Organ transplant patients

Invasive molds, particularly Aspergillus, have become an increasingly important complication of cancer therapy and organ transplantation. Patients with acute leukemia and recipients of allogeneic hematopoietic cell transplants are at especially high risk for invasive aspergillosis due to prolonged neutropenia and deficiencies in cell-mediated immunity associated... 

Deficiency of thiopurine S-methyl transferase (TPMT) is another phenotype that exhibits inter-ethnic differences in frequency. TPMT is an enzyme that catalyzes methylation of therapeutic agents used in the treatment of acute lymphoblastic leukemia, rheumatoid arthritis, and autoimmune/inflammatory diseases, as well as in organ transplantation. Patients who have TPMT deficiency experience less efficient methylation and are at greater risk of fatal toxicity when treated with standard doses of fhiopurines. TPMT phenotype is defined by erythrocyte 6-mercapto-purine methylation. African American populations exhibit a 20% lower erythrocyte TPMT than Caucasian Americans, and persons of Chinese descent tend to exhibit greater activity than either of these other American subpopulations. 

No, not unless there is a smallpox outbreak. Vaccinations could cause deaths in people with weakened immune systems those undergoing chemotherapy, organ transplant patients, and those with AIDS. There is no need to take that risk until there is... 

S. Masuda, and K. Inui. An up-date review on individualized dosage adjustment of calcineurin inhibitors in organ transplant patients. Pharmacol Ther 112 184—198 (2006). 

Only physicians experienced in immunosuppressive therapy and management of organ transplant patients should prescribe daclizumab. The physician responsible for daclizumab administration should have complete information requisite for the follow-up of the patient. Daclizumab should only be administered by health care personnel trained in the administration of the drug who have available adequate laboratory and supportive medical resources. 

Carcinogenesis As a result of depressed cell-mediated immunity, organ transplant patients have an increased risk of developing malignancies. 

Legionnaires disease is frequently characterized as an opportunistic disease, meaning that it most frequently attacks individuals who have an underlying illness or a weakened immune system. The most susceptible people include the aged, smokers, and immunosuppressed individuals. People with chronic obstructive pulmonary disease, organ transplant patients, and individuals on corticosteroid therapy are also at elevated risk. 

Several of these bioactive natural products have been successfully developed as therapeutics for clinical use. For example, Cyclosporin A is a fungal decapeptide principally used to suppress immune rejection in organ transplant patients. Mevinolin and compatin both control cholesterol synthesis in human. The search for enzyme- or receptor-targeted microbial products does not limit itself to medical use. Several commercially important antibiotics such as Nikkomycin and Avermectin have been found for agricultural applications in recent years. 

Drying lotions should not be used on skin lesions because they may increase scarring. In the child or adult for whom the skin lesions itch or are irritating, an oral antihistamine may help to prevent scratching, which can lead to secondary infection and thereby scarring. Recommended agents include oral chlorpheniramine or diphenhydramine.The use of cimetidine is controversial as an H2 blocker, oral cimetidine has an immunosuppressive action. The effects are not always consistent, however, and use of cimetidine is risky in autoimmune disorders and organ transplant patients. 

Boulieu R, Lenoir A, Bertocchi M, Mornex JF. Intracellular thiopurine nucleotides and azathioprine myelotoxicity in organ transplant patients. Br J Clin Pharmacol 1997 43(1) 116-18. 

Morales JM, Munoz MA, Fernandez Zatarain G, Garcia Canton C, Garcia Rubiales MA, Andres A, Aguado JM, Gonzalez Pinto I. Reversible acute renal failure caused by the combined use of foscarnet and cyclosporin in organ transplanted patients. Nephrol Dial Transplant 1995 10(6) 882-3. 

Billaud EM, Guillemain R, Tacco F, Chevalier P. Evidence for a pharmacokinetic interaction between itraconazole and tacrolimus in organ transplant patients. Br J Clin Pharmacol 1998 46(3) 271-2. 

Capone D, Aiello C, Santoro GA, Gentile A, Stanziale P, D Alessandro R, Imperatore P, Basile V. Drug interaction between cyclosporine and two antimicrobial agents, josa-mycin and rifampicin, in organ-transplanted patients. Int J Clin Pharmacol Res 1996 16(2-3) 73-6. 

Figure 39-17 In situ hybridization (iSH) for the Epstein-Barr virus (EBV). ISH hybridization for EBV shows numerous positive signals (dark-blue spots) for EBV using the EBER-I probe.The tissue sample was obtained from a solid-organ transplant patient who developed widespread nodal and extranoda masses.The positive reaction for EBV In this assay supports a diagnosis of posttransplant lymphoproliferative disease. (See Color Plate 6.)...

Ferreira-Gonzalez A, Fisher RA, Weymouth LA, Langley MR, Wolfe L, WiUdnson DS, et al. Clinical utility of a quantitative polymerase chain reaction for diagnosis of cytomegalovirus disease in solid organ transplant patients. Transplantation 1999 68 991-6. 

Humar A, Kumar D, Boivin G, Caliendo AM. Cytomegalovirus (CMV) viral load kinetics to predict recurrent disease in solid organ transplant patients with CMV disease. J Infect Dis 2002 186 829-33. 

Partovi, N. Chan, W. Nimmo, C.R. Evaluation of a patient education program for solid organ transplant patients. Can. J. Hosp. Pharm. 1995, 48 (2), 72-78. 

Immunosuppressive drugs Azathioprine, steroids, methotrexate, macrolides (Cyclosporin A, Tacrolimus, i.e., FK506 or fujimycin, Rapamycin), deoxyspergualin Association with risk of clinical infections clearly established. Organ transplant patients are known to develop more malignancies... 

---