[Review of clinical trials on minimization and interruption of calcineurin inhibitors (CNIs) and protocols without CNIs in the transplantation of different organs (kidney, heart, and liver)] (original) (raw)
Related papers
[Immunosuppressive agents in pediatric renal transplantation]
Revue médicale de Bruxelles
Advances in immunosuppressive therapy over the past decade have led to dramatic improvements of patient and graft survival. The immunosuppression that is used is constantly evolving. The goal remains to find the best combination that will optimize long-term graft survival, while minimizing the adverse effects. It is likely that in the near future the results will even be improved further by the development of new medications with a better therapeutic index and the induction of transplant tolerance.
[Living-donor kidney transplantation in the European countries and in North America (2001-2009)]
Néphrologie & Thérapeutique
In front of kidney transplants shortage, the alternative of living donor renal transplantation is discussed. The purpose of this work is to compare, in 16 European countries and of North America having a consequent activity, the levels of living donor renal transplantation activities and their possible impact on kidney shortage, usually reported in a fragmented and punctual way. In 2009 and in spite of a light growth, the French rate of 3,5 living donor kidney transplantation per million people (pmp) was one of the weakest just before Italy and Finland. Numerous countries exceeded the rate of 14 pmp. Others as Spain and Portugal know a regular growth while their transplant activity was mainly based on brain dead donor. This growth is also observed in Germany and in Austria. France, in spite of an increase of kidney transplantation activity, had a high level of kidney shortage (2,7 patients registered on the waiting list in 2009 for one kidney transplant) before Italy which has low r...
[Incidence and management of anemia in renal transplantation: an observational-French study]
Néphrologie & thérapeutique, 2008
The management of anemia after kidney transplantation remains poorly explored. The Management of Anemia in French Kidney Transplant Patients (MATRIX) study is an observational study conducted in 10 academic hospitals among kidney-transplant patients designed to evaluate the prevalence, associated factors and management of post-transplant anemia. Over two consecutive weeks, 418 recipients (males: 248; age: 50.8+/-12.7 years) were included, all were transplanted for more than six months. Mean serum creatinine (Scr) was 152+/-67 micromol/l and mean hemoglobin (Hb) was 12.4+/-1.8 g/dl (males: 12.8+/-1.9 g/dl; females 11.9+/-1.6 g/dl). Irrespective of the delay following transplantation, 23% of patients (n=95) were severely anemic (Hb < or = 11 g/dl). Eighteen percent of the patients received an antianemic treatment (10% oral iron, 7% erythropoiesis stimulating agents (ESA), 4% folic acid) and only 35% of the severely anemic patients were actually treated (n=33). A significantly-negat...
La prise en charge thérapeutique du patient transplanté rénal est le plus souvent complexe et expose à un risque d'évènements iatrogènes médicamenteux. Les patients sont confrontés, d'une part, à des médica-ments à marge thérapeutique étroite avec notamment les immunosuppresseurs et, d'autre part, à de nombreuses comorbidités associées. Celles-ci favorisent une polymédication, générant ainsi des interactions médicamenteuses et augmentant le risque d'apparition d'effets indésirables. Des comportements à risques tels que la mauvaise adhé-sion au traitement sont également à prendre en compte. Ce travail présenté sous la forme d'une synthèse de la littérature médicale, abordera le profil physiopathologique et thérapeutique du patient transplanté rénal ainsi que les problèmes reliés à la pharmacothérapie générés par les thérapeutiques immunosuppressives. Pour définir la place du pharmacien clinicien et l'intégration des soins pharmaceutiques, nous présenterons une revue de la littérature médicale sur les missions potentielles du pharmacien clinicien visant à optimiser la prise en charge thérapeutique du patient transplanté rénal. Abstract. The therapeutic management of renal transplant patient is often complex and exposed to a risk of occurrence of iatrogenic drug events. Patients are treated by drugs with a narrow therapeutic range including immunosuppressants, and have many comorbidities. These promote polymedication, generating drug interactions and increasing the risk of developing side effects. Risk behaviours such as poor adherence to treatment are also taken into account. This medical literature review discusses the pathophysiology and therapeutic profiles of renal transplant patients as well as drug-related problems generated by immunosuppressive therapy. To define the role of the clinical pharmacist and the integration of pharmaceutical care, we present a review of the potential missions of clinical pharmacist to optimize the therapeutic management of renal transplant patients.
The Pan African Medical Journal, 2010
Introduction: La transplantation rénale (TR) est actuellement considérée comme un traitement de choix de l'insuffisance rénale chronique terminale (IRCT). Ses résultats se sont améliorés au cours des dernières années. Cependant, les complications chirurgicales demeurent graves car elles touchent un rein unique et surviennent sur un terrain fragilisé par l'insuffisance rénale et l'immunosuppression. L'objectif de ce travail est d'évaluer la fréquence des complications chirurgicales lors de l'activité de TR au CHU Ibn Sina de Rabat, et de dégager les facteurs ayant influé l'apparition de ces complications. Méthodes : Étude rétrospective des patients transplantés rénaux à partir de donneurs vivants apparentés (DVA) de Juin 1999 à Décembre 2008 dans notre centre hospitalo-universitaire. Nous avons recensé les caractéristiques propres au receveur, au prélèvement, au donneur ainsi qu'au greffon. Les complications chirurgicales ont été colligées ainsi que leur prise en charge et évolution. Résultats: Soixante sept dossiers ont été analysés avec un suivi moyen de 55 +/-28 mois. 38 complications chirurgicales ont été recensées : sténose des artères rénales (38,7%), lymphocèle (21%), hématome (12,7%), thrombose vasculaire (7,8%), reflux vésico-urétéral (4,8%), rupture du greffon (3,2%), calcul (1 cas), éventration (1 cas), L'analyse statistique de notre série n'a pas mis en évidence de facteurs de risque significatifs semblant influer sur l'incidence des complications chirurgicales. Conclusion: La morbidité liée aux complications chirurgicales de la TR reste élevée nécessitant un diagnostic et un traitement adéquat afin d'éviter les répercussions sur la survie des patients et des greffons.
[Recent advances in liver surgery and transplantation]
Revue médicale de Liège
Over the last 20 years, significant improvements in hepatic surgery and transplantation have allowed better results. Better patients selection, new preoperative modalities aiming at modifying the volume of the liver or the tumour, new surgical techniques, and better postoperative management are the keys to improved outcome. These progresses are reviewed in this article. In hepatic surgery, the latest surgical improvements are the possibility of laparoscopic hepatic resection and of radiofrequency ablation. Modern neoadjuvant chemotherapy may in some cases allow a reduction of large liver colorectal metastases and render them resectable. Improved radiological techniques allow better planning of the surgical resections, reduction of the risks by calculation of the residual liver mass, and induction of liver hypertrophy by preoperative portal embolisation. In liver transplantation, the most significant changes were the use of living related liver donors and of non-heart beating donors ...