ABSTRACT
AIMS: Effect of early steroid withdrawal protocol using basiliximab in kidney transplantation (KTx) on the clinical outcomes was investigated as compared with triple regimen. METHODS: Kidney transplant patients in group 1 (n = 62) were treated with 8 mg/kg of cyclosporine (CsA), 2000 mg of MMF, two bolus IV injections of 20 mg of basiliximab and 500 mg of methylprednisolone (MP) rapidly tapered and withdrawn at 14 postoperative days (POD). Group 2 (n = 56) was treated with same dose of CsA and MMF, and 250 mg of MP tapered and continued. Acute rejection (AR) episodes were treated with MP pulse therapy followed by muromonab CD3 (OKT3) in case of steroid-resistant rejection. RESULTS: In 46 of 62 cases (74.2%) in group 1, steroid was successfully withdrawn at 13.7 +/- 1.7 POD. Graft survival at 3, 6, and 12 months in group 1 was 100%, 100%, and 98.4% (one death with functioning graft), and 100%, 98.2%, and 96.4% in group 2, respectively. The incidence of AR was 12.9% for group 1 and 42.9% for group 2, among which 21 cases in group 2 were treated with ALG or OKT3; no patient needed ALG or OKT3 in group 1. Fifteen cases in group 1 and 13 cases in group 2 developed CMV antigenemia, among which febrile episode was exhibited in 3 cases (4.8%) in group 1 and 5 cases (8.9%) in group 2. CONCLUSIONS: Early steroid withdrawal protocol using basiliximab is promising for reducing the incidence of AR (especially steroid-resistant rejection), CMV diseases, and steroid-related complications.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Antibodies, Monoclonal/therapeutic use , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/immunology , Mycophenolic Acid/analogs & derivatives , Recombinant Fusion Proteins/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Adult , Basiliximab , Cadaver , Calcineurin/adverse effects , Drug Administration Schedule , Drug Therapy, Combination , Female , Graft Rejection/drug therapy , Graft Rejection/immunology , Graft Rejection/prevention & control , Humans , Kidney Failure, Chronic/surgery , Living Donors , Male , Muromonab-CD3/therapeutic use , Mycophenolic Acid/therapeutic use , Tissue Donors , Treatment OutcomeSubject(s)
Adrenal Cortex Hormones/therapeutic use , Antibodies, Monoclonal/therapeutic use , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/immunology , Mycophenolic Acid/analogs & derivatives , Recombinant Fusion Proteins/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Basiliximab , Cadaver , Cytomegalovirus Infections/epidemiology , Cytotoxicity, Immunologic/drug effects , Cytotoxicity, Immunologic/immunology , Drug Administration Schedule , Drug Therapy, Combination , Female , Graft Rejection/epidemiology , Graft Rejection/immunology , Histocompatibility Testing , Humans , Kidney Failure, Chronic/surgery , Living Donors , Male , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Postoperative Complications/epidemiology , Tissue DonorsSubject(s)
Brain Diseases/chemically induced , Demyelinating Diseases/chemically induced , Immunosuppressive Agents/adverse effects , Liver Transplantation/immunology , Tacrolimus/adverse effects , Adult , Azathioprine/therapeutic use , Brain Diseases/diagnosis , Brain Diseases/diagnostic imaging , Cyclosporine/therapeutic use , Demyelinating Diseases/diagnosis , Demyelinating Diseases/diagnostic imaging , Drug Therapy, Combination , Family , Female , Humans , Immunosuppressive Agents/therapeutic use , Living Donors , Magnetic Resonance Imaging , Middle Aged , Prednisolone/therapeutic use , Syndrome , Tomography, X-Ray ComputedSubject(s)
Cyclosporins/toxicity , Islets of Langerhans/pathology , Mannose/analogs & derivatives , para-Aminobenzoates , 4-Aminobenzoic Acid/pharmacology , Animals , Fluorescent Antibody Technique , Islets of Langerhans/drug effects , Islets of Langerhans/ultrastructure , Mannose/pharmacology , Rats , Rats, Inbred Strains , Reference ValuesSubject(s)
4-Aminobenzoic Acid/therapeutic use , Aminobenzoates/therapeutic use , Cyclosporins/toxicity , Islets of Langerhans/drug effects , Mannose/analogs & derivatives , Animals , Body Weight/drug effects , Cyclosporins/analysis , Cyclosporins/pharmacokinetics , Glucose Tolerance Test , Insulin/blood , Islets of Langerhans/pathology , Islets of Langerhans/ultrastructure , Male , Mannose/therapeutic use , Pancreatic Extracts/analysis , Prostaglandins/analysis , Rats , Rats, Inbred Strains , Tissue Distribution , para-AminobenzoatesSubject(s)
4-Aminobenzoic Acid/pharmacology , Aminobenzoates/pharmacology , Cyclosporins/pharmacology , Kidney/physiology , Mannose/analogs & derivatives , Prostaglandins/metabolism , Renal Circulation/drug effects , Animals , Cyclosporins/pharmacokinetics , Cyclosporins/toxicity , Kidney/drug effects , Kidney/pathology , Male , Mannose/pharmacology , Rats , Rats, Inbred Strains , Reference Values , Tissue Distribution , para-AminobenzoatesABSTRACT
Change in the electrical charge of leukocyte surface membranes during hemodialysis (HD) using a cellulose membrane was studied by examining adsorbability of leukocytes taken from patients undergoing HD to cation and anion exchange resins. Leukocytes of HD patients were well adsorbed to both anion and cation exchange resins, whereas normal leukocytes were only minimally adsorbed to a cation exchange resin, suggesting that the surface membranes of normal leukocytes were charged electronegatively. Adsorbability to anion exchange resin by patients' leukocytes taken from the venous limb of the HD circuit line 15 minutes after starting HD was significantly decreased when using a cellulosic membrane. This suggests that the decrease in electronegative leukocyte surface membrane charge, which may facilitate the attachment of leukocytes to electronegatively charged endothelial cell membranes, is the factor leading to leukopenia. Adsorbability to anion exchange resin by normal leukocytes incubated with plasma taken from HD patients 10 to 60 minutes after starting HD was increased, suggesting an increase in electronegatively charged substances in patients' plasma; these recombine with leukocyte surface membranes thereby increasing the electronegative charges of the leukocyte surface membranes and enabling subsequent release of leukocytes from endothelial cells, consistent with the transient nature of the leukopenia.
Subject(s)
Anion Exchange Resins , Ion Exchange Resins , Leukocytes/physiology , Leukopenia/physiopathology , Renal Dialysis , Adsorption , Cation Exchange Resins , Cell Membrane/physiology , Electrophysiology , Humans , Leukopenia/etiology , Membranes, Artificial , Renal Dialysis/adverse effectsABSTRACT
Forty-eight hour hypothermic continuous perfusion preservation was attempted using a perfusion technique with an artificial blood substitute, a pyridoxylated hemoglobin-polyoxyethylene conjugated solution (stabilized hemoglobin, PHP). After preservation each of the 10 canine livers was orthotopically transplanted. Postoperative graft function was estimated by parameters such as activated clotting time (ACT), bile excretion, consciousness level, survival period, histologic findings, and adenosine triphosphoric acid (ATP) content of the perfused liver. Four of ten livers displayed good function, with bile excreted immediately after revascularization, and animal survival for over 24 hr. Cellular structure of the liver was well maintained, although atrophy of the hepatocytes and swelling of the mitochondria were seen. PHP solution is therefore considered suitable as a perfusate for long-term liver preservation.