Current Immunosuppressive Therapy In Organ Transplantation

Organ transplantation has revolutionized the treatment for end-stage organ failure. Immunosuppression is still a major approach currently used in the prevention and treatment of allograft rejection. Both editors Dr. Chen and Dr. Qian have been contributing to preclinical evaluation of immunosuppressants for more than 25 years in North America. Experts from the United States, Canada, the United Kingdom, China, Japan, Germany, Sweden, Hungary and Brazil contributed 23 chapters to this book, providing details of immunological basis in transplantation. They also describe six classes of immunosuppressive agents (calcineurin inhibitors, mTOR inhibitors, JAK-STAT inhibitors, antiproliferative agents, costimulation blockers and corticosteroids), as well as ischemia/reperfusion injury treated agents. Additionally, the new development of cell therapy in the induction of transplant tolerance is introduced. This book provides many important references for the research direction of novel immunosuppressants. Readers that will find this book useful include transplant physicians, surgeons, nurses, immunologists, pharmacologists, pharmacists, medical students, residents and trainees in transplantation.

This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop. As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicareâ€"or to society generallyâ€"is not evaluated for the services examined. The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004. In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions.

This title provides a comprehensive and state-of-the-art summary of current and future immunosuppressive strategies in transplantation, with emphasis on the basic science mechanisms and clinical applicability of these strategies. The uniqueness of this book is the inclusion of up-to-date information on the basic mechanisms of actions of the immunosuppressive drugs as well as a summary of the clinical trials data and the potential use of these drugs in clinical organ transplantation. In addition to describing the various immunosuppressive strategies, the book has three special features, including immunosuppression in xenotransplantation, gene therapy approaches, and transplantation tolerance. A group of outstanding investigators have been assembled to write the chapters. The book is intended for the transplant professional and the specialist who wants to stay abreast of the current status of immunosuppression in organ transplantation. The book is also useful for basic scientists who work in the field of transplantation immunology.

Pre- and post-operative care of transplant patients is an aspect of Critical Care Medicine in which most ICU physicians and nurses have received little or no formal training and are left to cope with this complex population with only spotty, incomplete 'on-the-job experience' as a guide. In response to this clinical knowledge gap, this book provides a concise 'at the bedside' resource for clinicians caring for abdominal organ transplant patients before and after surgery.

Transplantation is today firmly established as the therapy of choice for end-stage organ failure. However, despite recent developments, this therapy is still not without challenges and risks: The necessity to take immunosuppressive drugs for the rest of one's life to prevent allograft rejection trades the morbidity and mortality of organ failure for the risks of infection and cancer as well as for an increased mortality from cardiovascular disease. Thus, there is an urgent need for optimizing the outcome of transplantation by achieving long-term, drug-free graft acceptance with normal organ function.Recently, numerous insights into the dynamic inter-relationship of host immune responses elicited by donor antigen presentation have substantially broadened our understanding of the cascade of events resulting in the acquisition of tolerance. With the pharmacopoeia of the transplant biologist continually expanding, the potential treatment combinations have become baffling and their impact on strategies to induce tolerance even more complex.This book presents novel insights into the pathways of acute rejection and their monitoring through molecular tests, new immunosuppressive agents currently under development as well as the most recent and promising approaches to induce tolerance that have emerged from experimental animal studies.

Immunosuppression in solid organ transplantation is currently experiencing a worldwide revival since new drugs are now available and others are under development. In order to contribute to the design of future strategies, a critical approach of surrogate endpoints is given and long-term side effects are analysed, together with the impact of non-compliance, quality-of-life and economical parameters. In this book, international specialists have set up the scientific rationale and provided new bases for further immunosuppressive strategies.

One of the most interesting and at the same time most challenging fields of medicine and surgery has been that of organ donation and transplantation. It is a field that has made tremendous strides during the last few decades through the combined input and efforts of scientists from various specialties. What started as a dream of pioneers has become a reality for the thousands of our patients whose lives can now be saved and improved. However, at the same time, the challenges remain significant and so do the expectations. This book will be a collection of chapters describing these same challenges involved including the ethical, legal, and medical issues in organ donation and the technical and immunological problems the experts are facing involved in the care of these patients.The authors of this book represent a team of true global experts on the topic. In addition to the knowledge shared, the authors provide their personal clinical experience on a variety of different aspects of organ donation and transplantation.

Personalized Immunosuppression in Transplantation: Role of Biomarker Monitoring and Therapeutic Drug Monitoring provides coverage of the various approaches to monitoring immunosuppressants in transplant patients, including the most recently developed biomarker monitoring methods, pharmacogenomics approaches, and traditional therapeutic drug monitoring. The book is written for pathologists, toxicologists, and transplant surgeons who are involved in the management of transplant patients, offering them in-depth coverage of the management of immunosuppressant therapy in transplant patients with the goal of maximum benefit from drug therapy and minimal risk of drug toxicity. This book also provides practical guidelines for managing immunosuppressant therapy, including the therapeutic ranges of various immunosuppressants, the pitfalls of methodologies used for determination of these immunosuppressants in whole blood or plasma, appropriate pharmacogenomics testing for organ transplant recipients, and when biomarker monitoring could be helpful. Focuses on the personalized management of immunosuppression therapy in individual transplant patients Presents information that applies to many areas, including gmass spectrometry, assay design, assay validation, clinical chemistry, and clinical pathology Provides practical guidelines for the initial selection and subsequent modifications of immunosuppression therapy in individual transplant patients Reviews the latest research in biomarker monitoring in personalizing immunosuppressant therapy, including potential new markers not currently used, but with great potential for future use Explains how monitoring graft-derived, circulating, cell free DNA has shown promise in the early detection of transplant injury in liquid biopsy