[Show abstract][Hide abstract] ABSTRACT: Acute rejection, chronic allograft nephropathy, and cyclosporine (CsA) toxicity remain serious problems for renal transplant recipients and may lead to graft loss. We retrospectively analyzed 34 patients whose biopsies revealed acute and/or chronic allograft rejection, or CsA nephrotoxicity, and who converted from CsA to tacrolimus.
From July 1996 through September 2003, CsA was converted to tacrolimus in 34 renal transplant recipients (26 male, 8 female) with renal biopsy at our hospital. Blood pressure and serum creatinine levels were checked monthly and serum cholesterol, triglyceride, and glutamic-pyruvic transaminase (GPT) levels were checked every three months.
A consistently stable and better function after conversion was obtained in a significant portion (24, 71%) of patients. A statistically significant decline in serum creatinine and an improvement in the glomerular filtration rate were found at 3 m, 6 m, 12 m, 36 m, and 72 m after tacrolimus conversion. In 85.7% (12/14) of patients with acute rejection and in 35.7% (5/14) of patients with chronic allograft nephropathy (concomitant with acute rejection in 5), improved or stabilized graft function was noted. In addition, the systolic blood pressure and diastolic BP dropped significantly (P<0.05), while there was no significant change in cholesterol, triglyceride, and GPT levels.
The beneficial effect of tacrolimus conversion on patients with acute rejection, chronic allograft nephropathy, or CsA nephrotoxicity was demonstrated in long-term follow up. The improvement in both renal function and blood pressure may be of paramount importance in reducing long-term cardiovascular morbidity and mortality.
[Show abstract][Hide abstract] ABSTRACT: End-stage-renal disease (ESRD) is a final result of various etiologies. Prognostic indicators leading to ESRD in chronic kidney diseases have been studied extensively, of which, genetic factors remain a subject of great concern. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) are potent proinflammatory cytokines that are involved in several chronic kidney diseases. Studies on cytokine gene polymorphism have revealed important information about the role of genetic factors in disease susceptibility and severity. Gene polymorphism of interleukin-1 receptor antagonist (IL-1ra) and TNF-alpha were determined in 297 ESRD patients and in 145 normal healthy controls. IL-1ra gene polymorphism was characterized as a variable number of tandem repeats of a 86 bp sequence within intron 2. Five alleles were identified and were designated as IL1RN*1, IL1RN*2, IL1RN*3, IL1RN*4, and IL1RN*5, corresponding to 4,2,5,3, and 6 repeats, respectively. A polymorphism in the promoter region of the TNF-alpha gene was also studied. This polymorphism involved a guanidine to adenosine transition at position -308 and was designated as TNF1 (- 308 G) and TNF2 (-308 A). The genotypes and allele frequencies were compared between patients and control group. The distributions of genotypes of IL-1ra and TNF-alpha did not differ significantly between ESRD patients and normal controls. Analysis of allele frequencies revealed a trend toward an increase in IL1RN*2 frequency (7.5% versus 3.8 %, p=0.064) and noncarriage of TNF2 in the patient group (7.2% versus 11.0%, p=0.076) when compared with the control group. When both alleles were considered together, the patient group had a significantly higher frequency of carriage of IL1RN*2 in combination with noncarriage of TNF2 (p=0.0468). We conclude that carriage of IL-1RN*2 and noncarriage of TNF2 allele appear to be poor prognostic factors in patients suffering from various chronic renal diseases that eventually enter end-stage renal failure.
[Show abstract][Hide abstract] ABSTRACT: Constipation is a frequent health concern for long-term dialysis patients. The increased incidence of constipation in long-term dialysis patients is based mainly on self-reported data. Our aim is to investigate this problem objectively by using colonic transit time in long-term hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.
Segmental and total colonic transit time studies measured by means of radiopaque markers were conducted in 56 HD patients, 63 CAPD patients, and 25 healthy control subjects. Segmental colonic transit times were calculated separately for 3 segments of the colon (right, left, and rectosigmoid) and total transit time, which was the sum of all 3 segment times.
Colonic transit time was significantly prolonged in HD patients (43.0 +/- 22.2 versus 32.7 +/- 13.7 hours in CAPD patients and 24.3 +/- 11.9 hours in controls; P < 0.001). Increased colonic transit times in the right and rectosigmoid segments, but not the left segment, contributed to the prolongation in total colonic transit time. Age and interdialytic weight gain correlated well with prolongation of total and segmental colonic transit times in HD patients (P < 0.01). Diabetes and female sex in all groups were associated with longer total and segmental colonic transit times, but this trend was not statistically significant.
Total, right segmental, and rectosigmoid segmental colonic transit times are prolonged in long-term HD patients compared with CAPD patients and healthy controls. We believe colonic transit time measurement is helpful to tailor therapy because it helps define the pathogenesis of constipation.
No preview · Article · Sep 2004 · American Journal of Kidney Diseases
[Show abstract][Hide abstract] ABSTRACT: Interferon treatment of hepatitis C virus (HCV) infection in transplant recipients carries a high risk of rejection. We treated these patients with ultralow-dose interferon-alpha (1 x 10 units subcutaneously three times/week) plus ribavirin (600 mg/day) for 48 weeks. Treatment efficacy was evaluated by the changes of serum liver enzymes and viral load. A total of 11 patients were recruited for the study; biochemical response was obtained in all patients but one. Three patients terminated the therapy prematurely because of acute graft failure (one case) and urosepsis (two cases). Of the eight patients who completed a full course of therapy, five cleared HCV RNA at the end of treatment. Sustained biochemical and virologic responses were obtained in three patients (37.5%). Our regimen seemed to be relatively safe for renal transplant recipients with HCV. A significant portion of patients may achieve sustained biochemical and virologic responses.
[Show abstract][Hide abstract] ABSTRACT: Cancer is a well-documented complication after kidney transplantation. Increased incidence of bladder cancer had been reported in long-term hemodialysis patients in Taiwan. Herein, the authors report a very high cumulative incidence of transitional cell carcinoma (TCC) of the urinary tract after kidney transplantation in Taiwan.
The authors retrospectively reviewed the clinical data, medical records, and outcome of 730 kidney transplant (KT) recipients. The cumulative incidence of TCC was computed. The Cox regression method was used to analysis the role of potential risk factors.
After a mean follow-up duration of 72.2 +/- 54.4 months, 69 cancers were diagnosed in 63 (8.6%) KT recipients. Of them, 30 cases (4.1%) were TCC. The cumulative incidence for TCC was 3.0% after 3 years of graft survival, increasing to 7.2% at 6 years and 17.5% at 10 years. Compared with the general population in Taiwan, the standardized mortality ratio was 398.4 (male, 192.6; female, 875.6). Painless gross hematuria was the cardinal initial symptom in 22 (73.3%) of the 30 KT recipients with TCC. Another 4 (13.3%) KT recipients with TCC presented with chronic urinary tract infection (UTI). Bilateral nephroureterectomy with removal of bladder cuffs was performed in 18 (60%) patients. Synchronous TCC in bilateral upper urinary tracts was confirmed in 11 (36.7%) of KT recipients with TCC. The age at the time of KT, female sex, compound analgesics usage, Chinese herb usage, and underground water intake had statistical significance as risk factors (P < 0.05).
The KT recipients are at extremely high risk for TCC in Taiwan, with an incidence of 4.1%. This study indicates that hematuria and chronic UTI are the initial presentation of TCC in KT recipients. Carefully urologic screening is indicated for patients with high risk for TCC, including those with older age, compound analgesics usage, Chinese herbs usage, and underground water intake as well as women.
No preview · Article · Jun 2004 · American Journal of Kidney Diseases