Başkent Üniversitesi Yayınları

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search.filters.applied.f.language: search.filters.language.en_USSubject: search.filters.subject.Organ transplant

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    A Monocentric Observational Study of Darbepoetin Alfa in Anemic Hepatitis-C-Virus Transplant Patients Treated With Ribavirin
    (Başkent Üniversitesi, 2008-12) Kamar, Nassim; Rostaing, Lionel; Esposito, Laure; Ribes, David; Guitard, Joëlle
    Objectives: Darbepoetin alfa is used to treat renal anemia; however, little information is available concerning its use during the posttransplant period, especially in HCV-positive patients treated with ribavirin for active hepatitis C. Materials and Methods: This study investigated the efficacy and safety of using darbepoetin alfa in this population during a 6-month treatment period. All anemic patients were HCV/RNA-positive, treated with ribavirin, and had impaired renal function. Patients (n=7) who had not been treated previously with recombinant human erythropoietin (rHuEPO) were placed in “group no rHuEPO.” Patients previously with recombinant human erythropoietin (n=16; “group rHuEPO”) were switched to darbepoetin alfa according to the European summary of product characteristics. Results: Seventy-three percent of the patients were men. The mean creatinine clearance at baseline was 58.7 ± 21.5 mL/min. All patients received an immunosuppressive treatment. Although mean hemoglobin levels remained stable in group no rHuEPO and increased in group rHuEPO, the difference was not statistically significant. Also, the median darbepoetin-alfa–weighted dose in group no rHuEPO increased while it remained stable in group rHuEPO, as did the median daily dosage of ribavirin; however, these differences were not statistically significant. Creatinine levels and creatinine clearance levels remained stable throughout the study. No significant medical events related to the treatment were reported during the study. Conclusions: Darbepoetin alfa was found to be efficient and well tolerated in correcting renal anemia in transplant recipients treated with ribavirin for active hepatitis C.
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    Alteration of Direct and Indirect Effects of Cytomegalovirus
    (Başkent Üniversitesi, 2007-12) Kamar, Nassim; Rostaing, Lionel; Mengelle, Catherine
    For recipients of a solid organ transplant, cyto­megalo­virus infection causes many pathological conditions including direct and indirect effects, most notably owing to the potency of the immunosuppressive medications used. Effects attributed to cyto­megalovirus infection include graft rejection, decreased graft and patient survival rates, predisposition to other opportunistic infec­tions, virally mediated malignancies, and various injuries specific to the transplanted organs (eg, accelerated coronary atherosclerosis following heart transplant, bronchiolitis obliterans syndrome in lung transplants, and vanishing bile-duct syndrome in liver allografts). Other indirect effects include post­transplant lymphoproliferative disorders, posttransplant new onset diabetes, and recurrence of hepatitis C virus infection. Direct effects are related to viral burden, whereas indirect effects may be observed even in the presence of low levels of cytomegalovirus replication. Being a function of the interaction between the virus and the host’s immune and inflammatory responses, the underlying indirect effects of viral infection are not completely understood. Whereas it has been shown that cytomegalovirus prophylaxis can decrease the direct and indirect effects of the virus, recent data indicate that pre-emptive therapy has no long-term impact upon the indirect effects. Prevention of cytomegalovirus-related indirect effects might be achieved only with prophylaxis.