Background: We investigated a novel immunosuppressive protocol including thymoglobulin induction in combination with sirolimus and corticosteroids, followed by introduction of markedly reduced exposures to cyclosporine to prevent pancreas-transplant rejection.
Methods: A 7-day course of thymoglobulin (1.5 mg/kg per day) was begun on postoperative day (POD) 0, together with 15 mg of sirolimus on POD 1, and followed by 5 mg per day, targeting these doses to achieve a trough of 10 to 20 ng/mL. When the serum creatinine was below 2.5 mg/dL, cyclosporine was introduced at 50 mg twice daily with dose adjustment to maintain a trough concentration of 100 to 125 ng/mL.
Results: The 18 patients included 14 simultaneous pancreas-kidney and 4 pancreas-after-kidney transplant recipients. Two patients were African-American, three patients had a pretransplant panel reactive antibody greater than 20%, and the human leukocyte antigen (HLA) mismatch was 4.5+/-1 (mean+/-standard deviation). With a mean follow-up of 13.6+/-4.7 months, patient, kidney, and pancreas graft survivals are 100%, 100%, and 94%, respectively. A single pancreas graft was lost to thrombosis. There were no acute rejection episodes and no opportunistic infections. Mean hospital stay was 9+/-3 days. At 3 months posttransplantation, the mean value of serum creatinine was 1.2+/-0.3 mg/dL, fasting glucose was 88+/-15 mg/dL, and sirolimus dose at month 3 was 6.3+/-3 mg per day and at month 12 2.7+/-1 mg per day. The average total daily cyclosporine A dose at month 3 was 208+/-62 mg per day and 133+/-13 mg per day at 1 year.
Conclusions: This immunosuppressive regimen provided excellent prophylaxis against acute rejection with no opportunistic infections. We believe that careful monitoring of sirolimus and cyclosporine levels was critical to success of this protocol.
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http://dx.doi.org/10.1097/01.TP.0000061768.98058.EC | DOI Listing |
Clin Exp Nephrol
December 2024
Department of Nephrology, Ningbo Yinzhou Second Hospital, No. 998, North Qianhe Road, Yinzhou District, Ningbo City, 315000, Zhejiang Province, China.
Purpose: The study aimed to evaluate the efficacy and safety of rituximab (RTX) in primary IgA nephropathy (IgAN).
Methods: A retrospective review was conducted on the medical records of 22 patients diagnosed with primary IgAN who received RTX treatment. The clinical data, including blood tests, urine examinations and estimated glomerular filtration rate (eGFR), were analyzed at four time point: baseline, 3 months, 6 months and 12 months.
Vet Sci
December 2024
Department of Veterinary Science, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan.
An eight-year-old spayed female Abyssinian cat presented with lameness. Palpation revealed swelling, heat, and a reduced range of motion in the stifle and tarsal joints in both hind limbs. A radiographic examination of both hind limbs revealed periosteal proliferation from the distal tibia to the tarsal and metatarsal bones, which suggested hypertrophic osteopathy.
View Article and Find Full Text PDFPediatr Rep
December 2024
Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Background: Pediatric chronic kidney disease (CKD) requires reliable biomarkers for early detection and monitoring. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a potential marker due to its responsiveness to renal impairment and involvement in mineral metabolism.
Objectives: To evaluate serum NGAL levels in pediatric CKD patients and explore correlations with estimated glomerular filtration rate (eGFR), ferritin, calcium-phosphorus (Ca*P) product, and total serum protein.
J Pers Med
November 2024
Healthpoint Hospital, Abu Dhabi 112308, United Arab Emirates.
Primary biliary cholangitis (PBC) is an autoimmune chronic cholestatic disease of the liver that symptomatically can present with pruritus and fatigue. Its established first- and second-line therapies are ursodeoxycholic acid (UDCA) and obeticholic acid (OCA) although they provide limited symptom management. Liver transplantation offers a potentially curative therapeutic option in refractory cases progressing to cirrhosis.
View Article and Find Full Text PDFCurr Issues Mol Biol
November 2024
Department of Physiology, Medical Specialization Training Center (TUSMER), 06230 Ankara, Türkiye.
This study aimed to investigate the protective effects of vitamin B complex and alpha-lipoic acid (ALA) pre-treatments on hepatic ischemia-reperfusion injury (IRI) in rats, focusing on their potential to enhance antioxidant defense mechanisms and reduce post-ischemic liver damage. Thirty male Wistar albino rats were divided into four groups: sham group (n = 10), IRI group (n = 10), vitamin B group (n = 10), vitamin B + ALA group (n = 10). In the IRI, vitamin B, and vitamin B + ALA groups, the rats underwent 45 min of hepatic ischemia followed by 60 min of reperfusion.
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