RESUMEN
BACKGROUND: Induction therapy regimens classified as conventional immunosuppressive agents and lower doses of conventional agents combined with antibodies against T-cell antigens have been purposed to prevent acute rejection after renal transplantation. Various induction agents with different doses and durations have been suggested based on the risk profile of patients. OBJECTIVE: To assess the acute rejection rate (total rate and based on the type of induction therapy regimen) during the first year after kidney transplantation, the type of acute rejection based on Banff classification and to determine the associations between rate of acute rejection, type of the rejection and induction therapy regimen. METHODS: 249 kidney transplant candidates were divided into two groups-low-risk patients (n=208) who received conventional immunosuppressive agents, and high-risk patients (n=41) who received alemtuzumab-and followed for one year to detect acute rejection first diagnosed clinically, and confirmed by percutaneous kidney biopsy based on Banff criteria. RESULTS: The total incidence of acute rejection was 19.6% (20.7% of the low-risk and 14.4% of the high-risk patients). The most prevalent types of the acute rejection in patients treated with conventional immunosuppressive agents and patients received alemtuzumab as induction therapy were grade IB and grade IA, respectively. The incidence of acute rejection among recipients received a kidney from a deceased donor was 20.6% and grade IA was the most prevalent type (6.9%) whereas the most prevalent grade of acute rejection in patients who received living donor grafts was IB (8.3%). CONCLUSION: Despite the expected greater risk for acute rejection among high-risk patients, no significant difference was observed between low- and high-risk patients, which may be justified by the greater efficacy of alemtuzumab compared with standard triple induction therapy in reducing the rate of acute rejection.
RESUMEN
This study examined the incidence of human herpes virus-6 (HHV-6) and human cytomegalovirus (HCMV) infections that are potentially transmitted to haematopoietic stem cells (HSC) transplant recipients via bone marrow (BM) or umbilical cord blood (UCB). Bone marrow progenitor cells were collected from 30 allogenic BM donors. UCB HSC were collected from 34 subjects. The extracted DNA was then processed using nested polymerase chain reaction (nPCR) technique. HCMV and HHV-6 serological status were determined by enzyme immunoassay (EIA). Nested PCR identified HCMV in 22 (73%) of 30 samples of BM progenitor cells but in only eight (23.5%) of 34 samples of UBC HSC ( P = 0.001). HHV-6 DNA was detected in 11 (36.6%) of 30 BM progenitor cells and in only one (2.9%) of 34 UBC cells ( P = 0.002). Both HHV-6 and HCMV infections were determined in nine (26.5%) of 34 bone marrow samples. The results indicate that, the risk of HCMV and HHV-6 via BM progenitor cells is higher than transmission by UCB cells ( P= 0.04).