HLA-identical living related kidney transplantation: Outcomes of a national multicenter study.

OBJECTIVES: The kidney prognosis of HLA-identical seems theoretically very interesting with the lowest risk of acute rejection after that of identical twins. Objectives were to determine the prevalence of acute rejection and various complications in a cohort of HLA-identical living-related kidney transplant. METHODS: A retrospective, multicenter study was conducted in seven university centers in Morocco, which included all recipients of an HLA-identical living-related kidney transplant performed between 1990 and 2019. RESULTS: Data on 68 HLA-identical living-related kidney transplants were collected. The donors were siblings in 89.7%, the parents in 7.3%, and identical twins in 3% of cases. 53.6% of all recipients were under 35 years old, and 59.4% of them were male. 39.7% of all donors were under 35 years old, and 47% of them were male. 48.5% of HLA-identical living-related kidney transplants were performed before the year 2000. 18 kidney transplant biopsies were performed on 16 kidney transplant recipients. Seven episodes of acute rejection occurred in six patients, 8.8% of the whole cohort (n = 68). Two cases of acute rejection among the seven were related to poor adherence, cessation of immunosuppressive therapy, and loss of medical follow-up by these patients. These two patients were 20 years old at the time of kidney transplantation. The global kidney transplant survival was 66.7% versus 91.9% (P = 0.04) in the two patient groups having developed acute rejection and not having developed acute rejection, respectively. CONCLUSIONS: Acute rejection is a real threat to HLA-identical kidney transplant recipients. Therefore, it seems very important to codify the immunosuppressive regimen and to adopt a minimal and effective treatment.

Consumption of Argan Oil Improves Anti-Oxidant and Lipid Status in Hemodialysis Patients.

OBJECTIVE: Virgin Argan oil (VAO) is of interest in oxidative stress and lipid profile because of its fat composition and antioxidant compounds. We investigated the effect of VAO consumption on lipid profile and antioxidant status in hemodialysis patients after a 4-week period of consumption. METHODS: In a crossover, controlled trial, 37 patients (18 men, 19 women) with end-stage renal disease on maintenance hemodialysis, were randomly assigned to a 4-week VAO diet. Fasting plasma lipids, vitamin E and oxidized LDL (ox-LDL) were analyzed. Malondialdehyde (MDA) was determined before and after hemodialysis session. RESULTS: There was no significant change in serum total cholesterol and ox-LDL. However, VAO consumption decreased the levels of triglyceride (p = 0.03), total cholesterol (p = 0.02) and low-density lipoprotein (p = 0.03) and increased the levels of high-density lipoprotein (p = 0.01). Plasma vitamin E contents significantly increased from baseline only in VAO-group (p < 0.001). Hemodialysis session increased MDA levels, but the increase in VAO group was less than in control group. CONCLUSION: VAO consumption improved lipid profile and oxidative stress status in hemodialysis patients.

Impact of improving quality of dialysis fluid on oxidative stress and lipid profile in hemodialysis patients.

The aim of this study was to evaluate the levels of malondialdehyde as an oxidative stress marker in the same hemodialysis patients after changing the quality of dialysate with ultrapure dialysis fluid. Methods. This prospective study concerns hemodialysis patients; all patients were in the first step treated with conventional dialysate, and in the second step (three months later) the same patients were treated with online produced ultrapure dialysis fluid. The malondialdehyde, C-reactive protein, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, fibrinogen, and albumin were quantified before the two steps. Results. Thirty-seven patients completed the study. Ultrapure dialysis fluid reduced but not significantly the malondialdehyde concentrations. Both dialysis fluids were associated with improvement in the malondialdehyde level before and after the hemodialysis session. In lipid parameters, there was a significant decrease with conventional dialysis fluid versus ultrapure dialysis fluid of triglycerides, total cholesterol, and high-density lipoprotein in patients' blood. Instead, the level of low-density lipoprotein, fibrinogen, albumin, and C-reactive protein does not change significantly. Conclusion. The lipid parameters were improved for triglycerides and total cholesterol. Malondialdehyde increases following the hemodialysis session, and the conventional dialysate increased malondialdehyde levels more than the ultrapure dialysis but the differences were not statistically significant.

Acute renal failure following the Saharan horned viper (Cerastes cerastes) bite.

INTRODUCTION: The Saharan horned viper (Cerastes cerastes) is a common snake in the sandy and rocky regions in the south of Morocco. Although nearly all snakes with medical relevance can induce acute renal failure (ARF), it's unusual except with bites by some viper species. ARF has very rarely been reported following Cerastes cerastes bite. CASE REPORT: A 55-year-old Moroccan man was bitten on his right hand by a Saharan horned viper, Cerastes cerastes. He presented 24 hours later in a state of confusion, agitation and hypotension with marked swelling of his right hand. Investigations revealed evidence of disseminated intravascular coagulation (DIC) and rhabdomyolysis. The appropriate antivenom was not available. Despite adequate hydration, he developed acute renal failure necessitating prolonged hemodialysis. He subsequently improved and was discharged from the hospital after four weeks with normal renal function. CONCLUSION: Although uncommon, the bite of Cerastes cerastes can result in ARF due to DIC and rhabdomyolysis. The appropriate antivenom should be made available in areas where this snake is prevalent.

Frequencies of CYP3A5*1/*3 variants in a Moroccan population and effect on tacrolimus daily dose requirements in renal transplant patients.

The cytochromes P450 are a superfamily of oxidative enzymes, which are implicated in the metabolism of a large number of endogenous substances as well as exogenous chemicals. The cytochrome P450 (CYP3A5) appears to play an important role in drug metabolism activity. The most frequent mutation in the CYP3A5 gene, affecting its activity, consists of a G6986A transition within intron 3. In this study, we determined the allelic frequency of CYP3A5*3 in a Moroccan population, consisting of 108 individuals including 10 renal transplant patients. About 8.33% (9/108) of the subjects were homozygous wild-type (CYP3A5*1/*1), 37.04% (40/108) were heterozygous (CYP3A5*1/*3), and 54.63% (59/108) were homozygous (CYP3A5*3/*3). Therefore, CYP3A5*3 variant was the most frequent allele detected at 73.15%. In the second part of this work, we assessed the influence of the CYP3A5 polymorphism on tacrolimus doses required for 10 renal transplant patients who are receiving tacrolimus as immunosuppressive therapy. Our results showed that, during the first 3 months after kidney transplantation, the tacrolimus daily requirements for heterozygous patients (CYP3A5*3/*1) were higher compared with homozygous patients (CYP3A5*3/*3) (0.133 ± 0.026 vs. 0.21 ± 0.037 mg/kg/day). After the third month the difference was also observed, whereby the mean of tacrolimus daily requirements for patients with CYP3A5*3/*3 and CYP3A5*1/*3 was 0.053 ± 0.013 and 0.08 ± 0.014 mg/kg/day, respectively. This first study in Morocco provides genetic data related to the frequency of genetic polymorphisms of CYP3A5 and opens the perspective to develop other pharmacogenetic studies.