Browsing by Author "Woodle, E Steve"

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    Basic and Clinical Research in Polyomavirus Nephropathy
    (Başkent Üniversitesi, 2004-06) Trofe, Jennifer; Gordon, Jennifer; Roy-Chaudhury, Prabir; Koralnik, Igor; Atwood, Walter; Eash, Sylvia; Alloway, Rita R; Khalili, Kamel; Alexander, J W; Woodle, E Steve
    Over the last decade, polyomavirus nephropathy (PVN) has emerged as an important cause of renal allograft dysfunction and graft loss. PVN occurs with a prevalence of 1%-8% in renal transplant recipients and is most commonly reported within the first 12 months posttransplant. The human polyomavirus, BK virus, is thought to be the primary etiologic agent of PVN. Risk factors for PVN are not well defined and are most likely a result of a complex interaction between multiple donor and recipient factors. Definitive diagnosis of PVN is made through histological assessment of a renal allograft biopsy. Recent studies have also evaluated noninvasive urine and serum markers for screening of BK virus replication and as adjunct tools in PVN diagnosis and monitoring. The principal treatment for PVN is immunosuppression reduction, but this must be balanced against the risks of rejection. If rejection occurs concurrently with PVN, a brief increase in immunosuppression to treat the rejection episode followed by a subsequent reduction in immunosuppression is recommended. No antiviral treatments for PVN have been approved by the Food and Drug Administration. Although the antiviral drug cidofovir has shown invitro activity against murine polyomaviruses, and has been effective in some patients, it is associated with significant nephrotoxicity. Small series of patients treated with leflunomide and intravenous immune globulin therapy for PVN have also recently been reported. Retransplantation after graft loss due to PVN is feasible, but experience is limited. Current research is focusing on identifying PVN risk factors, refining screening, diagnostic and monitoring methods, and developing therapy for prophylaxis and treatment of PVN with the goals of decreasing the prevalence of PVN and improving allograft outcomes in renal transplant recipients diagnosed with PVN. This review will present recent advances in basic and clinical research related to PVN and renal transplantation.
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    Can Immunonutrients Reduce Rejection Rates in African Americans?
    (Başkent Üniversitesi, 2005-12) Alexander, J Wesley; Goodman, Hope R; Alloway, Rita R; Woodle, E Steve
    Objectives: African-American kidney allograft recipients have higher rates of rejection than do white patients. This study was performed to determine whether the use of immunonutrients may reduce the incidence of rejection in African Americans. Materials and Methods: Two studies have been done at our institution that demonstrate that immunonutrients can reduce the incidence of rejection, calcineurin inhibitor toxicity, and cardiovascular risk factors. The data were analyzed to determine whether or not a preferential benefit exists for race. Results: Twenty-four African-American patients received supplements and 28 did not. One patient (4.2%) who had received supplements had a rejection episode in the first year compared with 7 patients (25%) who did not receive supplements (P < .011). This compares with our rejection rate of 25% (14/56) for African Americans on other protocols without concurrent immunonutrients (P < .003). Conclusions: Immunonutrients appear to have a preferential beneficial response in reducing rejection in African-American patients. A randomized, prospective, clinical trial is warranted to further elucidate these results.