: To define the incidence, course, and etiology of hematologic abnormalities in children on tacrolimus‐based immunosuppression, we reviewed records of 106 transplant patients (70 heart, 16 heart and ...lung, 20 double lung), 0–21 yr of age, who were transplanted at the Children's Hospital of Pittsburgh from 1989 to 1997. Fifty‐four of the 106 patients (51%) developed 65 abnormal hematologic episodes (32 anemia, nine neutropenia, nine thrombocytopenia, 15 simultaneous anemia and neutropenia with or without thrombocytopenia). Common etiologies included: infections, post‐transplant lymphoproliferative disease, and medications. Eleven episodes (seven anemia, one neutropenia, and three simultaneous anemia and neutropenia) had unclear etiologies and process of elimination suggested an association with tacrolimus. Interventions included filgrastim (effective in 15 of 15 patients, with resolution of neutropenia in a median of 5 days) and epoetin alfa (effective in five of 16 patients, including four of four patients with anemia possibly related to tacrolimus). Five patients (two with neutropenia and three with simultaneous neutropenia and anemia) were switched to cyclosporin A (CsA); rapid resolution occured in four of the five patients, suggesting a possible association of the hematologic abnormalities with tacrolimus. In summary, hematologic abnormalities are common in children on tacrolimus‐based immunosuppression. Most of these hematologic abnormalities are caused by common etiologies; however, a sub‐population exists where tacrolimus may be the etiologic agent. Anemia and neutropenia respond to treatment with epoetin alfa and filgrastim. After thorough investigation, a trial switch to CsA may be warranted.
Nation, Culture, Text: Australian Cultural and Media Studies is the first collection of cultural studies from Australia, selected and introduced for an international readership.Participating in the ...`de-centring' of cultural studies - considering what perspectives other than the European and the American have to offer - the contributors raise important issues about the role of a national tradition of critical theory, and about the cultural specificity of theory itself.A key theme is the place of the postcolonial nation within contemporary cultural theory - particularly those aspects of contemporary theory which see the category of contemporary theory which see the category of the nation as either outdated or suspect. The writers tackle subjects ranging from the televising of the Bicentennial to the role of policy in film, television and the heritage industry, from the use of video technologies with remote Aboriginal communities to the role of ethnography in cultural studies.
Critical issues in pediatric lung transplantation Armitage, John M.; Kurland, Geoffrey; Michaels, Marian ...
The Journal of thoracic and cardiovascular surgery,
1995, 19950101, 1995-Jan, 1995-01-00, Letnik:
109, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Forty children (aged 1 to 18 years, 27 female and 13 male) have undergone heart-lung (21), double lung (17), and single lung (2) transplant procedures at our center from 1985 through April 1994. The ...indications for transplantation have been diverse, primary pulmonary hypertension (10), cystic fibrosis (11), congenital heart disease (10), arteriovenous malformation (3), emphysema (1), graft-versus-host disease (1), rheumatoid lung (1), cardiomyopathy (1), desquamative interstitial pneumonitis (1), and Proteus syndrome (1). The actuarial 1-year survival was 73% (mean follow-up 2 years). One-year actuarial survival for disease groups ranged from 60% for cystic fibrosis to 90% for congenital heart disease. We have identified six issues critical to the patient and programatic survival of pediatric lung transplantation. Our experience and management strategies in these areas are reviewed.
Cytomegalovirus : Cytomegalovirus disease developed in six of eight patients with cytomegalovirus mismatching (donor +/recipient -) and in seven of 32 patients who survived more than 30 days (23%). All but cytomegalovirus donor -/recipient-patients were treated with ganciclovir for 4 weeks after transplantation.
Obliterative bronchiolitis : Obliterative bronchiolitis developed in seven of 32 (25%) patients who survived more than 30 days. Obliterative bronchiolitis was manifest within the first posttransplantation year as a rapid decline in small airway function. Aggressive augmentation of immunosuppression has been used with little success.
Posttransplantation lymphoproliferative disease : Posttransplantation lymphoproliferative disease developed in five of 32 (15%) patients who survived more than 30 days developed. One patient died (17% mortality) despite retransplantation. In four patients the disease resolved with reduction in immunosuppression alone, and one required the addition of interferon alfa.
Cystic fibrosis : We have changed our management strategies to avoid triple drug immunosuppression, perioperative blood and bronchial cultures, aggressive antimicrobial therapy, and exclusion of patients with panresistant organisms; this has resulted in elimination of infectious mortalities thus far in the pediatric cystic fibrosis group.
Airways : In 21 heart-lung recipients with tracheal anastomoses we have had no airway complications. The double and single lung transplant recipients accounted for 34 bronchial and one tracheal anastomoses. Three (9%) bronchial stenoses developed. Two were treated with silicone stents and one with balloon dilation.
Finances : The average charge for lung transplant evaluation was $18,000 and for transplantation, $175,000. (J T
horac C
ardiovasc S
urg 1995;109:60-5)
The application of lung transplantation to the pediatric population was a natural extension of the success realized in our adult transplantation program, which began in 1982. Twenty pediatric ...patients (age range 3 to 18 years) have had heart-lung (n = 11), double lung (n = 8), and single lung (n = 1) transplantation procedures. The causes of end-stage lung disease were primary pulmonary hypertension (n = 7), congenital heart disease (n = 5), cystic fibrosis (n = 4), pulmonary arteriovenous malformation (n = 2), graft-versus-host disease (n = 1), and desquamative interstitial pneumonitis (n = 1). Four (20%) patients had thoracic surgical procedures before the transplantation operation. The survival was 80% at a mean follow-up of 2 years. Immunosuppressive drugs included cyclosporine (n = 9) or FK 506 (n = 11) based therapy with azathioprine and steroids. Children were followed up by means of spirometry, transbronchial biopsy, and primed lymphocyte testing of bronchoalveolar lavage fluid. The mean number of treated episodes of rejection was 1.4 at 30 days, 0.5 at 30 to 90 days, and 1.4 at more than 90 days, and the first treated rejection episode occurred on average 28 days after the operation. Obliterative bronchiolitis developed in four (25%) of 16 patients surviving more than 100 days. Results of pulmonary function tests have remained good in almost all recipients. The greatest infectious risk was that of cytomegalovirus: one death and one case of pneumonia. Posttransplantation lymphoproliferative disease was diagnosed in two (12.5%) patients; both recovered. The most common complications were hypertension (25%) and postoperative bleeding (15%). Early results indicate that lung transplantation is a most promising therapy for children with severe vascular and parenchymal lung disease.
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