The use of drotrecogin alfa (activated) in solid organ transplant patients: a case series
| Autor: | D.J. Taber, G.M. Baillie, Kenneth D. Chavin, Angello Lin, Nicole A. Weimert, P.K. Baliga, S. Berkman |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Population Hemorrhage Artificial respiration Sepsis Fibrinolytic Agents Internal medicine medicine Humans education APACHE Aged Transplantation Antiinfective agent education.field_of_study business.industry Incidence Drotrecogin alfa Organ dysfunction Organ Transplantation Middle Aged medicine.disease Recombinant Proteins Surgery Treatment Outcome Infectious Diseases Bacteremia Female medicine.symptom business Protein C medicine.drug |
| Zdroj: | Transplant Infectious Disease. 11:269-276 |
| ISSN: | 1399-3062 1398-2273 |
| Popis: | S.Berkman,N.A.Weimert,D.J.Taber,G.M.Baillie,A.Lin,P.Baliga,K.D.Chavin.Theuseofdrotrecoginalfa(activated)insolidorgantransplantpatients:acaseseries.TransplInfectDis2009:11:269^276.AllrightsreservedAbstract: Background.Drotrecogin alfa (activated) (DAA), arecombinanthumanactivatedproteinC,isindicatedforthereductionofmortalityinpatientswithseveresepsiswhohaveahighriskofdeath.Intheinitialtrial,DAAdemonstratedasigni¢cantreductioninmortalityat 28 days for patientstreatedwith DAA in comparisonwith standardsupportive treatment (placebo). However, solid organtransplantrecipientswereexcludedfromthestudy.Transplantrecipientsareatanincreasedriskforsepsisandthereisminimalliterature describingthesafety and e⁄cacyof DAA inthe transplant population.Methods.Thirteensolidorgantransplant recipientswhoreceivedDAAbetween November2001andJanuary2004wereincludedinthiscaseseries. Patientswere prospectively identi¢ed and datacollectionoccurred concurrently andby retrospective chart review. AllpatientsmettheDAAusecriteriabasedontheinstitutionalstandardprotocol.Results.Wereportthe outcomesof the13adulttransplantpatientswhoreceivedatotalof14coursesof DAAforseveresepsis.Atthetime ofDAA initiation, allpatients required mechanicalventilation,86%necessitatedvasopressorsupport,andhadamedianof3dysfunctionalorgans.The median Acute Physiology and Chronic Health Evaluation(APACHE)IIscoreatinitiationwas30.Overall,hemodynamicstabilityand APACHE II score improved atthe end of DAA infusion. Causes ofearlydiscontinuationwerebleeding (57%),scheduledprocedure (14%),increasedinternationalnormalizedratio(14%),anddeath(14%).In-hospital,28-day,and1-yearmortality was69%,62%,and83%,respectively.Conclusion.DAAappearstobesafewithappropriate monitoring.However,transplantrecipientshadahigherincidenceofbleedingeventsleading to earlydiscontinuationof DAA.E⁄cacyisdi⁄culttoassesswithout an appropriate control groupforcomparison.Correspondence to:Tel: 843 792 3702Ashley Ave., Charleston, SC 29425, USASepsisisthesecondleadingcause ofdeathamongabdomi-nal transplant patients despite advances in immunosup-pression, surgical techniques, and antibiotic prophylaxis(1). The mortality risk associated with bacteremia withinthe solid organ transplant population is reported to be ashigh as 70%, depending onthe organism, site of infection,and timing of occurrence post transplantation (2).Whenconsidering organ dysfunction across all patient popula-tions, risk of death increases by 15^20% with each addi-tional dysfunctioning organ. Angus et al. (3) reported anin-hospital mortality rate of 64.5% in patients with 3dysfunctionalorgansand76.2%inpatientswith4ormoredysfunctional organs. Trials involving the diagnosis andtreatment of sepsis have excluded solid organ trans-plantrecipientsbecauseoftheiroftenatypicalpresentationand alteredpathogenesis from standardpopulations. How-ever, this population would likely bene¢t the most frompharmacological interventions aimed at attenuating theprogression of sepsis secondary to their depleted immunefunction and altered in£ammatory system. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|