Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 32
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Rev Sci Instrum ; 92(4): 043520, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34243436

RESUMO

A machine learning approach has been implemented to measure the electron temperature directly from the emission spectra of a tokamak plasma. This approach utilized a neural network (NN) trained on a dataset of 1865 time slices from operation of the DIII-D tokamak using extreme ultraviolet/vacuum ultraviolet emission spectroscopy matched with high-accuracy divertor Thomson scattering measurements of the electron temperature, Te. This NN is shown to be particularly good at predicting Te at low temperatures (Te < 10 eV) where the NN demonstrated a mean average error of less than 1 eV. Trained to detect plasma detachment in the tokamak divertor, a NN classifier was able to correctly identify detached states (Te < 5 eV) with a 99% accuracy (an F1 score of 0.96) at an acquisition rate 10× faster than the Thomson scattering measurement. The performance of the model is understood by examining a set of 4800 theoretical spectra generated using collisional radiative modeling that was also used to predict the performance of a low-cost spectrometer viewing nitrogen emission in the visible wavelengths. These results provide a proof-of-principle that low-cost spectrometers leveraged with machine learning can be used to boost the performance of more expensive diagnostics on fusion devices and be used independently as a fast and accurate Te measurement and detachment classifier.

2.
Rev Sci Instrum ; 89(10): 10C111, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30399780

RESUMO

Translatable in-vessel mirrors have enabled the DIII-D Thomson scattering system to diagnose the divertor plasma in high triangularity shaped plasmas. Previous divertor Thomson scattering measurements in DIII-D were restricted to spatial locations along a Nd:YAG laser beam that was directed through a vertical port. This only allowed measurements to be made in low triangularity shaped plasmas. The new mirrors re-route the laser underneath floor tiles to a position of smaller major radius as necessary for high triangularity plasmas. New in-vessel collection optics transmit scattered light from regions inaccessible to external lenses. Damage to mirrors and high stray light levels are challenges that were overcome to successfully make these measurements. Through the careful use of baffles and light shields, stray light leakage into polychromator detector channels was reduced to negligible levels, allowing temperature measurements below 1 eV. The system is described and the initial results presented.

3.
Rev Sci Instrum ; 89(9): 093502, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278733

RESUMO

Coherence Imaging Spectroscopy (CIS) has emerged as a powerful tool for investigating complex ion phenomena in the boundary of magnetically confined plasma devices. The combination of Fourier-transform interferometry and high-resolution fast-framing cameras has made it possible to make sensitive velocity measurements that are also spatially resolved. However, this sensitivity makes the diagnostic vulnerable to environmental effects including thermal drifts, vibration, and magnetic fields that can influence the velocity measurement. Additionally, the ability to provide an absolute calibration for these geometries can be impacted by differences in the light-collection geometry between the plasma and reference light source, spectral impurities, and the presence of thin-films on in-vessel optics. This paper discusses the mitigation of these effects and demonstration that environmental effects result in less than 0.5 km/s error on the DIII-D CIS systems. A diagnostic comparison is used to demonstrate agreement between CIS and traditional spectroscopy once tomographic artifacts are accounted for.

4.
Phys Rev Lett ; 121(7): 075001, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-30169054

RESUMO

A bifurcative step transition from low-density, high-temperature, attached divertor conditions to high-density, low-temperature, detached divertor conditions is experimentally observed in DIII-D tokamak plasmas as density is increased. The step transition is only observed in the high confinement mode and only when the B×∇B drift is directed towards the divertor. This work reports for the first time a theoretical explanation and numerical simulations that qualitatively reproduce this bifurcation and its dependence on the toroidal field direction. According to the model, the bifurcation is primarily driven by the interdependence of the E×B-drift fluxes, divertor electric potential structure, and divertor conditions. In the attached conditions, strong potential gradients in the low field side (LFS) divertor drive E×B-drift flux towards the high field side divertor, reinforcing low density, high temperature conditions in the LFS divertor leg. At the onset of detachment, reduction in the potential gradients in the LFS divertor leg reduce the E×B-drift flux as well, such that the divertor plasma evolves nonlinearly to high density, strongly detached conditions. Experimental estimates of the E×B-drift fluxes, based on divertor Thomson scattering measurements, and their dependence on the divertor conditions are qualitatively consistent with the numerical predictions. The implications for divertor power exhaust and detachment control in the next step fusion devices are discussed.

5.
Rev Sci Instrum ; 87(11): 11E508, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27910482

RESUMO

A design to extend the unique divertor Thomson scattering system on DIII-D to allow measurements of electron temperature and density in high triangularity plasmas is presented. Access to this region is selectable on a shot-by-shot basis by redirecting the laser beam of the existing divertor Thomson system inboard - beneath the lower floor using a moveable, high-damage threshold, in-vacuum mirror - and then redirecting again vertically. The currently measured divertor region remains available with this mirror retracted. Scattered light is collected from viewchords near the divertor floor using in-vacuum, high temperature optical elements and relayed through the port window, before being coupled into optical fiber bundles. At higher elevations from the floor, measurements are made by dynamically re-focusing the existing divertor system collection optics. Nd:YAG laser timing, analysis of the scattered light spectrum via polychromators, data acquisition, and calibration are all handled by existing systems or methods of the current multi-pulse Thomson scattering system. Existing filtered polychromators with 7 spectral channels are employed to provide maximum measurement breadth (Te in the range of 0.5 eV-2 keV, ne in the range of 5 × 1018-1 × 1021 m3) for both low Te in detachment and high Te measurement up beyond the separatrix.

6.
Rev Sci Instrum ; 87(11): 11E517, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27910589

RESUMO

Thomson scattering produces ne profiles from measurement of scattered laser beam intensity. Rayleigh scattering provides a first calibration of the relation ne ∝ ITS, which depends on many factors (e.g., laser alignment and power, optics, and measurement systems). On DIII-D, the ne calibration is adjusted against an absolute ne from the density-driven cutoff of the 48 channel 2nd harmonic X-mode electron cyclotron emission system. This method has been used to calibrate Thomson ne from the edge to near the core (r/a > 0.15). Application of core electron cyclotron heating improves the quality of cutoff and depth of its penetration into the core, and also changes underlying MHD activity, minimizing crashes which confound calibration. Less fueling is needed as "ECH pump-out" generates a plasma ready to take up gas. On removal of gyrotron power, cutoff penetrates into the core as channels fall successively and smoothly into cutoff.

7.
Rev Sci Instrum ; 87(11): 11D426, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27910636

RESUMO

The Upper Wide Angle Viewing System (UWAVS) will be installed on five upper ports of ITER. This paper shows major requirements, gives an overview of the preliminary design with reasons for some design choices, examines self-emitted IR light from UWAVS optics and its effect on accuracy, and shows calculations of signal-to-noise ratios for the two-color temperature output as a function of integration time and divertor temperature. Accurate temperature output requires correction for vacuum window absorption vs. wavelength and for self-emitted IR, which requires good measurement of the temperature of the optical components. The anticipated signal-to-noise ratio using presently available IR cameras is adequate for the required 500 Hz frame rate.

8.
Rev Sci Instrum ; 85(11): 11D855, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25430268

RESUMO

An imaging system with a wide-angle tangential view of the full poloidal cross-section of the tokamak in simultaneous infrared and visible light has been installed on DIII-D. The optical train includes three polished stainless steel mirrors in vacuum, which view the tokamak through an aperture in the first mirror, similar to the design concept proposed for ITER. A dichroic beam splitter outside the vacuum separates visible and infrared (IR) light. Spatial calibration is accomplished by warping a CAD-rendered image to align with landmarks in a data image. The IR camera provides scrape-off layer heat flux profile deposition features in diverted and inner-wall-limited plasmas, such as heat flux reduction in pumped radiative divertor shots. Demonstration of the system to date includes observation of fast-ion losses to the outer wall during neutral beam injection, and shows reduced peak wall heat loading with disruption mitigation by injection of a massive gas puff.

9.
Rev Sci Instrum ; 85(11): 11E418, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25430325

RESUMO

New near infrared (NIR) spectroscopic measurements performed in the DIII-D tokamak divertor plasma suggest new viable diagnostic applications: divertor recycling and low-Z impurity flux measurements, a spectral survey for divertor Thomson scattering (DTS) diagnostic, and Te monitoring for divertor detachment control. A commercial 0.3 m spectrometer coupled to an imaging lens via optical fiber and a InGaAs 1024 pixel array detector enabled deuterium and impurity emission measurements in the range 800-2300 nm. The first full NIR survey identified D, He, B, Li, C, N, O, Ne lines and provided plasma Te, ne estimates from deuterium Paschen and Brackett series intensity and Stark line broadening analysis. The range 1.000-1.060 mm was surveyed in high-density and neon seeded divertor plasmas for spectral background emission studies for λ = 1.064 µm laser-based DTS development. The ratio of adjacent deuterium Paschen-α and Brackett Br9 lines in recombining divertor plasmas is studied for divertor Te monitoring aimed at divertor detachment real-time feedback control.

10.
Rev Sci Instrum ; 85(11): 11E825, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25430390

RESUMO

A conceptual design for a divertor Thomson scattering (DTS) diagnostic has been developed for the NSTX-U device to operate in parallel with the existing multipoint Thomson scattering system. Higher projected peak heat flux in NSTX-U will necessitate application of advanced magnetics geometries and divertor detachment. Interpretation and modeling of these divertor scenarios will depend heavily on local measurement of electron temperature, Te, and density, ne, which DTS provides in a passive manner. The DTS design for NSTX-U adopts major elements from the successful DIII-D DTS system including 7-channel polychromators measuring Te to 0.5 eV. If implemented on NSTX-U, the divertor TS system would provide an invaluable diagnostic for the boundary program to characterize the edge plasma.

11.
Am J Transplant ; 14(1): 133-43, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24354873

RESUMO

In this study, we analyze the outcomes of transplant renal artery stenosis (TRAS), determine the different anatomical positions of TRAS, and establish cardiovascular and immunological risk factors associated with its development. One hundred thirty-seven of 999 (13.7%) patients had TRAS diagnosed by angiography; 119/137 (86.9%) were treated with angioplasty, of which 113/137 (82.5%) were stented. Allograft survival in the TRAS+ intervention, TRAS+ nonintervention and TRAS- groups was 80.4%, 71.3% and 83.1%, respectively. There was no difference in allograft survival between the TRAS+ intervention and TRAS- groups, p = 0.12; there was a difference in allograft survival between the TRAS- and TRAS+ nonintervention groups, p < 0.001, and between the TRAS+ intervention and TRAS+ nonintervention groups, p = 0.037. TRAS developed at the anastomosis, within a bend/kink or distally. Anastomotic TRAS developed in living donor recipients; postanastomotic TRAS (TRAS-P) developed in diabetic and older patients who received grafts from deceased, older donors. Compared with the TRAS- group, patients with TRAS-P were more likely to have had rejection with arteritis, odds ratio (OR): 4.83 (1.47-15.87), p = 0.0095, and capillaritis, OR: 3.03 (1.10-8.36), p = 0.033. Patients with TRAS-P were more likely to have developed de novo class II DSA compared with TRAS- patients hazard ratio: 4.41 (2.0-9.73), p < 0.001. TRAS is a heterogeneous condition with TRAS-P having both alloimmune and traditional cardiovascular risk factors.


Assuntos
Anticorpos/análise , Antígenos de Histocompatibilidade Classe II/imunologia , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/imunologia , Doadores de Tecidos , Adulto , Idoso , Angiografia Digital/efeitos adversos , Feminino , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/cirurgia , Fatores de Risco , Stents , Resultado do Tratamento
12.
Rev Sci Instrum ; 84(2): 023505, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23464209

RESUMO

The divertor heat flux footprint in tokamaks is often observed to be non-axisymmetric due to intrinsic error fields, applied 3D magnetic fields or during transients such as edge localized modes. Typically, only 1D radial heat flux profiles are analyzed; however, analysis of the full 2D divertor measurements provides opportunities to study the asymmetric nature of the deposited heat flux. To accomplish this an improved 3D Fourier analysis method has been successfully applied in a heat conduction solver (TACO) to determine the 2D heat flux distribution at the lower divertor surface in the National Spherical Torus Experiment (NSTX) tokamak. This advance enables study of helical heat deposition onto the divertor. In order to account for heat transmission through poorly adhered surface layers on the divertor plate, a heat transmission coefficient, defined as the surface layer thermal conductivity divided by the thickness of the layer, was introduced to the solution of heat conduction equation. This coefficient is denoted as α and a range of values were tested in the model to ensure a reliable heat flux calculation until a specific value of α led to the constant total deposited energy in the numerical solution after the end of discharge. A comparison between 1D heat flux profiles from TACO and from a 2D heat flux calculation code, THEODOR, shows good agreement. Advantages of 2D heat flux distribution over the conventional 1D heat flux profile are also discussed, and examples of 2D data analysis in the study of striated heat deposition pattern as well as the toroidal degree of asymmetry of peak heat flux and heat flux width are demonstrated.

13.
Am J Transplant ; 13(2): 485-92, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23167441

RESUMO

In renal transplant patients with de novo donor-specific antibodies (dnDSA) we studied the value of microcirculation inflammation (MI; defined by the addition of glomerulitis (g) and peritubular capillaritis (ptc) scores) to assess long-term graft survival in a retrospective cohort study. Out of all transplant patients with standard immunological risk (n = 638), 79 (12.4%) developed dnDSA and 58/79 (73%) had an indication biopsy at or after dnDSA development. Based on the MI score on that indication biopsy patients were categorized, MI0 (n = 26), MI1 + 2 (n = 21) and MI ≥ 3 (n = 11). The MI groups did not differ significantly pretransplantation, whereas posttransplantation higher MI scores developed more anti-HLA class I + II DSA (p = 0.011), showed more TCMR (p < 0.001) and showed a trend to C4d-positive staining (p = 0.059). Four-year graft survival estimates from time of indication biopsy were MI0 96.1%, MI1 + 2 76.1% and MI ≥ 3 17.1%; resulting in a 24-fold increased risk of graft failure in the MI ≥ 3 compared to the MI0 group (p = 0.003; 95% CI [3.0-196.0]). When adjusted for C4d, MI ≥ 3 still had a 21-fold increased risk of graft failure (p = 0.005; 95% CI [2.5-180.0]), while C4d positivity on indication biopsy lost significance. In renal transplant patients with de novo DSA, microcirculation inflammation, defined by g + ptc, associates with graft survival.


Assuntos
Anticorpos/imunologia , Transplante de Rim/imunologia , Transplante de Rim/métodos , Rim/imunologia , Insuficiência Renal/terapia , Adulto , Biópsia , Complemento C4b/análise , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Inflamação , Masculino , Microcirculação , Pessoa de Meia-Idade , Modelos Estatísticos , Fragmentos de Peptídeos/análise , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos
14.
Rev Sci Instrum ; 83(10): 10D716, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23126890

RESUMO

A radiative divertor technique is used in present tokamak experiments and planned for ITER to mitigate high heat loads on divertor plasma-facing components (PFCs) to prevent excessive material erosion and thermal damage. In NSTX, a large spherical tokamak with lithium-coated graphite PFCs and high divertor heat flux (q(peak) ≤ 15 MW/m(2)), radiative divertor experiments have demonstrated a significant reduction of divertor peak heat flux simultaneously with good core H-mode confinement using pre-programmed D(2) or CD(4) gas injections. In this work diagnostic options for a new real-time feedback control system for active radiative divertor detachment control in NSTX-U, where steady-state peak divertor heat fluxes are projected to reach 20-30 MW/m(2), are discussed. Based on the NSTX divertor detachment measurements and analysis, the control diagnostic signals available for NSTX-U include divertor radiated power, neutral pressure, spectroscopic deuterium recombination signatures, infrared thermography of PFC surfaces, and thermoelectric scrape-off layer current. In addition, spectroscopic "security" monitoring of possible confinement or pedestal degradation is recommended. These signals would be implemented in a digital plasma control system to manage the divertor detachment process via an actuator (impurity gas seeding rate).

15.
Rev Sci Instrum ; 83(5): 053706, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22667624

RESUMO

A novel imaging adaptor providing the capability to extend a standard single-band infrared (IR) camera into a two-color or dual-band device has been developed for application to high-speed IR thermography on the National Spherical Tokamak Experiment (NSTX). Temperature measurement with two-band infrared imaging has the advantage of being mostly independent of surface emissivity, which may vary significantly in the liquid lithium divertor installed on NSTX as compared to that of an all-carbon first wall. In order to take advantage of the high-speed capability of the existing IR camera at NSTX (1.6-6.2 kHz frame rate), a commercial visible-range optical splitter was extensively modified to operate in the medium wavelength and long wavelength IR. This two-band IR adapter utilizes a dichroic beamsplitter, which reflects 4-6 µm wavelengths and transmits 7-10 µm wavelength radiation, each with >95% efficiency and projects each IR channel image side-by-side on the camera's detector. Cutoff filters are used in each IR channel, and ZnSe imaging optics and mirrors optimized for broadband IR use are incorporated into the design. In-situ and ex-situ temperature calibration and preliminary data of the NSTX divertor during plasma discharges are presented, with contrasting results for dual-band vs. single-band IR operation.

16.
Am J Transplant ; 11(1): 152-5, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21114651

RESUMO

Complement factor H-related protein 5 (CFHR5) nephropathy is a familial renal disease endemic in Cyprus. It is characterized by persistent microscopic hematuria, synpharyngitic macroscopic hematuria and progressive renal impairment. Isolated glomerular accumulation of complement component 3 (C3) is typical with variable degrees of glomerular inflammation. Affected individuals have a heterozygous internal duplication in the CFHR5 gene, although the mechanism through which this mutation results in renal disease is not understood. Notably, the risk of progressive renal failure in this condition is higher in males than females. We report the first documented case of recurrence of CFHR5 nephropathy in a renal transplant in a 53-year-old Cypriot male. Strikingly, histological changes of CFHR5 nephropathy were evident in the donor kidney 46 days post-transplantation. This unique case demonstrates that renal-derived CFHR5 protein cannot prevent the development of CFHR5 nephropathy.


Assuntos
Proteínas do Sistema Complemento/genética , Glomerulonefrite/genética , Idoso , Fator H do Complemento/genética , Chipre , Feminino , Humanos , Nefropatias/genética , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Recidiva
17.
Rev Sci Instrum ; 80(4): 043501, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19405654

RESUMO

A probe has been designed, constructed, and successfully used to inject methane into the DIII-D lower divertor in a manner imitating natural release by chemical erosion. This porous plug injector (PPI) probe consists of a self-contained gas reservoir with an integrated pressure gauge and a 3 cm diameter porous surface through which gas is injected into the lower divertor of the tokamak. The probe is positioned flush with the divertor target surface by means of the divertor materials evaluation system. Two gas delivery systems were developed: in the first, gas flow is regulated by a remotely controlled microvalve and in the second by a fixed micro-orifice flow restrictor. Because of the large area of the porous surface through which gas is admitted, the injected hydrocarbon molecules see a local carbon surface (>90% carbon) similar to that seen by hydrocarbons being emitted by chemical sputtering from surrounding carbon tiles. The distributed gas source also reduces the disturbance to the local plasma while providing sufficient signal for spectroscopic detection. In situ spectroscopic measurements with the PPI in DIII-D allow the direct calibration of response for measured plasma conditions from a known influx of gas.

18.
Rev Sci Instrum ; 79(10): 10F303, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19044616

RESUMO

Dust production and accumulation present potential safety and operational issues for the ITER. Dust diagnostics can be divided into two groups: diagnostics of dust on surfaces and diagnostics of dust in plasma. Diagnostics from both groups are employed in contemporary tokamaks; new diagnostics suitable for ITER are also being developed and tested. Dust accumulation in ITER is likely to occur in hidden areas, e.g., between tiles and under divertor baffles. A novel electrostatic dust detector for monitoring dust in these regions has been developed and tested at PPPL. In the DIII-D tokamak dust diagnostics include Mie scattering from Nd:YAG lasers, visible imaging, and spectroscopy. Laser scattering is able to resolve particles between 0.16 and 1.6 microm in diameter; using these data the total dust content in the edge plasmas and trends in the dust production rates within this size range have been established. Individual dust particles are observed by visible imaging using fast framing cameras, detecting dust particles of a few microns in diameter and larger. Dust velocities and trajectories can be determined in two-dimension with a single camera or three-dimension using multiple cameras, but determination of particle size is challenging. In order to calibrate diagnostics and benchmark dust dynamics modeling, precharacterized carbon dust has been injected into the lower divertor of DIII-D. Injected dust is seen by cameras, and spectroscopic diagnostics observe an increase in carbon line (CI, CII, C(2) dimer) and thermal continuum emissions from the injected dust. The latter observation can be used in the design of novel dust survey diagnostics.

19.
Transplant Proc ; 37(4): 1760-1, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15919456

RESUMO

INTRODUCTION: Acute rejection remains an important cause of graft loss after renal transplantation. It has been suggested that cytokine genotyping may play a predictive role in identifying individuals who are at higher risk of acute rejection with a view to individualizing their immunosuppression. The aim of this study was to investigate any possible associations between acute rejection and certain cytokine polymorphisms. METHODS: We genotyped 91 cadaveric renal transplant recipients on tacrolimus-based immunosuppression and 84 of their donors. The cytokine polymorphisms studied were the following: tumor necrosis factor (TNF)-alpha-1032 T/C, TNF-alpha-865 C/A, TNF-alpha-859 G/A, interleukin (IL)1-R1-970 C/T, IL-10 haplotype [-1082, -819, -592], and IL-6-174 C/G. RESULTS: We found no association between any polymorphism and the incidence of acute rejection. This was true for both the recipient and donor population. CONCLUSION: Cytokine polymorphisms did not influence acute rejection in our study. We conclude that in the modern era of immunosuppression cytokine genotyping is not a significant predictor of acute rejection in renal transplantation.


Assuntos
Citocinas/genética , Rejeição de Enxerto/epidemiologia , Transplante de Rim/imunologia , Polimorfismo Genético , Tacrolimo/uso terapêutico , Adulto , Cadáver , Genótipo , Humanos , Imunossupressores/uso terapêutico , Fatores de Risco
20.
Transplant Proc ; 37(4): 1795-6, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15919469

RESUMO

INTRODUCTION: We conducted a study to assess the safety of staged, late steroid withdrawal in kidney or kidney/pancreas transplant recipients on steroids, tacrolimus, and mycophenolate mofetil (MMF). MATERIALS AND METHODS: We studied 50 patients including 33 recipients of cadaveric kidneys, eight living donor kidneys, and nine kidney-pancreas transplants. The mean time posttransplantation was 5.1 years (range 2.1 to 7.9 years). All patients were induced on prednisolone, tacrolimus, and MMF; steroids were withdrawn over 5 to 6 months. The rate of steroid reduction was altered in the face of typical steroid withdrawal symptoms (limb-girdle arthralgia/myalgia). RESULTS: No rejection episodes occurred during steroid withdrawal. No patient required transplant biopsy for graft dysfunction. Six patients failed steroid withdrawal: five due to arthralgia/myalgia and one due to recurrent pulmonary sarcoidosis. The unexplained rise in serum creatinine following steroid withdrawal described in several other steroid withdrawal studies was not observed in this patient cohort. The mean serum creatinine was 137 micromol/L with deltacreatinine -6.8 micromol/y per year prior to steroid cessation versus 132 micromol/L with deltacreatinine -5.9 micromol/y in the year post-steroid cessation. There were 14 patients with posttransplant diabetes mellitus in this cohort: eight on gliclazide and six on insulin. We observed a reduction in their daily insulin/gliclazide requirements from 52 units to 41 units, and 73 mg to 65 mg, respectively. Two patients became gliclazide-independent at the time of steroid cessation. CONCLUSIONS: Careful steroid withdrawal from a platform of tacrolimus and MMF is safe and not associated with a significant risk of rejection or graft dysfunction.


Assuntos
Glucocorticoides/administração & dosagem , Transplante de Rim/fisiologia , Ácido Micofenólico/análogos & derivados , Tacrolimo/uso terapêutico , Adulto , Creatinina/sangue , Esquema de Medicação , Feminino , Seguimentos , Taxa de Filtração Glomerular , Glucocorticoides/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/imunologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Segurança , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...