Başkent Üniversitesi Dergileri

Permanent URI for this collectionhttps://hdl.handle.net/11727/13093

Browse

Now showing 1 - 20 of 109

Acute Gastric Variceal Bleeding During Orthotopic Liver Transplant
(Başkent Üniversitesi, 2010-09) Shapiro, David P.; Aniskevich, Stephen; Shine, Timothy S.
We present a case of intraoperative gastric variceal bleeding during liver transplant. After an uneventful induction and surgical dissection, our patient developed hemodynamic instability during the anhepatic phase. We believe that an increase in portal pressures, owing to clamping of the portal system, led to spontaneous variceal rupture; however, placement of an oral gastric tube or transesophageal echocardiography probe may have contributed to this also. After intraoperative banding, the patient was stabilized and surgery proceeded uneventfully. The patient had no long-term sequelae. Anesthesiologists involved in the care of patients with end-stage liver disease should be aware of this infrequent intraoperative complication and be prepared to treat it appropriately.
Switch From Beta-Thalassemia Major to Beta-Thalassemia Intermedia After Secondary Graft Failure
(Başkent Üniversitesi, 2010-09) Mellouli, Fethi; Béjaoui, Mohamed; Othman, Tarek Ben; Hmida, Slama; Ladeb, Saloua; Abdelkefi, Abderrahman; Torjmen, Lamia; Lakhal, Amel; Ksouri, Habib
In this article, we report a switch of β-thalassemia major to intermedia β-thalassemia after allogeneic bone marrow transplant of a 6-year-old girl from her HLA-matched brother. After stable mixed chimerism, the patient had a secondary graft rejection and returned to total recipient chimerism as assessed by real-time polymerase chain reaction assay. Nonetheless, with a medium hemoglobin rate of 89 g/L, she did not need further transfusions for 60 months after rejection. We conclude that complete loss of donor cells after bone marrow transplant for β-thalassemia major is compatible with a stable clinical state, probably due to a γ-globin gene demethylation that enhances γ-globin chain production and further allows constitution of a fetal hemoglobin rate compatible with free transfusion survival.
Liver Transplant in a Patient with Active Pulmonary Tuberculosis
(Başkent Üniversitesi, 2010-09) Yankol, Yucel; Kalayoglu, Munci; Acarli, Koray; Alan, Servet; Kanmaz, Turan; Kocak, Burak; Topaloglu, Serdar
Objectives: Immunosuppressive treatment generally increases the severity of active infection. Therefore, liver transplant is contraindicated in the presence of active tuberculosis. Despite the importance of supportive treatment, liver transplant is the only treatment for fulminant hepatic failure. Materials and Methods: We report a case of successful liver transplant for fulminant hepatic failure in the presence of active tuberculosis infection. Results: We immediately performed a liver transplant from a live donor. The patient received low-dose immunosuppressive treatment and antituberculosis treatment. The patient was cured and discharged on the 25th day after surgery. We stopped antituberculosis treatment 10 months after discharge. The patient has been followed for 32 months after transplant with normal graft function and has been free of pulmonary tuberculosis infection. Conclusions: Liver transplant can be performed in cirrhotic patients with active infections, such as tuberculosis, as a life-saving procedure.
Low Prevalence of BK Virus Nephropathy on Nonprotocol Renal Biopsies in Iranian Kidney Transplant Recipients: One Center’s Experience and Review of the Literature
(Başkent Üniversitesi, 2010-12) Soleymanian, Tayebeh; Najafi, Iraj; Hakemi, Monirsadat; Saddadi, Fereshteh; Amin, Manoochehr; Naderi, Gholamhosein; Ganji, Mohammad Reza; Sotoodeh, Masoud; Rasulzadegan, Mohammad Hosein
Background: BK virus-associated nephropathy in renal transplant recipients has been increasing in frequency in recent years. This rise is probably because of widespread use of highly potent immunosuppressive regimens, and increased immunosuppression load leads to inability of the recipients to increase a successful antiviral immune response. The incidence of BK virus-associated nephropathy in different reports is between 1% and 10%, with an allograft loss in significant numbers of patients, especially when timely diagnosis and treatment is not restored. We report our experience on BK virus nephropathy in our institute. Materials and Methods: All renal transplant biopsies performed at our center between 2001 and 2006 were immunohistochemically screened for the presence of PV-specific protein (SV40 Ag). The histologic diagnosis of BK virus-associated nephropathy was made upon the observation of morphologic changes in tubular epithelium and confirmation with immunohistochemical staining. We reviewed the clinical records of the subjects for demographic, clinical, and laboratory data. Results: BK virus nephropathy was found in 0.93% of all investigated allograft biopsies (1/108) and in 1.04% of all recipients (1/96; mean age of recipients, 36.48 ±14.10 years; age range, 13-74 years); 54 of them were male (57%). Type of kidney transplant was living-unrelated donor 76 (79%), living-related donor 13 (14%), and deceased donor 7. Seventeen patients (18%) were transplanted for a second time. Immunosuppressive drugs in 87 of recipients (90%) were cyclosporine, mycophenolate mofetil, and prednisolone. Our patient who developed BK virus-associated nephropathy 9 months after transplant was a 37-year-old man on prednisone, cyclosporine, and azathioprine immunosuppresion. He lost his graft 4 months after diagnosis. Conclusions: Although BK virus nephropathy after renal transplant is uncommon, it is a serious complication causing loss of the allograft. It should be included in the clinical differential diagnosis of transplant dysfunction.
Swine H1N1 Infection in a Renal Transplant Recipient
(Başkent Üniversitesi, 2010-12) Ozkan, Gulsum; Kazaz, Nazli; Cansiz, Muammer; Oztuna, Funda; Kaynar, Kubra; Ulusoy, Sukru
Influenza pandemics have been observed in several periods throughout history. The first influenza pandemic of the 21st century began in Mexico in 2009 and has spread rapidly all over the world. Swine H1N1 has been officially declared a pandemic by the World Health Organization in June 2009. As has been observed in previous pandemics, pregnant women, adolescents, and immunosuppressed individuals are affected more severely in this pandemic. Despite several reports about the pandemic, there have not been any reports of swine H1N1 infection in individuals who underwent renal transplant. The aim of the current study was to present oseltamivir therapy in a swine H1N1-infected patient who underwent renal transplant 10 months earlier, and was thus under immunosuppressive treatment. To the best of our knowledge, this is the first case report of a swine H1N1 infection in a renal transplant recipient.
Cutaneous Metastasis of Pancreatic Adenocarcinoma After Kidney Transplant: A Case Report and Review of the Literature
(Başkent Üniversitesi, 2010-12) Pontinen, Thomas; Ortiz, Jorge; Zaki, Radi; Kung, Shiang Cheng; Chewaproug, Daranee; Khanmoradi, Kamran; Varadi, Gabor; Melin, Alyson
Objectives: Pancreatic cancer is one of the most lethal human cancers. Each year in the United States, about 42 470 individuals are diagnosed with this condition, and 35 240 die, despite advances in imaging, medical treatment, and surgical intervention. Often, 80% to 90% of pancreatic cancers are diagnosed at the locally advanced or metastatic stage. However, cutaneous metastases originating from pancreatic cancer are rare. If cutaneous metastases do indeed occur, it is often near the umbilicus, known as the Sister Mary Joseph’s nodule. Nonumblical cutaneous metastases are rare, with only several cases reported, but none regarding lesions after organ transplant. We introduce the first reported case of a cutaneous metastatic lesion of pancreatic adenocarcinoma after the transplant of an organ. We also performed a literature review and an analysis of reported cases of nonumblical cutaneous metastases of pancreatic adenocarcinoma. Materials and Methods: We performed a MEDLINE and PubMed search of reported nonumblical cutaneous metastases of pancreatic adenocarcinoma since 1980 after a literature review and analysis. Results: Our case involved a 76-year-old woman who developed cutaneous pancreatic adenocarcinoma metastases in her surgical wound 2 years after a bilateral kidney transplant. This is the first case of pancreatic adenocarcinoma cutaneous metastases after an organ transplant. Conclusions: The death rate from cancer has increased as the population has aged. This also holds true for transplant recipients. Some believe that cancer will soon surpass cardiovascular disease as the major cause of mortality after transplant. Therefore, it is incumbent upon us to appropriately screen patients with age-appropriate evidence-based examinations. Additionally, those patients with suspicious presentations should be judiciously evaluated to discover a cure for cancer as quickly as possible.
The Role of Generics in Kidney Transplant: Mycophenolate Mofetil 500 Versus Mycophenolate: 2-Year Results
(Başkent Üniversitesi, 2010-12) Abdallah, Taieb Ben; Kheder, Adel; Abderrahim, Ezzeddine; Bacha, Med Mongi; Mhibik, Sonia; Karoui, Cyrine; Helal, Imed; Cherif, Mejda; Ounissi, Mondher
Objectives: The introduction of mycophenolate mofetil has proven itself effective in preventing acute rejection in renal transplant recipients. However, this cost is ineffective with countries with a limited income. This study sought to compare the clinical and therapeutic profiles of a generic formulation with mycophenolate mofetil. Materials and Methods: This 2-year, single-center, prospective, randomized, open-label study investigated the efficacy and safety of a new mycophenolate mofetil generic formulation compared with mycophenolate renal transplant recipients. The study divided patients in 2 groups: 8 patients in G1 received mycophenolate mofetil 500 and 10 patients in G2 received mycophenolate. Their demographics were similar: mean age, 36.6±7.1 and 33.3±11.7 years; sex M/F: 2/6 and 5/5; mean donor age, 42.6±11.1 and 43.6±13.9 years; mean HLA mismatches, 2.7±1.2 and 3.3±1.5; deceased donors, 25% and 20%; and warm ischemia time, 40.2±11.9 and 38.7±10.5 minutes. All patients received 2 g daily of mycophenolate mofetil 500 or mycophenolate with initial dosage of 0.1 mg/kg/d and prednisolone. Results: One patient of 7 in the mycophenolate mofetil group and 4 of 6 in the mycophenolate group had 1 episode of acute tubular necrosis, and 1 patient in each group had an acute rejection with no significant differences between the groups. The area under the curve of the mycophenolate mofetil did not show any difference between the 2 groups. The values of serum creatinine were also comparable. Patient survival rate at 6, 12, and 24 months was 100% in the groups. The frequencies of digestive and hematologic adverse effects were comparable in the groups with no significant differences. Conclusions: Use of mycophenolate mofetil 500 provided safe and effective immunosuppressive therapy compared with mycophenolate. However, as the duration of the study was short, these results need to be confirmed in a long-term study.
Sorafenib As Adjuvant Therapy For High-Risk Hepatocellular Carcinoma in Liver Transplant Recipients: Feasibility and Efficacy
(Başkent Üniversitesi, 2010-12) Saab, Sammy; Busuttil, Ronald W.; Finn, Richard S.; McTigue, Michael
Objectives: Liver transplant can be a definitive treatment for hepatocellular carcinoma. However, recurrence limits long-term survival. Sorafenib is the first agent to improve survival for patients with advanced hepatocellular carcinoma. Materials and Methods: A retrospective, case- control match analysis was performed, along with assessment of safety and tolerability. The endpoints of the study were recurrence incidence, episodes of rejection, and disease-free overall survival. Eight patients who underwent liver transplant for hepatocellular carcinoma between May 2007 and April 2009, and tolerated adjuvant therapy with sorafenib were matched with patients who did not receive sorafenib according to age, sex, year of transplant, tumor burden, and presence of vascular invasion. Results: During follow-up, there were no episodes of rejection in either group. Eight patients were able to tolerate a predetermined duration of therapy. During a mean (± standard deviation [SD]) follow-up of 17.75 ± 6.26 months, 1 of 8 patients (12.5%) treated with sorafenib developed hepatocellular carcinoma recurrence. During a mean (± SD) follow-up of 31.63 months (± 22.30 months), 4 of 8 matched controls (50.0%) developed hepatocellular carcinoma recurrence. Disease-free 1-year survival for sorafenib and control group was 85.7% and 57.1%. Overall, 1-year survival for sorafenib and control group was 87.5% and 62.5%. Conclusions: Our study demonstrates the safety and potential benefit of sorafenib in reducing the incidence of hepatocellular carcinoma recurrence and in extending disease-free and overall survival for high-risk liver transplant recipients. A prospective trial is needed to fully assess the role sorafenib as prophylaxis against hepatocellular carcinoma recurrence.
Reasons of Preclusion of Living-Related Donor Renal Transplants in Oman
(Başkent Üniversitesi, 2010-12) Mohsin, Nabil; Metry, Abdelmessih
Objectives: Renal transplant, especially from genetically related living-donors, is associated with excellent results. The security and free will of the donor are of paramount importance. A significant percentage of such transplants are not accomplished for both medical and nonmedical reasons. Materials and Methods: We looked retrospectively into the causes of nonaccomplishment of renal transplants from living-related donor transplants at our center from January 2006 through June 2008. Results: During this period, 69 and 99 potential renal transplant recipient and donors were investigated. Transplants could be performed only in 35 patients (51%). About 59% of the donors were rejected or declined. Reasons for exclusion were immunologic in 14 donors (14%). Medical and nonmedical conditions precluded donation in 35 donors (35%) and 12 donors (12%). Medical reasons consisted mainly of undiagnosed hypertension, obesity, diabetes mellitus, and renal anomalies. In the recipients, the major reason was option for transplant tourism, occurred in 11 cases (16%). Conclusions: A substantial number of investigated recipients and donors for living-related transplant are not accomplished. The major reasons are medical for the donor and transplant tourism for the recipient.
Vitamin D Receptor Polymorphisms in Liver Transplant Recipients
(Başkent Üniversitesi, 2010-12) Azarpira, Negar; Daraie, Masumeh; Geramizadeh, Bita; Salahi, Heshmatolah
Objectives: Liver transplant is an established treatment for end-stage liver failure. Vitamin D has been shown to exert multiple immunomodulatory effects, which act through its own receptor (vitamin D receptor). In the present study, the association between Iranian patients with liver transplant and the polymorphism of vitamin D receptor FokI T>C (rs10735810) was investigated. Materials and Methods: The candidate gene locus was genotyped in 51 liver transplant recipients, and the association of each genotype with allograft acute rejection was evaluated. Results: In this study, we found no evidence to suggest that vitamin D receptor FokI polymorphism determines the incidence of acute rejection after liver transplant. The distribution of alleles was not different according to the underlying liver disease. Conclusions: Larger epidemiologic studies are needed to elucidate the importance of vitamin D receptor gene polymorphism in transplant recipients.
Extracorporeal Membrane Oxygenation Bridging to Lung Transplant Complicated by Heparin-Induced Thrombocytopenia
(Başkent Üniversitesi, 2010-12) Dolch, Michael E.; Munich Lung Transplant Group; Irlbeck, Michael; Behr, Jürgen; Beiras-Fernandez, Andres; Überfuhr, Peter A.; Hatz, Rudolf; Frey, Lorenz
In patients with acute respiratory failure and life-threatening impairment of pulmonary gas exchange, venovenous extracorporeal membrane oxygenation offers further therapeutic options. During extracorporeal membrane oxygenation treatment, systemic anticoagulation is usually achieved by heparin administration, which exposes patients to the risk of heparin-induced thrombocytopenia type II. We present a patient with acute respiratory distress syndrome on venovenous extracorporeal membrane oxygenation who experienced heparin-induced thrombocytopenia type II and in whom anticoagulation was continued with argatroban. Because respiratory failure did not resolve, the patient was bridged to lung transplant with extracorporeal membrane oxygenation. Argatroban anticoagulation was safely used until lung transplant (on day 114 after extracorporeal membrane oxygenation initiation) and after transplant in the presence of hepatic failure.
Yönetim Araştırma Dergisi
(2011) Başkent Üniversitesi
Bellek
(2011) Başkent Üniversitesi
Treatment of Hepatitis C-Virus–Reinfection After Liver Transplant with Silibinin in Nonresponders to Pegylated Interferon-based Therapy
(Başkent Üniversitesi, 2011-02) Eurich, Dennis; Neumann, Ulf; Neuhaus, Peter; Neuhaus, Ruth; Biermer, Michael; Boas-Knoop, Sabine; Berg, Thomas; Bahra, Marcus
Objectives: Hepatitis C-virus–persistence after orthotopic liver transplant leads to reduced patient and graft survival compared to other indications. Current interferon-based antiviral therapy of hepatitis C-virus–infection posttransplant provides a sustained response rate of 30% to 40%. This study, performed in an hepatitis C-virus-reinfected liver transplant population, examines the antiviral effect of intravenously administered silibinin, recently reported to exhibit strong antiviral properties in the natural setting of hepatitis C-virus–related liver disease. Patients and Methods: Four patients after orthotopic liver transplant with hepatitis C-virus–recurrence, previously having not responded to peg-interferon-ribavirin therapy, were treated with intravenous silibinin and additionally, after the 10th day, with standard interferon-based therapy. Aminotransferases and hepatitis C-virus–RNA were measured during treatment. Results: All patients demonstrated normalization of liver enzymes and significant decline of hepatitis Cvirus–RNA measured at day 10 (mean 2.8 logarithmic levels: 1.7, 2.3, 2.9, and 4.3) during silibinin monotherapy. One patient cleared hepatitis C-virus–RNA under silibinin monotherapy and another patient eliminated hepatitis C virus under subsequent interferon-based therapy. No adverse effects were observed during silibinin application. Conclusions: Intravenous silibinin is an effective therapeutic approach for treating hepatitis C-virus–reinfection after liver transplant and should be evaluated further.
Comparison of Intima-media Thickness of the Common Carotid Artery in Dialysis and Kidney Transplant Recipient Patients
(Başkent Üniversitesi, 2011-02) Saedi, Daryoush; Khak, Mohammad; Saffari, Samira; Narooinejad, Minoo
Objectives: Cardiovascular events are a major cause of mortality and morbidity of chronic renal failure causing 40% to 50% of all deaths in these patients. The intima-media thickness of the common carotid artery is used to predict atherosclerosis. To assess the effect of early renal transplant on the vascular atherosclerosis, we compared the common carotid intima-media thickness between dialysis and transplant patients. Materials and Methods: In a cross-sectional study, 75 kidney transplant recipients and 75 dialysis patients were assessed in a subspecialized renal and urethral diseases center from April 2008 to March 2010. Demographic characteristics, smoking history, and information on comorbid and kidney diseases were recorded through a checklist. The common carotid intima-media thickness was measured using ultrasonography. Spearman's rank correlation coefficient was used to find any correlation between duration of dialysis and intima-media thickness. Results: In all, 79 patients (53%) were male. The mean age (SD) of dialysis and transplant patients was 55 ± 11 and 51 ± 15 years. The 2 groups had no statistically significant sex or age differences (P > .05). Considering all patients, 54 (36%) had a history of hypertension, 30 (20%) had a history of diabetes mellitus, 15 (10%) had a history of hyperlipidemia, and 41 (27.3%) had a history of smoking. There were no significant differences between the 2 groups when these variables were considered (P > .05). The mean thickness of the common carotid intima-media was 1.2 mm (0.35 mm) in the dialysis patients, which was higher compared with 0.73 mm (0.18 mm) in the transplanted group (P < .001). There was a significant correlation between duration of dialysis and intima-media thickness (P < .001, r=0.882) in the dialysis group. Conclusions: Common carotid intima-media thickness in dialysis patients is significantly higher compared with kidney transplant recipients. Carotid intima-media thickness increases by prolongation of dialysis duration.
Meningoencephalitis With Aspergillus and Mycobacterium Tuberculosis in a Renal Transplant Recipient
(Başkent Üniversitesi, 2011-02) Petramfar, Peyman; Rahmati, Hashem; Davarpanah, Mohammad Ali; Ashraf, Mohammad Hosein; Yousefian, Marzieh
Objectives: We report a case of central nervous system coinfection with 2 types of opportunistic organisms—Aspergillus and Mycobacterium tuberculosis—in a 33-year-old woman who underwent a renal transplant. Materials and Methods: She developed a high-grade fever and right-sided weakness 1 month after the transplant while on mycophenolate mofetil, prednisolone, and cyclosporine. Results: Brain magnetic resonance imaging revealed multiple mass lesions with peripheral ring enhancement. Colony-stimulating factor polymerase chain reaction was positive for Aspergillus and Mycobacterium tuberculosis. Conclusions: Broad-spectrum antibiotics, antituberculous agents, and amphotericin were started. Unfortunately, the woman’s condition deteriorated, and she died 2 weeks after admission to the hospital.
Analysis of Right Lobe Living-Liver Donor Complications: A Single Center Experience
(Başkent Üniversitesi, 2011-02) Yaprak, Onur; Tokat, Yaman; Yuzer, Yildiray; Tabendeh, Babek; Demirbas, B. Tolga; Dayangac, Murat
Objectives: Living-donor liver transplant provides an alternative source of organ to patients with end-stage liver disease. This study sought to determine and classify the donor morbidities after right lobe donor hepatectomy in a single center. Materials and Methods: One-hundred eighty-one right lobe living-donor hepatectomy were performed in our center between January 2004 and December 2009. Of the 181 donors, 104 donors were men and 77 donors were women. Mean age of the donors was 38 years (range, 18-63 years). The mean follow-up was 33.3 months (range, 3-66 months). Complications after the operation were stratified according to the Clavien classification. Results: Eighty-one complications occurred in 73 of the 181 donors (40.3%). The most common complication was wound infection, which was seen in 14 of 181 donors (7.7%). Biliary complications were seen in 4.4% of donors. There was no postoperative mortality. Also, grade 4 complications, which are life-threatening, did not occur. Blood transfusion were not required during the operation. The incidence of reoperation was 1.6% in all donors. Conclusions: Living-donor liver transplant ensures a new graft to patients with end-stage liver disease. Donor morbidity is one of the realities of the donor hepatectomy procedure. Because the donors are healthy individuals, the aim of the process must be to eliminate the donor mortality while decreasing the complication rates.
Retroperitoneoscopic Live-donor Right Nephrectomy: A Chinese Single Center
(Başkent Üniversitesi, 2011-02) Ma, Lulin; Chen, Yingtao; Tang, Wenhao; Tian, Xiaojun; Wang, Guoliang; Zhao, Lei; Hou, Xiaofei; Huang, Yi; Li, Gang
Objectives: To evaluate our right-retroperitoneoscopic live-donor nephrectomy by comparing the left side with the right side, and reporting our single-center experience for right-retroperitoneoscopic live-donor nephrectomy. Patients and Methods: In China, live-kidney transplant is limited. It is even more essential now, because the deceased-donor kidney has become fewer after enacting the Chinese Regulation on Human Organ Transplantation. Therefore, there is a continued need to use the limited live-donor population. We chose 103 consecutive cases (84 left and 19 right) that underwent retroperitoneoscopic live-donor nephrectomy between December 2005 and December 2009, to compare the intraoperative and postoperative characteristics between the left and right sides, and report our experiences for 19 right-retroperitoneoscopic live-donor nephrectomies. Results: All 84 left and 19 right-retroperitoneoscopic live-donor nephrectomies were accomplished successfully without open conversion and transfusion. No significant differences were observed between the 2 groups regarding operative time, warm ischemia time, estimated blood loss, length of hospital stay, and serum creatinine level at discharge (Table 1). Eight of the donors and 3 of the grafts had minor complications that were all resolved with conservative treatment. The recipients’ serum creatinine levels at 1 day and 1 month after surgery were the same in both groups. No acute renal tubule necrosis or delayed graft function was observed in the recipients. Conclusions: Our right-retroperitoneoscopic live-donor nephrectomy achieves comparable outcomes with the left side and proves to be a feasible, cost-effective, safe, and minimally invasive alternative for live-kidney donation. This maximally uses the innately limited donors and potentially increases the donor pool in China.
Importance of Socioeconomic, Clinical, and Psychological Factors on Health-related Quality of Life in Adolescents After Kidney Transplant
(Başkent Üniversitesi, 2011-02) Malekahmadi, Mohammad Reza; Assari, Shervin; Einollahi, Behzad; Lankarani, Maryam Moghani; Nejad, Mohammad Lorgard Dezfuli; Rahimzadeh, Shadi
Objectives: Health-related quality of life after kidney transplant in adolescents is a major concern; nevertheless, there is a paucity of data on the variables that have an effect on it. This study evaluated the extent to which socioeconomic, clinical, and psychological characteristics explain the variance in the health-related quality of life of adolescent Iranian kidney transplant recipients. Materials and Methods: Into a hierarchical regression analysis, the cross-sectional socioeconomic, clinical, and psychological characteristics were entered among 55 adolescent Iranian kidney transplant recipients. Results: The relative predictive power of socioeconomic, clinical, and psychological variables with respect to health-related quality of life was 21.8% (P = .088), 21.2% (P = .014), and 27.6% (P = .001). Conclusions: Psychological factors had a greater relative predictive power in postrenal transplant health-related quality of life of adolescents than did the socioeconomic and clinical characteristics. Further research should target to improve the health-related quality of life in adolescent kidney recipients by psychological intervention.
Conversion From Cyclosporine to Sirolimus in Chronic Renal Allograft Dysfunction: A 4-Year Prospective Study
(Başkent Üniversitesi, 2011-02) Han, Fei; Chen, Jianghua; Wang, Huiping; Wang, Suya; Wang, Yimin; He, Qiang; Zhang, Xiaohui; Huang, Hongfeng; Wu, Jianyong
Objectives: The long-term use of cyclosporine always contributes to chronic renal allograft dysfunction. Converting from cyclosporine to sirolimus and reducing cyclosporine dosage under high mycophenolate mofetil levels are 2 common therapies. Their efficacy and safety have not been compared in Chinese patients. Materials and Methods: In this prospective, open-label, randomized study, 51 kidney recipients with an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m2 were enrolled. Patients in the sirolimus group (n=22) initiated sirolimus 12 hours after cessation of cyclosporine. Patients in the cyclosporine group (n=29) significantly reduced cyclosporine dosage under high mycophenolate mofetil dosages. Both groups were followed-up for 4 years. Results: The baseline estimated glomerular filtration rate was 36.46 ± 6.22 mL/min/1.73 m2 in sirolimus group and 36.07 ± 6.18 mL/min/1.73 m2 in the cyclosporine group (P = NS). In cyclosporine group, the estimated glomerular filtration rate declined significantly at 12, 18, 24, 30, 36, 42, and 48 months after inclusion compared with baseline, and was lower than the sirolimus group at 30, 36, 42, and 48 months after inclusion (P < .05). As for the endpoints of graft loss and return to dialysis, the 4-year graft survival was 77.3% in the sirolimus group and 55.2% in the cyclosporine group (P = NS). As for the endpoint of serum creatinine doubling, 4-year survival was 77.3% in the sirolimus group and 41.4% in the cyclosporine group (P < .05). Three patients in sirolimus group (2 acute rejections, 1 pneumonia) and 2 patients in the cyclosporine group (owing to acute rejection) dropped out (P = NS). Conclusions: Conversion from cyclosporine to sirolimus could improve long-term survival of renal grafts in Chinese patients.