Browsing by Author "Ghoneim, Mohamed Ahmed"

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Rescue Immunosuppressive Therapies in Living-Related Renal Allotransplant: A Long-term Prospective Randomized Evaluation
(Başkent Üniversitesi, 2008-03) Bakr, Mohemed Adel; Ghoneim, Mohamed Ahmed; El-Dein, Ahmed Bayomi Shehab; Baz, Mahmoud El; Ismael, Amani Mostafa; Gheith, Osama Ashry
Objectives: The majority of our patients are maintained on prednisolone, cyclosporine, and azathioprine as primary immunosuppression. In the presence of repeated episodes of acute rejection, this maintenance immunosuppressive regimen is increased by replacing cyclosporine with tacrolimus or azathioprine with mycophenolate mofetil. To the best of our knowledge, there are no available data among living-related renal allotransplants that evaluate the long-term efficacy and safety of these rescue immunosuppressive therapies. Therefore, we sought to evaluate the long-term efficacy and safety of rescue immunosuppressive therapies among living-related renal allotransplant recipients. Materials and Methods: We reviewed the long-term follow-up data of 212 renal transplant recipients at the Urology and Nephrology Center Mansoura University in Mansoura, Egypt, who had been maintained on a primary immunosuppressive protocol that included prednisolone, cyclosporine, and azathioprine. Patients were randomized at a ratio of 1:2 to receive more-intensive maintenance immunosuppression by replacing cyclosporine with tacrolimus in 65 patients (group TAC) and replacing azathioprine with mycophenolate mofetil in 147 patients (group MMF). Results: We found no statistically significant difference between the 2 groups regarding rejection-free patients or those who experienced 1 or more episodes of acute rejection (P > .5). In group TAC and group MMF, graft survival rates were 87.3% and 96.3% at 2 years and 78.7% and 80% at 5 years, respectively (P = .07). The corresponding patient survival rates were 98.4% and 98.5% at 1 year, 98.4% and 97.7% at 2 years, and 94.4% and 94.4% at 5 years, respectively (P = .65%). There were more patients with diabetes and serious bacterial infections in group TAC than there were in group MMF (P = .001 and .04, respectively). Conclusions: Conversion from cyclosporine to tacrolimus or from azathioprine to mycophenolate mofetil is a safe, equipotent rescue especially with repeated acute rejections. However, mycophenolate mofetil rescue therapy was more beneficial regarding graft survival.
Risk Factors for Steroid-Resistant T-Cell–Mediated Acute Cellular Rejection and Their Effect on Kidney Graft and Patient Outcome
(Başkent Üniversitesi, 2012-10) Awadain, Waleed; Fouda, Ashraf; el-Agroudy, Amjad; El-Deeb, Salem; Hassan, Nabil; Hassan, Ahmed; Gheith, Osama; Ghoneim, Mohamed Ahmed
Objectives: Acute rejection in renal transplant is considered a risk factor for short-term and long-term allograft survival. The expected reversal rate for the first acute cellular rejection, by steroid pulse, ranges between 60% and 100%, and lack of improvement within 1 week of treatment is defined as steroid-resistant rejection. This work sought to evaluate factors that lead to steroid-resistant acute cellular rejection among patients with first live-donor renal allotransplant and its effect on graft and patient survival. Materials and Methods: Patients with an improvement in serum creatinine levels were considered controls (group 1; n=100); while the others were considered an early steroid-resistant group (group 2; n=99). Both groups were matched demographically. Results: Patients with a target cyclosporine level below accepted therapeutic levels were significantly higher in group 2 (P = .02). We found no significant differences between the groups regarding posttransplant complications (P > .05). Mean hospital stay was longer in group 2 (P = .021). Living patients with functioning graft were more prevalent in group 1, while those alive on dialysis were more prevalent in group 2. The groups were comparable regarding long-term patient and graft survival despite significantly lower creatinine values in patients of group 1 at 6 months’ follow-up (P ≤ .001). Conclusions: Prebiopsy low cyclosporine trough levels and associated chronic changes among patients who were maintained on calcineurin inhibitor-based regimens represented the most-important risk factors for the early steroid-resistant group. Rescue therapies improve short-term graft outcome; however, they did not affect either patient or long-term graft survival after 5 years’ follow-up.
Value of Donor-specific Antibody Detection in First-Graft Renal Transplant Recipients with a Negative Complement-dependent Cytotoxic Crossmatch
(Başkent Üniversitesi, 2009-06) Kamal, Mohamed Mohamed; Ghoneim, Mohamed Ahmed; Mahmoud, Khaled Mohamed; Ismail, Amani Mostafa; Sheashaa, Hussein Attia; Gheith, Osama Ashry
Objectives: The clinical significance of pretransplant donor specific antihuman leukocyte antigen antibodies that occur despite negative cytotoxicity crossmatches is still unclear. In this study, we assessed the impact of those antibodies on the outcome of renal transplants. Materials and Methods: Our study subjects consisted of 153 living-donor kidney transplant recipients whose pretransplant sera were available. All subjects had a negative complement-dependent cytotoxic crossmatch and were retrospectively evaluated for antihuman leukocyte antigen antibodies and their donor specificities by means of LABScan 100 Flow analyzer (Luminex Corporation, Texas, USA). The follow-up data of all subjects were reviewed. Results: Antihuman leukocyte antigen antibodies were detected in 49 patients, donor nonspecific antihuman leukocyte antigen antibodies were found in 33, and donor specific antihuman leukocyte antigen antibodies were identified in 16. There was a trend toward more acute rejection in the patients with antihuman leukocyte antigen antibodies (22%) than in those without antihuman leukocyte antigen antibodies (17%), but that difference had no statistical significance (P = .378). Patients with donor specific antihuman leukocyte antigen antibodies had a significantly higher incidence of acute cellular rejection (19% vs. 6%, respectively) and vascular rejection (25% vs. 6%, respectively) than did patients with donor nonspecific antihuman leukocyte antigen antibodies (P = .04). Conclusions: Our results suggest that there is a higher incidence of acute rejection in patients with donor specific antihuman leukocyte antigen antibodies and a negative complement-dependent cytotoxic crossmatch; however, those factors had no statistically significant impact on patient or graft survival.