Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Immunosuppressive agents

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    Neurologic Complications After Renal Transplant
    (Başkent Üniversitesi, 2008-09) Yardimci, Nilgul; Haberal, Mehmet; Zileli, Turgut; Benli, Sibel; Sevmis, Sinasi; Colak, Turan
    Objectives: Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants. We sought to evaluate the nature and incidence of neurologic complications in patients undergoing a renal transplant. Patients and Methods: Between January 2005 and December 2007, 132 adults (35 women, 97 men; mean age, 34.32 ± 0.90 years) underwent a renal transplant at our institution. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were obtained from patients' medical records. Results: Major indications for renal transplant were hypertensive nephropathy (14.4%), vesicoureteral reflux (11.4%), and idiopathic causes (21.2%). Mean follow-up was 17.26 ± 0.89 months (range, 2 weeks to 40 months). Twenty neurologic complications were found in 18 patients (6 women, 12 men; mean age, 33.83 ± 2.37 years). Presenting symptoms included posterior leukoencephalopathy syndrome, 1 (5.6%); cephalgia, 10 (55.6%); cerebral infarcts, 2 (11.1%); seizure, 3 (16.7%); tremor, 2 (11.1%); encephalopathy, 1 (5.6%); and sinus thrombosis, 1 (5.6%). Immuno­suppressive agents were the primary cause of 16 of the 20 neurologic complications. Effectiveness and complications of cyclosporine were screened for a total of 1858.50 months, tacrolimus for 853.50 months, and sirolimus for 620 months; 50.2% of the neurologic complications appeared during the first 3 months after transplant; the blood level of immunosuppressive medications did not need to be higher than normal in every case. Discussion: In addition to cyclosporine and tacrolimus, we suggest (for the first time) sirolimus as a cause of neurocomplications after renal transplant.
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    Immunosuppression Modifications and Graft Outcome in Patients With Chronic Allograft Nephropathy
    (Başkent Üniversitesi, 2008-09) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; El-Baz, Mahmoud; Ismail, Amani M.; Mahmoud, Khaled; El-Dahshan, Khaled
    Objectives: This retrospective study was done to assess the efficacy and safety of immuno­suppression conversion on progression of chronic allograft nephropathy Materials and Methods: One hundred seventy-four cyclosporine-treated renal transplant recipients were studied. Patients were included if they had biopsy-proven chronic allograft nephropathy (mild to moderate) with a serum creatinine level of 300 µmol/L or less. The treatments groups were (1) mycofenolate mofetil and reduced-dosage cy­closporine (group MMF/CsA; n=132) and (2) azathioprine and reduced-dosage tacrolimus (group Aza/Tac; n=42). Patient records were checked for graft function, survival, and comorbidities after conversion. Results: Mean follow-up before conversion was 52.2 ± 31.1 and 47.9 ± 27.4 month in groups MMF/CsA and Aza/Tac, respectively. There was a significant deterioration of graft function in group Aza/Tac after 5 years (P < .05). Ten-year actuarial graft survival in group MMF/CsA was 38%; in group Aza/Tac it was 19% (P = .04). Nine patients started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P = .05) but a significantly higher incidence of diabetes mellitus (P = .04). There were no significant changes or differences in blood pressure between the groups. Conclusions: Our results suggest that in patients with chronic allograft nephropathy and deteriorating allograft function, cyclosporine minimization and addition of mycofenolate mofetil achieve favorable effects in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.