Change of cyclosporine absorption over the time after kidney transplantation

Although the immunosuppressant cyclosporine [CsA] is widely used after kidney transplantation over the long term, there is still no firm consensus on the best way to monitor of CsA blood levels. Cyclosporine [CsA] assay is critical for the management of renal transplant recipients due to inter- and intra-patient variation in CsA absorption and metabolism. Patients and In a retrospective cross sectional study, blood levels of CsA [through and 2 hours post dose] measured at least 5 times during 3 years post transplantation, in 7702 kidney transplant recipients from different transplant center of Tehran, IR Iran between 2008 and 2012. Cyclosporine absorption [CA] calculated C2/CO ratio. CA had a significant correlation with allograft function [P = 0.000, r =.0.285], this correlation was stronger than its relationship with CO and C2 blood levels [P = 0.000 and P = 0.000 as well as r = 0.033 and r = 0.090, respectively]. In univariate analysis during different times after transplantation, CO and C2 blood levels significantly decreased over three years follow up [P = 0.000], [P = 0.000]; While, CA reversely increases over the time [P = 0.000]. In linear regression model overall CA levels had correlation with lower age of recipient [P = 0.02], hypokalemia [P = 0.001], higher level of creatinine [P = 0.02] and triglyceride [P = 0.001]. The present study shows that CsA absorption changes trough the post-transplant time and appears to increases over time in long-term period after kidney transplantation

impact of hepatitis C virus infection on kidney transplantation outcomes: a systematic review of 18 observational studies

Hepatitis C virus [HCV] infection occursin 0% to 51% of dialysis patients, and many HCV-positive patients are urged to undergo kidney transplantation. However, the outcome of renal transplantation in HCV-positive recipients is unknown. Our review aimed to address the outcomes of renal transplantation recipients [RTRs] following kidney transplantation. We selected studies that used the adjusted relative risk [aRR] and 95% CI of all-cause mortality and graft loss in HCV-positive compared with HCV-negative RTRs as study endpoints. Cox proportional hazard analysis was usedin all studies to calculate the independent effects of HCV infection on RTR outcomes. Sixteen retrospective cohort studies and 2 clinical trials were selected for our review. Sixteen studies were related to patient survival, and 12 examined graft survival. The combined hazard ratio in HCV-infected recipients was 1.69-fold [1.33-1.97, p< 0.0001] and 1.56 times [1.22-2.004, p < 0.0001] greater than that of HCV-negative recipients for mortality and graft loss, respectively. Although HCV-infected RTRs have worseoutcomes than HCV-negative RTRS, kidney transplantation is the preferred treatment for patients with HCV infection and end-stage renal disease

Impact of cigarette smoking on kidney transplant recipients. a systematic review

Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. However, there are surprisingly few studies on the impact of cigarette smoking among kidney transplant recipients and its consequences after transplantation. We performed a systematic review of the literature to identify the effects of cigarette smoking on patient and graft survival rates among kidney transplant recipients. We searched the PubMed from 1968 to 2009 to identify studies on the effect of cigarette smoking on kidney transplant recipients, using the following keywords: kidney transplantation, cigarette, smoking, tobacco, and nicotine. The electronic and manual searches yielded 357 articles, of which 39 were considered potentially relevant by titles and abstracts and were selected for full text review. Twenty-seven irrelevant reports were excluded. A total of 12 papers were selected for review, comprising of 1801 kidney transplant recipients with a history of smoking. The impact of cigarette smoking on kidney recipient survival was only evaluated by 6 studies and the relative risk of smoking for death was available in 3 reports, varying between 0.8 and 2.2. Cigarette smoking was an independent risk factor for patient death. In addition, on univariable and multivariable analyses, graft survival correlated with a history of cigarette smoking and the relative risk for graft failure ranged from 1.06 to 2.3. Cigarette smoking was associated with an increased risk of death and graft loss. Therefore, every attempt should be made to encourage kidney transplant candidates to stop smoking