The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Nov 2002
Non-immune acute graft injury after lung transplantation and the risk of subsequent bronchiolitis obliterans syndrome (BOS).
Primary graft dysfunction remains a major cause of early morbidity and mortality after lung transplantation. Evidence from animal models shows acute non-immune lung injury increases organ immunogenicity by enhancing MHC Class II expression. We hypothesized that acute non-immune injury in the lung allograft may impact, not only on early survival, but also on longer term survival by increasing the incidence of bronchiolitis obliterans syndrome (BOS). ⋯ The development of severe non-immune acute graft injury after lung transplantation has a poor early prognosis. However, recipients with non-immune acute graft injury who survive >30 days show no significant difference in long-term survival or BOS-free time compared with recipients without early injury.
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J. Heart Lung Transplant. · Sep 2002
A limited sampling strategy for the estimation of 12-hour Neoral systemic drug exposure in heart transplant recipients.
Therapeutic drug monitoring of cyclosporine in heart transplant patients is used to monitor therapy and prevent rejection. Of the various methods available for performing therapeutic drug monitoring of cyclosporine, the method of limited sampling strategy for area under the concentration-time curve profiling has been used most widely recently. The process of identifying sparse data points to predict area under the concentration-time curve is essentially a variable selection problem, with the variables being the drug concentrations at the various timepoints. Although fitting more variables into a model will typically allow for a better prediction of area under the concentration-time curve, improving the prediction has to be traded-off against the desirability of using as few timepoints as possible. The objective of this study was thus to formulate a model that would provide a good prediction of area under the concentration-time curve based on a limited number of sampling points. ⋯ We recommend using C(1h) and C(4h) as surrogate markers of area under the concentration-time curve from time 0 h to 12 h in our heart transplant patients. Because C(1h) and C(4h) represent timepoints within the zone of highest variability for Neoral's absorption phase, a model incorporating these timepoints would be able to explain a greater degree of variability associated with the Neoral absorption profile.
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J. Heart Lung Transplant. · Aug 2002
Pre-operative renal function predicts development of chronic renal insufficiency after orthotopic heart transplantation.
Risk factors for the development of chronic renal insufficiency after solid-organ transplantation remain unclear. ⋯ Pre-operative serum creatinine concentration predicts development of renal insufficiency after heart transplantation.
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J. Heart Lung Transplant. · Jul 2002
Upregulation of chemokines in bronchoalveolar lavage fluid as a predictive marker of post-transplant airway obliteration.
The early stage of post-transplant obliterative bronchiolitis (OB) is characterized by an influx of inflammatory cells to the lung, among which neutrophils may play a role in key events. The potential for chemokines to induce leukocyte accumulation in the alveolar space was investigated. We assessed whether changes in the chemotactic expression profile could be used as sensitive markers of the onset of OB. ⋯ These data support the belief that RANTES, IL-8 and MCP-1 play a crucial role in the pathogenesis of OB. The results show that relevant increased levels of such chemokines may predict BOS, and suggest that there is potential for some of these markers to be used as early and sensitive markers of the onset of BOS. Longitudinal monitoring of these chemokine signals may contribute to better management of patients at risk for developing OB, at a stage when remodeling can either be reversed or altered.
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J. Heart Lung Transplant. · May 2002
Respiratory viruses and chronic rejection in lung transplant recipients.
BACKGROUND; Chronic rejection manifested as obliterative bronchiolitis (OB) and bronchiolitis obliterans syndrome (BOS) continue to be major causes of morbidity and mortality after lung transplantation. Community respiratory virus (CRV) infection, including respiratory syncytial virus, parainfluenza virus, and influenza virus, can infect and also cause morbidity in lung transplant recipients. Because CRV and OB/BOS affect the small airways, we sought to determine whether CRV infections predisposed patients to OB/BOS. ⋯ Patients with CRV infection of the lower respiratory tract were predisposed to high-grade BOS development, and patients with OB and BOS were predisposed to CRV infections.