Background. Intellectual disability (ID) in patients with chronic kidney disease is a relative contraindication for kidney transplantation. Methods. We analysed a retrospective cohort of 16 ...recipients of kidney transplantation with ID and 83 controls. Results. Graft survival at 5 years was similar between patients (81.2%) and controls (80.2%), P = 0.9. Patient survival at 5 years was lower among patients (81.2% versus 94.4%, P < 0.05). Patients had more infection episodes, but no risk factors were identified. Conclusion. Although recipients with ID have lower long-term patient survival, the equivalent graft survival rates support the indication of renal transplantation in such disability.
Cytomegalovirus (CMV) infection is highly prevalent in transplant patients, especially in those submitted to a more intense immunosuppression. We monitored CMV infection in 34 patients during 60 days ...after antilymphocyte therapy without CMV prophylaxis. Six patients received sirolimus and 28 received no sirolimus as immunosuppression. During 60 days of follow-up time, 24/28 (86%) patients who did not use sirolimus developed CMV infection at a mean time of 32.43±13.67 days after antilymphocyte treatment. In contrast, no patient on sirolimus had CMV infection during the same follow-up (
p<0.001). During a further 4-month follow-up, six patients on sirolimus-free therapy had recurrence of CMV, 46.5±18.5 days after the first episode. During this same period, one patient receiving sirolimus had one positive cell for CMV antigenemia, 169 days after antilymphocyte therapy. In conclusion, the use of sirolimus significantly reduced the incidence of CMV infection in patients treated with antilymphocyte antibodies.
BACKGROUNDElderly (≥60years) recipients are receiving renal transplants more frequently. The pharmacokinetics studies (PK) of immunosuppressive drugs in healthy volunteers, rarely, include old ...patients.
METHODSWe studied 208 12-hour Tacrolimus (TAC) PK (0,20,40,60,90,120,180,240,360,480,600,720 min) in 44 elderly (Eld) (65±3year) and compared the results with 31 younger controls (Ctrl) (35±6y) recipients, taking oral Tacrolimus (TAC)/Mycophenolate Sodium (MPS)/prednisone, at 4 different time-pointsPK1 (8±2days; n=72); PK2 (31±4d; n=61); PK3 (63±6d; n=44) and PK4 (185±10days; n=31). TAC-PK was measured by Ultra Performance Liquid Chromatography coupled to a mass spectrometer repetition (UPLC/MS/MS) and non-compartmental PKs were analyzed using Phoenix WinNonlin.
RESULTSMean TAC dose was lower in the Eld group than in Ctrl ones throughout time points either by total daily dose or adjusted per body weight (adj). Mean TAC trough level (Cmin), used to adjust daily dose, was not different between the two groups in all time-points. adjCmax and AdjTAC-AUC0-12hr were both higher in the Eld compared to the Ctrl group in PKs1, 3 and 4. Estimated total body clearance (Clss_F) normalized by dose and weight was lower in the Eld group compared to the Ctrl in all PKs and statistically lower at PKs 1 and 3. Similar to younger recipients TAC trough level has also a high correlation (R=0.76) with AUC0-12h.
CONCLUSIONSThese data indicate that elderly recipients have a lower TAC clearance and therefore need a lower TAC dose than younger recipients.
The discard rate of kidneys recovered from deceased donors with acute renal failure (ARF) is higher compared with those without ARF mainly due to the uncertainty regarding short-term and long-term ...outcomes.
We retrospectively analyzed 1-year patient, graft, and rejection-free survivals and renal function of transplantations performed with kidneys recovered from deceased donors with or without ARF, defined as serum creatinine level of more than 1.5 mg/dL. We performed multivariable analysis to evaluate whether ARF was an independent risk factor associated with inferior outcomes.
Of a total of 1518 patients, 253 received kidneys from expanded-criteria donors (ECD; with ARF n=116 and without ARF n=137) and 1265 from standard-criteria donors (SCD; with ARF n=369 and without ARF n=896). The incidence of delayed graft function was higher in ECD (68.1% vs. 58.4%; P=0.072) and SCD (69.9% vs. 50.6%; P<0.001) recipients of kidneys with ARF compared with those without ARF, respectively. At 1 year, patient, graft, and rejection-free survivals were not statistically different in SCD or ECD recipients with or without ARF. Renal function at 1 year was similar in recipients of ECD (41.9±26.3 vs. 40.1±21.7 mL/min; P=0.565) or SCD (50.9±29.9 vs. 53.6±28.5 mL/min; P=0.131) kidneys with and without ARF, respectively. Compared with kidneys without ARF, receiving a kidney allograft with ARF was not associated with increased risk of death, graft lost, or inferior renal function 1 year after transplantation.
In this cohort of patients, kidneys from deceased donors with ARF provided graft survival and renal function comparable with kidneys from donors without ARF 1 year after transplantation.
We summarize broadband observations of the TeV-emitting blazar 1ES 1959+650, including optical R-band observations by the robotic telescopes Super-LOTIS and iTelescope, UV observations by Swift ...Ultraviolet and Optical Telescope, X-ray observations by the Swift X-ray Telescope, high-energy gamma-ray observations with the Fermi Large Area Telescope, and very-high-energy (VHE) gamma-ray observations by VERITAS above 315 GeV, all taken between 2012 April 17 and 2012 June 1 (MJD 56034 and 56079). The contemporaneous variability of the broadband spectral energy distribution is explored in the context of a simple synchrotron self Compton (SSC) model. In the SSC emission scenario, we find that the parameters required to represent the high state are significantly different than those in the low state. Motivated by possible evidence of gas in the vicinity of the blazar, we also investigate a reflected emission model to describe the observed variability pattern. This model assumes that the non-thermal emission from the jet is reflected by a nearby cloud of gas, allowing the reflected emission to re-enter the blob and produce an elevated gamma-ray state with no simultaneous elevated synchrotron flux. The model applied here, although not required to explain the observed variability pattern, represents one possible scenario which can describe the observations. As applied to an elevated VHE state of 66% of the Crab Nebula flux, observed on a single night during the observation period, the reflected emission scenario does not support a purely leptonic non-thermal emission mechanism. The reflected emission model does, however, predict a reflected photon field with sufficient energy to enable elevated gamma-ray emission via pion production with protons of energies between 10 and 100 TeV.
We summarize broadband observations of the TeV-emitting blazar 1ES 1959+650, including optical R-band observations by the robotic telescopes Super-LOTIS and iTelescope, UV observations by Swift ...Ultraviolet and Optical Telescope, X-ray observations by the Swift X-ray Telescope, high-energy gamma-ray observations with the Fermi Large Area Telescope, and very-high-energy (VHE) gamma-ray observations by VERITAS above 315 GeV, all taken between 2012 April 17 and 2012 June 1 (MJD 56034 and 56079). The contemporaneous variability of the broadband spectral energy distribution is explored in the context of a simple synchrotron self Compton (SSC) model. In the SSC emission scenario, we find that the parameters required to represent the high state are significantly different than those in the low state. Motivated by possible evidence of gas in the vicinity of the blazar, we also investigate a reflected emission model to describe the observed variability pattern. This model assumes that the non-thermal emission from the jet is reflected by a nearby cloud of gas, allowing the reflected emission to re-enter the blob and produce an elevated gamma-ray state with no simultaneous elevated synchrotron flux. The model applied here, although not required to explain the observed variability pattern, represents one possible scenario which can describe the observations. As applied to an elevated VHE state of 66% of the Crab Nebula flux, observed on a single night during the observation period, the reflected emission scenario does not support a purely leptonic non-thermal emission mechanism. The reflected emission model does, however, predict a reflected photon field with sufficient energy to enable elevated gamma-ray emission via pion production with protons of energies between 10 and 100 TeV.
The immunosuppressive effect of OKT3 depends upon both T cell depletion and antigenic modulation of CD3 complex. To establish the effect of low doses of OKT3 on peripheral T lymphocytes, we analyzed ...47 kidney transplant recipients receiving OKT3 for the first time. OKT3 was used as rescue therapy in 39 patients and as part of induction protocols in 8. The mean age of patients was 39±10 years, 30 were females and 9 were re-transplants. Half of them (51.1%) received kidney from cadaver donors. Among those receiving OKT3 as rescue therapy, 82% recovered graft function, including patients with severe BANFF-graded rejections. After the first dose of OKT3, it a pronounced T cell depletion was observed followed by an increase in CD4 and CD8 expression in CD3 negative T cells, supporting the idea that T cell modulation was present. In conclusion, low dose OKT3 was effective in treating severe allograft rejection by inducing a sustained TCR/CD3 down modulation without long-lasting T cell depletion.
PDF
