ABSTRACT
We performed a pilot study in which 22 kidney recipients (14 LD: 8 DCD) were given alemtuzumab induction (30 mg day 0 and 1), steroids (500 mg mp day 0 and 1, none thereafter), mycophenolate mofetil (MMF) maintenance (500 mg b.i.d) and sirolimus (concentration controlled 8-12 ng/mL). With a mean follow-up of 15.9 months, patient survival is (21/22) 96% and graft survival (19/22) 87%. Acute rejections occurred in (8) 36.3% (two humoral). Of 19 surviving grafts, 18 (95%) remain steroid and 15 (79%) CNI-free. At 1 year, mean creatinine was 1.43 mg/dL. Overall infection rates were low, but 2 patients developed severe acute respiratory distress syndrome (ARDS) at month 3 and 7, respectively, resulting in mortality in one and a graft loss in the other. No cancer or PTLD was observed. Leukopenia was common and MMF dose was reduced or eliminated in 6/22 (27%) patients. The reported higher than expected rate of acute rejection, leukopenia and possible pulmonary toxicity suggests excessive morbidity. Modifications such as an initial period of CNI use should be considered.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Antibodies, Neoplasm/administration & dosage , Antineoplastic Agents/administration & dosage , Graft Rejection/drug therapy , Immunosuppressive Agents/administration & dosage , Kidney Transplantation , Mycophenolic Acid/analogs & derivatives , Sirolimus/administration & dosage , Acute Disease , Adult , Aged , Alemtuzumab , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Antibodies, Neoplasm/adverse effects , Antineoplastic Agents/adverse effects , Drug Therapy, Combination , Female , Follow-Up Studies , Graft Survival/drug effects , Humans , Immunosuppressive Agents/adverse effects , Infections , Kidney/pathology , Kidney/physiology , Male , Middle Aged , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/adverse effects , Pilot Projects , Sirolimus/adverse effects , SteroidsABSTRACT
Esophageal cancer is a devastating illness that has often metastasized before diagnosis. Diagnostic options include barium x-ray and endoscopy. Staging is most accurate using endoscopic ultrasonography. Treatment modalities that are widely used include radiotherapy, chemotherapy, dilatation, prosthesis placement, neodymium-yttrium-aluminum-garnet laser and combinations thereof. Photodynamic therapy is a treatment currently used on an experimental basis that offers selective ablation of cancerous cells. Nursing support for these patients is critically important and must be ongoing. Education for patients and families is continuous throughout the course of treatment.
