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Organ transplantation has been successfully performed over the last 35 years and the number of organ allograft recipients is steadily increasing. Long-term immunosuppression, necessary for good graft function, inevitably induces undesired effects (particularly infectious and neoplastic ones) among which cutaneous ones are very frequent and potentially life-threatening. This book deals with all aspects of cutaneous disorders that may be encountered in the setting of organ transplantation. It reflects the pioneering work performed since long by Dermatologists in Lyon, in collaboration with teams specialised in kidney, heart, lung, liver and pancreas transplantation.
Skin disease is a serious long-term problem for the recipients of solid organ transplants. The potent systemic immunosuppression therapy necessary to sustain a life-saving solid organ transplant is associated with many adverse cutaneous effects, including significantly increased rates of cutaneous malignancies, difficult-to-treat cutaneous infections, and cutaneous adverse manifestations of multiple medications. This book is the first scholarly compilation of the knowledge base surrounding the care of solid organ transplant recipients with dermatologic diseases. Supplemented with dozens of full-color photographs, this work brings together decades of knowledge into a cohesive format and establishes transplant dermatology as an important subspecialty within the field of dermatology and transplant medicine. Skin Disease in Organ Transplantation is an outstanding resource for transplant providers and dermatologists to determine the optimal diagnostic and therapeutic approach to the difficult problems of cutaneous disease in organ transplant recipients.
Organ transplantation has been performed for almost 40 years with steadily increasing success regarding long-time survival of the graft, as well as quality of life for the patient. However, graft tolerance only can be achieved via induction and maintenance of an impaired immunological surveillance. An increase of skin cancers as a consequence of the lowered cellular immunoresponse seems to parallel the overall increased long-time survival rate of organ transplant recipients. Against the background of chronic immunosuppression known risk factors like the amount of sun exposure prior and post transplantation, oncogenic viruses as well as the genetic background, and place of residence (latitude) are strongly related with the increased skin cancer incidence. The increasing incidence of non-melanoma skin cancer, paralleling a prolonged survival of patients after organ transplantation, represents a significant reason for morbidity and long-term morbidity in organ transplant recipients worldwide. The incidence of non-melanoma skin cancer in liver-, kidney- and heart transplant recipients varies from 1.5 to 22 %, 2 to 24 % and 6 to 34 % after 5 years post transplant. Ultraviolet radiation as well as immunosuppressive therapy are crucial risk-factors regarding the induction and progression of skin cancer. Ultraviolet radiation is related to the induction of DNA damage, as well as interference with Langerhans cell antigen presentation and a Th1 – Th2 shift induced via a release of IL-10. Whereas the overall duration of immunosuppression and the cumulative dosage applied are relevant parameters in the evaluation of an increased tumor risk, individual differences between specific immunosuppressive agents remain unclear. The workup of genetic as well as other unclear phenomenon like the reverse BCC/SCC ratio might shed some further light into the genesis and immunology of the non-melanoma skin cancer in general.
This textbook brings together experts in the field of transplant dermatology to review both state of the art and practical knowledge regarding the clinical presentation and management of the various cutaneous diseases seen in patients with solid organ transplant. Practicing dermatologists, trainees, and other health care providers involved in the care of transplant patients can learn the current diagnostic and management options, and how to apply these guidelines and principles in their everyday practice.
An essential update and comprehensive review Patients undergoing solid organ and hematopoietic stem cell transplantation frequently develop skin diseases that can be challenging to themselves and their doctors. In the first part of this volume, prevalent epidemiological, clinical and histological skin problems of solid organ recipients are discussed. Pre- and posttransplant management as well as follow-up programs are presented focusing on European and Swiss guidelines. A special chapter is dedicated to immunosuppressive drugs considering current standards, and new and upcoming medication. The second part starts with a summary of historical aspects of hematopoietic stem cell transplantation, and proceeds with a description of skin manifestations of graft-versus-host disease and their therapy. Covered are early, late and very late periods after transplantation with a focus on recent consensus classification and treatment aspects of chronic graft-versus-host disease. The publication ends with a comprehensive review and practical guidance on photoprotection in transplant recipients. This book covers all the important dermatological aspects that should be considered in diagnosis and treatment of recipients of solid organ and hematopoietic stem cell transplants. It is intended as a guide for dermatologists, nephrologists, hemato-oncologists and all specialists involved in the field of transplantation.
The number of solid organ transplant recipients is increasing worldwide every year, which has meant a significant improvement of recipient’s survival and quality of life. To prevent graft rejection, patients require long-term immunosuppression, which is responsible for their increased risk of neoplastic and infectious diseases. This practical and concise atlas presents the most important dermatoses in solid organ transplant recipients. Providing a guide to diagnosis and appropriate therapy, it helps dermatologists, general practitioners and physicians manage the dermatoses found in organ transplant recipients. The first three chapters discuss immunosuppressive regimens and the prevalence of dermatoses, while the other chapters approach the main diseases didactically, providing a large number of illustrations.
This book describes a practical approach to the diagnosis, management, and prevention of infectious complications in solid-organ transplant (SOT) candidates and recipients, based on both up-to-date clinical evidence and state of the art expert opinion from world-renowned experts in the field. The book is divided into three parts, the first of which explains risk assessment and the general approach to infectious diseases in the pre-, peri-, and early and late post-transplant periods. The remaining two sections address the prevention and treatment of infection with particular pathogens and the management of specific syndromes, such as pneumonia, CNS infections, UTIs, and skin infections. Infections in SOT recipients – often due to multidrug-resistant organisms – represent a major challenge. Preventive strategies need to be adapted according to the type of allograft and period after transplantation. Moreover, toxicity and drug interaction with immunosuppressive drugs must be taken into consideration when treating infectious complications. In explaining in depth how best to ensure allograft and patient survival, this book will be of value to infectious disease specialists and transplant physicians at all levels of experience.
This book is open access under a CC BY 4.0 license. This textbook, endorsed by the European Society for Blood and Marrow Transplantation (EBMT), provides adult and paediatric nurses with a full and informative guide covering all aspects of transplant nursing, from basic principles to advanced concepts. It takes the reader on a journey through the history of transplant nursing, including essential and progressive elements to help nurses improve their knowledge and benefit the patient experience, as well as a comprehensive introduction to research and auditing methods. This new volume specifically intended for nurses, complements the ESH-EBMT reference title, a popular educational resource originally developed in 2003 for physicians to accompany an annual training course also serving as an educational tool in its own right. This title is designed to develop the knowledge of nurses in transplantation. It is the first book of its kind specifically targeted at nurses in this specialist field and acknowledges the valuable contribution that nursing makes in this area. This volume presents information that is essential for the education of nurses new to transplantation, while also offering a valuable resource for more experienced nurses who wish to update their knowledge.
This comprehensive volume provides a platform from which both major and minor infectious diseases related issues are addressed in-depth among this highly susceptible population. The book begins with an overview of infections in various modalities. This is followed by chapters on clinical disorders, etiologic agents, therapeutics, and infection prevention. Chapters include easy-to-follow figures and tables, radiologic images, and pictorial demonstrations of various disease states to familiarize and reacquaint the transplant clinicians and surgeons in practice and training, and those belonging to subspecialties providing supportive care for these patients. Discussions to enumerate the noninfectious causes that mimic infectious diseases; clinical relevance and effective utility of existing and emerging diagnostic tools are presented throughout the book. Authored by leaders in their fields, this book is the go-to reference for management of patients undergoing hematopoietic and solid organ transplantation.
Organ transplantation has been performed for almost 40 years with steadily increasing success regarding long-time survival of the graft, as well as quality of life for the patient. However, graft tolerance only can be achieved via induction and maintenance of an impaired immunological surveillance. An increase of skin cancers as a consequence of the lowered cellular immunoresponse seems to parallel the overall increased long-time survival rate of organ transplant recipients. Against the background of chronic immunosuppression known risk factors like the amount of sun exposure prior and post transplantation, oncogenic viruses as well as the genetic background, and place of residence (latitude) are strongly related with the increased skin cancer incidence. The increasing incidence of non-melanoma skin cancer, paralleling a prolonged survival of patients after organ transplantation, represents a significant reason for morbidity and long-term morbidity in organ transplant recipients worldwide. The incidence of non-melanoma skin cancer in liver-, kidney- and heart transplant recipients varies from 1.5 to 22 %, 2 to 24 % and 6 to 34 % after 5 years post transplant. Ultraviolet radiation as well as immunosuppressive therapy are crucial risk-factors regarding the induction and progression of skin cancer. Ultraviolet radiation is related to the induction of DNA damage, as well as interference with Langerhans cell antigen presentation and a Th1 – Th2 shift induced via a release of IL-10. Whereas the overall duration of immunosuppression and the cumulative dosage applied are relevant parameters in the evaluation of an increased tumor risk, individual differences between specific immunosuppressive agents remain unclear. The workup of genetic as well as other unclear phenomenon like the reverse BCC/SCC ratio might shed some further light into the genesis and immunology of the non-melanoma skin cancer in general.