Başkent Üniversitesi Yayınları
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Item Monitoring Human Cytomegalovirus (HCMV) in HCMV-Seropositive Orthotopic Liver-transplant Recipients by Means of Quantitative Real-time Polymerase Chain Reaction(Başkent Üniversitesi, 2006-12) Mengelle, Catherine; Abravanel-Legrand, Florence; Kamar, Nassim; Alain, Sophie; Basse, Grégoire; Pillet, Adèle; Lavayssière, Laurence; Suc, Bertrand; Izopet, Jacques; Rostaing, LionelObjective: Human Cytomegalovirus can be reactivated after orthotopic liver transplantation in patients who are seropositive for cytomegalovirus. Whether those cytomegalovirus-seropositive patients require immediate posttransplant (anti)cytomegalovirus prophylactic therapy or preemptive treatment as opposed to deferred treatment remains controversial. The aims of our study were to evaluate the relevance of cytomegalovirus monitoring with quantitative real-time polymerase chain reaction in whole blood and to analyze the factors that determine the treatment of the first episode of cytomegalovirus infection with intravenous ganciclovir in seropositive liver-transplant patients. Patients and Methods: Forty-two cytomegalovirus-seropositive liver-transplant patients were assessed for cytomegalovirus DNAemia every 2 weeks until posttransplant day 90 and every 3 to 4 weeks until day 180. Biochemical and hematologic parameters were also prospectively monitored. Results: Cytomegalovirus DNAemia was detected at least once in 27 patients (64%). Treatment was initiated in 12 patients (group 1) but not in 15 others (group 2). Median HCMV viral loads of the first positive and the highest DNAemia were statistically higher in group 1 than in group 2 (P = 0.01). Univariate analysis of DNAemia showed that alkaline phosphatase levels were significantly higher in group 1 than in group 2 (P = .0011) and that hemoglobin levels were significantly lower in group 1 than in group 2 (P = .0443). The results of multivariate analysis showed that the only factor that predicted the treatment of the first episode of HCMV DNAemia was a level of alkaline phosphatase greater than 150 IU/L [odds ratio, 20; range, 1.97-203.32; P = .01]. Conclusions: A combination of criteria, including viral-load kinetics, clinical factors, alkaline phosphatase levels (in particular), and the patient’s immune condition, is required to efficiently monitor patients who are seropositive for cytomegalovirus after orthotopic liver transplantation.Item Renal Function and Histology in Kidney Transplant Patients Receiving Tacrolimus and Sirolimus or Mycophenolate Mofetil(Başkent Üniversitesi, 2006-12) Kamar, Nassim; Van, Tuan Tran; Ribes, David; Modesto, Anne; Cointault, Olivier; Lavayssière, Laurence; Ader, Jean Louis; Durand, Dominique; Rostaing, LionelObjective: The aim of this study was to assess the effects of tacrolimus in combination with either sirolimus (n = 10) or mycophenolate mofetil (n = 7) on renal function and renal histopathologic factors 6 and 12 months after kidney transplantation. Materials and Methods: Renal function was assessed by the glomerular filtration rate (as measured by the inulin clearance rate) and by determining renal functional reserve. A renal allograft biopsy was performed at the time of transplantation and 6 and 12 months later. Results: Serum creatinine levels tended to be higher in the sirolimus group 12 months after transplantation. In contrast, inulin clearance and renal functional reserve were similar in both groups 6 and 12 months after transplantation. With respect to histopathologic findings, only mononuclear-cell interstitial inflammation was significantly higher in the sirolimus group than in the mycophenolate mofetil group 12 months after transplantation. However, the progression of tubular atrophy, interstitial fibrosis, and vascular fibrous intimal thickening within the first postoperative year was significantly greater in the sirolimus group. Conclusions: In the long term, the addition of sirolimus to treatment with tacrolimus in de novo renal transplant patients might more adversely affect renal allograft survival than might the addition of mycophenolate mofetil to tacrolimus therapy.Item Vertigo After Renal Transplantation: A Sign of Paucisymptomatic Cryptococcal Meningitis(Başkent Üniversitesi, 2006-12) Mehrenberger, Marion; Kamar, Nassim; Borde, Jean-Sébastien; Estève-Fraysse, Marie-Josée; Viguier, Alain; Recco, Paulette; Durand, Dominique; Rostaing, LionelWe report what is to our knowledge the first case of severe isolated vertigo that developed after renal transplantation and was a manifestation of cryptococcal meningitis. Treatment with antifungal therapy resulted in the complete resolution of vertiginous symptoms. Immunosuppressed patients with an opportunistic infection of the central nervous system can present with extremely tenuous features of infection and atypical neurologic signs.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