Document Detail


Systemic immunosuppression in ocular surface stem cell transplantation: results of a 10-year experience.
MedLine Citation:
PMID:  22333664     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To describe the systemic immunosuppression protocol used at the Cincinnati Eye Institute and University of Cincinnati, and to evaluate the success, tolerability, and side effects of systemic immunosuppression in patients undergoing ocular surface stem cell transplantation (OSST).
METHODS: Retrospective study of all patients who had OSST from 1997 to 2007 and received follow-up for systemic immunosuppression at the Cincinnati Eye Institute. Patients were analyzed for demographics, systemic immunosuppression exposure, ocular surface stability, efficacy, and toxicity variables.
RESULTS: A total of 225 eyes from 136 patients with a mean age of 43.6 years (range, 8.9-80.6 years) underwent OSST with systemic immunosuppression. The most common systemic immunosuppression regimen consisted of tacrolimus, mycophenolate mofetil, and a short course (1-3 months) of prednisone (102/136 patients, 75%). Prophylactic valganciclovir and trimethoprim/sulfamethoxazole (dapsone if sulfa allergy was present) were also used. Mean duration of immunosuppression was 42.1 months (range, 3.6-128 months) and mean follow-up time after OSST was 53.9 months (range, 3.6-147.3 months). At the patients' final follow-up visit, 105/136 patients (77.2%) had a stable ocular surface. There were 3 severe adverse events in 2 patients (1.5%) and 21 minor adverse events in 19 patients (14.0%). Of the 21 patients with adverse events, 10 (47.6%) had systemic comorbidities at initial presentation.
CONCLUSIONS: The prevention of graft rejection with the use of systemic immunosuppression after OSST is crucial and should be approached with the same rigor as in solid organ transplantation. With appropriate long-term monitoring by the cornea specialist and transplant physician, the risk of irreversible toxicity at current dosages of systemic immunosuppression in this population is minimal.
Authors:
Edward J Holland; Gautham Mogilishetty; Heather M Skeens; David B Hair; Kristiana D Neff; Joseph M Biber; Clara C Chan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cornea     Volume:  31     ISSN:  1536-4798     ISO Abbreviation:  Cornea     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-14     Completed Date:  2012-07-18     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8216186     Medline TA:  Cornea     Country:  United States    
Other Details:
Languages:  eng     Pagination:  655-61     Citation Subset:  IM    
Affiliation:
Cincinnati Eye Institute, Cincinnati, OH 41017, USA. eholland@holprovision.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Corneal Diseases / therapy*
Drug Therapy, Combination
Epithelium, Corneal / transplantation*
Female
Follow-Up Studies
Graft Rejection / prevention & control*
Humans
Immunosuppression*
Immunosuppressive Agents / therapeutic use*
Limbus Corneae / cytology*
Male
Middle Aged
Mycophenolic Acid / analogs & derivatives,  therapeutic use
Prednisone / therapeutic use
Retrospective Studies
Stem Cell Transplantation*
Tacrolimus / therapeutic use
Time Factors
Young Adult
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 24280-93-1/Mycophenolic Acid; 53-03-2/Prednisone; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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