RESUMO
Talc lung granulomatosis results from the intravenous use of medication intended for oral use. Talc (magnesium silicate) acts as filler in some oral medications; when injected intravenously, it deposits in the lungs leading to airflow obstruction and impaired gas exchange. Allocation of donor lungs to previous intravenous drug users is controversial. After a careful selection process, 19 patients with talc lung granulomatosis have received lung allografts in our program. Long-term survival for these patients is excellent and our results suggest the previous use of intravenous drugs should not necessarily preclude lung transplantation.
Assuntos
Usuários de Drogas , Excipientes/efeitos adversos , Granuloma de Corpo Estranho/cirurgia , Pneumopatias/cirurgia , Transplante de Pulmão , Abuso de Substâncias por Via Intravenosa/complicações , Talco/efeitos adversos , Feminino , Granuloma de Corpo Estranho/diagnóstico , Granuloma de Corpo Estranho/etiologia , Humanos , Injeções Intravenosas , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Masculino , Seleção de Pacientes , Estudos Retrospectivos , Abuso de Substâncias por Via Intravenosa/reabilitação , Talco/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
Human Leukocyte Antigen (HLA) antibodies posttransplant have been associated with an increased risk of early graft failure in kidney transplants. Whether this also applies to islet transplantation is not clear. To achieve insulin independence after islet transplants multiple donor infusions may be required. Hence, islet transplant recipients are at risk of sensitization after transplantation. Islet transplant recipients were screened for HLA antibodies posttransplant by flow-based methods. A total of 98 patients were studied. Twenty-nine patients (31%) developed de novo donor specific antibodies (DSA) posttransplant. Twenty-three patients developed DSA while on immunosuppression (IS). Among recipients who have discontinued IS, 10/14 (71%) are broadly sensitized with panel reactive antibody (PRA) >or=50%. The risk of becoming broadly sensitized after transplant was 11/69 (16%) if the recipient was unsensitized prior to transplant. The majority of these antibodies have persisted over time. Appearance of HLA antibodies posttransplant is concerning, and the incidence rises abruptly in subjects weaned completely from IS. This may negatively impact the ability of these individuals to undergo further islet, pancreas or kidney transplantation and should be discussed upfront during evaluation of candidates for islet transplantation.