Mycophenolate mofetil absorption quotient: interest to clinical practice.

Use of mycophenolate mofetil (MMF) in kidney transplantation has led to significant improvements in the acute rejection index and graft survival. Posttransplant MMF levels are known to be of value for discriminating patients at risk of acute rejection. Trough MMF levels were measured in 153 patients who had undergone kidney transplantation more than 1 year before and showed stable graft function. MMF dosage was adjusted based on hematologic or gastrointestinal toxicity. The quotient between the weight-adjusted dose and through MMF levels was calculated in order to establish absorption type. We analyzed the diagnostic value of this quotient in relation to creatinine proteinuria, hematologic and gastrointestinal toxicity based upon percentiles of 10, 25, 50, 75, and 90, which were used as cutoff points. Mean MMF levels were 3.79 +/- 3.3 mg/L. Mean quotient value was 6.55 +/- 9.2. A significant correlation was found between MMF dosage and MMF trough levels (r = .34, P < .01). However, no correlation was seen between MMF dosage and the quotient. There were no significant differences in the analyzed parameters and the percentiles established as cutoff points. However, patients with gastrointestinal toxicity had a larger quotient (9.07 +/- 7.45.3 vs 5.28 +/- 4.9). The relationship between MMF dose and levels does not establish differences in kidney function and proteinuria among stable transplant patients; patients with diarrhea may show decreased absorption.

Complete switch to everolimus in long-term kidney transplants: evolution of the renal function.

INTRODUCTION: The use of M-tor inhibitors plus withdrawal of anticalcineurins after 3 months of posttransplantation is usually linked to improvements in renal function. The long-term effects of substitution of anticalcineurinis by everolimus remain unknown. The aim in this study was to evaluate the evolution of renal function and the proteinuria after a complete switch of long-term functioning allograft patients to everolimus. We treated 30 renal transplanted patients with everolimus, at a mean time posttransplantation of 123.8 +/- 74.2 months. The 27 patients, including 17 treated with tacrolimus and 10 with cyclosporine, who were controlled for at least 6 months were included in this study. Seventeen of them were diagnosed to display chronic allograft nephropathy (CAN). RESULTS: The patients with CAN showed a basal creatinine of 1.81 +/- 0.4; with after a year, 1.61 +/- 0.38; and after 2 years, 1.56 +/- 0.49 mg/dL (P < .05). No significant changes were observed among patients without CAN: 1.1 +/- 0.32, 0.97 +/- 0.15, and 0.97 +/- 0.15 mg/dL, respectively. In CAN patients, the protein/creatinine quotient was: basal = 0.30 +/- 0.13, one year = 0.63 +/- 0.68, and 2 years = 0.48 +/- 0.34. In the other patients the values were 0.2 +/- 0.07, 0.73 +/- 0.7, and 0.32 +/- 0.17, respectively, after a late switch to everolimus. CONCLUSION: The improved renal function occurred mainly in patients with CAN. Patients who did not suffer from it showed a greater rise in proteinuria. Nevertheless, both groups experienced decreased proteinuria after 2 years.

Prophylaxis and treatment of cytomegalovirus infection postrenal transplantation in two Madrid units.

INTRODUCTION: Complete prevention of cytomegalovirus (CMV) disease continues to be an unresolved problem in renal transplantation. MATERIALS AND METHODS: From January 2005 to May 2006, we implemented a protocol for early detection and preemptive treatment of CMV infection as detected by antigenemia or polymerase chain reaction determined every 2 weeks during the first 3 months posttransplant and monthly thereafter. Prophylaxis was given to all CMV-negative patients who received CMV-positive kidneys and to those who received polyclonal or monoclonal antibody induction therapy. RESULTS: Among 100 transplants, 15 subjects received prophylaxis due to poly- or monoclonal antibody induction and/or negative recipient serology using a mean valgancyclovir dose of 485 +/- 276 mg/d for an average duration of 129 days. After completion of the prophylaxis four patients (26.6%) required preemptive therapy for asymptomatic virus reactivation; the mean dose of drug in these patients had been 450 +/- 275.56 mg, with a treatment time that was significantly shorter than those not suffering reactivation (91.75 vs 143.45 days). In addition, preemptive therapy was given for virus reactivation in seven patients, for illness with mild viral syndrome in two, with moderate illness and positive pretransplantation serology in one. The average treatment time was 79 days and the mean dose was 375 mg. CONCLUSION: In those not at risk, CMV infections occurred among 11.7% of patients in our early detection program. Prophylaxis for at-risk patients should continue for more than 3 months to prevent reactivation.

Risk factors for early renal graft thrombosis: a case-controlled study in grafts from the same donor.

Renal graft thrombosis is an important cause of early graft loss. In a case-controlled analysis including only thrombosed kidneys and their counterparts from the same donors, we found that the right kidney as opposed to the left kidney was the only risk factor for early graft vascular thrombosis. No other recipient, donor, or perioperative factor was significantly associated with the complication. Our findings suggested that implantation of a right kidney might be followed by prophylactic anticoagulant or antiaggregant therapy.