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Increasing the success of liver transplants by managing levels of anti-rejection drugs
June 13, 2005Approximately 600 children receive liver transplants each year in the United States. The use of immunosuppressant drug therapy, namely calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus, has decreased the risk of liver rejection and increased patient survival rates. While these medications can aid positive outcomes, high levels of CNIs can cause seizures and kidney damage, and low levels increase the risk of rejection of the transplanted liver. A study in the June issue of The Journal of Pediatrics discusses an approach to managing the levels of CNIs to keep them within a safe range for each patient in order to minimize risks and maximize success.
John C. Bucuvalas, MD, and colleagues from Cincinnati Children's Hospital Medical Center and Intermountain Health Center employed a method of controlling the blood levels of CNIs to stay within target ranges for individual patients. The study involved 217 patients, aged 6 months to 21 years, who received liver transplantation at least three months before the start of the study.
In the past, doctors relied on their experience to make decisions about how and when to change CNI dosages. The method in this study used a four-step process of care that allows the dose to be changed only when the CNI blood levels fall outside certain ranges based on each patient's previous responses to dosage changes. A team of transplantation experts used a statistical process control methodology and a novel Web-based system to review each patient's CNI levels to determine potential toxicity, possible modification of the patient's target range due to post-transplant complications, excessive variation of immunosuppressant levels in the blood, and if the CNI levels were within an acceptable range for that particular patient. The team then used the data to determine if the patient's medication required adjustment to keep the levels within a safe range.
Initially, only 50% of CNI levels were within the acceptable target ranges; this increased to 80% after the process was implemented. The amount of variation in CNI levels was significantly reduced, and the method decreased the proportion of CNI levels in the toxic range from 10% to 5%, reducing the risk of negative effects.
The method used in this study, statistical process control, is relatively new to the healthcare industry. Although the management of CNI blood levels is important for liver transplant patients, Dr. Bucuvalas points out that "the essential observation of the current work is that managing variation can improve the quality of care." This method is currently being applied to liver transplantation, but it may also be used to decrease the risk in the care of patients with diabetes, seizure disorders, asthma, and hypertension.
Elsevier Health Sciences
Initially, only 50% of CNI levels were within the acceptable target ranges; this increased to 80% after the process was implemented. The amount of variation in CNI levels was significantly reduced, and the method decreased the proportion of CNI levels in the toxic range from 10% to 5%, reducing the risk of negative effects.
The method used in this study, statistical process control, is relatively new to the healthcare industry. Although the management of CNI blood levels is important for liver transplant patients, Dr. Bucuvalas points out that "the essential observation of the current work is that managing variation can improve the quality of care." This method is currently being applied to liver transplantation, but it may also be used to decrease the risk in the care of patients with diabetes, seizure disorders, asthma, and hypertension.
Elsevier Health Sciences
Liver Transplants Current Events and Liver Transplants News RSSExtending treatment after liver transplant may benefit patients with hepatitis C recurrence
Extending hepatitis C treatment for liver transplant patients beyond current practice results in high rates of clearance of the hepatitis C virus from the blood, as well as a low rate of relapse, according to a Henry Ford Hospital study.
Liver cells grown from patients' skin cells
Scientists at The Medical College of Wisconsin in Milwaukee have successfully produced liver cells from patients' skin cells opening the possibility of treating a wide range of diseases that affect liver function.
Women, blacks, Medicare recipients less likely to be evaluated for liver transplantation
Patient race, gender and insurance status influence decisions about who will go on to receive liver transplants, according to a University of Pittsburgh School of Medicine study.
New biomarker predicts response to hepatitis C treatment
Researchers have identified the first genetic marker that predicts response to hepatitis C treatments, and a single letter of DNA code appears to make a huge difference.
First human gets new antibody aimed at hepatitis C virus
Building upon a series of successful preclinical studies, researchers at MassBiologics of the University of Massachusetts Medical School (UMMS) today announced the beginning of a Phase 1 clinical trial, testing the safety and activity of a human monoclonal antibody they developed that can neutralize the Hepatitis C virus (HCV).
Novel antibody prevents infection by hepatitis C virus
Taking aim at a leading cause of liver failure in the United States, a team of scientists at the Massachusetts Biologic Laboratories (MBL) of the University of Massachusetts Medical School (UMMS) has developed a human monoclonal antibody that neutralizes the Hepatitis C virus (HCV).
Hepatitis C Treatment Reduces the Virus but Liver Damage Continues
Treating patients who have chronic hepatitis C and advanced liver disease with long-term pegylated interferon significantly decreased their liver enzymes, viral levels and liver inflammation, but the treatment did not slow or prevent the progression of serious liver disease, a study finds.
Gene variant boosts risk of fatty liver disease, scientists discover
Researchers at UT Southwestern Medical Center have found that individuals who carry a specific form of the gene PNPLA3 have more fat in their livers and a greater risk of developing liver inflammation.
Children's Hospital researchers identify genetic mutation that may predict organ rejection
Using a novel combination of cutting-edge technologies to scan the human genome, researchers at Children's Hospital of Pittsburgh of UPMC have identified a genetic mutation that identifies transplant recipients who experience rejection.
Older liver donors not associated with negative outcomes in transplant recipients with hepatitis C
Receiving a liver from a donor older than age 60 does not appear to be associated with transplant failure, death or recurrent disease in the next five years among transplant patients with the hepatitis C virus.
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