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  1. Article: Modern approaches to incompatible kidney transplantation.

    Wongsaroj, Patarapha / Kahwaji, Joseph / Vo, Ashley / Jordan, Stanley C

    World journal of nephrology

    2014  Volume 4, Issue 3, Page(s) 354–362

    Abstract: The presence of human-leukocyte antigen (HLA)-antibodies and blood group incompatibility remain a large barrier to kidney transplantation leading to increased morbidity and mortality on the transplant waiting list. Over the last decade a number of new ... ...

    Abstract The presence of human-leukocyte antigen (HLA)-antibodies and blood group incompatibility remain a large barrier to kidney transplantation leading to increased morbidity and mortality on the transplant waiting list. Over the last decade a number of new approaches were developed to overcome these barriers. Intravenous immunoglobulin (IVIG) remains the backbone of HLA desensitization therapy and has been shown in a prospective, randomized, placebo controlled trial to improve transplantation rates. Excellent outcomes with the addition of rituximab (anti-B cell) to IVIG based desensitization have been achieved. There is limited experience with bortezomib (anti-plasma cell) and eculizumab (complement inhibition) for desensitization. However, these agents may be good adjuncts for patients who are broadly sensitized with strong, complement-fixing HLA antibodies. Excellent short and long-term outcomes have been achieved in ABO incompatible transplantation with the combination of antibody removal, B cell depletion, and pre-transplant immunosuppression. Kidney paired donation has emerged as a reasonable alternative for programs who cannot provide desensitization or in conjunction with desensitization. Future therapies directed toward cytokines that alter B cell proliferation are under investigation.
    Language English
    Publishing date 2014-09-01
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2220-6124
    ISSN 2220-6124
    DOI 10.5527/wjn.v4.i3.354
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Rabies neutralizing antibody after 2 intradermal doses on days 0 and 21 for pre-exposure prophylaxis.

    Wongsaroj, Patarapha / Udomchaisakul, Piyada / Tepsumethanon, Saowaluck / Khawplod, Pakamatz / Tantawichien, Terapong

    Vaccine

    2013  Volume 31, Issue 13, Page(s) 1748–1751

    Abstract: Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third ... ...

    Abstract Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third booster dose given 2-3 weeks later. Neutralizing antibody response is virtually 100%, and the individual remains sensitized indefinitely. Intradermal pre-exposure regimen for rabies prophylaxis is more economical compared with the conventional intramuscular regimen in terms of vaccine volume. However, both regimens require three clinic visits. In order to reduce non-medical expenses such as transportation to the clinics and to increase compliance, the immunogenicity and safety of two-visit intradermal regimen for pre-exposure prophylaxis were studied. Fifty-five healthy subjects aged between 18 and 24 years were enrolled and divided into two groups. Group A (n=39) received 0.1 ml of purified Vero cell rabies vaccine (PVRV; Sanofi Pasteur, Lyon, France; Lot no. Z0996 with an antigenic value of 4.8 IU/0.5 ml vial) intradermally each at two sites on days 0 and 21. Group B (n=16) received 0.5 ml of PVRV intramuscularly on days 0, 7 and 21, as conventional intramuscular regimen for pre-exposure prophylaxis. Rabies neutralizing antibody (Nab) titers were measured on days 0, 35, 365 and 379 (14 days after simulated post-exposure booster vaccination). All subjects from two groups had Nab titers ≥0.5 IU/ml on day 35. In addition, the difference between geometric mean titers for group A (4.51 IU/ml; range of Nab titers 1.69-13.0 IU/ml) and group B (6.74 IU/ml; range of Nab titers 2.20-14.23 IU/ml) on day 35 was not statistically significant (p>0.05). One year after pre-exposure vaccination, all subjects in both groups received simulated post-exposure booster vaccination with 0.1 ml of PVRV ID on days 0 and 3 (day 365 and day 368 after pre-exposure vaccination). After simulated booster vaccinations with 0.1 ml PVRV ID on days 0 and 3, all subjects in groups A (GMT 14.38 IU/ml; range 2.99-308.44 IU/ml) and in group B (GMT 14.06 IU/ml; range 3.12-62.09 IU/ml) had rabies Nab titers ≥0.5 IU/ml on day 14 post-booster (p>0.05). Mild local adverse events such as pain at injection site, pruritus and erythema were observed. Our study indicated that 2-site intradermal pre-exposure regimen on days 0 and 21 with 0.1 ml of cell-culture rabies vaccine is safe and immunogenic as the conventional intramuscular regimen.
    MeSH term(s) Adolescent ; Antibodies, Neutralizing/blood ; Antibodies, Viral/blood ; Drug-Related Side Effects and Adverse Reactions/epidemiology ; Drug-Related Side Effects and Adverse Reactions/pathology ; Female ; France ; Humans ; Injections, Intradermal ; Injections, Intramuscular ; Male ; Rabies/prevention & control ; Rabies Vaccines/administration & dosage ; Rabies Vaccines/adverse effects ; Rabies Vaccines/immunology ; Young Adult
    Chemical Substances Antibodies, Neutralizing ; Antibodies, Viral ; Rabies Vaccines
    Language English
    Publishing date 2013-03-25
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2013.01.035
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Six-year outcomes in broadly HLA-sensitized living donor transplant recipients desensitized with intravenous immunoglobulin and rituximab.

    Kahwaji, Joseph / Jordan, Stanley C / Najjar, Reiad / Wongsaroj, Patarapha / Choi, Jua / Peng, Alice / Villicana, Rafael / Vo, Ashley

    Transplant international : official journal of the European Society for Organ Transplantation

    2016  Volume 29, Issue 12, Page(s) 1276–1285

    Abstract: Desensitization with intravenous immunoglobulin (IVIG) and rituximab can improve transplantation rates in broadly sensitized kidney transplant recipients. However, long-term outcomes are lacking. Here we analyze long-term outcomes in living donor kidney ... ...

    Abstract Desensitization with intravenous immunoglobulin (IVIG) and rituximab can improve transplantation rates in broadly sensitized kidney transplant recipients. However, long-term outcomes are lacking. Here we analyze long-term outcomes in living donor kidney transplant recipients desensitized with this regimen and compare them to low-risk recipients. Living donor kidney transplants that took place between July 2006 and December 2010 were considered retrospectively. The primary end point of the study was death-censored allograft survival at last follow-up. Secondary end points included patient survival, incidence of rejection, glomerular filtration rate (GFR), and proteinuria. There were 66 sensitized and 111 low-risk patients included. Average follow-up was 68 months. There was no difference in long-term patient or graft survival. The rate of rejection was similar in the groups with more early rejection in the sensitized group and more late rejection in the low-risk group. There was more antibody-mediated rejection in the sensitized group. Estimated GFR was similar during the follow-up period. Risk factors for rejection included a positive cross-match (HR: 2.4 CI: 1.35-4.40) and age (HR: 0.97 CI: 0.95-0.99). Desensitization with IVIG and rituximab has good long-term results with graft outcomes similar to non-HLA-sensitized patients despite higher immunologic risk.
    MeSH term(s) Adult ; Desensitization, Immunologic ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Graft Rejection ; Graft Survival ; HLA Antigens/immunology ; Histocompatibility Testing ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Immunosuppression ; Immunosuppressive Agents/therapeutic use ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/surgery ; Kidney Transplantation/methods ; Living Donors ; Male ; Middle Aged ; Proteinuria/immunology ; Retrospective Studies ; Risk Factors ; Rituximab/therapeutic use ; Transplant Recipients ; Treatment Outcome
    Chemical Substances HLA Antigens ; Immunoglobulins, Intravenous ; Immunosuppressive Agents ; Rituximab (4F4X42SYQ6)
    Language English
    Publishing date 2016-12
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 639435-8
    ISSN 1432-2277 ; 0934-0874
    ISSN (online) 1432-2277
    ISSN 0934-0874
    DOI 10.1111/tri.12832
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    Zs.A 2358: Show issues Location:
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  4. Article: Rabies neutralizing antibody after 2 intradermal doses on days 0 and 21 for pre-exposure prophylaxis

    Wongsaroj, Patarapha / Pakamatz Khawplod / Piyada Udomchaisakul / Saowaluck Tepsumethanon / Terapong Tantawichien

    Vaccine. 2013 Mar. 25, v. 31, no. 13

    2013  

    Abstract: Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third ... ...

    Abstract Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third booster dose given 2–3 weeks later. Neutralizing antibody response is virtually 100%, and the individual remains sensitized indefinitely. Intradermal pre-exposure regimen for rabies prophylaxis is more economical compared with the conventional intramuscular regimen in terms of vaccine volume. However, both regimens require three clinic visits. In order to reduce non-medical expenses such as transportation to the clinics and to increase compliance, the immunogenicity and safety of two-visit intradermal regimen for pre-exposure prophylaxis were studied. Fifty-five healthy subjects aged between 18 and 24 years were enrolled and divided into two groups. Group A (n=39) received 0.1ml of purified Vero cell rabies vaccine (PVRV; Sanofi Pasteur, Lyon, France; Lot no. Z0996 with an antigenic value of 4.8IU/0.5ml vial) intradermally each at two sites on days 0 and 21. Group B (n=16) received 0.5ml of PVRV intramuscularly on days 0, 7 and 21, as conventional intramuscular regimen for pre-exposure prophylaxis. Rabies neutralizing antibody (Nab) titers were measured on days 0, 35, 365 and 379 (14 days after simulated post-exposure booster vaccination). All subjects from two groups had Nab titers ≥0.5IU/ml on day 35. In addition, the difference between geometric mean titers for group A (4.51IU/ml; range of Nab titers 1.69–13.0IU/ml) and group B (6.74IU/ml; range of Nab titers 2.20–14.23IU/ml) on day 35 was not statistically significant (p>0.05). One year after pre-exposure vaccination, all subjects in both groups received simulated post-exposure booster vaccination with 0.1ml of PVRV ID on days 0 and 3 (day 365 and day 368 after pre-exposure vaccination). After simulated booster vaccinations with 0.1ml PVRV ID on days 0 and 3, all subjects in groups A (GMT 14.38IU/ml; range 2.99–308.44IU/ml) and in group B (GMT 14.06IU/ml; range 3.12–62.09IU/ml) had rabies Nab titers ≥0.5IU/ml on day 14 post-booster (p>0.05). Mild local adverse events such as pain at injection site, pruritus and erythema were observed. Our study indicated that 2-site intradermal pre-exposure regimen on days 0 and 21 with 0.1ml of cell-culture rabies vaccine is safe and immunogenic as the conventional intramuscular regimen.
    Keywords cell culture ; compliance ; disease control ; erythema ; immune response ; injection site ; mammals ; neutralization ; neutralizing antibodies ; pain ; people ; pruritus ; rabies ; Rabies virus ; secondary immunization ; transportation ; vaccination ; vaccines ; World Health Organization ; France
    Language English
    Dates of publication 2013-0325
    Size p. 1748-1751.
    Publishing place Elsevier Ltd
    Document type Article
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2013.01.035
    Database NAL-Catalogue (AGRICOLA)

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    Zs.MO 458: Show issues

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  5. Article ; Online: Failure of rabies postexposure prophylaxis in patients presenting with unusual manifestations.

    Shantavasinkul, Prapimporn / Tantawichien, Terapong / Wacharapluesadee, Supaporn / Jeamanukoolkit, Anuruck / Udomchaisakul, Piyada / Chattranukulchai, Pairoj / Wongsaroj, Patarapha / Khawplod, Pakamatz / Wilde, Henry / Hemachudha, Thiravat

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2010  Volume 50, Issue 1, Page(s) 77–79

    Abstract: We report an atypical case of paralytic rabies presenting with trismus followed by limb weakness, areflexia, ophthalmoparesis, and bilateral ptosis. Atypical presentations and history of rabies postexposure prophylaxis led to delayed diagnosis. ... ...

    Abstract We report an atypical case of paralytic rabies presenting with trismus followed by limb weakness, areflexia, ophthalmoparesis, and bilateral ptosis. Atypical presentations and history of rabies postexposure prophylaxis led to delayed diagnosis. Nucleocapsid and glycoprotein genes of rabies viruses from the patient's and biting dog's brains were of identical sequences.
    MeSH term(s) Adult ; Fatal Outcome ; Humans ; Immunization, Passive/methods ; Male ; Post-Exposure Prophylaxis/methods ; Rabies/diagnosis ; Rabies/drug therapy ; Rabies/prevention & control ; Rabies/virology ; Rabies Vaccines/therapeutic use ; Treatment Outcome
    Chemical Substances Rabies Vaccines
    Language English
    Publishing date 2010-01-01
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1086/649873
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1505: Show issues Location:
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    Zs.MO 480: Show issues

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  6. Article: Rabies neutralizing antibody after 2 intradermal doses on days 0 and 21 for pre-exposure prophylaxis

    Wongsaroj, Patarapha / Udomchaisakul, Piyada / Tepsumethanon, Saowaluck / Khawplod, Pakamatz / Tantawichien, Terapong

    Vaccine

    Volume v. 31,, Issue no. 1

    Abstract: Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third ... ...

    Abstract Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third booster dose given 2–3 weeks later. Neutralizing antibody response is virtually 100%, and the individual remains sensitized indefinitely. Intradermal pre-exposure regimen for rabies prophylaxis is more economical compared with the conventional intramuscular regimen in terms of vaccine volume. However, both regimens require three clinic visits. In order to reduce non-medical expenses such as transportation to the clinics and to increase compliance, the immunogenicity and safety of two-visit intradermal regimen for pre-exposure prophylaxis were studied. Fifty-five healthy subjects aged between 18 and 24 years were enrolled and divided into two groups. Group A (n=39) received 0.1ml of purified Vero cell rabies vaccine (PVRV; Sanofi Pasteur, Lyon, France; Lot no. Z0996 with an antigenic value of 4.8IU/0.5ml vial) intradermally each at two sites on days 0 and 21. Group B (n=16) received 0.5ml of PVRV intramuscularly on days 0, 7 and 21, as conventional intramuscular regimen for pre-exposure prophylaxis. Rabies neutralizing antibody (Nab) titers were measured on days 0, 35, 365 and 379 (14 days after simulated post-exposure booster vaccination). All subjects from two groups had Nab titers ≥0.5IU/ml on day 35. In addition, the difference between geometric mean titers for group A (4.51IU/ml; range of Nab titers 1.69–13.0IU/ml) and group B (6.74IU/ml; range of Nab titers 2.20–14.23IU/ml) on day 35 was not statistically significant (p>0.05). One year after pre-exposure vaccination, all subjects in both groups received simulated post-exposure booster vaccination with 0.1ml of PVRV ID on days 0 and 3 (day 365 and day 368 after pre-exposure vaccination). After simulated booster vaccinations with 0.1ml PVRV ID on days 0 and 3, all subjects in groups A (GMT 14.38IU/ml; range 2.99–308.44IU/ml) and in group B (GMT 14.06IU/ml; range 3.12–62.09IU/ml) had rabies Nab titers ≥0.5IU/ml on day 14 post-booster (p>0.05). Mild local adverse events such as pain at injection site, pruritus and erythema were observed. Our study indicated that 2-site intradermal pre-exposure regimen on days 0 and 21 with 0.1ml of cell-culture rabies vaccine is safe and immunogenic as the conventional intramuscular regimen.
    Keywords cell culture ; mammals ; neutralizing antibodies ; vaccines ; neutralization ; pruritus ; pain ; transportation ; compliance ; disease control ; people ; vaccination ; erythema ; World Health Organization ; injection site ; Rabies virus ; immune response ; secondary immunization ; rabies
    Language English
    Document type Article
    ISSN 0264-410X
    Database AGRIS - International Information System for the Agricultural Sciences and Technology

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