CLDF Title
Home | Contact Us | Bookmark
HBV HE HCC HCV
About CLDF Centers of Educational Expertise  
Live CME Meetings Telewebs Webcasts Slide Library Abstract Library Conference Highlights
 
Back  
 
Reuters Health Information (2005-06-01): Immune reconstitution syndrome may occur in organ transplant recipients

Epidemiology

Immune reconstitution syndrome may occur in organ transplant recipients

Last Updated: 2005-06-01 15:39:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Apparently successful treatment of Cryptococcus neoformans infection in organ transplant recipients may be followed by an immune reconstitution syndrome (IRS)-like illness that is potentially fatal, investigators report in the June 15th issue of Clinical infectious Diseases.

IRS "is believed to result from enhanced -- but partially reconstituted -- pathogen-specific, cell-mediated immunity and induction of proinflammatory cytokines, leading to an exaggerated inflammatory reaction," explain Dr. Nina Singh, at the University of Pittsburgh Medical Center, and other members of the Cryptococcal Collaborative Transplant Study Group. IRS has been particularly associated with immune restoration in HIV infection.

Dr. Singh's group reports on a series of 83 organ transplant recipients with cryptococcosis, four of whom developed an IRS-like entity. The patients ranged in age from 34 to 65 years when they underwent transplantation (liver, kidney, or kidney and pancreas) with the initial diagnosis of C. neoformans occurring 3 to 29 months later.

All four were being treated with tacrolimus, mycophenolate mofetil (MMF) and prednisone as the immunosuppressive regimen when the IRS-like entity was detected, compared with 21 of the remaining 79 patients (26.6%, p = 0.007), the authors note, but this was the only significant difference that they identified.

In all four cases, MMF was discontinued and tacrolimus and prednisone decreased or discontinued. Two days to 3 months after instituting antifungal therapy, symptoms of the infection reappeared, C. neoformans titers increased, but the organism could not be grown in culture.

The IRS-syndrome led to forearm amputation in one patient, while one patient died 5 months after his initial infection. One patient died of MI 2 years after the initial infection. The other two patients remain alive 2 to 3 years later.

"The proposed basis of this phenomenon is reversal of a predominantly Th2 response at the onset of infection to a Th1 proinflammatory response as a result of receipt of effective antifungal therapy and a reduction in or cessation of immunosuppressive therapy," the study group indicates.

They also speculate that careful use of immunomodulatory agents such as interferon-gamma may be of use in such cases, with monitoring of serum levels to avoid a heightened inflammatory response or allograft rejection.

J Infect Dis 2005;40:1756-1761.

 
 
 
 
                 
 
HBV
Webcasts
Slide Library
Abstract Library
 
HE
Live CME Meetings
Webcasts
Slide Library
Abstract Library
 
HCC
Slide Library
Abstract Library
 
 
HCV
Live CME Meetings
Webcasts
Slide Library
Abstract Library
 
CLDF Follow Us
   
 
About CLDF
Mission Statement
Board of Trustees
Board of Advisors
CLDF Supporters
 
Other Resources
Liver News Library
Journal Abstracts
Hep C Link to Care
 
Centers of
Educational Expertise
Regional Map
     
   
  The Chronic Liver Disease Foundation is a non-profit organization with content developed specifically for healthcare professionals.
© Copyright 2012-2014 Chronic Liver Disease Foundation. All rights reserved. This site is maintained as an educational resource for US healthcare providers only.
Use of this Web site is governed by the Chronic Liver Disease Foundation terms of use and privacy statement.