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Renal Transplant Population (renal + transplant_population)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Does peak systolic velocity correlate with renal artery stenosis in a pediatric renal transplant population?

PEDIATRIC TRANSPLANTATION, Issue 5 2006
Anthony Cook
Abstract:, PSV of renal transplant vessels, calculated during allograft ultrasonography, has previously been shown to correlate with TRAS. Controversy exists regarding the threshold PSV value (adult range: 1.5,3.0 ms), which should prompt further, more invasive investigations to confirm the diagnosis of TRAS. Furthermore, there is a paucity of literature regarding PSV values in the pediatric renal transplant population. In a group of pediatric renal transplant patients, we correlated post-operative renal transplant PSV values with BP, renal function (serum creatinine) and TRAS. All patients who underwent cadaveric or living-related renal transplantation at the HSC between 2001 and 2004 with at least 6 months of follow-up were reviewed through the HSC multi-organ transplant database. Post-operative allograft Doppler ultrasonography was performed during routine follow-up. PSV values obtained were correlated with BP and serum creatinine performed concomitantly. Finally, we correlated PSV in those patients who underwent more intensive investigations, including magnetic resonance and conventional angiography. Fifty-three patients underwent transplantation during the study period. Complete data available for 50/53 demonstrated a mean PSV of 2.13 m/s (range: 0.9,6.1 m/s) for all patients. Of six patients who underwent MRA for suspicion of TRAS, two (with mean PSV values of 1.93 m/s) were found to have clinically significant stenoses. Four of six without angiographic evidence of TRAS had mean PSV values of 2.22 m/s. Patients suspected of having TRAS demonstrated elevated median serum creatinine values compared with those without clinical suspicion of TRAS. However, both mean PSV and BP were not found to be statistically different in both patient subgroups. Furthermore, there was no correlation identified between PSV and serum creatinine and BP in these patient populations. Despite the utility of PSV for monitoring adult renal transplant patients, we did not find that PSV correlated with BP, nadir creatinine or identify those patients who, through subsequent investigations, were found to have TRAS in this pediatric population. Maintaining cognizance in conjunction with close clinical follow-up may identify patients at risk for this rare but potentially morbid complication of transplantation. [source]

BK viral infection in an Australian pediatric renal transplant population

PEDIATRIC TRANSPLANTATION, Issue 5 2004
L. Haysom
Abstract: BK virus (BKV) is recognized as a significant cause of renal allograft dysfunction in adults, and there is growing awareness of its importance in the pediatric population. Eighteen pediatric renal transplant recipients and 18 age-matched controls were prospectively studied. Anti-BKV immunoglobulin G (IgG) and IgM titres were assayed in all subjects at entry to the study. Polymerase chain reaction (PCR) for BKV DNA was performed on urine and serum at entry, and prospectively tested again at 4, 8 and 12 months. Mean age ± s.d. of transplant recipients and controls was 14.6 ± 3.3 and 13.9 ± 0.33 yr respectively [not significant (NS)]. Transplant patients were studied at a mean time of 5.6 ± 4.2 yr post-transplant. 56% of transplant patients and 39% of controls were seropositive (+ve BKV IgG) (NS). Plasma BKV PCR was positive in one transplant patient (who also had positive urine PCR) and in none of the controls. The prevalence of positive urine PCR in transplant patients was greater than in controls (33% vs. 0%, p = 0.02). Positive urine BKV PCR was more commonly found in patients treated with mycophenolate than azathioprine (p = 0.04). We conclude that the prevalence of BKV seropositivity and viral activation in this Australian pediatric renal transplant population is similar to that reported in adult and pediatric populations in other countries. BK viruria was more common in children with greater immunosuppression, suggesting that this group is at higher risk of BKV induced nephropathy. [source]

Effect of fluvastatin on cardiac outcomes in kidney transplant patients with systemic lupus erythematosus: A randomized placebo-controlled study,

ARTHRITIS & RHEUMATISM, Issue 4 2009
Gudrun E. Norby
Objective Patients with systemic lupus erythematosus (SLE), with or without end-stage renal failure, are at increased risk of premature cardiovascular disease. Although statin therapy has been found to reduce cardiovascular risk in the general population, its effectiveness in kidney transplant recipients with SLE has not been examined. This study was undertaken to investigate the effect of fluvastatin on cardiac end points in a randomized controlled trial of renal transplant patients with SLE. Methods Patients with SLE were identified from among participants in the Assessment of Lescol in Renal Transplantation trial, a randomized, double-blind, placebo-controlled study of the effect of fluvastatin (40,80 mg/day) on cardiovascular outcomes in renal transplant recipients. Patients were randomized to either a group receiving fluvastatin or a placebo group for the duration of the 5,6-year trial, and then invited to continue in a 2-year open-label extension during which all participants, regardless of original group, received fluvastatin. Patients were followed up for a total of 7,8 years for assessment of the primary end point of major cardiac events, comprising nonfatal myocardial infarction, cardiac death, and coronary intervention procedures. Results Fluvastatin reduced low-density lipoprotein cholesterol levels by 29.2% (95% confidence interval [95% CI] 18.3,40%), from a mean ± SD of 4.0 ± 0.9 mmoles/liter to 2.8 ± 1.1 mmoles/liter, and total cholesterol by 19.6% (95% CI 11.7,27.5%), from 6.4 ± 0.9 mmoles/liter to 5.1 ± 1.1 mmoles/liter. Compared with placebo-treated patients, patients randomized to receive fluvastatin exhibited a 73.4% reduction in the risk of major cardiac events (relative risk 26.6 [95% CI 5.9,119.4], P = 0.064). Conclusion Our results indicate that the effect of fluvastatin on cardiac events in renal transplant recipients with SLE is similar to that observed with statin therapy in the renal transplant population as a whole. [source]

The effect of Daclizumab in a high-risk renal transplant population

CLINICAL TRANSPLANTATION, Issue 5 2000
Herwig-Ulf Meier-Kriesche
Introduction: African,American (AA) renal transplant recipients have a higher incidence of acute rejection when compared to Caucasian renal transplant recipients. This higher rejection rate holds true even with the addition of several of the newer immunosuppressive agents (e.g. mycophenolate mofetil (MMF) and Rapamycin). Acute rejection rates among Hispanic (H) renal transplant recipients are higher in some settings, while lower or the same as in Caucasians in other settings. IL-2 receptor antibodies have been shown to decrease rejection rates when added to a regimen of cyclosporine (CsA), azathioprine and prednisone. Limited data are available on these agents in conjunction with triple CsA, MMF and prednisone therapy, particularly in higher risk group patients. We studied the effect of the addition of the IL-2 receptor antibody Daclizumab to a CsA, MMF, prednisone regimen in a group of African,American and high-risk Hispanic renal transplant recipients. Methods: This was a non-randomized, prospective study. A total of 49 renal transplant recipients (29 African,American and 20 Hispanic) were studied and followed. A simultaneous cohort of 56 (31 African,American and 25 Hispanic) renal transplant recipients receiving CsA, MMF and prednisone with no standard induction agent served as the control group. The study cohort received the same regimen with the addition of Daclizumab at 1 mg/kg for five doses over 10 wk. Multivariate analysis was performed to isolate independent factors influencing the study's results. Results: A total of 56 patients in the control group and 49 patients in the Daclizumab group received an average follow-up of 17.1±6.9 and 12.7±5.1 months, respectively. Acute rejection rates were lower in the Daclizumab group as compared to the control group 26.4% versus 49.3% per patient years, respectively. A total of eight recurrent rejections in 6 patients occurred in the control group and none in the Daclizumab arm. Graft loss at this follow-up was no different between the groups. Conclusion: The addition of Daclizumab to a regimen of CsA, MMF and prednisone decreases acute rejection episodes in a high-risk group of African,American and Hispanic renal transplant recipients. [source]

Obesity following kidney transplantation and steroid avoidance immunosuppression

CLINICAL TRANSPLANTATION, Issue 3 2008
Eric A. Elster
Abstract:, Obesity is an important co-morbidity within end-stage renal disease (ESRD) and renal transplant populations. Previous studies have suggested that chronic corticosteroids result in increased body weight post-transplant. With the recent adoption of steroid-sparing immunosuppressive strategies, we evaluated the effect of these strategies on body mass index (BMI) after renal transplantation. We examined 95 renal transplant recipients enrolled in National Institutes of Health clinical transplant trials over the past three yr who received either lymphocyte depletion-based steroid sparing or traditional immunosuppressive therapy that included steroids for maintenance immunosuppression. Recipients were overweight prior to transplant and no significant differences existed in pre-transplant BMI among treatment groups. Regardless of therapy, BMI increased post-transplant in all recipients. The BMI increase consisted of an average weight gain of 5.01 ± 7.12 kg (mean, SD) post-transplant. Additionally, in a number of recipients placed on maintenance steroids, subsequent withdrawal at a mean of 100 d post-transplant had no impact on weight gain. Thus, body weight and BMI increase following kidney transplantation, even in the absence of steroids. Thus, patients gain weight after renal transplantation regardless of the treatment strategy. Steroid avoidance alone does not reduce risk factors associated with obesity in our patient population. [source]