Postrenal transplantation body composition: different evolution depending on gender.

OBJECTIVE: Patients receiving regular hemodialysis have a lower body mass index, which is mainly caused by the reduction of fat mass and body cell mass (BCM) and the accompanying extracellular water (ECW) expansion. Kidney transplant (Tx) recipients normally regain subnormal renal filtration, and they must cope with significant therapeutic-associated metabolic side effects, which may compromise the recovery of normal nutritional status. We investigated the influence of renal function recovery on body fluid composition during the first period post-Tx, when immunosuppressive drugs doses are at their highest. We also analyzed the differences between males and females and compared them with healthy controls. METHODS: Eighteen patients (11 males and 7 females) were studied. Biolectric impedance analysis was done pre-Tx and at months 1 and 3 post-Tx. We considered the following parameters: total body water, ECW, intracellular water, Na:K exchangeable ratio, phase angle, and BCM. The healthy group was evaluated three times in a year interval. RESULTS: We observed differences between genders. Compared with healthy males, resistance, reactance, intracellular water, and BCM were greater and ECW was lower among Tx males at pre-Tx time. At months 1 and 3, we observed only different total body water in males compared with controls. Females did not display any differences in biolectric impedance analysis parameters compared with healthy controls, with the exception of lower reactance at month 1. CONCLUSIONS: Compared with healthy subjects, uremic males presented body water disturbances pre-Tx. During the first 3 months post-Tx, males showed an incomplete recovery of bioelectric impedance analysis parameters with a greater total body water, probably the result of drug therapy side effects. Pre-Tx, Tx females at pre-Tx time had no differences as compared with healthy females.

Compared to mycophenolate mofetil, rapamycin induces significant changes on growth factors and growth factor receptors in the early days post-kidney transplantation.

BACKGROUND: The new immunosuppressive drug Rapamycin (Rapa) is endowed with a mechanism of action that is distinct from that of calcineurin inhibitors. It has been claimed that Rapa does not significantly modulate either the cytokine expression or the transcription of several growth factors in mitogen-activated T cells. Previously, we reported that fine-needle aspiration biopsy (FNAB) sample cultures synthesize a large array of cytokines, and some of them may be powerful predictors of acute rejection in renal transplants. We hypothesized that Rapa may induce significant changes on cytokine production by FNAB sample cultures and on serum cytokine receptors when compared to other immunosuppressive drugs. METHODS: Kidney transplants treated with CsA-Rapa-Pred (Rapa group) were compared with transplants treated with CsA-mycophenolate mofetil-Pred (MMF group). They were studied on day 7 posttransplantation, and they remained rejection free for at least the first 6 months. FNAB samples were cultured and the supernatants were collected at 48 hr of incubation and analyzed by ELISA for interleukin 1 receptor antagonist (IL-1ra), IL-2, IL-6, IL-10, IL-18, monocyte chemotactic protein 1 (MCP-1), soluble tumor necrosis factor I, and transforming growth factor (TGF)-beta(1). The soluble receptors for IL-1, IL-2, IL-6, and tumor necrosis factor alpha, together with IL-2 and IL-18 were also measured in serum. RESULTS: Significant differences were observed when comparing Rapa with the MMF group. IL-18 and TGF-beta(1) synthesis were up-regulated, whereas IL-6 and MCP-1 were down-regulated in FNAB sample cultures. The Rapa group showed a significant down-regulation of each cytokine receptor and of IL-2 in serum. CONCLUSIONS: Rapa was associated with a decreased synthesis of primarily monocyte-derived cytokines and enhanced production of TGF-beta(1), which in an appropriate cytokine milieu may promote allograft tolerance. The down-regulation of cytokine receptors and IL-2 may be associated with a depressed immune response towards the kidney allograft.