timing of initiation of calcineurin inhibitors

Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy...

BK polyomavirus-associated nephropathy (PyVAN) is responsible for a significant percentage of transplanted kidneys prematurely terminating their function. Its occurrence is closely related to the intensity of immunosuppressive therapy. In a group of 161 newly transplanted patients, we prospectively evaluated 457 protocol renal biopsies performed within the first year after transplantation. Using the calcineurin inhibitors (CI) nephrotoxicity score, the incidence of nephrotoxicity was monitored as a manifestation of excessive immunosuppression...

Background: Chronic renal dysfunction (CRD), as predominantly related to calcineurin-inhibitor (CNI) nephrotoxicity, is associated with increased morbidity and mortality after lung transplantation (LTx). Basiliximab (BSX), a recombinant chimeric monoclonal antibody against CD25+ on activated T-lymphocytes, although often employed as an "induction immunosuppression" after solid organ transplantation, may further allow for reduction in CNI exposure with monthly administration and amelioration of CRD...

We present six cases of antimelanoma differentiation-associated gene 5 antibody (anti-MDA5-Ab)-positive clinically amyopathic dermatomyositis (CADM) with rapidly progressive interstitial lung disease (RP-ILD), which is known to have a poor prognosis. The outcomes of these cases are described after treatment with therapeutic plasma exchange (TPE). Clinical and therapeutic data for patients with CADM with RP-ILD were collected retrospectively from medical records. All six patients received early intensive care including high-dose corticosteroids, intravenous cyclophosphamide, and a calcineurin inhibitor, but lung disease and hypoxia became more severe...

INTRODUCTION: Crystalline arthritis (CA), characterized by acute joint pain and erythema secondary to calcium pyrophosphate deposition (CPPD, or pseudogout) or monosodium urate crystals (gout), is a potentially underreported complication following allogeneic hematopoietic cell transplant (alloHCT). Graft-versus-host disease prophylaxis with calcineurin inhibitors (CNIs) causes hypomagnesemia and hyperuricemia, resulting in CA. CA related to tacrolimus has yet to be characterized following alloHCT...

OBJECTIVES: Mycophenolate mofetil (MMF) is mainly used in conjunction with calcineurin inhibitors as an additional immunosuppressive for renal sparing after liver transplantation. However, few reports about MMF use in infants after living donor liver transplantation (LDLT) are available. The purpose of this study was to examine the efficacy and safety of MMF in infants. METHODS: This study enrolled infants younger than 1 year of age who received LDLT at our institution...

PURPOSE: CYP3A5 enzyme allele status affects metabolism of Calcineurin inhibitors . There is data on influence of Polymorphism in CYP alleles on Tacrolimus levels in Caucasian and Afro - American patients, but little data available for Indian patients METHODS: We studied 93 Heart, lung and Combined Heart plus lung transplant patients from our Hospital with 6 months Followup . The age range was 12 yrs to 72 yrs (70 M, 23 F) .Pattern of expression of 2 alleles CYP3A 5 *1 and * 3 were analysed to classify the patients in Two groups - Group A Poor metabolisers (*3*3) and Group B made of intermediate metaboliser (*1*3) or Extensive metaboliser (*1*1) ...

PURPOSE: Antibody induction therapy has been shown to reduce acute rejection episodes in organ transplantation. Universal basiliximab (BAS) induction therapy was discontinued at our center due to lack of efficacy versus no induction. Targeted induction therapy with BAS was developed for patients with acute kidney injury. This study compares the incidence of acute and chronic rejection in lung transplant (txp) recipients who received basiliximab for acute kidney injury (AKI). METHODS: Patients transplanted between 2008-2018 were retrospectively divided into two groups (grps): (1) BAS vs (2) no induction...

PURPOSE: EVE has proven benefits when prescribed post heart or kidney transplantation. The role of EVE is less well defined in LTx. We reported our experience with EVE over a 14-year period. METHODS: Single-center retrospective cohort study evaluating 124 adult LTx recipients initiated on EVE between 2005 and 2018 for calcineurin inhibitor (CNI) minimization / elimination. Data collected include demographics, prescribing patterns, mean EVE dose/ trough levels, adverse events and clinical parameters...

PURPOSE: Immunosuppression induction is commonly utilized in heart transplant (HT) to prevent acute rejection and/or delay calcineurin inhibitor (CNI) initiation. However, guidance on whether to use induction and preferred agent(s) are not well defined. This is reflected by high practice variability across centers. According to ISHLT registry data, 54% of adult HT cases utilized induction, 31% with an IL-2R antagonist and 23% with a T-cell depleting agent. Our center has primarily utilized 3 strategies based on rejection risk and need to delay CNI: IL-2R antagonist (basiliximab), T-cell depleting (anti-thymocyte globulin, rabbit (rATG)), or no induction...

PURPOSE: The goal of induction therapy with rabbit anti-thymocyte globulin (rATG) and basiliximab in cardiac transplant is to minimize incidence of biopsy-proven acute cellular rejection (BPAR). However, rATG has been associated with increased risk for hematologic and infectious complications. At Mayo Clinic, dual induction, consisting of rATG cumulative doses less than 6 mg/kg and basiliximab, has been utilized in recipients experiencing complications from rATG. The impact of dual induction in cardiac transplant recipients is unknown...

BACKGROUND: Despite improved overall outcomes, rejection continues to occur frequently after pancreas transplantation. OBJECTIVE: To review the literature and to provide a state-of-the-art assessment of current practice and developments of immunosuppressive regimens in pancreas transplantation. METHODS: The literature was reviewed and relevant articles were retrieved and analyzed. RESULTS: Induction therapy is used in approximately 90% of the transplants, with T-cell depleting antibodies being the prevalent therapy (>90%)...

OBJECTIVES: To clarify the efficacy and safety of calcineurin inhibitors (CNI) for treating adult-onset Still's disease (AOSD). METHODS: This multicentre historical cohort study enrolled the consecutive patients with AOSD according to Yamaguchi classification criteria. The endpoints were set as the time from the initiation of treatment to events, the persistency rate of CNI and safety. Based on the recurrent event data analysis, these endpoints were evaluated for each event...

Graft-versus-host disease (GVHD) is a common complication of allogeneic stem cell transplantation (allo-SCT) that carries a high mortality. Although calcineurin inhibitors (CNIs) have been widely used in GVHD prophylaxis, the incidence of acute GVHD (aGVHD) remains at roughly 30% to 50%. Moreover, some allo-SCT recipients cannot tolerate CNI. Thus, improved GVHD prevention methods are needed. Our study aimed to determine the prophylactic value of ruxolitinib for GVHD in CNI-intolerant patients after allo-SCT...

Fast tacrolimus (TAC) metabolism (concentration/dose (C/D) ratio < 1.05 ng/ml/mg) is a risk factor for inferior outcomes after renal transplantation (RTx) as it fosters, e.g., TAC-related nephrotoxicity. TAC minimization or conversion to calcineurin-inhibitor free immunosuppression are strategies to improve graft function. Hence, we hypothesized that especially patients with a low C/D ratio profit from a switch to everolimus (EVR). We analyzed data of 34 RTx recipients (17 patients with a C/D ratio < 1...

BACKGROUND: Following induction therapy with a calcineurin inhibitor (CNI) in severe ulcerative colitis, transitioning to vedolizumab as maintenance therapy could be an option. AIM: To report on the largest cohort of patients successfully induced with CNIs who were transitioned to vedolizumab maintenance therapy. METHODS: This is a retrospective observational study of adult patients with severe steroid-refractory ulcerative colitis. Patients were included if they were induced with a CNI followed by maintenance therapy with vedolizumab between January 2014 and December 2018...

We describe a unique case of a 53-year-old woman who underwent a nonrelated living donor kidney transplant 9 years after a previous small bowel transplant from her sister. The patient had suffered from short bowel syndrome secondary to volvulus after undergoing bariatric surgery for morbid obesity. Her entire small bowel had to be resected emergently, but she also developed acute kidney failure at the time. This initial kidney injury associated with long-term exposure to calcineurin-inhibitor medication eventually led to end-stage renal disease...

Adolescent transplant recipients are at risk for nonadherence, development of de novo donor-specific antibody (dnDSA), and allograft loss. Belatacept, a selective T cell costimulatory blocker, is associated with reduced dnDSA, improved renal function, and prolonged allograft survival when compared to calcineurin inhibitor-based regimens in adults; however, its use in children is scant. Three adolescents were initiated on belatacept between August 2017 and September 2018 at the time of kidney transplantation...

BACKGROUND: The nature of immunoglobulin M (IgM) nephropathy has been controversial for a long time, but it is now considered an independent disease like immunoglobulin A nephropathy. IgM nephropathy has been known to have various clinical manifestations ranging from asymptomatic hematuria and/or proteinuria to nephrotic syndrome. Recently, one case of IgM nephropathy manifesting as crescentic glomerulonephritis (GN) was reported in a child. CASE PRESENTATION: We experienced a case of IgM nephropathy that manifested clinically as nephritic and nephrotic syndrome with pathologically confirmed crescentic GN in a 30-year-old woman...

Background: Since the early 2000s rituximab (RTX) has been thought of as an alternative treatment for steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS). Objective: This study aimed to determine the effects of RTX treatment on disease outcome and growth in pediatric SSNS and SRNS patients. Materials and Methods: The medical records of pediatric SSNS and SRNS patients that began RTX treatment at the mean age of 10.8 ± 5.1 years between 2009 and 2017 were retrospectively reviewed...