Infectious disease organ transplant

Solid-organ transplant recipients are at increased risk of infectious diseases, which is a major cause of early morbidity and mortality. The prevalence of posttransplant infection depends... 

Efficacious mAbs are used in a variety of therapeutic indications such as cancer, rheumatoid arthritis, Crohn s disease, psoriasis, organ transplantation, asthma, infectious diseases, and cardiovascular diseases, while for other diseases research and development is currently ongoing. The current three major therapeutic areas include oncology (eight mAbs against solid tumors and lymphoma/leukemia), inflammatory diseases (five mAbs), and the immunosuppression/prophylaxis or treatment of organ rejection in transplantation (three mAbs). The reader is referred to Chapter 12 for a detailed discussion on the exposure-response relationships and pharmacodynamics of therapeutically administered mAbs. 

Patients with solid organ transplants tend to suffer from oral candidiasis and cryptococcosis, whereas neutropenic patients (chemotherapy because of cancer or bone marrow transplantation) are susceptible to aspergillosis, systemic candidiasis or mucormycosis. AIDS patients - as a general sign of their defective immune system - present with more severe courses of infectious diseases in general, including mycoses like candidiasis, dermatophytosis or seborrhoic dermatitis. 

TABLE 120—4. Infectious Complications after Bone Marrow and Solid Organ Transplantation Syndromes of Disease and Treatment Guidelines... 

Total Artificial Heart. Although heart transplants have been performed since the pioneering work of Christian Barnard in 1967, this procedure always requires a donor heart, which may not always be available. In addition, the body does tend to reject any implanted organs as undesired foreign material, and close matching of the tissues is difficult at the best. Although various immunosuppressant drugs can minimize this problem, the patient becomes more susceptible to infectious disease. A total artificial heart (TAH) would offer at least a partial answer to both of these problems. 

The immune system plays a major role in protecting the host from infectious disease and, arguably, from cancer. This is demonstrated by the association between the therapeutic use of chemical immunosuppressants (i.e., in cancer chemotherapy or organ transplantation) and an increased incidence of infections (1) and certain cancers (2). This relationship is also illustrated by the Acquired Immune Deficiency Syndrome (AIDS), in which a loss of immune responsiveness is associated with infection with Pneumocysti s carinii and other... 

The potential for presymptomatic detection of prions in the blood of infected individuals has profound importance for humans exposed, or potentially exposed, to contaminated food. Saa et al. (2006) show that the scrapie disease prion (PrFO can be detected biochemically in the blood of scrapie-infected hamsters during most of the presymptomatic phase of the disease. Infectious prions have also been found in the blood of CWD-positive deer (Mathiason et al., 2006). Because the human population may have been seeded with vCJD disease as a result of the BSE epidemic, the potential to detect prions in presymptomatic individuals would seem to have profound importance for human blood donation and organ transplantation, as well as for the screening of farm and game animals. The potential for development of immunity (Peretz et al., 2001 Heppner et al., 2001 Pankiewicz et al., 2006) or of effective vaccines (Sadowski and Wisniewski, 2004) may open the door to effective management or cure, which are at present out of reach. 

The issue of damaged or lost organ due to accidents or certain diseases has been usually settled through organ transplant. However, this solution showed several drawbacks that include for instance (i) immunological problems where the patient s body may reject the transplanted organ, (ii) infectious diseases, and/or (iii) shortage of donors (Niklason 2001 Pham et al. 2006). 

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