Clinical transplantation
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Clinical transplantation · Nov 2008
Multicenter StudyClinical efficacy of prophylactic strategy of long-term low-dose acyclovir for Varicella-Zoster virus infection after allogeneic peripheral blood stem cell transplantation.
Varicella-Zoster virus infection (VZV) has a high incidence post-allogeneic peripheral blood stem cell transplant (PBSCT). However, data regarding long-term acyclovir prophylaxis for VZV prevention are limited. We evaluated the clinical efficacy of long-term low-dose acyclovir prophylaxis for VZV infection after allogeneic PBSCT at the Princess Margaret Hospital (PMH), Canada and the Kyungpook National University Hospital (KNUH), Korea. ⋯ With a median of 26.5 months of follow-up, the incidences of VZV infection at one and two yr were 15.8% and 20.7% in the PMH group, and 2.5% and 5.8% in the KNUH group, respectively (p = 0.001). By controlling the other potential risk factors for VZV infection in multivariate analysis, the use of long-term acyclovir was the only protective factor for VZV infection after allogeneic PBSCT (p = 0.04, hazard ratio = 0.296). Long-term use of acyclovir appears to be protective for VZV infection after allogeneic PBSCT, especially during the period of immunosuppressive therapy.
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Clinical transplantation · Sep 2008
Model for the end-stage liver disease and death prediction in a cohort of Brazilian patients on the waiting list for liver transplantation.
To examine the performance of the model for end-stage liver disease (MELD) score to predict mortality three and six months after enlistment of patients with chronic diseases for their first liver transplantation (LT) and to compare the performances of the Child-Turcotte-Pugh (CTP) and the Erasmus Model for End-stage Resistant-to-therapy All etiology Liver Disease (EMERALD) scores with the MELD to predict mortality. ⋯ The scores predicted mortality for the three or six months, but the performance of the MELD was better than CTP and EMERALD scores.
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Clinical transplantation · May 2008
Exploring the psychological effects of deceased organ donation on the families of the organ donors.
Our specific aim was to investigate whether the donation process hindered or ameliorated the bereavement process for organ donor families, specifically with regard to depression, post-traumatic stress and grief. ⋯ Our data suggest that donation has a beneficial effect on the bereavement process.
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Clinical transplantation · Mar 2008
Case ReportsGeneralized lymphedema in a sirolimus-treated renal transplant patient.
Generalized lymphedema is an extremely rare effect of sirolimus therapy in renal transplant recipients. We describe the development of this complication in a 56-yr-old woman, who was given an experimental protocol with cyclosporine, sirolimus, steroids, and basiliximab. Following the protocol, after one month, the patient was randomized to the "sirolimus only" group, while cyclosporine was completely suspended and the oral steroids were continued. ⋯ A chest radiography and an ultrasound study of the heart showed a moderate pleural and pericardial effusion. An abdominal ultrasound scan showed two small lymphoceles next to the transplanted kidney, confirmed with a CT scan. After sirolimus discontinuation the generalized lymphedema started to improve and three months later all the symptoms had disappeared.
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Clinical transplantation · Mar 2008
Attitude of health care professionals to brain death: influence on the organ donation process.
The acceptance and application of the concept that brain death is a valid determination of death is the central issue in organ donation. However, whether attitude to brain death of health care professionals influences the organ procurement process has not been systematically studied. ⋯ The understanding and acceptance of brain death as a valid determination of death was associated with a positive effect on the level of comfort of health care professionals in performing key donor-related tasks. Reinforcing a positive attitude to brain death among health care professionals may facilitate the procurement process.