Efficacy of anti-interleukin-2 receptor antibody [daclizumab] in reducing the incidence of acute rejection after renal transplantation

Acute rejection remains a major problem in renal transplantation and represents one of the most important causes of chronic allograft dysfunction and late graft loss. Daclizumab is a genetically engineered human IgGl monoclonal antibody that binds specifically to the a chain of the interleukin-2 receptor, and may thus reduce the risk of reection after renal transplantation. The aim of this study was to examine the effect of daclizumab induction therapy combined with a triple immunosuppressive protocol including prednisolone, cyclosporine microemulsion [CsA], and mycophenolate mofetil [MMF], in reducing the incidence of acute rejection in recipients of living unrelated donor kidneys. In this historical cohort study, 43 adult recipients of their first kidney allograft received daclizumab [three l mg/kg doses administered every 2 weeks] with triple immunosuppressive therapy [steroids, CsA, and MMF]. This group was compared to 43 first-time graft recipients who received maintenance triple immunosuppressive therapy comprising steroids, CsA, and MMF. The end point was the incidence of biopsy-confirmed acute rejection within 6 months after transplantation. Results: At 6 months, 5 [11.6%] of the patients in the daclizumab group had biopsy-proven rejections, as compared to 14 [32.5%] in the control group [P = 0.017]. The sex and the age of recipients had no impact on the incidence of acute rejection episodes in the two groups. Adding interleukin-2 receptor antibody [daclizumab] to maintenance triple immunosuppressive therapy [prednisolone, CsA, and MMF] reduces the incidence of acute rejection episodes at 6 months in first-time transplant recipients of living unrelated donor

Effects of heparin and dalteparin on oxidative stress during hemodialysls in patients with end-stage renal disease

Dialysis-induced oxidative stress is one of the mechanisms of atherosclerotic changes. Heparin, used in hemodialysis, is an anticoagulant drug with anti-inflammatory and antioxidant effects. This study was planned in order to evaluate the antioxidant effects of heparin and dalteparin [low-molecular weight heparin]. Twenty-two patients underwent 3 hemodialysis sessions with 48-hour intervals. They underwent hemodialysis with heparin, with a bolus dose of 1000 U followed by 1000 U/h during the procedure. The second hemodialysis was done using hypertonic saline solution instead of heparin, and the third, using dalteparin, 4000 U, infused during hemodialysis. Before and after each dialysis session, we measured serum levels of total blood cholesterol, triglyceride, high- and low-density lipoprotein cholesterols and oxidized low-density lipoprotein cholesterol, in addition to total antioxidant capacity and paraoxonase 1 activity. Serum concentrations of triglyceride, cholesterol, and oxidized low-density lipoprotein cholesterol, as well as paraoxonase activity and total antioxidant capacity equally increased after the three hemodialysis sessions. Heparin and daltepain increased total antioxidant capacity, but they did not change the ratio of paraoxonase 1 to high-density lipoprotein cholesterol after hemodialysis. No significant differences were found through the study between the two heparin products in their antioxidant activities. Regarding these findings and considering higher price and less availability of dalteparin in comparison to conventional heparin, we recommend using conventional heparin during hemodialysis as the anticoagulant-antioxidant agent