Başkent Üniversitesi Yayınları
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Item Impact of Mycophenolic Acid Dose Modifications on Renal Function After Kidney Transplantation(Başkent Üniversitesi, 2006-12) Kamar, Nassim; Oufroukhi, Loubna; Sallusto, Federico; Cointault, Olivier; Lavayssière, Laurence; Mouzin, Marc; Guitard, Joelle; Durand, Dominique; Rostaing, LionelObjective: Mycophenolic acid dose modifications after renal transplantation seem to adversely affect renal allograft outcome. The aim of this retrospective study was to examine the effect of mycophenolic acid dose modifications on renal function 1 year after transplantation and to determine the factors predictive of those dose modifications within the first year after renal transplantation. Patients and Methods: All 130 patients at our institution who were treated de novo between January 2002 and April 2003 with either a mycophenolate mofetil-based or an enteric-coated mycophenolate sodium-based therapy and who had a functioning renal allograft 1 month after transplantation were included in this study. Results: Fifty-seven patients (43.8%) underwent a dose modification during the first year after transplantation. One, 3, 6, and 12 months after transplantation, renal function was significantly improved in the patients who did not receive a dose modification. A mycophenolic acid dose that 1 year after transplantation was less than the initial dose received just after transplantation was an independent factor associated with deteriorating renal function. Sirolimus immunosuppression, Cytomegalovirus infection, and pretransplant lymphocyte counts were independent factors associated with mycophenolic acid dose modifications within the first year after kidney transplantation. Conclusions: Modification of the mycophenolic acid dose may adversely affect renal function 1 year after transplantation.Item Effects of Intraoperative versus Postoperative Administration of Rabbit Antithymocyte Antibodies on 1-Year Renal Function in Renal Transplant Patie(Başkent Üniversitesi, 2006-06) Kamar, Nassim; Esposito, Laure; Ribes, David; Tkaczuk, Jean; Cointault, Olivier; Lavayssiere, Laurence; Abbal, Michel; Durand, Dominique; Rostaing, LionelObjectives: The aim of our study was to prospectively assess 1-year allograft outcomes and the evolution of lymphocyte subsets in a group of renal transplant patients who had received intraoperative rabbit antithymocyte antibodies (RATG). Materials and Methods: We compared 1-year allograft transplant outcomes in renal transplant recipients who had received intraoperative RATG (group 1, n = 53) with the outcomes observed in patients in a historical control group who had received postoperative RATG (group 2, n = 49). RATG were given at the same dosage (1 mg/kg) during the first 3 days, and then the dosage was adapted according to CD2 count, until calcineurin inhibitors were started. Results: The overall dosage of RATG administered was significantly lower in group 1. At day 4, CD2, CD3, and CD19 T-cell subset counts were significantly higher in patients in group 1. From 3 months after transplantation, CD4/CD8 ratios were significantly lower in patients in group 1 because of a rapid regeneration of CD8 T cells. One-year total lymphocyte counts were significantly higher in patients in group 1. There were fewer severe infectious complications in patients in group 1. One-year renal function was better in patients in group 2. Donor age was the only independent factor associated with renal function at both 1 month and 1 year after transplantation. Conclusions: When RATG are infused intraoperatively, a lower total amount of RATG is required to prevent acute rejection as compared with postoperative RATG infusion. Consequently, fewer serious lymphopenia-associated complications are observed during the first year after transplantation