[Evaluation of long-term effect of adding low-dose daclizumab to standard protocol on kidney rejection in kidney recipients]

Daclizumab is a monoclonal antibody directed against CD25 subunit of interlukin 2 receptor. Several studies have shown the effectiveness of daclizumab on reduction of acute rejection in renal transplantation with regular or limited dose. The present study assessed the outcomes of 3 and 5 years follow-up of a prospective case-control trial comparing safety and efficacy of induction therapy with two doses of daclizumab, compared with no induction treatment, in renal transplant recipients. This clinical-trial study was started in 2006 on 140 living donor kidney recipients admitted to kidney transplant ward of Kerman Afzalipour hospital, Iran. These patients were randomly assigned into two 70 patients, intervention and control groups. All patients received cyclosporine, mycophenolate mofetil and prednisolone. Intervention group recieved daclizumab at a dose of 1 mg/kg before transplantation and then two weeks later, also. All patients were followed up for 3 and 5 years for graft and patient survival and side effect of daclizumab, so.After 3 years, 58 patients remained in case and 61 in control group. Function of transplanted kidney was evaluated on base of calculated glomerular filtration rate [GFR], and after 3 and 5 years, were same between two groups. Rate of sepsis was same between two groups but infection with varicella zuster, in first 6 months after transplantation, was significantly more in intervention group [P = 0.04].Daclizumab did not have any effect on patient or graft survival. It did not increase the rate of sepsis but might increase the rate of varicella zuster infection

[ efficacy of amlodipine and diltiazem in cyclosporine dose adjustment with respect to trough and 2-hour concentrations in kidney transplant patients]

Hypertension, hyperuricaemia and nephrotoxicity are some common side-effects of Cyclosporine A [CsA] treatment in renal transplant recipients. Previous studies suggest that Calcium Channel Blockers [CCB] can increase serum level of CsA and may improve graft function in patients receiving CsA. The aim of this study was to evaluate the effects of Diltiazem and Amlodipine on cyclosporine dose adjustment with respect to trough and 2-hour concentrations in renal transplant recipients treated with CsA. This observer-blind randomized clinical trial was performed on 120 renal transplant recipients treated with CsA. Patients received either Amlodipine [5-10mg/day] or Diltiazem [90-180mg/day] for 3 months and were compared with control group receiving no CCB. Data were analyzed using ANOVA, Post Hoc and Correlation tests. Diltiazem significantly decreased CsA dosage [20%] from 162.03 +/- 40.6 mg/dl to 128.5 +/- 25.5 mg/dl [P=0.000] and Amlodipine, too, decreased it to 140.5 +/- 22.3 mg/dl [13%] which was significant [P=0.008]. Trough concentration in patients who had received Amlodipine were significantly higher than control group [P=0.019]. Diltiazem significantly decreased Cholesterol Level [P=0.027] but other parameters were not significantly different between Amlodipine / Diltiazem and control groups. Diltiazem and Amlodipine were well tolerated in co-administration with CsA with no adverse effect on graft function and did not affect blood pressure or heart rate. Our findings support that these two CCBs can be used in clinical settings to reduce the administered dose of cyclosporine

[Plasma Homocysteine Concentration in Hemodialysis Patients of Kerman/Iran in 2005]

Homocysteine is an aminoacid yielded from methionin to cysteine metabolism. Normal plasma concentration of homocysteine in human is between 5-15 micro mol/l and an increase more than 5 micro mol/l can increase the risk of cardiovascular diseases, atherosclerosis and thrombosis. On the other hand in dialysis patients due to some reasons such as uremia, genetic factors, dialysis related factors and vitamin B group deficiency, the plasma level of homocysteine increases. This study was done to evaluate Plasma vitamin B12, Folic acid and homocysteine levels in kerman hemodialysis patients in comparison to healthy persons. In this cross-sectional study performed in two hemodialysis units of kerman-Iran, 25 hemodialysis patients and 25 healthy persons were studied. Blood samples were drawn prior to the dialysis session. The samples were centrifuged and the plasma was kept frozen at -20°C until analysis. Homocysteine level was determined by Gas-Chromatography and vitamin levels analysis were determined by radio assay method. Mean homocysteine level in hemodialysis patients [19.7 +/- 8.8 micro mol/l] showed significant difference [P=0.024] with healthy persons, homocysteine level [15.3 +/- 3 micro mol/l]. There were no relationship between the time passed since the first dialysis [p=0.188] and patients, age [p=0.419] with homocysteine levels. Plasma vitmin B12 and folic acid levels in hemodialysis patients were 4672 +/- 2379 pg/ml and 47 +/- 17 ng/ml respectively. These values were much more than those in healthy persons [959 +/- 409 Pmol/L and 14 +/- 12nmol/L respectively]. Although homocysteine level in our patients was more than healthy persons, but it was lower than that of hemodialysis patients in other countries. This difference may be related to some factors such as genetic factors and administration of daily oral folic acid and Intravenous injection of B12 and B Complex after each dialysis session. Therefore this procedure is recommended in hemodialysis patients