Daclizumab reduces the frequency and severity of heart rejection during the induction period, and some recipients of lung transplants develop deadly increases in blood ammonia levels, according to two recently published studies.
* Ainat Beniaminovitz, MD, and colleagues at Columbia-Presbyterian Medical Center in New York reported on March 2 in The New England Journal of Medicine that induction therapy with daclizumab safely reduced the frequency and severity of heart rejection in a study of 55 patients (2000;342:613-619). They gave immunossuppressive therapy including cyclosporine, mycophenolate mofetil, and prednisone to 27 patients after heart transplantation, and they added daclizumab to the regimen for the other 28 patients. Acute rejection developed in 17 of the 27 patients (63%) in the control group and in 5 of the 28 patients (18%) receiving daclizumab. There was no difference between the two groups in the incidence of infection or cancer during the follow-up period.
* Gary R. Lichtenstein, MD, and colleagues at the University of Pennsylvania Medical Center in Philadelphia reported on February 15 in Annals of Internal Medicine that hyperammonemia is a potentially fatal adverse event following lung transplantation (2000;132:283-287). Six of 145 patients the authors studied developed hyperammonemia within 26 days of transplantation. A total of 17% of the patients without hyperammonemia died within the first month of lung transplantation, and five of the six patients with hyperammonemia died within 34 days of surgery. In the sixth patient, the condition was recognized early, and the patient survived after receiving hemodialysis and medications to lower her blood ammonia level.
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