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Biomedical subjects

I Penn

Publications and source records attributed to I Penn.

At least 55 records · Page 3Linked to original sources
PubMed1994

De novo malignancy in pediatric organ transplant recipients.

Study of 7,393 types of cancer that occurred in 6,934 organ transplant recipients showed that the pattern of malignancies that developed in pediatric recipients was very different from that of the general pediatric population and that of adult recipients. Tumors (334) occurred in 326 pediatric patients (aged < or = 18 years), and 7,059 neoplasms occurred in 6,608 adults. Lymphomas were the predominant cancer in pediatric recipients and comprised 50% of all tumors compared with 15% in adult recipients. Among lymphomas in pediatric patients, 85% occurred during childhood. Of the patients who had lymphoma, there was a preponderance of recipients of nonrenal organs (61%); of those who had nonlymphomatous tumors, only 13% received nonrenal organs. The second most common malignancy in pediatric patients was skin cancer (20% of tumors), but this occurred less frequently than in adult recipients, for whom it comprised 38% of neoplasms. In only 11 pediatric patients (16%) did skin cancers develop during childhood (5 had malignant melanomas), with an average time of appearance after transplantation of 118 months (range, 9.5 to 282 months). Malignant melanomas were more common in pediatric than adult recipients (15% v 5% of skin cancers), as were lip cancers (29% v 13%). Spread to lymph nodes was also more common in pediatric than in adult recipients (13% v 6%). The third most common tumor (4%) in patients who had transplantation during childhood was carcinoma of the vulva, perineum, and/or anus. These patients were female, and the tumors occurred after childhood, at an average of 140 months (range, 43-262 months) posttransplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Occurrence of cancers in immunosuppressed organ transplant recipients.

The findings in this study emphasize the need for lifetime follow-up of organ transplant recipients. Although a high percentage of posttransplant tumors are low-grade malignancies that are readily amenable to treatment, cancer has become a major cause of death in patients otherwise successfully treated by transplantation (6). An Australasian study of the causes of death of patients who survived for at least 10 years with a functioning renal allograft compared to those on dialysis for at least 10 years without transplantation, or with a failed transplant, showed that the proportions of deaths caused by cancer were 26%, 1%, and 3%, respectively. Nonetheless, the future holds promise. Attempts are being made to modify the present blunderbuss attack on the immune system with more specific methods of control. Much work is currently being done to induce states of immune unresponsiveness directed specifically, and only, at the foreign antigens of the allograft. Hopefully these efforts will eliminate the need for long term or intense immunosuppressive therapy and the problem of posttransplant malignancies will be relegated to a footnote in the history of organ transplantation.

Adolescent↗
PubMed1994

Malignancy.

Although cancer is a complication of transplantation, one must emphasize that the great majority of organ allograft recipients do not develop this problem. The risk of developing a de novo malignancy is generally not a contraindication to transplantation. Many patients who develop de novo malignancies have readily treatable in situ carcinomas of the cervix, low-grade skin tumors, and in situ carcinomas of the vulva and perineum. However, with the limited experience gained thus far, nonrenal allograft recipients appear to be more prone to develop potentially life-threatening tumors, mainly lymphomas. Their occurrence may be related to the more intense immunosuppressive therapy that the surgeon is forced to give to some patients compared with renal allograft recipients. In these patients efforts to preserve a rejecting kidney may be abandoned in favor of dialysis and cessation of immunosuppressive therapy. A second transplantation can be performed at a later date when the patient has recovered from the effects of heavy immunosuppression. When large numbers of nonrenal allograft recipients have been followed for prolonged periods, it is likely that the pattern of malignancies described in renal allograft recipients will be seen in them as well.

Adolescent↗
PubMed1994

Depressed immunity and the development of cancer.

Various disorders of immune competence are associated with increases in uncommon tumors, particularly non-Hodgkin's lymphomas (NHLs), which often exhibit unusual features: they are frequently extranodal, show a broad spectrum of lesions, ranging from benign polyclonal hyperplasia to frankly malignant monoclonal lymphomas, and are frequently localized to the brain. Of 7136 tumors in organ transplant recipients, the predominant lesions are NHLs, carcinomas of the skin and lips, carcinomas of the vulva/perineum, Kaposi's sarcoma (KS), and renal carcinomas. Skin cancers present unusual features: predominance of squamous cell carcinomas, young age of the patients, and a high incidence of multiple tumors. Cancers of the vulva/perineum occur at a much younger age than in the general population. In AIDS patients the most common malignancy is KS, which occurs in 14%, whereas NHLs afflict 2.9%. A variety of other tumors occur in these patients. The most common tumors in patients with primary immunodeficiency states are NHLs (49%), leukemias (13%), various carcinomas (9%), and Hodgkin's disease (7%).

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clinical course of malignancies in renal transplant recipients.

BACKGROUND: The incidence of cancers after renal transplantation is significantly higher than in populations that have not undergone transplantation. The authors report a group of renal transplant patients from the University of Cincinnati who had cancer develop; the focus is on the patients' clinical course. METHODS: Since 1968, 876 renal transplantations have been performed for a variety of causes of end stage renal disease. Charts of transplant patients who had neoplasms were reviewed. RESULTS: Forty-four patients had epithelial skin cancers, and 36 had nonskin cancers or melanoma. No correlations could be established between disease course and type of immunosuppressive agent, type of disease for which transplantation was required, or type of renal allograft donor. The skin cancers demonstrated a propensity for multifocality: 22 of the 44 patients had multiple separate lesions develop. Of the patients with cancer not of the skin, six were treated surgically for carcinoma in situ, and none have experienced disease recurrence. Of 11 patients treated for early invasive disease, 6 are disease-free, 3 died of intercurrent disease, and 2 died of progressive disease 11 and 13 months, respectively, after disease diagnosis. Nineteen patients had advanced disease, and only 1 is alive and disease-free. Sixteen died of progressive disease at a median of 1 month from the time of diagnosis, and 2 died of intercurrent disease within 1 week of diagnosis. CONCLUSIONS: The natural history of cancers developing in renal transplant patients often is more aggressive than would be expected in patients who have not undergone transplants. The immunosuppression induced to allow viability of the renal allograft may allow tumor cells to thrive.

Adult↗
PubMed1993

The effect of immunosuppression on pre-existing cancers.

This study of 939 pre-existing malignancies that occurred in 913 renal transplant recipients showed that in 823 patients the tumors were treated prior to or at transplantation, in 78 after transplantation, at an unspecified time in 20, while 18 received no treatment. Of patients treated pretransplantation 185 (22%) developed recurrences posttransplantation. Low recurrence rates (0-10%) occurred with incidentally discovered renal tumors; lymphomas; and testicular, uterine cervical, and thyroid carcinomas. Intermediate recurrence rates (11-25%) occurred with carcinomas of the uterine body; Wilms' tumors; and carcinomas of the colon, prostate, and breast. High recurrence rates (> or = 26%) occurred with carcinomas of the bladder, sarcomas, malignant melanomas, symptomatic renal carcinomas, nonmelanomatous skin cancers, and myelomas. Overall 53% of 185 recurrences occurred in patients treated 0-24 months pretransplantation, 34% in patients treated 25-60 months pretransplantation, and 13% in patients treated > 60 months pretransplantation. Of 78 patients whose cancers were first treated after transplantation, 27% developed recurrences. However, 63% did not do so in follow-ups averaging 53 months. A two-year waiting period between treatment of cancer and transplantation is justified for most neoplasms except for incidentally discovered renal carcinomas, in situ carcinomas, and possibly focal neoplasms (a small single focus), low-grade bladder cancers, and basal cell skin cancers. In these cases no waiting period is necessary. On the other hand, a waiting period > 2 years is necessary for most malignant melanomas, breast carcinomas, and colorectal carcinomas. Conflicting data are presented as to whether immunosuppression affects growth of existing tumor cells but most of the evidence suggests acceleration of neoplastic growth.

Adult↗
PubMed1993

Neoplastic complications of transplantation.

Cancer incidence in transplant patients ranges from 4% to 18% (average, 6%). We present data on 7668 types of malignancy that occurred in 7192 patients. The predominant tumors are skin/lip carcinomas, lymphomas, vulvar/perineal carcinomas, in situ uterine cervical carcinomas, Kaposi's sarcoma (KS), renal carcinomas, hepatobiliary tumors, and soft tissue/visceral sarcomas. Tumors appear relatively early after transplantation. The earliest is KS, appearing an average of 22 months post-transplantation whereas the latest are vulva/perineal carcinomas, presenting an average of 113 months posttransplantation. Skin cancers present unusual features: a remarkable frequency of KS; reversal of the high ratio of basal to squamous-cell carcinomas seen in the general population; the low age of the patients; and a high incidence of multiple tumors (in 42% of patients). Unusual features of lymphomas are the high incidence of non-Hodgkin's lymphoma (NHL); common involvement of extranodal sites; marked predilection for the brain; and frequent allograft involvement. Lymphomas are much more common in nonrenal than in renal allograft recipients. Vulvar/perineal carcinomas occur at a much lower age than in the general population, and are often preceded by condyloma acuminatum. Neoplastic regression following reduction or cessation of immunosuppressive therapy occurs in some patients with NHL or KS.

Adolescent↗
PubMed1993

Tumors after renal and cardiac transplantation.

Organ transplant recipients treated with immunosuppressive therapy are prone to develop malignancies particularly squamous cell carcinomas of the skin, non-Hodgkin's lymphomas, Kaposi's sarcomas, carcinomas of the vulva and perineum, in situ carcinomas of the uterine cervix, renal carcinomas, hepatomas, and various sarcomas. The earliest tumors to appear are the Kaposi's sarcoma at an average of 21 months after transplantation, and the latest are carcinomas of the vulva and perineum, at an average of 112 months after transplantation. The tumors that develop in cardiac allograft recipients compared with renal transplant recipients are predominantly non-Hodgkin's lymphomas and more rarely, skin, uterine cervical and vulvar tumors. Major factors accounting for these differences are the intensity of immunosuppressive therapy given to the cardiac patients and the much longer follow-up of the renal allograft recipients.

Heart Transplantation↗
PubMed1992

Protein S deficiency and skin necrosis associated with continuous ambulatory peritoneal dialysis.

Skin necrosis associated with protein C deficiency has recently been reported to occur in hemodialysis patients. The clinical presentation and course of this syndrome appears indistinguishable from skin necrosis (purpura fulminans) seen in other settings with inherited or acquired deficiency of the naturally occurring anticoagulant proteins, protein C and S. Patients on maintenance hemodialysis may have low levels of these factors. However, patients on peritoneal dialysis have normal or elevated levels of these proteins despite documented peritoneal losses. We report two patients in whom the occurrence of protein S deficiency and subsequent skin necrosis can be related to demonstrated peritoneal dialysis-associated losses. We suggest that these losses may become critical under appropriate conditions and suggest caution in peritoneal dialysis patients requiring warfarin therapy.

Blood Proteins↗
PubMed1992

The induction of immunologic hyporesponsiveness by preoperative donor-specific transfusions and cyclosporine in human cadaveric transplants. A preliminary trial.

A prospective randomized preliminary trial was performed in patients undergoing cadaveric renal transplantation to determine the potential benefits, disadvantages, and logistic problems associated with the administration of donor-specific transfusions and cyclosporine initiated 24 hr before transplantation. Ten patients received DST followed by continuous intravenous CsA approximately 24 hr before cadaveric renal transplantation from the same donor. Twelve patients receiving sequential therapy with Minnesota antilymphoblast globulin, azathioprine, and steroids with subsequent conversion to CsA served as controls. Patient demographics and the donor characteristics were evenly matched in the two groups. While the study group had longer cold ischemia time and more evidence of renal dysfunction within the first two weeks, subsequent renal function was identical in the groups and there were fewer episodes of severe rejection requiring treatment with OKT3 within the first six months in the DST group (5 vs. 0, P less than 0.05), which also had less reactivity in mixed lymphocyte cultures against preserved donor-specific lymphocytes than did the control group (stimulation index 9.0 +/- 3.0 vs. 25.3 +/- 6.0, respectively, P less than 0.05). The need for dialysis, incidence of infections and other complications, and subsequent immunosuppressive therapy were not different in the two groups. It is concluded that DSTs and intravenous CsA initiated 24 hr prior to transplantation are capable of inducing reduced immunologic responsiveness against the specific donor. Patients treated with this therapy should receive organs from "ideal" donors without risk factors and cold ischemia time should not exceed 30 hr. Further clinical studies of this approach are warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Selection criteria for liver transplant donors.

As the number of successful liver transplants has increased, the demand for donors has outpaced the supply. Approximately 25% of patients die awaiting an appropriate donor. Current criteria for assessing potential donors need to be closely examined. Fifty-six potential donors were evaluated by our transplant team by utilizing standard liver function tests (LFT's)-SGOT, SGPT, bilirubin. Additionally, a lidocaine metabolism test was performed by giving a 1 mg/kg IV dose of lidocaine over 1 minute and measuring the accumulation of the major metabolite monoethylglycinxylidide (MEGX) at 15 minutes by fluorescent polarization immunoassay (Abbott Diagnostics, Abbott Park, IL). Previous work has suggested that a MEGX less than 50 ng/mL is associated with initial non-function. Thirty-four donors were transplanted (group I) and all had initial function (all MEGX values were greater than 50). Twenty-two donors (39%) were judged unacceptable (group II) by our transplant team and by outside centers based upon one of the following criteria: II A) elevated LFT's--8, 11 B) donor age--5, II C) donor instability--4, II D) no available recipient--3, II E) miscellaneous--2. Standard LFT's were not statistically different in the donors used and in those not used when excluding category II A. Six of seven donors excluded in group I had acceptable MEGX values indicating they may have been transplantable. Ten of 12 patients excluded in groups II B-D had normal LFT's and nine of 12 had acceptable MEGX values indicating they may have been transplantable also. In this era of organ shortage, a reevaluation of donor selection criteria utilizing new tests like MEGX may be necessary to meet the increased need.

Adolescent↗
PubMed1991

Hepatic transplantation for primary and metastatic cancers of the liver.

Long-term results of transplantation for primary and metastatic hepatic malignancies were evaluated retrospectively in 637 patients. Recurrence rates and 2-year and 5-year patient survival rates were calculated. The overall recurrence rate was 40%, with 81% of deaths from recurrence occurring within 2 years after transplantation. Best results were obtained with uncommon tumors: incidental hepatomas (13% recurrence; 57% 2-year and 5-year follow-up); epithelioid hemangioendotheliomas (33% recurrence; 82% and 43% 2-year and 5-year survival); hepatoblastomas (33% recurrence; 50% 2-year and 5-year survival); and fibrolamellar hepatomas (39% recurrence; 60% and 55% 2-year and 5-year survival). Hemangiosarcomas had 64% recurrence, and all patients died within 27.5 months. Tumors metastatic to the liver had 59% recurrence, with 38% and 21% 2-year and 5-year survival rates. Transplantation should be abandoned for hemangiosarcomas and most metastatic tumors, except possibly for some slowly growing neuroendocrine tumors. The usual hepatomas had 39% recurrence with 2-year and 5-year survival rates of 30% and 18%, respectively. Cholangiocarcinomas had 44% recurrences with 2-year and 5-year survival rates of 30% and 17%, respectively. Transplantation for hepatomas and cholangiocarcinomas should be reserved for patients with favorable risk factors or when combined with well-defined chemotherapy protocols before and after operation.

Adenoma, Bile Duct↗