BACKGROUND Pancreatic cystic lesions are common in patients eligible for solid organ transplan-tation.It has been shown that the need for immunosuppression after organ transplantation increases the rate of malignancie...BACKGROUND Pancreatic cystic lesions are common in patients eligible for solid organ transplan-tation.It has been shown that the need for immunosuppression after organ transplantation increases the rate of malignancies in organ recipients.However,the impact of immunosuppression on pancreatic cystic lesions is yet unknown.AIM To evaluate the prevalence of pancreatic cystic lesions and the risk of cyst progression in immunosuppressed patients.METHODS A systematic literature search was performed in relevant databases.Studies reporting either on the prevalence and/or the incidence of pancreatic cyst progression compared to a control group were implemented in the first systematic review and meta-analysis on this topic.RESULTS The prevalence of pancreatic cystic lesions was comparable with 7%(95%CI:5%-11%)in the immunosuppressed cohort and 9%(95%CI:5%-16%)in the control cohort.The mean cyst size increase in the immunosuppression group was 3.2 mm(range 1.0-5.2mm)compared to 3.5 mm(1.0-6.9)in the control group(standar-dized mean difference 0.0 mm,95%CI:-0.3-0.2 mm,P=0.72).There was also no significant increase in the development of resection criteria or worrisome features under immunosuppression either[relative risk 1.1(fixed effect model),1.2(ran-dom effects model),P=0.61].CONCLUSION Immunosuppression does not increase the prevalence of pancreatic cystic lesions,nor does it increase the risk of cyst progression in terms of cyst size and development of resection criteria.Therefore,pancreatic cystic lesions in transplant candidates should not be a contraindication for solid organ transplantation.展开更多
Exposure to heparin is associated with a high incidence of immunization against platelet factor 4(PF4)/heparin complexes. A subgroup of immunized patients is at risk of developing heparin-induced thrombocytopenia(HIT)...Exposure to heparin is associated with a high incidence of immunization against platelet factor 4(PF4)/heparin complexes. A subgroup of immunized patients is at risk of developing heparin-induced thrombocytopenia(HIT), an immune mediated prothrombotic adverse drug effect. Transplant recipients are frequently exposed to heparin either due to the underlying end-stage disease, which leads to listing and transplantation or during the transplant procedure and the perioperative period. To review the current scientific knowledge on antiheparin/PF4 antibodies and HIT in transplant recipients a systematic Pub Med literature search on articles in English language was performed. The definition of HIT is inconsistent amongst the publications. Overall, six studies and 15 case reports have been published on HIT before or after heart, liver, kidney, and lung transplantation, respectively. The frequency of seroconversion for anti-PF4/heparin antibodies ranged between 1.9% and 57.9%. However, different methods to detect anti-PF4/heparin antibodies were applied. In none of the studies HIT-associated thromboembolic events or fatalities were observed. More importantly, in patients with a history of HIT, reexposure to heparin during transplantation was not associated with thrombotic complications. Taken together, the overall incidence of HIT after solid organ transplantation seems to be very low. However, according to the current knowledge, cardiac transplant recipients may have the highest risk to develop HIT. Different alternative suggestions for heparin-free anticoagulation have been reported for recipients with suspected HIT albeit no official recommendations on management have been published for this special collective so far.展开更多
文摘BACKGROUND Pancreatic cystic lesions are common in patients eligible for solid organ transplan-tation.It has been shown that the need for immunosuppression after organ transplantation increases the rate of malignancies in organ recipients.However,the impact of immunosuppression on pancreatic cystic lesions is yet unknown.AIM To evaluate the prevalence of pancreatic cystic lesions and the risk of cyst progression in immunosuppressed patients.METHODS A systematic literature search was performed in relevant databases.Studies reporting either on the prevalence and/or the incidence of pancreatic cyst progression compared to a control group were implemented in the first systematic review and meta-analysis on this topic.RESULTS The prevalence of pancreatic cystic lesions was comparable with 7%(95%CI:5%-11%)in the immunosuppressed cohort and 9%(95%CI:5%-16%)in the control cohort.The mean cyst size increase in the immunosuppression group was 3.2 mm(range 1.0-5.2mm)compared to 3.5 mm(1.0-6.9)in the control group(standar-dized mean difference 0.0 mm,95%CI:-0.3-0.2 mm,P=0.72).There was also no significant increase in the development of resection criteria or worrisome features under immunosuppression either[relative risk 1.1(fixed effect model),1.2(ran-dom effects model),P=0.61].CONCLUSION Immunosuppression does not increase the prevalence of pancreatic cystic lesions,nor does it increase the risk of cyst progression in terms of cyst size and development of resection criteria.Therefore,pancreatic cystic lesions in transplant candidates should not be a contraindication for solid organ transplantation.
文摘Exposure to heparin is associated with a high incidence of immunization against platelet factor 4(PF4)/heparin complexes. A subgroup of immunized patients is at risk of developing heparin-induced thrombocytopenia(HIT), an immune mediated prothrombotic adverse drug effect. Transplant recipients are frequently exposed to heparin either due to the underlying end-stage disease, which leads to listing and transplantation or during the transplant procedure and the perioperative period. To review the current scientific knowledge on antiheparin/PF4 antibodies and HIT in transplant recipients a systematic Pub Med literature search on articles in English language was performed. The definition of HIT is inconsistent amongst the publications. Overall, six studies and 15 case reports have been published on HIT before or after heart, liver, kidney, and lung transplantation, respectively. The frequency of seroconversion for anti-PF4/heparin antibodies ranged between 1.9% and 57.9%. However, different methods to detect anti-PF4/heparin antibodies were applied. In none of the studies HIT-associated thromboembolic events or fatalities were observed. More importantly, in patients with a history of HIT, reexposure to heparin during transplantation was not associated with thrombotic complications. Taken together, the overall incidence of HIT after solid organ transplantation seems to be very low. However, according to the current knowledge, cardiac transplant recipients may have the highest risk to develop HIT. Different alternative suggestions for heparin-free anticoagulation have been reported for recipients with suspected HIT albeit no official recommendations on management have been published for this special collective so far.
