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ABSTRACT Introduction: Previous research demonstrated benefits of late conversion to mTOR inhibitors against cutaneous squamous cell carcinomas (cSCC) in kidney transplant recipients (KTR), despite of poor tolerability. This study investigated whether stepwise conversion to sirolimus monotherapy without an attack dose modified the course of disease with improved tolerability. Methods: This prospective exploratory study included non-sensitized KTR with more than 12-months post-transplant, on continuous use of calcineurin inhibitors (CNI)-based therapy, and with poor-prognosis cSCC lesions. Incidence densities of high-risk cSCC over 3-years after conversion to sirolimus-monotherapy were compared to a non-randomized group with high-risk cSCC but unsuitable/not willing for conversion. Results: Forty-four patients were included (83% male, mean age 60 ± 9.7years, 62% with skin type II, mean time after transplantation 9 ± 5.7years). There were 25 patients converted to SRL and 19 individuals kept on CNI. There was a tendency of decreasing density of incidence of all cSCC in the SRL group and increasing in the CNI group (1.49 to 1.00 lesions/patient-year and 1.74 to 2.08 lesions/patient-year, p = 0.141). The density incidence of moderately differentiated decreased significantly in the SRL group while increasing significantly in the CNI group (0.31 to 0.11 lesions/patient-year and 0.25 to 0.62 lesions/patient-year, p = 0.001). In the SRL group, there were no sirolimus discontinuations, no acute rejection episodes, and no de novo DSA formation. Renal function remained stable. Conclusions: This study suggests that sirolimus monotherapy may be useful as adjuvant therapy of high-risk cSCC in kidney transplant recipients. The conversion strategy used was well tolerated and safe regarding key mid-term transplant outcomes.
RESUMO Introdução: Pesquisas anteriores demonstraram benefícios da conversão tardia para inibidores de mTOR contra carcinomas espinocelulares cutâneos (CECs) em receptores de transplante renal (RTR), apesar da baixa tolerabilidade. Este estudo investigou se a conversão gradual para monoterapia com sirolimo sem dose de ataque modificou o curso da doença com melhor tolerabilidade. Métodos: Esse estudo prospectivo exploratório incluiu RTR não sensibilizados com mais de 12 meses pós-transplante, uso contínuo de terapia imunossupressora baseado em inibidor de calcineurina (CNI) associado a micofenolato de sódio ou azatioprina, com lesões de CECs de mau prognóstico. Comparou-se densidades de incidência de CECs de alto risco durante 3 anos após conversão para monoterapia com sirolimo à um grupo não randomizado com CECs classificados conforme os mesmos critérios de gravidade do grupo sirolimo, mas inadequado/não disposto à conversão. Resultados: Foram incluídos 44 pacientes (83% homens, idade média 60 ± 9,7 anos, 62% com fototipo de pele II, tempo médio pós-transplante 9 ± 5,7 anos). 25 pacientes foram convertidos para SRL e 19 indivíduos mantidos em CNI. Foi observado tendência de diminuição da densidade de incidência de todos CECs no grupo SRL e de aumento no grupo CNI (1,49 a 1,00 lesões/paciente-ano; 1,74 a 2,08 lesões/paciente-ano; p = 0,141). A densidade de incidência de lesões moderadamente diferenciadas diminuiu significativamente no grupo SRL enquanto aumentou significativamente no grupo CNI (0,31 a 0,11 lesões/paciente-ano; 0,25 a 0,62 lesões/paciente-ano; p = 0,001). No grupo SRL não houve descontinuação do sirolimo, nenhum episódio de rejeição aguda e nenhuma formação de DSA de novo. Função renal permaneceu estável. Conclusões: Esse estudo sugere que a monoterapia com sirolimo pode ser útil como terapia adjuvante de CECs de alto risco em RTR. A estratégia de conversão usada foi bem tolerada e segura em relação aos principais desfechos do transplante a médio prazo.
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Abstract Background: the predictive ability of severity scores for mortality in patients admitted to intensive care units is not well-known among kidney transplanted (KT) patients, especially those diagnosed with coronavirus disease 2019 (COVID-19). The purpose of the present study was to evaluate the predictive ability of severity scores for mortality in KT recipients. Methods: 51 KT recipients with COVID-19 diagnosis were enrolled. The performance of the SOFA, SAPS 3, and APACHE IV tools in predicting mortality after COVID-19 was compared by the area under the ROC curve (AUC-ROC) and univariate Cox regression analysis was performed. Results: The 90-day cumulative incidence of death was 63.4%. Only APACHE IV score differed between survivors and nonsurvivors: 91.2±18.3 vs. 106.5±26.3, P = 0.03. The AUC- ROC of APACHE IV for predicting death was 0.706 (P = 0.04) and 0.656 (P = 0.06) at 7 and 90 days, respectively. Receiving a kidney from a deceased donor (HR = 3.16; P = 0.03), troponin levels at admission (HR for each ng/mL = 1.001; P = 0.03), APACHE IV score (HR for each 1 point = 1.02; P = 0.01), mechanical ventilation (MV) requirement (HR = 3.04; P = 0.002) and vasopressor use on the first day after ICU admission (HR = 3.85; P < 0.001) were associated with the 90-day mortality in the univariate analysis. Conclusion: KT recipients had high mortality, which was associated with type of donor, troponin levels, early use of vasopressors, and MV requirement. The other traditional severity scores investigated could not predict mortality.
RESUMO Introdução: a capacidade preditiva dos escores de gravidade para mortalidade em pacientes admitidos em unidades de terapia intensiva não é bem conhecida entre pacientes transplantados renais (TR), especialmente aqueles diagnosticados com doença coronavírus 2019 (COVID-19). Este estudo avaliou a capacidade preditiva dos escores de gravidade para mortalidade em receptores de TR. Métodos: Foram inscritos 51 receptores de TR diagnosticados com COVID-19. O desempenho das ferramentas SOFA, SAPS 3, APACHE IV em predizer mortalidade após COVID-19 foi comparado pela área sob a curva ROC (AUC-ROC) e realizou-se análise de regressão univariada de Cox. Resultados: A incidência cumulativa de óbito em 90 dias foi 63,4%. Somente APACHE IV diferiu entre sobreviventes e não-sobreviventes: 91,2±18,3 vs. 106,5±26,3; P = 0,03. A AUC-ROC do APACHE IV para predizer óbito foi 0,706 (P = 0,04) e 0,656 (P = 0,06) aos 7 e 90 dias, respectivamente. Receber rim de doador falecido (HR = 3,16; P = 0,03), níveis de troponina na admissão (HR para cada ng/mL = 1,001; P = 0,03), escore APACHE IV (HR para cada 1 ponto = 1,02; P = 0,01), necessidade de ventilação mecânica (VM) (HR = 3,04; P = 0,002), uso de vasopressor no primeiro dia após admissão na UTI (HR = 3,85; P < 0,001) foram associados à mortalidade em 90 dias na análise univariada. Conclusão: Receptores de TR apresentaram alta mortalidade, associada ao tipo de doador, níveis de troponina, uso precoce de vasopressores e necessidade de VM. Os outros escores tradicionais de gravidade investigados não puderam predizer mortalidade.
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Background: High-risk human papillomavirus (hrHPV) infection is linked with uterine cervix premalignant lesions and invasive carcinoma of the uterine cervix. Methods: Descriptive cross sectional study carried out among female kidney transplant (KTx) recipients in Kenyatta National Hospital, Nairobi-Kenya. We studied the risk factors for acquisition of hrHPV, examined cervical cytology and assayed for 14 hrHPV DNA using Cervista® HPV HR test and Cervista® MTA (Hologic®) automated platforms. Results: The 14-hrHPV genotypes assayed were 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 and the prevalence rate was 31.25 % (10/32). Abnormal cervical cytology was noted in 4/32 (12.5%) and included low-grade squamous intraepithelial lesion (2/32), atypical squamous cells of undetermined significance (1/32) and atypical glandular cells (1/32). The average age was 41.9years with mean age at first coitus being 20.4 years. Majority of the women 20(62.5%) were married while 8(25%) were single. About 18(56.3%) had only one sexual partner. About 20% of women were nulliparous and 4(12.5%) had a parity of five. Duration sincetransplantation ranged between 1-21 years. Conclusions: The burden of hrHPV and abnormal cervical cytology in our study seemed lower than that reported elsewhere and even in general population. This study may form basis for further studies about HPV infections and carcinoma of the uterine cervix among the kidney allograft recipients in our setting
Subject(s)
Humans , Female , Adult , Middle Aged , Uterine Cervical Neoplasms , Kidney Transplantation , Papillomavirus Infections , Transplant Recipients , AlphapapillomavirusABSTRACT
BACKGROUND: Cancer rates are increasing not only in the general population but also in patients with end-stage renal disease. We investigated the changing pattern of pretransplant malignancy in kidney transplant recipients over 5 decades.METHODS: We reviewed 3,748 kidney transplant recipients between 1969 and 2016. We divided patients into three groups (1969–1998, 1999–2006, 2007–2016) based on the era of the cancer screening system used throughout the nation. We analyzed the incidence and pattern of pretransplant malignancy among the three groups. We also evaluated recurrent and de novo malignancy in these patients compared to patients without pretransplant malignancy.RESULTS: A total of 72 patients exhibited pretransplant malignancy (1.9%). There were no cases of pretransplant cancer until 1998, but the rate of pretransplant malignancy gradually increased to 1.1% during 1999–2006 and further increased to 4.3% thereafter. The most frequent types of pretransplant malignancy changed from the bladder, liver, and stomach cancers to thyroid cancer and renal cell carcinoma. There were no de novo cases, but there were three cases of recurrent cancer in patients with pretransplant malignancy; the recurrence rate among kidney transplant recipients with pretransplant malignancy was not significantly different from the incidence rate of de novo malignancy among kidney transplant recipients without pretransplant malignancy (4.2% vs. 6.9%, P = 0.48).CONCLUSION: The incidence of pretransplant malignancy in kidney transplantation candidates is gradually increasing, and recent increases were accompanied by changes in cancer types. Pretransplant malignancy may not be a hindrance to kidney transplantation because of the low incidence of posttransplant recurrence and de novo malignancy.
Subject(s)
Humans , Carcinoma, Renal Cell , Early Detection of Cancer , Incidence , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Liver , Recurrence , Stomach Neoplasms , Thyroid Neoplasms , Transplant Recipients , Urinary BladderABSTRACT
OBJECTIVE: To monitor and investigate the influencing factors of 6-methylmercaptopurine ribonucleotides (6-MMPR) in human red blood cell (RBC) in Chinese kidney transplant recipients treated with azathiopurine (AZA), and to provide references for clinical personalized medicine. METHODS: In 100 Chinese kidney transplant recipients, the concentration of 6-MMPR in RBC was detected by validated HPLC-UV method. Correlation analysis was performed to analyze the effects of various factors, including patient age, gender, weight, AZA dose and thiopurine S-methyltransferase (TPMT) activity, on the 6-MMPR concentration, and multivariate linear regression analysis was performed using SPSS20.0 software to investigate the influencing factors of 6-MMPR concentration. RESULTS: The concentration of 6-MMPR in 100 Chinese kidney transplant recipients was not normally distributed (P0.05), however, there was a significant positive correlation between TPMT activity and 6-MMPR concentration in RBC (P<0.001). CONCLUSION: TPMT activity in RBC is an independent factor affecting 6-MMPR concentration, which in turn affects the clinical efficacy and toxicity of the drug.
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<p><b>Background</b>Mineral and bone disorder is one of the severe complications in kidney transplant recipients (KTRs). Previous studies showed that bisphosphonates had favorable effects on bone mineral density (BMD). We sought to compare different bisphosphonate regimens and rank their strategies.</p><p><b>Methods</b>We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to April 01, 2017, for randomized controlled trials (RCTs) comparing bisphosphonate treatments in adult KTRs. The primary outcome was BMD change. We executed the tool recommended by the Cochrane Collaboration to evaluate the risk of bias. We performed pairwise meta-analyses using random effects models and network meta-analysis (NMA) using Bayesian models and assessed the quality of evidence.</p><p><b>Results</b>A total of 21 RCTs (1332 participants) comparing 6 bisphosphonate regimens were included. All bisphosphonates showed a significantly increased percentage change in BMD at the lumbar spine compared to calcium except clodronate. Pamidronate with calcium and Vitamin D analogs showed improved BMD in comparison to clodronate with calcium (mean difference [MD], 9.84; 95% credibility interval [CrI], 1.06-19.70). The combination of calcium and Vitamin D analogs had a significantly lower influence than adding either pamidronate or alendronate (MD, 6.34; 95% CrI, 2.59-11.01 and MD, 6.16; 95% CrI, 0.54-13.24, respectively). In terms of percentage BMD change at the femoral neck, both pamidronate and ibandronate combined with calcium demonstrated a remarkable gain compared with calcium (MD, 7.02; 95% CrI, 0.30-13.29 and MD, 7.30; 95% CrI, 0.32-14.22, respectively). The combination of ibandronate with calcium displayed a significant increase in absolute BMD compared to any other treatments and was ranked best.</p><p><b>Conclusions</b>Our NMA suggested that new-generation bisphosphonates such as ibandronate were more favorable in KTRs to improve BMD. However, the conclusion should be treated with caution due to indirect comparisons.</p>
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Female , Humans , Male , Bone Density , Diphosphonates , Therapeutic Uses , Kidney Transplantation , Osteoporosis , Randomized Controlled Trials as TopicABSTRACT
In this study,we compared the serum levels of transforming growth factor-β1 (TGF-β1),interleukin-10 (IL-10),and arginase-1 in long-term survival kidney transplant recipients (LTSKTRs) with those in short-term survival kidney transplant recipients (STSKTRs).We then evaluated the relationship between these levels and graft function.Blood samples were collected from 50 adult LTSKTRs and 20 STSKTRs (graft survival approximately 1-3 years post-transplantation).All patients had stable kidney function.The samples were collected at our institution during the patients' follow-up examinations between March 2017 and September 2017.The plasma levels of TGF-β1,IL-10,and arginase-1 were analyzed using enzyme-linked immunosorbent assays (ELISA).The levels of TGF-β1 and arginase-1 were significantly higher in the LTSKTRs than in the STSKTRs.The time elapsed since transplantation was positively correlated with the levels of TGF-β 1 and arginase-1 in the LTSKTRs.The estimated glomerular filtration rate was positively correlated with the TGF-β1 level,and the serum creatinine level was negatively correlated with the TGF-β1 level.Higher serum levels of TGF-β1 and arginase-1 were found in LTSKTRs than in STSKTRs,and we found that TGF-β1 was positively correlated with long-term graft survival and function.Additionally,TGF-β1 and arginase-1 levels were positively correlated with the time elapsed since transplantation.On the basis of these findings,TGF-β1 and arginase-1 may play important roles in determining long-term graft survival.Thus,we propose that TGF-β1 and arginase-1 may potentially be used as predictive markers for evaluating long-term graft survival.
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In this study,we compared the serum levels of transforming growth factor-β1 (TGF-β1),interleukin-10 (IL-10),and arginase-1 in long-term survival kidney transplant recipients (LTSKTRs) with those in short-term survival kidney transplant recipients (STSKTRs).We then evaluated the relationship between these levels and graft function.Blood samples were collected from 50 adult LTSKTRs and 20 STSKTRs (graft survival approximately 1-3 years post-transplantation).All patients had stable kidney function.The samples were collected at our institution during the patients' follow-up examinations between March 2017 and September 2017.The plasma levels of TGF-β1,IL-10,and arginase-1 were analyzed using enzyme-linked immunosorbent assays (ELISA).The levels of TGF-β1 and arginase-1 were significantly higher in the LTSKTRs than in the STSKTRs.The time elapsed since transplantation was positively correlated with the levels of TGF-β 1 and arginase-1 in the LTSKTRs.The estimated glomerular filtration rate was positively correlated with the TGF-β1 level,and the serum creatinine level was negatively correlated with the TGF-β1 level.Higher serum levels of TGF-β1 and arginase-1 were found in LTSKTRs than in STSKTRs,and we found that TGF-β1 was positively correlated with long-term graft survival and function.Additionally,TGF-β1 and arginase-1 levels were positively correlated with the time elapsed since transplantation.On the basis of these findings,TGF-β1 and arginase-1 may play important roles in determining long-term graft survival.Thus,we propose that TGF-β1 and arginase-1 may potentially be used as predictive markers for evaluating long-term graft survival.
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Objective: To establish an HPLC-fluorescence detection method for the determination of thioguanosine-monophosphate (TGMP), thioguanosine-diphosphate (TGDP) and thioguanosine-triphosphate (TGTP) in red blood cells (RBC), as well as quantify the individual thioguanine nucleotides metabolites in kidney transplant recipients with azathioprine (AZA) therapy.Methods: The individual thioguanosine phosphates were extracted from RBC by dichloromethane and subsequently oxidized by potassium permanganate.The separation was achieved on a Nucleosil C18 column (150 mm×4.6 mm,5 μm) with an ion pairing reagent and detected by a fluorescence detector (excitation at 315 nm, emission at 390 nm).The mobile phase consisted of 20 mmol·L-1 potassium phosphate buffer (pH was adjusted to 6.8 by 5 mmol·L-1 tetrabutylammonium hydrogensulfate)-acetonitril (80:20) with the flow rate of 1.0 ml·min-1.Results: TGMP, TGDP and TGTP were quantified from RBC within the range of 50-500, 50-1000 and 100-5 000 pmol·ml-1, respectively.The limit of quantification (LOQ) was 50, 50 and 100 pmol·ml-1 RBC for TGMP, TGDP and TGTP, respectively.The intra-and inter-day RSDs were below 7.0% with the method recovery between 95.0% and 103.6%.The mean extraction recovery was above 90%.The assay was applied in the blood samples of 30 kidney transplant recipients with AZA therapy, and the results indicated that TGTP was the predominant phosphate metabolite in RBC.Conclusion: The method is simple, rapid, sensitive and specific, and it can quantitatively determine the individual thioguanosine phosphates in RBC of kidney transplant recipients with AZA therapy.
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OBJECTIVE: This study evaluated the diagnostic performance of two methods for the detection of influenza virus in immunocompromised transplant patients. METHODS: A total of 475 respiratory samples, 236 from patients in a hematopoietic stem cell transplantation program and 239 from kidney transplant patients, were analyzed by a direct fluorescence assay and the Centers for Disease Control real-time polymerase chain reaction protocol for influenza A and B detection. RESULTS: Influenza detection using either method was 7.6% in the hematopoietic stem cell transplant group and 30.5% in the kidney transplant patient group. Influenza detection by real-time polymerase chain reaction yielded a higher positive rate compared with fluorescence than that reported by other studies, and this difference was more pronounced for influenza A. The fluorescence assay sensitivity, specificity, positive and negative predictive values, and kappa coefficient were 17.6%, 100%, 1, 0.83, and 0.256, respectively, and lower detection rates occurred in the kidney transplant patients. CONCLUSIONS: The real-time polymerase chain reaction performance and the associated turnaround time for a large number of samples support the choice of this method for use in different routine diagnostic settings and influenza surveillance in high-risk patients. .
Subject(s)
Adult , Humans , Middle Aged , Young Adult , Fluorescent Antibody Technique, Direct , Immunocompromised Host/immunology , Influenza A virus/isolation & purification , Influenza B virus/isolation & purification , Influenza, Human/diagnosis , Real-Time Polymerase Chain Reaction , Chi-Square Distribution , Hematopoietic Stem Cell Transplantation , Influenza A virus/immunology , Influenza B virus/immunology , Influenza, Human/immunology , Kidney Transplantation , Logistic Models , Predictive Value of Tests , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
The purpose of our study was to evaluate the dietary intake of kidney transplant recipients (KTRs) and assess oral intake related nutrition problems. Fifty patients who had undergone kidney transplantation were included: 24 males, 26 females. The mean age was 46.8 +/- 11.2 years, height was 161.3 +/- 8.3 cm, and body weight was 60.5 +/- 8.7 kg. We conducted nutrition education based on the diet guideline for KTRs (energy 32 kcal/kg of ideal body weight [IBW], protein 1.3 g/kg of IBW) and neutropenic diet guideline before discharge. Dietary intake of the patients at 1 month after transplantation was investigated by 3-day food records. Body weight and laboratory values for nutritional status and graft function were also collected. Body weight was significantly decreased from admission to discharge. Body weight from discharge to 1 month and 3 months after transplantation was increased but was not significant. Biochemical measurements were generally improved but the number of patients with hypophosphatemia increased. The daily dietary intake of energy and protein was adequate (33.1 kcal/kg, 1.5 g/kg, respectively). However, the dietary intake of calcium, folate, and vitamin C did not meet the Korean Recommended Nutrient Intake of vitamins and minerals (86.8%, 62.4%, and 88.0%, respectively). Patients with low intake of calcium, folate, and vitamin C presented low intake in milk and dairy products, vegetables, and fruits, and these foods were related to restricted food items in neutropenic diet. More attention should be paid on improving quality of diet, and reconsideration of present neutropenic diet guideline is necessary. These results can be used to establish evidence-based medical nutrition therapy guideline for KTRs.
Subject(s)
Female , Humans , Male , Ascorbic Acid , Body Weight , Calcium , Dairy Products , Diet , Education , Folic Acid , Fruit , Hypophosphatemia , Ideal Body Weight , Kidney Transplantation , Kidney , Milk , Minerals , Nutrition Therapy , Nutritional Status , Transplantation , Transplants , Vegetables , VitaminsABSTRACT
BACKGROUND: Kidney transplant recipients inevitably take a life-long immunosuppressive medication to prevent graft rejection. Non-compliance to immunosuppressive medication is one of the main causes leading to acute and chronic rejection and diminished renal function, resulting in a return to dialysis, increased morbidity, or mortality with an additional health care cost and poor quality of life. The purpose of this study was to investigate actual medication compliance and its related factors. METHODS: A total of 222 functioning kidney transplant recipients were surveyed in a single center, and 25 patients were excluded due to incomplete responses. We reviewed medical records retrospectively, and the data were statistically analyzed with SPSS version 13.0. RESULTS: Among 197 patients, 113 (57.4%) were compliant to the immunosuppressive agents, and 84 (42.6%) recipients were non-compliant. Non-compliant patients were significantly younger (P=0.004), highly educated (P=0.004), employed (P=0.005), more likely to live alone (P=0.035), and drank more (P=0.001) than the compliant patients. Regarding psychosocial factors, more barriers (P=0.015), weak beliefs about the necessity of taking medications (P=0.001), strong beliefs about specific concerns related to medications (P=0.038), and low self efficacy (P=0.003) were identified in the non-compliant group compared with the compliant group. CONCLUSIONS: This study revealed that multiple factors affected medication compliance in patients taking immunosuppressants. It would be helpful to identify potential recipients with a risk for non-compliance based on their general characteristics and psychosocial factors, so they can be provided a specialized education program to promote compliance. This strategy may help produce more favorable long-term outcomes among kidney transplant recipients.
Subject(s)
Humans , Compliance , Dialysis , Graft Rejection , Health Care Costs , Immunosuppressive Agents , Kidney , Kidney Transplantation , Medical Records , Medication Adherence , Quality of Life , Rejection, Psychology , Retrospective Studies , Self EfficacyABSTRACT
n a more rational basis.
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The purpose of this study was to understand and describe how people with kidney transplantation experience using grounded theory method. Purposeful sampling was employed. Total of 20 kidney recipients participated in the study. To collect the data 11 individual in-depth interviewes and two focus group interviews were utilized. Each interview took about one hour, ranging from one to three hours and were audio-taped under the permission of the participants. All interviewes were transcribed to analyze. The results of the study show three stages of life process after kidney transplantation; 1) honeymoon stage, 2) anxiety and depression stage: 3) recovery and stable stage. In the honeymoon stage, all kidney recipients were exhilerated after the operation. They were happy receiving healthy kidney from others, often from beloved families. In the anxiety and depression stage, however, they experienced numerous psychosocial problems mainly due to the health, interpersonal, financial, and physical appearance problems. In the recovery and stable stage, they came out from the psychosocial problems by viewing their situation more objectively and by using many effective coping strategies to imporve their quality of life. Nine strategies which were identified as significant are 1) complying therapeutic regimens, 2) seeking information, 3) keeping their own job, 4) restricting social activities, 5) lowering aimes in their life, 6) managing the fact about their own kidney transplantation, 7) comforting themselves by comparing with others, 8) living religious or altruistic life, and 9) accepting redialysis and retransplantation. In the end, most of them experienced changed value system of life. They were satisfied with their current life, and thanked for living so many years after the transplantation. However, some of them, especially younger ones, regreted of losing hope and ambition they had planned when they were young. And many of them also experienced restricted social life, financial difficulties, and continuous fear of rejection of kidney. The results of the study might help nurses who work with kidney recipients in establishing and implementing effective nursing interventions by understanding the stages of life after kidney transplantations as well as their problems and strategies.
Subject(s)
Humans , Anxiety , Depression , Focus Groups , Hope , Kidney Transplantation , Kidney , Nursing , Quality of LifeABSTRACT
Cytomegalovirus (CMV) is a ubiquitous virus and its infections occur commonly after renal transplantation and immunosuppressive therapy. Early and accurate laboratory diagnosis of CMV infection in renal transplant is necessary but often difficult. To find optimal diagnostic methods for CMV infection, we compared shell vial culture and polymerase chain reaction (PCR) and Southern blot of PCR products. A total of 301 specimens of urine, blood neutrophils, tissues, or body fluids were obtained from 75 renal transplant recipients and were submitted to shell vial culture for CMV as well as DNA PCR using primers for immediate early(IE) gene of CMV. The human fibroblast cell line (MRC-5) was used to culture CMV and were examined with immunofluorescence staining using monoclonal antibody to the early antigen of CMV. The PCR products (274 and 379 bp) were detected by gel electrophoresis and ethidium bromide staining. When PCR products were not clearly visible on electrophoresis, PCR products were analyzed by Southern blot using IE gene probe. Sixty four(85.3%) of 75 renal transplant recipients showed CMV infection as analyzed by PCR and Southern blot as well as shell vial culture. On shell vial culture, CMV were detected in 81 specimens from 30(40%) renal transplant recipients in viremic state. On PCR and Southern blot analysis CMV were detected in 55 and 26 specimens, respectively from 59 patients. The sensitivity of culture and PCR to detect CMV infection were 42.4% and 83.3%, respectively. The results of two studies were concordant in 48%. PCR and Southern blot did not detect CMV in 10 and 5 culture proven CMV positive samples, respectively. Mutant CMV were found in 3 patients which showed 5-10 bp deletion in IE gene. Moreover, DNA sequencing analysis showed 5 mutant strains among 11 strains which appeared same by PCR prodcut. These results suggest that PCR followed by Southern blot may be more sensitive, but less specific than shell vial culture in the diagnosis of CMV disease. PCR followed by Southern blot may not detect mutant CMV. Combined analysis using both shell vial culture and PCR followed by Southern blot may be necessary to diagnose CMV infection in renal transplant recipients.