Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Renal allograft

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    Pretransplant Detection of Anti-Endothelial Cell Antibodies Could Predict Renal Allograft Outcome
    (Başkent Üniversitesi, 2009-06) Ismail, Amani M.; Mansour, Merveet A.; El-Agroudy, Amgad E.; Badawi, Rasha M.
    Objectives: Endothelial cells that line the vasculature are targets for immune-mediated assault through anti-endothelial cell antibodies. The aim of this work was to detect anti-endothelial cell antibodies and describe the association with kidney allograft rejection and graft survival. Materials and Methods: The study included 60 patients who had undergone live-donor kidney transplant. Inclusion criteria included first kidney transplant, panel reactive antibody titer less than 5%, cause of end-stage renal disease not including vasculitis or systemic lupus erythematosus, and age > 18 years. Patients were classified into 2 groups: 40 patients with anti-endothelial cell antibodies (referred to as the positive group) and 20 patients without anti-endothelial cell antibodies (referred to as the negative group). Results: Serum creatinine level was higher in the positive group at 1 month and 1 year (P = .04). The occurrence of acute rejection was not significantly different in the positive group (18 patients [45.0%]) compared with the negative group (5 patients [25.0%], P = .5). However, the number of acute rejection episodes was higher in the positive group (22 episodes) compared with the negative group (6 episodes, P = .04). In patients who experienced acute rejection, chronic nephropathy was more frequent in the positive group (6 of 18 patients, 33.3%) compared with the negative group (1 of 5 patients, 20.0%) (P = .03). One-year and 5-year graft survival was 91% and 79% in the positive group, and 100% and 91% in the negative group, respectively. The difference at 5 years was significant (P = .04). Conclusions: The presence of anti-endothelial cell antibodies was associated with a higher number of acute rejection episodes and lower long-term graft survival in kidney transplants. It could be an informative test to identify patients at high risk for immunological graft loss.
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    Characteristics of Recipients Whose Kidney Allograft Has Functioned for More Than 20 Years
    (Başkent Üniversitesi, 2008-06) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; Ismail, Amani M.; Abbass, Tarek M.; El-Dahshan, Khaled
    Objectives: To study the characteristics of, and predictors for, survival in renal transplant recipients with an allograft functioning for more than 20 years. Materials and Methods: Of 144 renal transplants done between 1976 and 1985, 31 allografts were still functioning for more than 20 years (range, 21-28.5 years). The characteristics of the patients and determinants of the outcomes were obtained by reviewing the patients’ medical records. Results: Fourteen patients were treated with cyclosporine, while 17 patients had primary immunosuppression with azathioprine-based regimens. Episodes of acute rejection occurred in 17 patients (58%), 7 of these experienced 2 or more episodes. At most-recent follow-up, the mean serum creatinine level was 132 ± 44 µmol/L . Four patients were assessed by graft biopsy 15 or more years after the transplant, revealing 2 cases of mild glomerulosclerosis and 2 cases of moderate chronic allograft nephropathy. The most common complication was hypertension (54%). The independent determinants of long-term graft survival were donor age and source, hypertension both before and after renal transplant, and histopathological findings of chronic allograft nephropathy. Conclusions: Renal transplant offers a near-normal life to patients with end-stage renal disease soon after transplant and for upwards of 20 years and more. We found no significant benefit to cyclosporine-based immunosuppression on long-term graft survival.
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    Parvovirus B19 Microepidemic in Renal Transplant Recipients With Thrombotic Microangiopathy and Allograft Vasculitis
    (Başkent Üniversitesi, 2008-06) Ardalan, Mohammad R.; Jayne, David; Tubbs, R. Shane; Shoja, Mohammadali M.
    Parvovirus B-19 (B-19) can lead to various clinical scenarios in renal transplant recipients. Here, we report a B-19 microepidemic that occurred between January and March 2007, involving renal transplant recipients from a single center in Tabriz, Iran. We observed 6 patients in whom there was a temporal association between active B-19 infection and thrombotic microangiopathy and intrarenal small- and medium-sized vessel vasculitis. Patients typically presented with deteriorating renal allograft function and anemia, and laboratory findings revealed thrombotic microangiopathy. Ultimately, extensive endothelial injury and renal allograft vasculitis that mimicked a vascular rejection ensued. In conclusion, B-19–related thrombotic microangiopathy may precede allograft vasculitis in renal transplant recipients. A high index of suspicion is required for early diagnosis and treatment of B-19 infection. To the best of our knowledge, this series represents the first report of B-19–related renal allograft vasculitis in the English literature.