ABSTRACT
Acute rejection remains a major problem in renal transplantation and represents one of the most important causes of chronic allograft dysfunction and late graft loss. Daclizumab is a genetically engineered human IgGl monoclonal antibody that binds specifically to the a chain of the interleukin-2 receptor, and may thus reduce the risk of reection after renal transplantation. The aim of this study was to examine the effect of daclizumab induction therapy combined with a triple immunosuppressive protocol including prednisolone, cyclosporine microemulsion [CsA], and mycophenolate mofetil [MMF], in reducing the incidence of acute rejection in recipients of living unrelated donor kidneys. In this historical cohort study, 43 adult recipients of their first kidney allograft received daclizumab [three l mg/kg doses administered every 2 weeks] with triple immunosuppressive therapy [steroids, CsA, and MMF]. This group was compared to 43 first-time graft recipients who received maintenance triple immunosuppressive therapy comprising steroids, CsA, and MMF. The end point was the incidence of biopsy-confirmed acute rejection within 6 months after transplantation. Results: At 6 months, 5 [11.6%] of the patients in the daclizumab group had biopsy-proven rejections, as compared to 14 [32.5%] in the control group [P = 0.017]. The sex and the age of recipients had no impact on the incidence of acute rejection episodes in the two groups. Adding interleukin-2 receptor antibody [daclizumab] to maintenance triple immunosuppressive therapy [prednisolone, CsA, and MMF] reduces the incidence of acute rejection episodes at 6 months in first-time transplant recipients of living unrelated donor
ABSTRACT
The incidence of major risk factors of chronic kidney disease [CKD] in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran. In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged >/= 18 years, was analyzed. CKD was determined based on glomerular _ltration rate [GFR] and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated. 1557 subjects with a mean age of 56.76 +/- 12.04 years were enrolled in this study. Based on the modi_cation of diet in renal disease [MDRD] equation, 137 subjects [8.89%] were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus [DM], hypertension [HTN], ischemic heart disease [IHD], waist to hip ratio, myocardial infarction [MI], and cerebrovascular accident [CVA]. CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD
ABSTRACT
In the September and November 2006 issues of Nature Clinical Practice Nephrology, two articles regarding living unrelated kidney donor transplantation alluded to the practices in Iran. Having served in the planning, supervision and implementation of various aspects of health care in Iran, including organ transplantation [ANH], and as transplant nephrologists who have actively participated in the care of transplanted patients in Iran [ANH and NG], we feel obligated to elucidate the realities surrounding organ transplantation in Iran. So that unbiased researchers are provided with information to judge for themselves