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Biomedical subjects

A B Cosimi

Publications and source records attributed to A B Cosimi.

246 records · Page 14Linked to original sources
PubMedDate not supplied

Psychiatric disease and cytomegalovirus viremia in renal transplant recipients.

Although cytomegalovirus (CMV) is rarely cultured from peripheral-blood leukocytes of immunocompetent patients, it may be cultured from up to 60% of renal transplant recipients, 1 to 4 months after transplantation. During this same period, renal transplant recipients are often referred for psychiatric evaluation. Since CMV may infect the central nervous system, the relationship between isolation of CMV from peripheral-blood leukocytes (viremia) and psychiatric evaluation was investigated in 80 renal allograft recipients at the Massachusetts General Hospital. Five of 16 (31%) patients with viremia and 7 of 64 (11%) patients without viremia required psychiatric consultation (P = 0.04, two-tailed Fisher exact test). CMV viremia may be an important but treatable contributor to psychiatric symptoms in the transplant recipient.

Cytomegalovirus↗
PubMedDate not supplied

A study of tolerance in a concordant xenograft model.

Antibody-mediated rejection appears to constitute the major difference between concordant xenografts and allografts in nonhuman primates. Consistent with its known effect on antibody responses, 5-7 addition of DSG to the conditioning regimen has extended concordant primate xenograft survival for up to 6 months after discontinuation of conventional immunosuppression. In contrast to our observations in recipients of renal allografts, donor-specific skin graft rejection can occur and even in long-term recipients may induce rejection of a previously accepted renal xenograft.

Animals↗
PubMedDate not supplied

A controlled study of trimethoprim-sulfamethoxazole prophylaxis of urinary tract infection in renal transplant recipients.

Urinary tract infection (UTI) during the four months after renal transplantation occurs in 30%-40% of recipients at the Massachusetts General Hospital and is often associated with gram-negative bacteremia, significant graft dysfunction, and relapse. Of these "early" UTIs, 90% affect the graft itself. In a randomized trial of prophylaxis of UTI with trimethoprim-sulfamethoxazole (TMP-SMZ), 52 consecutive allograft recipients received either no prophylaxis or one TMP-SMZ tablet (160 mg of TMP plus 800 mg of SMZ) daily for four months, beginning on removal of the Foley catheter (usually during the first four days after transplantation). Three of the first five patients given TMP-SMZ developed oral candidiasis; they and all subsequent recipients of TMP-SMZ were given oral mycostatin throughout prophylaxis. Two of 26 patients (8%) taking TMP-SMZ developed UTIs; 10 of 26 patients (38%) not taking the drug developed UTIs with evidence of graft infection (P less than 0.05). The two groups were comparable in age, sex, history of UTI before transplantation, type of donor, type of ureteral anastomosis, and antibiotic use for other types of infection. Only one complication, a skin eruption, was observed among patients taking TMP-SMZ and mycostatin. It is concluded that TMP-SMZ is well tolerated and effective prophylaxis in this setting.

Adult↗
PubMedDate not supplied

Rapid activation of the alternative pathway of complement by extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is an effective therapy for patients with severe respiratory distress syndromes. However, an inflammatory response has been observed with the use of this therapy. We measured complement activation in vivo in two adults receiving ECMO for acute respiratory distress syndrome (ARDS). Production of complement activation fragments C4d, Bb, iC3b, and SC5b-9 was determined using commercial ELISA kits. In both patients there was intense activation of complement that peaked 1 hour (mean SC5b-9 increase to 1135% of baseline) after the start of ECMO and occurred predominantly via the alternative pathway (Bb production). Early and acute complement activation may be responsible for the initiation of the inflammatory response that has been observed in patients treated with ECMO.

Adult↗
PubMedDate not supplied

Some ethical and psychiatric aspects of right-lobe liver transplantation in the United States and Japan.

Cadaver sources are insufficient for the increasing demand for liver transplantation. Right-lobe liver transplantation from living donors is fully developed in Japan and has been rapidly increasing in the United States during the past 2 years, although donor risk is greater than in other types of solid organ transplantation. The authors examine the psychiatric and ethical aspects of right-lobe liver transplantation in light of cultural differences between the United States and Japan.

Ethics, Medical↗
PubMedDate not supplied

Actinomycin D is an effective adjunctive immunosuppressive agent in recurrent cardiac allograft rejection.

BACKGROUND: Actinomycin D is a potent cytotoxic agent which inhibits DNA transcription by DNA-dependent RNA polymerases and has previously been used as adjunctive immunosuppressive agent for refractory renal allograft rejection. METHODS: To assess the efficacy of actinomycin D in cardiac allograft rejection, we studied seven patients with recurrent cellular or humoral rejection. All patients received intravenous actinomycin D 5 micrograms/kg every 6 weeks. RESULTS: During the 6-months after initiation of actinomycin D treatment, the mean number of treated cellular or humoral rejection episodes per patient (0.14) and the mean number of International Society for Heart and Lung Transplantation grade 2 or higher endomyocardial biopsy specimens per patient (0.3) were lower compared with those observed during the 6-month pre-actinomycin D period (1.6 and 2.6, respectively). By 6 months after initiation of actinomycin D, all seven patients were receiving lower daily maintenance doses of corticosteroids. The mean total corticosteroid dose after actinomycin D administration per patient per month (615 +/- 177 mg) was significantly lower than the pre-actinomycin D dose (1012 +/- 347 mg; p = 0.019). No patient had significant adverse effects. CONCLUSIONS: Actinomycin D is an effective immunosuppressive agent for prevention of recurrent cellular or humoral rejection after cardiac allograft rejection. The corticosteroid sparing effect of actinomycin D may be of particular benefit.

Biopsy↗