Başkent Üniversitesi Yayınları

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Author: search.filters.author.Nair, PrasadSubject: search.filters.subject.Renal transplant

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    Effective Therapy for Acute Antibody-Mediated Rejection With Mild Chronic Changes: Case Report and Review of the Literature
    (Başkent Üniversitesi, 2012-08) Osama Gheith,; Ibraheim, Mona; Saied, Tarek; Muzeirei, Ibraheem; Al-Waheeb, Salah; Nair, Prasad; Halim, Medhat; Nampoory, Narayanan; Al-Otaibi, Torki
    To reduce the long-term toxicities of immuno­suppressant drugs, corticosteroid-sparing and calcineurin-inhibitor–sparing immunosuppression protocols have become increasingly popular in managing kidney transplant recipients. The most vexing clinical condition caused by antibodies in organ transplants is antibody-mediated rejection. Limitations of the current antibody-mediated rejection therapies include (1) antibody-mediated rejection reversal tends to be gradual rather than prompt, (2) expense, (3) rejection reversal rates below 80%, (4) common appearance of chronic rejection after antibody-mediated rejection treatment, and (5) long-term persistence of donor specific antibodies after therapy. Because these limitations may be due to a lack of effects on mature plasma cells, the effects of bortezomib on mature plasma cells may represent a quantum advance in antihumoral therapy. Our experiences represent the first clinical use of bortezomib as an antihumoral agent in renal allograft recipients in Kuwait. We present 2 cases with resistant-acute antibody-mediated rejection to the standard therapies that were managed successfully with bortezomib.
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    Successful Management of Critical Illness Polyneuropathy and Myopathy in Renal Transplant Recipients
    (Başkent Üniversitesi, 2012-02) Gheith, Osama; Nampoory, M.R. Narayanan; Balaha, Mohamed; Hosni, Waleed; Zakareya, Zakareya; Abd-el-Tawab, Khalid; Nair, Prasad; Said, Tarek; Halim, Medhat; Otaibi, Torki Al
    Critical illness polyneuropathy and myopathy commonly occur in patients with multiorgan failure and sepsis. Distal muscle weakness and loss of deep tendon reflexes are usually found, with sparing of the cranial nerve musculature. Many risk factors have been identified, specifically hypoxia, hypotension, hyperpyrexia, and age. Other independent risk factors include female sex, severity of illness, duration of organ dysfunction, renal failure and renal replacement therapy, hyperosmolality, parenteral nutrition, low serum albumin level, duration of intensive care unit stay, vasopressor and catecholamine support, and central neurologic failure. Hyperglycemia also has been identified as an independent risk factor, with important potential affect in terms of prevention. Herein, we report the development of critical illness polyneuropathy and myopathy in 7 of 22 renal transplant recipients who underwent successful ventilator weaning during treatment for bronchopneumonia. This is the first report of critical illness polyneuropathy and myopathy among renal transplant recipients. Clinical suspicion and electrophysiologic studies are tools for early diagnosis. Proper management, including correction of risk factors (especially diabetes) and long-term rehabilitation measures might be beneficial.