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2 results on '"Haifa S, Lyster"'

1. Fungal infection in cardiothoracic transplant recipients: outcome without systemic amphotericin therapy

Author

Dhruva, Dhar, Jennifer L, Dickson, Martin R, Carby, Haifa S, Lyster, Anne V, Hall, and Nicholas R, Banner

Subjects
Adult, Male, Antifungal Agents, Time Factors, Adolescent, Middle Aged, Cohort Studies, Treatment Outcome, Anti-Infective Agents, Mycoses, Amphotericin B, Heart Transplantation, Humans, Drug Interactions, Female, Immunosuppressive Agents, Aged, Lung Transplantation
Abstract

Transplant recipients require immunosuppression to prevent allograft rejection, placing them at risk of opportunistic infections including fungal infection. Difficulties in managing fungal infections include: establishing diagnosis, poor treatment response, drug interactions and toxicity. We report our single centre experience of treating fungal infections using systemic non-Amphotericin current generation antifungals. Patients receiving inpatient antifungal therapy from September 2005 to December 2010 were identified from pharmacy records. Fungal infections were retrospectively classified according to European Organization for Research and Treatment of Cancer (EORTC) criteria. Treatment outcomes were classified in a manner similar to those used in clinical trials. Two hundred and forty-nine recipients received antifungal treatment, 204 lungs and 45 hearts. One hundred and one patients received Voriconazole, 82 Caspofungin and 65 received both agents. One patient was unsuccessfully treated with additional Amphotericin. Treatment duration varied from 1.5 to 12 weeks. One hundred and sixty-five patients had a complete response, 24 had a partial response and in 60 patients treatment was unsuccessful. The response to systemic non-Amphotericin based antifungal therapy was high. We propose that diagnostic criteria without positive identification of a fungus allow treatment to be started early with few clinically relevant side effects.

Published
2012

2. Chronic kidney disease after heart transplantation.

Author

Iman M. Hamour, Fazir Omar, Haifa S. Lyster, Andrew Palmer, and Nicholas R. Banner

Subjects
HEART transplantation complications, KIDNEY diseases, NEPHROTOXICOLOGY, GLOMERULAR filtration rate, DIET in disease, DISEASE incidence
Abstract

Background. Chronic kidney disease (CKD) is a complication of heart transplantation related to calcineurin inhibitor nephrotoxicity. However, it is unclear whether early ciclosporin (CsA) exposure influences CKD in the long term. Methods. We analysed risk factors for CKD in 352 patients who underwent orthotopic heart transplantation (1995–2005). In 2000, we reduced our target CsA levels in the first year after transplantation. Results. Actuarial patient survival was 79% at 1 year and 62% at 10 years. Estimated median glomerular filtration rate (eGFR) by the four-variable Modification of Diet in Renal Disease formula was 64 ml/min/1.73 m2 before transplantation, inter-quartile range (IQR) 54–78. After transplantation, the eGFR was 48 (IQR 37–61) at Year 1, and 41(35–57) at Year 10. The cumulative probability of eGFR P P = 0.005; increasing recipient age, P P = 0.029; female donor, P = 0.04, but not CsA regimen. The cumulative probability of developing stage 5 CKD (eGFR P = 0.008), there was no significant effect by Year 3 (P = 0.7). Conclusion. The incidence of CKD increased with time and was not influenced by the CsA regimen. Some risk factors are not modifiable but measures to reduce the incidence of post-operative ARF may help to reduce CKD. [ABSTRACT FROM AUTHOR]

Published
2009
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