Treatment of HD in transplant recipients

Leprosy Mailing List, January 23rd, 2009

Ref.: Treatment of HD in transplant recipients
From: Scollard, David M., Stryjewska B, Baton Rouge , LA , USA


Dear Salvatore,

In response to Dr. Ariyawansa, LML Jan 19 09:

We have experience with the treatment of HD in transplant recipients in the United States , in addition to those that have been reported in the literature, as well as with patients receiving immunosuppressive therapy for cancer.

There is no standard MDT protocol for such patients, but we recommend continuation of at least 2 drugs long after completing the standard MDT regimen. We have seen that HD treatment can be discontinued after a few more years of treatment and complete resolution of lesions, even while they are still immunosuppressed. To be cautious, however, we recommend that such patients should also be followed with annual checkups for several additional years.

Generally, we recommend that the management of Type 1or Type 2 reactions in such patients is similar to that in non-immunosuppressed patients. After the bacterial/ antigen load has been substantially reduced, the occurrence of ENL will decline. There is no simple protocol for this, either. Like Dr. Ariyawansa, we would be interested in others' experience with such patients.

David M. Scollard, M.D., Ph.D.
Barbara Stryjewska, M.D.
National Hansen's Disease Programs
1770 Physician Park Dr .
Baton Rouge , LA 70816
tel 225-756-3713
FAX 225-756-3819