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Biomedical subjects

Jim J Wade

Publications and source records attributed to Jim J Wade.

6 recordsLinked to original sources
PubMed2006

Toxoplasmosis following alemtuzumab based allogeneic haematopoietic stem cell transplantation.

Alemtuzumab is a humanised monoclonal antibody against CD52 used as an immunosuppressive agent in allogeneic HSCT. Regimens including alemtuzumab for allogeneic haematopoietic stem cell transplant (HSCT) conditioning have been associated with an increased incidence of viral complications. Patients with prior toxoplasma exposure undergoing alemtuzumab containing HSCT could therefore be expected to be at a higher risk of toxoplasma reactivation. We conducted a retrospective review of 220 alemtuzumab based allogeneic HSCT performed over a 4 year period, of which 202 were reduced intensity conditioning (RIC) HSCT. A total of 67 patients (30%) in whom the pre-transplant recipient toxoplasma IgG test was positive were classified as high-risk for toxoplasma infection. All patients started trimethoprim/sulfamethoxazole prophylaxis following HSCT when the neutrophil count was > or = 1x10(9)/l. Two high-risk patients developed toxoplasma invasive disease with cerebral involvement at 2 and 4 months post-transplantation respectively. The incidence of toxoplasma disease in the entire cohort and amongst high-risk patients was 0.9% and 3.0% respectively. Despite in vivo T-cell depletion with alemtuzumab, the incidence of toxoplasma disease in our cohort was comparable with previously reported T-cell replete HSCT studies.

Adult↗
PubMed2006

Immunization issues before and after solid organ transplantation in children.

Solid-organ transplant recipients are at risk from various infectious diseases, many of which can be prevented by immunizations that could reduce morbidity and mortality. However, it is not uncommon for children requiring transplantation to have received inadequate or no immunizations pre-transplant. Every effort should be made to immunize transplant candidates early in the course of their disease according to recommended schedules prior to transplantation. It is also important to immunize their household contacts and healthcare workers. In this review, we summarize the major immunization issues for children undergoing transplantation, the data currently available on immunization safety and efficacy, and suggest immunization practices to reduce vaccine-preventable disease. There is a real need for a standardized approach to the administration and evaluation of immunizations in this group of patients.

Child↗
PubMed2005

Risk factors for fungal infection in paediatric liver transplant recipients.

Fungal infection (FI) is a major and potentially fatal complication in liver transplantation (LT). Published experience of FI in paediatric LT is limited. We therefore reviewed case records of 79 children, aged between 0.16 and 16 yr, who underwent LT between 1997 and 1998 to document the incidence of, and identify risk factors for, FI. Sixty-eight pre-, peri- and post-LT variables were assessed in relation to FI by univariate and multivariate analyses. The major indications for LT were biliary atresia in 26 (33%) patients, fulminant hepatic failure in 16 (20%) and intrahepatic cholestasis in 11 (14%); eight patients required re-LT. Thirty-two (40.5%) children developed a FI within 1 yr of LT. The median time to FI was 42 days (range 1-342 days). Candida spp. caused 29 (90.7%) FIs; 21 (66%) of these were Candida albicans. Although FI was associated with increased mortality, most patients responded well to antifungal treatment. The variables independently associated with FI were pre-LT fungal colonization and pyrexia and, post-LT, bacterial infection, Epstein-Barr virus (EBV) infection and tacrolimus administration. Identifying risk factors for FI should contribute to the development of strategies for prophylaxis or preemptive therapy.

Adolescent↗
PubMed2004

Hepatocyte transplantation for inherited factor VII deficiency.

Hepatocyte transplantation has been investigated in patients with liver-based metabolic disorders and acute liver failure. We report the first use of hepatocyte transplantation in two brothers with severe inherited coagulation factor VII deficiency. Patient 1 received a total of 1.09x10(9) cryopreserved hepatocytes, and patient received 2.18x10(9) fresh and cryopreserved hepatocytes through a Hickman line inserted in the inferior mesenteric vein. Infusion of isolated human hepatocytes improved the coagulation defect and markedly decreased the requirement for exogenous recombinant factor VII (rFVIIa) to approximately 20% of that before cell transplantation. In both patients, episodes of line sepsis were associated with an increase in rFVIIa requirement. Six months posthepatocyte transplantation, higher rFVIIa doses were required, suggesting loss of transplanted hepatocyte function. Because of increasing problems with venous access and long-term uncertainty of the efficacy of hepatocyte transplantation, orthotopic liver transplantation was performed successfully in both cases.

Adolescent↗
PubMed2002

Non-viral infections of the liver.

The function and anatomy of the liver renders this organ peculiarly susceptible to bacterial and parasitic infections; fungal infections are increasingly recognised in the immunocompromised. As biochemical abnormalities of liver function can be non-specific, a high index of suspicion of liver or biliary infection is required. A need for prompt investigation is emphasised by the potentially rapid progression and poor prognosis of some bacterial and fungal infections, and the public health implications of parasitic diseases. This review encompasses the major infections of the liver and biliary tree other than viral hepatitis and includes aspects of pathogenicity, epidemiology, clinical presentation, diagnosis and management.

Bacterial Infections↗