes with r-ATG compared with no induction or interleukin-2 receptor-α induction. Compared with the no-induction group, an inverse probability weighted Cox proportional hazard model showed no independent association of induction therapy with the primary outcome. In sub-group analysis, r-ATG appeared to lower mortality in sensitized patients with panel reactive antibody of 10% or higher (hazard ratio, 0.19; 95% confidence interval, 0.05-0.71). CONCLUSION r-ATG may provide a survival benefit in SHKT, especially in sensitized patients maintained on TAC/MPA/PRED at hospital discharge.
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Affiliation(s)
| | - Alpesh A Amin
- Division of, Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark H Drazner
- Division of, Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Faris Araj
- Division of, Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pradeep P A Mammen
- Division of, Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mehmet Ayvaci
- Information Systems, School of Management, University of Texas at Dallas, Dallas, Texas
| | - Mutlu Mete
- Department of Computer Science, Texas A&M University-Commerce, Commerce, Texas
| | - Fatih Ozay
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mythili Ghanta
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sumit Mohan
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Prince Mohan
- Division of Nephrology, Geisinger Medical Center, Danville, Pennnsylvania
| | - Bekir Tanriover
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas
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Sato T, Seguchi O, Ishibashi-Ueda H, Yanase M, Okada N, Kuroda K, Hisamatsu E, Sunami H, Watanabe T, Nakajima S, Wada K, Hata H, Fujita T, Fukushima N, Kobayashi J, Nakatani T. Risk Stratification for Cardiac Allograft Vasculopathy in Heart Transplant Recipients – Annual Intravascular Ultrasound Evaluation –. Circ J 2016; 80:395-403. [DOI: 10.1253/circj.cj-15-1037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takuma Sato
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Osamu Seguchi
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | | | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Norihiro Okada
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Kensuke Kuroda
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Eriko Hisamatsu
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Haruki Sunami
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Takuya Watanabe
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Seiko Nakajima
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Kyoichi Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Hiroki Hata
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Norihide Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takeshi Nakatani
- Department of Transplantation, National Cerebral and Cardiovascular Center
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