Is azathioprine harmful to chronic viral hepatitis in renal transplantation? A long-term study on azathioprine withdrawal

David‐Neto, Elias; Ja, da Fonseca; Fj, de Paula; Wc, Nahas; Sabbaga, E; Le, Ianhez

doi:10.1016/s0041-1345(98)01941-1

Cited by 11 publications

(3 citation statements)

References 7 publications

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“…It is approved for the prevention of rejection in renal transplant recipients and for the treatment of rheumatoid arthritis. Infections reported in patients taking azathioprine are bacterial infections in the setting of leukopenia, herpes zoster, exacerbation of hepatitis B and C virus infections and opportunistic infections such as PML caused by JC virus, Nocardia, P. jirovecii pneumonia, and CMV viremia (96,97).…”

Section: Immunosuppressive Therapy For the Prevention And Treatment O...mentioning

confidence: 99%

Overview of Infections in the Immunocompromised Host

2016

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Understanding the components of the immune system that contribute to host defense against infection is key to recognizing infections that are more likely to occur in an immunocompromised patient. In this review, we discuss the integrated system of physical barriers and of innate and adaptive immunity that contributes to host defense. Specific defects in the components of this system that predispose to particular infections are presented. This is followed by a review of primary immunodeficiency diseases and secondary immunodeficiencies, the latter of which develop because of a specific illness or condition or are treatment-related. The effects of treatment for neoplasia, autoimmune diseases, solid organ and stem cell transplants on host defenses are reviewed and associated with susceptibility to particular infections. In conclusion, an approach to laboratory screening for a suspected immunodeficiency is presented. Knowledge of which host defects predispose to specific infections allows clinicians to prevent, diagnose, and manage infections in their immunocompromised patients most effectively.

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Section: Immunosuppressive Therapy For the Prevention And Treatment O...mentioning

confidence: 99%

Overview of Infections in the Immunocompromised Host

2016

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Section: Immunosuppressive Therapy For the Prevention And Treatment O...mentioning

confidence: 99%

Overview of Infections in the Immunocompromised Host

Dropulic

Lederman

2008

Diagnostic Microbiology of the Immunocompromised Host

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Host defense from infection depends upon a complex integrated system of physical barriers (e.g., skin, stomach acid, and mucociliary clearance), innate immunity (e.g., phagocytic cells, natural killer cells, complement) and adaptive immunity (B and T lymphocytes). An individual may have deficiencies of one or more components of host defense, but no individual is defenseless. Because each functional compartment of the immune system plays a specialized role in host defense, defects in specific functions lead to increased susceptibility to specific pathogens. The key to understanding the susceptibility of a particular patient is to understand the specific host defense defects of that patient. This chapter will briefly review the components of host defense and the types of infections that are most likely to occur with specific defects in those defense mechanisms. Following that will be descriptions of the infections that occur in patients with a variety of primary and secondary immune deficiency disorders, with the intent of providing illustrative examples. B. Overview of Host DefensesHost defense depends upon physical barriers, as well as the immune system. In conceptual terms, the components of the immune system can be divided into two compartments -innate and adaptive -with fundamentally different modes of action (Table 1). Innate host defense mechanisms are rapid (minutes to hours), depend upon patterned responses to pathogens (e.g., by phagocytic cells, complement) and do not improve with repeated exposure to one or many pathogens. In contrast, adaptive immune mechanisms are slow (days), depend upon very specific responses to individual antigens (e.g., by B and T lymphocytes), and improve with repeated exposure to an individual antigen. Successfully integrated and functioning together, physical barriers and the components of innate and adaptive immunity form a critical homeostatic mechanism necessary for the host's defense against infection and the generation of normal inflammatory responses (1, 2).

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“…Earlier series relied on double immunosuppression with azathioprine and high‐dose prednisone for the prevention of rejection ( 25, 35, 36) It is likely that steroids have the greatest adverse effect, but there are also some reports that azathioprine may be harmful in patients with viral hepatitis undergoing renal transplantation. In many cases this may be due to a predisposition to azathioprine hepatotoxicity rather than increased viral replication ( 37, 38).…”

Section: Renal Transplantationmentioning

confidence: 99%

Hepatitis B in transplantation

Bain

2000

Transplant Infectious Dis

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Hepatitis B has been a major challenge within the field of transplantation over the past few decades. Due to aggressive recurrence post-transplant, patients with hepatitis B have been excluded from the benefits of both solid organ and bone marrow transplants. Progress has been made, however, through an improved understanding of the biology of hepatitis B and the development of new antiviral strategies that can reliably suppress the virus. Patients with hepatitis B are now candidates for transplantation in an increasing number of circumstances. Careful pre-transplant evaluation is mandatory, together with a tailored antiviral regimen depending on the replicative status of the virus and the organ being transplanted. Minimizing steroid dose following transplantation is an important part of the strategy to reduce the risk of viral reactivation. Lamivudine has been an important development and it has assumed an increasing role in the management of these patients. As additional antivirals are developed, increasingly effective drug combinations will prevent viral recurrence as well as the emergence of drug-resistant mutants, which plagues the use of single agents. It is a rapidly evolving field and there is every reason for continued optimism.

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Is azathioprine harmful to chronic viral hepatitis in renal transplantation? A long-term study on azathioprine withdrawal

Cited by 11 publications

References 7 publications

Overview of Infections in the Immunocompromised Host

Overview of Infections in the Immunocompromised Host

Overview of Infections in the Immunocompromised Host

Hepatitis B in transplantation

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