Başkent Üniversitesi Makaleler

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Author: search.filters.author.El-Agroudy, Amgad E.Subject: search.filters.subject.Kidney transplant

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    Pretransplant Detection of Anti-Endothelial Cell Antibodies Could Predict Renal Allograft Outcome
    (Başkent Üniversitesi, 2009-06) Ismail, Amani M.; Mansour, Merveet A.; El-Agroudy, Amgad E.; Badawi, Rasha M.
    Objectives: Endothelial cells that line the vasculature are targets for immune-mediated assault through anti-endothelial cell antibodies. The aim of this work was to detect anti-endothelial cell antibodies and describe the association with kidney allograft rejection and graft survival. Materials and Methods: The study included 60 patients who had undergone live-donor kidney transplant. Inclusion criteria included first kidney transplant, panel reactive antibody titer less than 5%, cause of end-stage renal disease not including vasculitis or systemic lupus erythematosus, and age > 18 years. Patients were classified into 2 groups: 40 patients with anti-endothelial cell antibodies (referred to as the positive group) and 20 patients without anti-endothelial cell antibodies (referred to as the negative group). Results: Serum creatinine level was higher in the positive group at 1 month and 1 year (P = .04). The occurrence of acute rejection was not significantly different in the positive group (18 patients [45.0%]) compared with the negative group (5 patients [25.0%], P = .5). However, the number of acute rejection episodes was higher in the positive group (22 episodes) compared with the negative group (6 episodes, P = .04). In patients who experienced acute rejection, chronic nephropathy was more frequent in the positive group (6 of 18 patients, 33.3%) compared with the negative group (1 of 5 patients, 20.0%) (P = .03). One-year and 5-year graft survival was 91% and 79% in the positive group, and 100% and 91% in the negative group, respectively. The difference at 5 years was significant (P = .04). Conclusions: The presence of anti-endothelial cell antibodies was associated with a higher number of acute rejection episodes and lower long-term graft survival in kidney transplants. It could be an informative test to identify patients at high risk for immunological graft loss.
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    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.