Sulfonamide desensitization in solid organ transplant recipients: A protocol-driven approach during the index transplant hospitalization.

Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for Pneumocystis jiroveci pneumonia (PJP) prophylaxis for solid organ transplant (SOT) recipients because of its efficacy for this indication, extended antimicrobial coverage, and favorable cost. Reported sulfonamide allergy is not uncommon and often results in TMP-SMX avoidance. Desensitization offers an efficacious and cost-effective alternative to TMP-SMX avoidance.

The role of the pharmacist in the management of kidney transplant recipients.

Pharmacists may play a key role on the multidisciplinary transplant team. This article describes the development and current status of pharmacists in the management of transplant recipients in the United States. Traditionally, pharmacists played an important support role in transplant medicine.

Drug dosing in elderly patients with chronic kidney disease.

As the elderly population in the United States increases, health care professionals need to be aware of potential age-related changes that affect medication prescribing. Increased emphasis on careful patient assessment and safety can reduce the incidence of adverse events related to medications.

The old and new methods of assessing kidney function.

Chronic kidney disease is a worldwide problem. Accurate assessment of kidney function is important for defining stages of kidney disease and assisting with drug dosing. Glomerular filtration rate (GFR) is a good index of the health of the kidney.

A quantitative approach to drug dosing in chronic kidney disease.

Chronic kidney disease (CKD) is increasing at an alarming rate. Medication prescribing in this growing population is especially difficult. Many pharmacological agents or their metabolites are eliminated unchanged through the kidney.

Drug dosing in the elderly patients with chronic kidney disease.

Chronic kidney disease is a common disorder that affects many patients with a prevalence approaching 19 million people in the United States. Kidney failure and renal impairment is a common occurrence in the geriatric population. Most types of kidney diseases are chronic conditions and frequently manifest at the late stages of life.

Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry.

Background: Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.

Methods: Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified.

Presentation of the PATH Alliance registry for prospective data collection and analysis of the epidemiology, therapy, and outcomes of invasive fungal infections.

Randomized clinical trials for patients with invasive fungal infections (IFIs) are often limited or precluded, necessitating alternate sources of information. The Prospective Antifungal Therapy Alliance (PATH Alliance) is a registry that collects data on patients with IFIs at medical centers in North America. Patients with a diagnosis of proven or probable IFI are enrolled and followed prospectively for 12 weeks.

Hepatitis C infection increases the risk of new-onset diabetes after transplantation in liver allograft recipients.

Background: Recent evidence suggests that new-onset diabetes after transplant (NODAT) adversely affects orthotopic liver transplant (OLTX) patient and graft survival. The objective of this study is to evaluate the effect of hepatitis C infection on the natural history of NODAT.

Methods: A retrospective review of 492 OLTX recipients at a single center was conducted from January 1993 to January 2003.

Cardiovascular complications of immunosuppressive agents in renal transplant recipients.

Fatal and nonfatal cardiovascular events are the most important cause of graft loss in patients with a functioning graft following transplantation. The available data indicate that transplant patients have a high prevalence of hypertension, hyperlipidaemia and new onset diabetes mellitus after transplantation. The aetiology and pathogenesis of post-transplant hypertension, hyperlipidaemia and diabetes are multifactorial.

Autosomal-dominant polycystic kidney disease as a risk factor for diabetes mellitus following renal transplantation.

Background: Posttransplant diabetes mellitus is an important complication of renal transplantation that is associated with a significant impact on quality of life and an increase in long-term morbidity and mortality. Autosomal-dominant polycystic kidney disease (ADPKD) is a hereditary disease that commonly leads to end-stage renal disease (ESRD) in adulthood. The association between ADPKD and posttransplant diabetes mellitus has not been previously studied in a large cohort of patients.

Renal transplantation at Oregon Health and Science University: recent results and protocols.

Renal transplants have been performed at the University Hospital, Portland, OR since 1959. In the 5-year period between January 1997 and December 2001, 736 kidney-only transplants were performed at our institution. Living donor transplants comprise an increasing proportion of the transplants performed.

Management of invasive aspergillosis in high-risk patients.

Invasive aspergillosis can be difficult to diagnose and control, and conventional drug treatment is often highly toxic, producing medical complications that further compromise patients' health status and escalate health care costs. This article describes the clinical manifestations of Aspergillus infection and discusses approaches to its therapy, including newer pharmaceutical agents with fewer adverse effects, which offer the potential to improve outcomes and substantially lower the cost of treating aspergillosis.

Graft failure from severe recurrent primary sclerosing cholangitis following orthotopic liver transplantation.

Unlabelled: Speculation that primary sclerosing cholangitis (PSC) may recur in the transplanted liver is based on the relative increase in frequency of biliary abnormalities and histologic evidence of periportal fibrosis without other causes. A recent study demonstrated almost 9% of patients undergoing liver transplantation (OLT) for primary sclerosing cholangitis (PSC) develop recurrent sclerosing cholangitis although the patient and graft survival is not different from those in whom recurrence does not develop. Most reports of PSC recurrence post-OLT estimate rates of 1% to 14%, but to date, no center has reported rapidly progressive fibro-obliterative cholangitis leading to graft failure.

Immunosuppression impact on long-term cardiovascular complications after liver transplantation.

Background: With current early transplant patient and allograft survivals nearly optimized, long-term medical complications have become a significant focus for potential improvement in patient outcomes. Cardiovascular disease and associated risk factors have been shown in renal transplant patients to be related to the pharmacologic immunosuppression employed.

Objective: The objective of this study is to investigate at 3 years postliver transplant (OLTx) the incidence of hypertension (HTN), hyperlipidemia (HLIP), diabetes mellitus (DM), nephrotoxicity (NTX), and cardiovascular disease (MI, angioplasty, CHF, CVA, and seborth) as well as rejection in two cohorts of liver transplant recipients who received either tacrolimus (FK-506) or cyclosporine (CSA) and to analyze the consequences of these complications on mortality following transplantation.