Dual IFN-γ/hypoxia priming enhances immunosuppression of mesenchymal stromal cells through regulatory proteins and metabolic mechanisms
Holly WobmaMariko KanaiP. StephenYing ShihHao Wei LiRaimon Duran‐StruuckRobert WinchesterShahar GoetaLewis M. BrownGordana Vunjak‐Novakovic
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Priming (agriculture)
Immunosuppression
Post-transplant immunosuppression almost always includes a combination of drugs and approaches based on a patient's individual situation, organ transplanted, and current developments in the field. Depending on these factors, approaches could include Induction immunosuppression, Maintenance immunosuppression, or Anti-rejection immunosuppression.
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For children with liver transplants (LT), achieving an "ideal outcome" is a balancing act: too little immunosuppression begets graft injury; too much begets systemic complications. We aimed to delineate the parental perspective on this tightrope.Parents of children with LT completed an internet-based survey about their child's immunosuppression.Children of respondents (n = 82) were a median 4 years from primary LT (range 0-22); 73% were on immunosuppression monotherapy. Parents' top concerns were related to immunosuppression complications; 46% were more concerned about immunosuppression complications than rejection; only 17% were more concerned about rejection than immunosuppression complications. Among parents of children on immunosuppression monotherapy, 29% still worried more about immunosuppression complications than rejection, 48% expressed equal concern for both. Time since LT (0-4 vs. >4 years) was not associated with concern level for rejection or immunosuppression complications. Caregivers were significantly more certain that their child's immunosuppression regimen was correct to prevent rejection than to mitigate complications (p < .005).Caregivers of children with LTs reported higher levels of concern and uncertainty about immunosuppression complications than rejection risk. Understanding parent and patient perspectives on IS, and incorporating them into immunosuppression counseling and decision-making, is critical to achieving truly "ideal" long-term outcomes.
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Liver disease
Orthotopic liver transplantation
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(1) Immunosuppression is responsible for excellent patient outcomes. (2) Immunosuppression withdrawal fails in most patients. (3) Patients who may benefit from immunosuppression withdrawal cannot currently be identified. (4) No data suggest that immunosuppression withdrawal decreases patient morbidity (ie, nephrotoxicity). (5) The minimization of immunosuppression instead of withdrawal may be adequate for improving patient outcomes.
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Objective To evaluate the significance of individual immunosuppression regime in liver transplant recipients with high risk factors. Methods Every liver transplant recipient received different immunosuppression regime based on different clinical conditions. Renal failure, acute rejection, bacterial, fungal and cytomegaloviral infection rate and hospital mortality were compared among the high risk recipients ( n =20) with individual immunosuppression regime, high risk recipients ( n =22) with routine immunosuppression regime and common recipients ( n =26) with routine regime. Results Renal failure, bacterial, fungal infection rate and hospital mortality were significantly different between high risk patients with individual immunosuppression regime and those with routine immunosuppression regime ( P 0.05 ). There was no significant difference in acute rejection and cytomegaloviral infection rate between two groups ( P 0.05 ). There was no significant difference in the above observed parameters between high risk recipients with individual immunosuppression regime and common recipients with routine regime ( P 0.05 ). Conclusion Individual immunosuppression regime can prolong the survival of the recipients with high risk factors and is proved to be more safe and reliable.
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An important goal in transplantation is to tailor immunosuppression to the individual needs of the patient, avoiding both rejection and over-immunosuppression. Opportunistic infections and malignancies remain a significant cause of death after transplantation and are obvious consequences of over-immunosuppression. Currently, monitoring of immunosuppression is conducted mainly on the basis of pharmacokinetic characteristics, which do not necessarily predict clinical outcome in the individual. This review focuses on the potential of using biomarkers as a monitoring tool to prevent over-immunosuppression after transplantation. Clinical Pharmacology & Therapeutics (2011) 90 2, 316–322. doi:10.1038/clpt.2011.111
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