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Milagros D Samaniego
Nephrology news & issues 04/2009; 23(3):54-5.
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Julio Pascual, Milagros D Samaniego,
José R Torrealba,
Jon S Odorico,
Arjang Djamali,
Yolanda T Becker,
Barbara Voss,
Glen E Leverson,
Stuart J Knechtle,
Hans W Sollinger,
John D Pirsch
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ABSTRACT: The prevalence, risk factors, and outcome of antibody-mediated rejection (AMR) of the kidney after simultaneous pancreas-kidney transplantation are unknown. In 136 simultaneous pancreas-kidney recipients who were followed for an average of 3.1 yr, 21 episodes of AMR of the kidney allograft were identified. Eight episodes occurred early (</=90 d) after transplantation, and 13 occurred later. Histologic evidence of concomitant acute cellular rejection was noted in 12 cases; the other nine had evidence only of humoral rejection. In 13 cases, clinical rejection of the pancreas was diagnosed simultaneously, and two of these were biopsy proven and were positive for C4d immunostaining. Multivariate analysis identified only one significant risk factor: Female patients were three times more likely to experience AMR. Nearly all early episodes resolved with treatment and did not predict graft loss, but multivariate Cox models revealed that late AMR episodes more than tripled the risk for kidney and pancreas graft loss; therefore, new strategies are needed to prevent and to treat late AMR in simultaneous pancreas-kidney transplant recipients.
Journal of the American Society of Nephrology 05/2008; 19(4):812-24. · 9.66 Impact Factor
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Julio Pascual,
Joshua D Mezrich,
Arjang Djamali,
Glen Leverson,
L Thomas Chin,
José Torrealba,
Debra Bloom,
Barbara Voss,
Bryan N Becker,
Stuart J Knechtle,
Hans W Sollinger,
John D Pirsch, Milagros D Samaniego
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ABSTRACT: An increase in the incidence of autoimmune diseases has been described in patients receiving alemtuzumab.
To determine whether induction with alemtuzumab increases recurrence of glomerular disease, we performed a retrospective study in 443 patients with biopsy-proven glomerular diseases undergoing kidney transplantation. Patients receiving alemtuzumab (n=161) were compared with those receiving interleukin (IL)-2-receptor antagonists (n=217) or antithymocyte globulin (n=64).
Biopsy-proven glomerular disease recurrence was similar in patients induced with alemtuzumab or IL-2 receptor antagonists. Patients receiving antithymocyte antibody had a lower recurrence rate than patients treated with other induction agents, with borderline significance (hazard ratio [HR] 0.13, 95% confidence interval [95% CI] 0.02-0.98, P=0.047). Patients with systemic lupus treated with alemtuzumab had a similar re-emergence of autoreactive antibodies to patients treated with other agents. Recurrent disease increased the risk of allograft failure (HR 2.36, 95% CI 1.28-4.32, P=0.0056). The development of acute rejection and the use of deceased (vs. living) donor kidneys were also significant factors influencing graft survival. A greater risk of mortality was detected in those patients with recurrent glomerular disease (HR 3.76, 95% CI 1.37-10.35, P=0.01), whereas increased age at transplantation (HR 1.05) and the use of deceased (vs. living) donor kidneys (HR 3.20) also increased mortality. No specific induction agent significantly affected graft loss or mortality when using adjusted or unadjusted hazard ratios.
In this retrospective analysis, induction with alemtuzumab did not increase the rate of re-emergence of autoantibodies or biopsy-proven recurrence of glomerular disease. A slight reduction in the incidence of recurrence was observed in patients treated with thymoglobulin, yet this observation can only be validated in a prospective randomized trial.
Transplantation 07/2007; 83(11):1429-34. · 4.00 Impact Factor
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ABSTRACT: Renal vein thrombosis occurring after the immediate post-transplant period often leads to loss of the transplant organ. We report two cases of renal vein thrombosis in the setting of de novo membranous nephropathy occurring 5 and 26 months post-transplantation. Both cases were treated with percutaneous mechanical thrombectomy and localized catheter-directed thrombolysis with resolution of clot burden, and regained kidney function after thrombolysis without subsequent thromboses. Percutaneous mechanical thrombolysis can be safely done in renal transplant recipients and should be considered in patients with renal vein thrombosis beyond the immediate post-operative period in order to minimize exposure to systemic thrombolysis.
American Journal of Transplantation 04/2005; 5(3):621-6. · 6.39 Impact Factor
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ABSTRACT: We describe a case of West Nile virus encephalitis in a 54-year-old kidney transplant recipient. The clinical course was rapid and fatal. Serial CSF samples showed an evolving mononuclear pleiocytosis and serial MRIs showed increasing signs of cytotoxic edema in her basal ganglia. Seroepidemiological testing indicated that the infection was most likely acquired from transfusion of fresh frozen plasma at the time of transplantation.
American Journal of Transplantation 06/2004; 4(5):830-3. · 6.39 Impact Factor
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ABSTRACT: Glomerular disease is an important cause of allograft loss. Treatment regimens for posttransplant glomerular disease are not well defined. Several reports have demonstrated that mycophenolate mofetil (MMF) is effective in treating native kidney glomerular disease. The effects of MMF are dose related. Therefore, we hypothesized that high-dose MMF (3 g/day) would be effective in treating glomerular disease in the allograft, minimizing the need for intravenous steroids and/or cyclophosphamide. This case series describes the results of the use of high-dose MMF in 6 patients.
High-dose MMF (3 g/day) was used to treat biopsy-proven glomerular disease (focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, proliferative lupus nephritis, and perinuclear antineutrophil cytoplasmic antibodies glomerulonephritis) in 6 renal transplant recipients. Patients were offered this treatment if they had failed or did not tolerate standard treatment regimens. Remission was defined by a decrease or stabilization of serum creatinine, decrease in proteinuria and, where applicable, improvement in immunological markers of disease.
All 6 patients had disease remission after starting MMF with the most common side effect being leukopenia, which responded to dose reduction.
High-dose MMF may be an effective agent in treating glomerular disease in the allograft.
Nephron Clinical Practice 02/2004; 98(3):c61-6. · 2.04 Impact Factor
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Nephrology Dialysis Transplantation 07/2002; 17(6):1122-5. · 3.40 Impact Factor
