Cytotoxicity in Vero cells and cytokines analyses in Balb/c mice as safety assessments of the probiotic mixture Saccharomyces cerevisiae RC016 and Lactobacillus rhamnosus RC007 for use as a feed additive.

The objective was to carry out cytotoxicity assays in Vero cells and cytokines analyses in Balb/c mice as safety assessments to evaluate the probiotic mixture (M) Saccharomyces cerevisiae RC016 (Sc) and Lactobacillus rhamnosus RC007 (Lr) for use as feed additive. Vero cells (104 cells per well) were exposed to Sc (2·08 × 107 , 2·08 × 106 ; 2·08 × 105 cells per ml), Lr (8·33 × 107 ; 8·33 × 106 ; 8·33 × 105 cells per ml) and their M (1 : 1). Sc concentrations did not affect the Vero cells viability; in contrast, they were lower when exposed to Lr (P Ë‚ 0·0001). Vero cells showed increasing viability with M decreasing concentrations (91% viability with M2). Control BALB/c mice received only phosphate buffer saline and the others received the M. The IL-10, IL-6 and TNFα concentrations from intestinal fluid were analysed and no significant differences were observed among treatments. The same occurred with the ratio between IL-10/TNF-α. Beneficial effects of probiotics are associated with the regulation of the excessive inflammatory response; it is desirable they can modulate the cytokines production only under pathological conditions. Here, M administration to healthy mice did not induce negative side effects and expands the knowledge about beneficial effects of using probiotic microorganisms in mixture for feed additives development.

Sirolimus immunotherapy: the Albany Medical Center experience.

At the Albany Medical Center, we have a long-term experience, mean follow-up of 61 months, in 31 renal transplant recipients treated with sirolimus, cyclosporine microemulsion formulation, and prednisone. In these patients the rate of acute rejection was 13%, actual patient and graft survival at 1 year was 100%, and the mean serum creatinine at 1 year was 1.3 mg/dL. Furthermore, long-term graft survival was 90%. The success of this regimen stimulated us to evaluate a subsequent sirolimus-based protocol, initiated in April, 2001, which decreased exposure to calcincurin inhibitors at 3 months posttransplant (n = 50). At a mean follow-up of 10 months, graft survival was 96%. The rate of acute rejection was only 10% and the mean serum creatinine was 1.5 mg/dL. Furthermore, no acute rejection episodes have developed subsequent to the reduction in calcineurin inhibitor dosing at 3 months. Sirolimus is an effective immunosuppressive agent that safely allows for a reduction in calcineurin-inhibitor dosing.

Prognostic factors and early resumption of cyclosporin A in renal allograft recipients with thrombotic microangiopathy and hemolytic uremic syndrome.

Biopsy-proven thrombotic microangiopathy (TMA) was found in 22 of 436 (5%) renal transplant recipients, with similar incidence in recipients of cadaver or living related allografts. All patients with TMA presented different degrees of severity of the hemolytic uremic syndrome (HUS). Prognosis was poor when HUS occurred shortly after transplant in recipients of cadaveric kidneys (55% graft loss). It was more favorable when HUS occurred later in the post-transplant course or in recipients with allografts from living related donors, irrespective of time of occurrence. Other factors such as extent of TMA, degree of thrombocytopenia, hemolysis or renal dysfunction were not predictive of graft loss. Cyclosporine was resumed in 14 of 16 recipients shortly after clinical recovery without recurrence of HUS. In conclusion, HUS carries poor prognosis when occurring shortly after transplant in cadaver kidney recipients. Once the graft function improves, cyclosporine can be safely resumed.

Successful identification of acute renal allograft rejection with duplex ultrasonography.

Duplex ultrasonography has met with variable accuracy in identifying acute renal allograft rejection. These published studies have focused on using mathematical indices. We have applied duplex ultrasonography differently by insonating the site of rejection, i.e. renal cortex, to identify by subjective analysis the changes of the velocity spectral patterns. This subjective analysis method was compared to the mathematical indices of diastolic/systolic ratio and pulsatility index in 126 episodes of clinical acute renal allograft rejection which all had biopsy correlation. This present study represents the largest published experience with duplex ultrasonography and renal transplant rejection. Subjective analysis of velocity spectral patterns (SUBJ) resulted in sensitivity of 87%, specificity of 94% and overall accuracy of 88%. This technique was statistically better than the diastolic/systolic ratio (DSR) sensitivity of 40%, specificity of 72% and overall accuracy of 49%, or the pulsatility index (PI) sensitivity of 47%, specificity of 75% and overall accuracy of 55%. The superior results of the subjective analysis technique of duplex ultrasonography to identify acute renal allograft rejection suggests that this diagnostic approach has sufficient accuracy to avoid invasive allograft biopsies.

Extracorporeal shock wave lithotripsy in the renal transplant patient: a case report and review of literature.

Renal allograft lithiasis is a rare complication of renal transplantation, which in the past has required various invasive procedures for adequate stone fragmentation and dissolution. Noninvasive techniques such as extracorporeal shock wave lithotripsy (ESWL) can now be extended to the renal transplant patient. Five cases have been previously reported in which ESWL was used effectively for dissolution of renal allograft calculi. We now report a 6th case in which a calculus, initially identified 2 weeks after renal transplantation, was effectively fragmented 3 years later using ESWL. Based on our experience and the reviewed composite experience in the literature, ESWL is a safe therapy for renal allograft calculi.