Posts Tagged ‘mycophenolate mofetil’

Patients who have an imbalanced body mass index (BMI) meaning that they are either underweight or overweight face a high risk of death as per a study by doctors at the University of Washington.

These study findings were presented in an issue of Liver Transplantation, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases.

From News-Medical.Net:

After transplantation, the very severely obese patients experienced higher rates of death due to infectious complications and cancer. The authors propose that one mechanism for this apparent immune deficiency is the presence of diabetes in patients with BMI > 40 kg/m2. Previous studies show that diabetic patients are at increased risk of infectious complications after surgical procedures, and supplemental immunosuppressive medication may further exacerbate this process. “An appropriate weight-based immunosuppressive regimen, careful management of severely obese patients’ co-morbidities (diabetes, hypertension) and aggressive facilitation of weight reduction can optimize the health of these patients and potentially improve patient outcomes,” suggest the researchers.

For patients who are severely obese, past protocol was to resolve their co-morbidities and help them achieve weight loss prior to transplantation. “A better approach might be to transplant these patients sooner by not requiring weight loss or working with the United Network for Organ Sharing (UNOS) for a policy change to assign additional Model for End-Stage Liver Disease (MELD) points for severe obesity, as is done for patients with hepatocellular carcinoma,” concluded the authors. “Aggressive management of the patients’ co-morbid factors and posttransplantation weight loss is a must.” The researchers also recommend a posttransplantation immunosuppressive regimen favoring less immunosuppressive medications without steroids and low dose tacrolimus based on the ideal body weight.

The involved researchers were of the view that there is an urgent need to adopt more aggressive immunosuppressive regimen with higher doses of mycophenolate mofetil and tacrolimus to provide great relief to the patients.

Immunosuppressive drugs can be largely withdrawn after kidney transplantation from an HLA-identical sibling donor, according to researchers from the Erasmus Medical Centre in Rotterdam showed in a study funded by the Dutch Kidney Foundation (DKF).

Project leader Dr. Nicole van Besouw remarked that during a study of 29 patients, azathioprine and mycophenolate mofetil were withdrawn completely in 27 patients to leave only a low dose of steroids and there was no acute rejection. In four of the patients, there was a return of underlying renal disease but that was no abnormality with the group that continued immunosuppression.

From Sciencedaily.com:

“Further, we found that the dendritic cells had shifted to more mature types after medication withdrawal. It may be that the drugs are impeding the dendritic cell maturation process.’ Dendritic cells are specialized in presenting foreign material to reactive immune cells. This way they play an important role in setting off immune reactions against germs and also transplant rejection.

Dr. van Besouw: ‘Withdrawal of immunosuppressive drugs is important to improve quality of life. We need more and larger clinical trials to better investigate withdrawal and to find reliable biomarkers for predicting rejection risks.’

It was remarked that there were some changes in the immune reactions after the withdrawal and the numbers of interleukin-10 producing cells increased significantly after stopping azathioprine or mycophenolate mofetil.

Patients with abnormal body mass index (BMI) meaning considerably overweight or underweight before liver transplantation are at a greater risk of dying after the transplantation surgery according to a recent study by doctors at the University of Washington.

The study findings were published in the August issue of Liver Transplantation, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases.

From News-Medical.Net:

After transplantation, the very severely obese patients experienced higher rates of death due to infectious complications and cancer. The authors propose that one mechanism for this apparent immune deficiency is the presence of diabetes in patients with BMI > 40 kg/m2. Previous studies show that diabetic patients are at increased risk of infectious complications after surgical procedures, and supplemental immunosuppressive medication may further exacerbate this process. “An appropriate weight-based immunosuppressive regimen, careful management of severely obese patients’ co-morbidities (diabetes, hypertension) and aggressive facilitation of weight reduction can optimize the health of these patients and potentially improve patient outcomes,” suggest the researchers.

For patients who are severely obese, past protocol was to resolve their co-morbidities and help them achieve weight loss prior to transplantation. “A better approach might be to transplant these patients sooner by not requiring weight loss or working with the United Network for Organ Sharing (UNOS) for a policy change to assign additional Model for End-Stage Liver Disease (MELD) points for severe obesity, as is done for patients with hepatocellular carcinoma,” concluded the authors. “Aggressive management of the patients’ co-morbid factors and posttransplantation weight loss is a must.” The researchers also recommend a posttransplantation immunosuppressive regimen favoring less immunosuppressive medications without steroids and low dose tacrolimus based on the ideal body weight.

It was suggested by the involved researchers that a more aggressive immunosuppressive regimen with higher doses of mycophenolate mofetil and tacrolimus is necessary to ensure that patients can be offered considerable relief.