RESUMEN
In February 2013, the Organ Procurement and Transplantation Network mandated that transplant centers perform screening of living kidney donors prior to transplantation for Strongyloides, Trypanosoma cruzi and West Nile virus (WNV) infection if the donor is from an endemic area. However, specific guidelines for screening were not provided, such as the optimal testing modalities, timing of screening prior to donation and the appropriate selection of donors. In this regard, the American Society of Transplantation Infectious Diseases Community of Practice, together with disease-specific experts, has developed this viewpoint document to provide guidance for the testing of live donors for Strongyloides, T. cruzi and WNV infection, specifically identifying at-risk populations and testing algorithms, including advantages, limitations and interpretation of results.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/transmisión , Selección de Donante , Enfermedades Endémicas , Trasplante de Riñón , Tamizaje Masivo , Donantes de Tejidos , Recolección de Tejidos y Órganos/normas , Algoritmos , Enfermedades Transmisibles/diagnóstico , Humanos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To determine the frequency, predisposing factors, clinical presentation, and outcome of posttransplantation lymphoproliferative disorders (PTLDs) in pediatric thoracic organ transplant recipients. METHODS: Retrospective review of the medical records of all 120 children who survived longer than 1 month after thoracic organ transplantation at our center. RESULTS: PTLD was diagnosed in 14 patients (11.7%), including 7.7% of heart and 19.5% of heart-lung/lung recipients. Presentation of PTLD was variable, ranging from asymptomatic lung nodules on chest radiograph to diffuse multiorgan failure. Treatment with a reduction of immunosuppression and antiviral therapy resulted in resolution of PTLD in eight patients. Eight patients died. PTLD contributed to death in five. No patient seropositive for Epstein-Barr virus (EBV) before transplantation had PTLD. There was a significant association between primary EBV infection after transplantation and the presence of PTLD. CONCLUSIONS: PTLD occurs with greater frequency in pediatric thoracic organ transplant recipients than in the adult transplant population. Primary EBV infection after transplantation is the major risk factor for the development of PTLD. Patients in whom primary EBV infection develops after transplantation should be managed with a reduction in immunosuppression and with heightened surveillance for the development of PTLD.
Asunto(s)
Trastornos Linfoproliferativos/etiología , Trasplante de Órganos/efectos adversos , Cirugía Torácica , Adolescente , Adulto , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Causas de Muerte , Niño , Preescolar , Femenino , Trasplante de Corazón/efectos adversos , Trasplante de Corazón-Pulmón/efectos adversos , Infecciones por Herpesviridae/complicaciones , Infecciones por Herpesviridae/tratamiento farmacológico , Herpesvirus Humano 4 , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Lactante , Recién Nacido , Trasplante de Hígado/efectos adversos , Enfermedades Pulmonares/etiología , Trasplante de Pulmón/efectos adversos , Trastornos Linfoproliferativos/tratamiento farmacológico , Masculino , Insuficiencia Multiorgánica/etiología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento , Infecciones Tumorales por Virus/complicaciones , Infecciones Tumorales por Virus/tratamiento farmacológicoRESUMEN
The application of lung transplantation to the pediatric population was a natural extension of the success realized in our adult transplant program, which began in 1982. Thirty-two pediatric patients (age range 1 to 18 years) have undergone heart-lung (n = 16), double-lung (n = 14), and single-lung (n = 2) transplantation procedures. The cause of end-stage lung disease was primary pulmonary hypertension (n = 7), congenital heart disease (n = 7), cystic fibrosis (n = 9), pulmonary arteriovenous malformation (n = 2), desquamative interstitial pneumonitis (n = 2), graft-versus-host disease (n = 1), emphysema (n = 1), rheumatoid lung (n = 1), cardiomyopathy (n = 1), and Proteus syndrome (n = 1). Six patients (19%) underwent pretransplantation thoracic surgical procedures. The survival rate was 78% at a mean follow-up of 1.8 years. The survival rate in the 23 recipients without cystic fibrosis was 87% (95% since 1985). The actuarial 1-year survival rate in the nine recipients with cystic fibrosis was 55%. Immunosuppression was cyclosporine (n = 9) or FK 506 (n = 23)-based therapy with azathioprine and steroids. Children were followed up by spirometry, transbronchial biopsy, and primed lymphocyte testing of bronchoalveolar lavage fluid. The mean number of treated episodes of rejection per patient in the groups treated with cyclosporine and FK 506, respectively, was 1.0 and 1.2 at 30 days, 0.67 and 0.38 at 30 to 90 days, and 2.33 and 0.46 at greater than 90 days (p < 0.001, Fisher exact test).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Trasplante de Pulmón/tendencias , Adolescente , Niño , Preescolar , Rechazo de Injerto , Trasplante de Corazón-Pulmón/estadística & datos numéricos , Trasplante de Corazón-Pulmón/tendencias , Humanos , Terapia de Inmunosupresión , Lactante , Infecciones/diagnóstico , Infecciones/etiología , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón/mortalidad , Trasplante de Pulmón/estadística & datos numéricos , Preservación de Órganos , Complicaciones Posoperatorias , Tasa de SupervivenciaRESUMEN
We studied dapsone pharmacokinetics in eight children with compromised immune function who were receiving three different preparations. Peak serum concentration was less than 0.25 microgram/ml after doses of an extemporaneous liquid preparation but ranged from 0.72 to 1.33 micrograms/ml after initial tablet or proprietary liquid doses and 1.48 to 2.48 microgram/ml during long-term proprietary liquid administration. Elimination followed first-order kinetics; the mean elimination half-life was 15.1 hours.
Asunto(s)
Dapsona/farmacocinética , Disponibilidad Biológica , Niño , Preescolar , Dapsona/sangre , Femenino , Semivida , Humanos , Huésped Inmunocomprometido , Lactante , MasculinoRESUMEN
Although the case presented was easily treated, it caused anguish and expense that might have been avoided had the diagnosis been entertained initially. Considering the high frequency of occurrence, radial head subluxation should be thought of in young children with upper extremity injuries, typical posturing, and no other evidence of trauma or deformity. A suggestive history should be sought, and an attempt to reduce the subluxation should be made. Parents and caretakers should be advised about the potential for recurrence of this injury, as well as the dangers of sudden traction on a child's arm.