Browsing by Author "El-Agroudy, Amgad E."

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Characteristics of Recipients Whose Kidney Allograft Has Functioned for More Than 20 Years
(Başkent Üniversitesi, 2008-06) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; Ismail, Amani M.; Abbass, Tarek M.; El-Dahshan, Khaled
Objectives: To study the characteristics of, and predictors for, survival in renal transplant recipients with an allograft functioning for more than 20 years. Materials and Methods: Of 144 renal transplants done between 1976 and 1985, 31 allografts were still functioning for more than 20 years (range, 21-28.5 years). The characteristics of the patients and determinants of the outcomes were obtained by reviewing the patients’ medical records. Results: Fourteen patients were treated with cyclosporine, while 17 patients had primary immunosuppression with azathioprine-based regimens. Episodes of acute rejection occurred in 17 patients (58%), 7 of these experienced 2 or more episodes. At most-recent follow-up, the mean serum creatinine level was 132 ± 44 µmol/L . Four patients were assessed by graft biopsy 15 or more years after the transplant, revealing 2 cases of mild glomerulosclerosis and 2 cases of moderate chronic allograft nephropathy. The most common complication was hypertension (54%). The independent determinants of long-term graft survival were donor age and source, hypertension both before and after renal transplant, and histopathological findings of chronic allograft nephropathy. Conclusions: Renal transplant offers a near-normal life to patients with end-stage renal disease soon after transplant and for upwards of 20 years and more. We found no significant benefit to cyclosporine-based immunosuppression on long-term graft survival.
Cyclosporine Therapeutic Monitoring With Cmax in Kidney Transplant Recipients: Does it Fit for All Populations?
(Başkent Üniversitesi, 2008-12) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Nassar, Mohamed; Ismail, Amani M.
Background: We sought to assess whether the single cyclosporine concentration taken 2 hours after administration (C2) is a good parameter to predict a drug’s maximal concentration (Cmax) value in Egyptian kidney transplant recipients Materials and Methods: Fifty stable Egyptian kidney transplant recipients with a previously diagnosed schistosomal infection were compared with 50 Egyptian kidney transplant recipients without a schistosomal infection regarding cyclosporine concentrations at time 0 (trough), and then at 1.5, 2, 2.5, 3, and 3.5 hours after a dose of cyclosporine. We used a linear regression analysis to assess any statistically significant differences between the different cyclosporine time concentrations and drug dosages Results: Patients in the schistosomal group had significantly lower C2 levels (511 ± 118 nmol/L) compared with those in the nonschistosomal (control) group (669 ± 213 nmol/L) (P < .05), whereas the C2.5 level was significantly higher (730 ± 215 and 527 ± 129 nmol/L, respectively; P < .05). A significant linear regression relation was determined for only C2.5 in the schistosomal group with both morning cyclosporine dose and cyclosporine dose expressed as mg/kg/d (P = .0123, r = .573018). Conclusions: Egyptian patients have special characteristics with regard to drug absorption and metabolism, mostly owing to schistosomal infection, and they may need the use of C2.5 to monitor cyclosporine. If confirmed by subsequent, larger studies, our findings may have a significant effect on our understanding and management of cyclosporine immunosuppression in clinical renal transplants with persons of different ethnicities.
Immunosuppression Modifications and Graft Outcome in Patients With Chronic Allograft Nephropathy
(Başkent Üniversitesi, 2008-09) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; El-Baz, Mahmoud; Ismail, Amani M.; Mahmoud, Khaled; El-Dahshan, Khaled
Objectives: This retrospective study was done to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy Materials and Methods: One hundred seventy-four cyclosporine-treated renal transplant recipients were studied. Patients were included if they had biopsy-proven chronic allograft nephropathy (mild to moderate) with a serum creatinine level of 300 µmol/L or less. The treatments groups were (1) mycofenolate mofetil and reduced-dosage cyclosporine (group MMF/CsA; n=132) and (2) azathioprine and reduced-dosage tacrolimus (group Aza/Tac; n=42). Patient records were checked for graft function, survival, and comorbidities after conversion. Results: Mean follow-up before conversion was 52.2 ± 31.1 and 47.9 ± 27.4 month in groups MMF/CsA and Aza/Tac, respectively. There was a significant deterioration of graft function in group Aza/Tac after 5 years (P < .05). Ten-year actuarial graft survival in group MMF/CsA was 38%; in group Aza/Tac it was 19% (P = .04). Nine patients started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P = .05) but a significantly higher incidence of diabetes mellitus (P = .04). There were no significant changes or differences in blood pressure between the groups. Conclusions: Our results suggest that in patients with chronic allograft nephropathy and deteriorating allograft function, cyclosporine minimization and addition of mycofenolate mofetil achieve favorable effects in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.