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[Problems with long-term immunosuppression following organ transplantation]
G Thiel1, J Landmann, M Mihatsch
1Departemente für Chirurgie, Medizin und Pathologie, Kantonsspital, Universität Basel.
Therapeutische Umschau. Revue Therapeutique
|February 1, 1990
Summary
Long-term immunosuppression increases cancer risk and infections like bacteremia. Cyclosporine A causes kidney damage, categorized into dysfunction, acute, and chronic nephrotoxicity, requiring specific management strategies.
Area of Science:
- Immunology
- Nephrology
- Oncology
Background:
- Long-term immunosuppression is associated with increased risks of malignancies, including skin cancer, lymphomas, and Kaposi's sarcoma.
- Infectious complications are common, with up to 48% incidence of bacteremia, and a higher prevalence of Listeria, Salmonella, and herpes virus infections.
Purpose of the Study:
- To outline the oncologic and infectious risks associated with long-term immunosuppression.
- To detail the nephrotoxic effects of Cyclosporine A and classify renal functional impairment.
- To discuss management strategies for chronic nephrotoxicity.
Main Methods:
- Literature review of immunosuppression complications.
- Classification of Cyclosporine A-induced renal impairment.
- Discussion of clinical management approaches.
Main Results:
- Immunosuppression elevates cancer and infection rates (bacteremia, specific bacterial and viral pathogens).
- Azathioprine's primary side effect is hematologic.
- Cyclosporine A is nephrotoxic, with three defined classes of renal impairment: dysfunction, acute, and chronic nephrotoxicity.
Conclusions:
- Long-term immunosuppression necessitates vigilant monitoring for malignancies and infections.
- Cyclosporine A-induced nephrotoxicity is a significant concern requiring classification and tailored management.
- Effective strategies for handling chronic nephrotoxicity are crucial for patient outcomes.