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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Mártinez, J. M. A. Pulido, L. B. Bellido, C. B. Usero, D. D. Aguilar, L. T. Moreno, J. L. G. Artacho, G. S. Díez-Canedo, J. S. Gómez, L. M. M. Bravo, M. A. G. |
| Description | Country affiliation: Spain Author Affiliation: Mártinez JM ( Liver Transplant Unit, Virgen del Rocío Hospital, Seville, Spain. jmalamom@terra.es) |
| Abstract | BACKGROUND: Mammalian target of rapamycin (mTOR) inhibitors behave as potent immunosuppressants, which have the advantages, with respect to calcineurin inhibitors (CNI; cyclosporine or tacrolimus), of no nephrotoxicity but inhibition of cell proliferation. They are particularly suitable for patients with renal insufficiency or neoplasias. MATERIALS AND METHODS: Twenty-eight liver transplant patients were immunosuppressed with everolimus or sirolimus as rescue therapy after CNI treatment: 8 hepatocellular carcinomas; 7 de novo malignancies; 6 renal insufficiencies; 3 chronic rejections; 3 acute rejection episodes; and 1 epilepsy. RESULTS: There were 0% tumor recurrences, 50% improvements in 33% no change, and 17% worsening of renal function among cases of renal insufficiency; 0% improvement in cases of chronic rejection, and 33% improvement in acute rejection episodes. There was a 7% incidence of acute rejection episodes, but no kidney failure, gastrointestinal intolerance, hydrocarbon intolerance, hypertension, or arterial or venous thrombosis. Diarrhea occurred in 7%; hypercholesterolemi in 46% hypertriglyceridemia in 50% thrombocytopenia in 14%, leukopenia in 14%, and anemia in 39%. The 12% intercurrent infection rate included oral thrush in 11%. Lower limb edema occurred in 21%; 1 case displayed facial edema and 1, alopecia. CONCLUSIONS: mTOR inhibitors were safe immunosuppressive drugs whose side effects were controlled and easily managed. They have advantages with respect to CNI due to their slight effects on kidney function and lack of promotion of diabetes mellitus. Although their long-term effectiveness for control of neoplastic diseases is yet to be seen, they can be used safely in these patients with a low incidence of rejection. Their effectiveness to control steroid-resistant acute rejection episodes or renal insufficiency seems significant, but they are of doubtful benefit for chronic rejection. |
| File Format | HTM / HTML |
| ISSN | 00411345 |
| Issue Number | 2 |
| Volume Number | 42 |
| e-ISSN | 18732623 |
| Journal | Transplantation Proceedings |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2010-03-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Transplantation__semicolon__medicine Immunosuppressive Agents Therapeutic Use Intracellular Signaling Peptides And Proteins Antagonists & Inhibitors Liver Transplantation Immunology Protein-serine-threonine Kinases Sirolimus Analogs & Derivatives Carcinoma, Hepatocellular Surgery Everolimus Graft Rejection Humans Adverse Effects Liver Neoplasms Neoplasm Recurrence, Local Epidemiology Safety Tor Serine-threonine Kinases Journal Article |
| Content Type | Text |
| Resource Type | Article |
| Subject | Transplantation Surgery |
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