Effect of pretransplantation hemoglobin blood concentration on renal allograft survival and function.

The effect of pretransplantation hemoglobin (Hb) concentration on the outcome of kidney transplantation (KTx) was studied in 188 adult kidney transplant recipients. Patients were divided into 2 groups: high Hb (>or=10 g/dL; n=97) and low Hb (<10 g/dL; n=91). Both groups were matched for recipient sex, donor age and sex, donor-recipient blood groups, indications for kidney transplantation, and degree of sensitization. Acute rejection episodes occurred in 20 patients in the high-Hb group (20.6%) and 18 in the low-Hb group (19.8%). Antithymocyte globulin-Fresenius therapy was required in 6 patients in the high-Hb group compared with 5 patients in the low-Hb group. Infection rate, 1-year actuarial patient and graft survival, incidence of delayed and slow graft function, and number of surgical complications were comparable between groups. Compared with the low Hb group, in the high-Hb group, hospital stay was longer, creatinine concentration at 12 months post-KTx and serum glucose concentration at 6 months post-KTx were significantly higher, and pre- and posttransplantation Hb concentrations were higher. The need for post-KTx transfusions was comparable between groups. Pretransplantation Hb concentration did not affect outcome except for longer initial hospital stay and 1-year creatinine concentration.

Effect of pretransplantation body mass index on allograft function and patient survival after renal transplantation.

We evaluated the effects of pretransplantation recipient body mass index (BMI) on allograft survival and on kidney function. Kidney transplant recipients were grouped according to their pretransplantation BMIs: Group I (BMI<18.5 kg/m2; n=10); Group II (BMI 18.5-24.9 kg/m2; n=62); Group III (BMI 25.0-29.9 kg/m2; n=47); and Group IV (BMI>30.0 kg/m2; n=16). Excellent 1-year patient and graft survival rates were observed in all groups. Increased BMI was associated with increased hypertension and longer hospital stays. The incidence of acute rejection episodes, slow graft function, and delayed graft function, as well as the need for antithymocyte globulin Fresenius (ATG-F) rescue therapy were comparable between the 4 patient groups. The 1-year glomerular filtration rate was markedly different between the 4 patient groups. The 1-year posttransplantation glucose level was higher among obese patients compared with the other groups. A multivariate regression analysis confirmed the association of a higher 1-year GFR with obesity (BMI>30.0 kg/m2). Overweight and obese recipients showed excellent long-term patient and graft survival rates. Accordingly, denying patients renal transplantation because of obesity may not be justified.

Tacrolimus (FK506) versus cyclosporine microemulsion (neoral) as maintenance immunosuppression therapy in kidney transplant recipients.

The effects of the calcineurin inhibitors tacrolimus (FK506) and cyclosporine (Neoral) on graft survival, function, and metabolic profile were evaluated in 69 patients receiving Neoral (group 1) and 54 patients receiving FK506 (group 2) for maintenance immunosuppression following kidney transplantation. Recipient and donor demographics and induction therapy were comparable, except for a higher number of sensitized patients in group 2 (n = 13). Acute rejection timing, severity, and infection rates and types were similar in both groups. During hospitalization, at 6 months, and at 1 year following transplantation, no significant differences were noted between groups in fasting glucose, serum cholesterol levels, triglyceride levels, or need for insulin or antihypertensive therapy. Mean serum creatinine levels on discharge (1.42 mg/dL +/- 0.14 vs 1.68 mg/dL +/- 0.3), at 1 month (1.45 mg/dL +/- 0.1 vs 1.39 mg/dL +/- 0.11), 3 months (1.46 mg/dL +/- 0.09 vs 1.32 mg/dL +/- 0.14), and 1 year (1.29 mg/dL +/- 0.08 vs 1.19 mg/dL +/- 0.09), but not at 6 months (1.42 +/- 0.37 vs 1.10 +/- 0.07; P = .001), were comparable between groups. The 1-year patient and graft survival rates were 98.3% for group 1 and 94.5% for group 2. When evaluated for acute rejection, infection, and metabolic differences, we conclude that both tacrolimus and cyclosporine are effective and safe calcineurin inhibitors for short-term use in kidney transplantation. A similar study is proposed to evaluate the long-term effects of both agents.

Seroprevalence of hepatitis C virus and hepatitis B virus among dialysis patients in Bahrain and Saudi Arabia.

Dialysis patients are at risk for contracting blood-borne infections, including hepatitis viruses (HBV and HCV). The aim of this study was to assess the prevalence of HBV and HCV infection among hamodialysis patients in Bahrain and Saudi Arabia. Study subjects comprised 81 Bahraini and 34 Saudi dialysis patients, and as control 7714 Bahraini and 2330 Saudi blood donors. Serologic markers of HBV (HBsAg, anti-HBc) and HCV (anti-HCV) were determined by EIA and confirmed by PCR (HBV) and RT-PCR (HCV). Higher prevalence of HCV (9.240% vs 0.300%, P <.001), HBsAg (5.88% vs 0.620%; P <.001), but not anti-HBc (1.7% vs 4.6%; P =.01) were seen in patients compared to controls, respectively. When compared to Bahrainis, higher prevalence of HBsAg (11.8% vs 3.7%) and anti-HCV (14.7% vs 7.4%) were seen among Saudi patients, respectively. Double HCV infection was frequent, and the most prevalent types were HCV1a/1b plus HCV4 in Bahraini, and HCV 2/2a plus HCV 4 among Saudi dialysis patients. Our results are the first report on viral hepatitis among dialysis patients in Bahrain, and the first to compare HBV/HCV rates among dialysis patients in the Eastern Arabian peninsula, and confirms other results that documented increased HBV and HCV infection among dialysis patients. Future studies aimed at assessing the status and to monitor the progress of viral hepatitis infection among dialyzed and transfused patients will have a strong impact on patient diagnosis, follow-up, and treatment.

Distribution of HLA class II (DRB1/DQB1) alleles and haplotypes among Bahraini and Lebanese Arabs.

The genetic relationship between Bahraini and Lebanese Arabs in terms of HLA class II (DRB1 and DQB1) gene and haplotype frequencies was investigated in a group of 90 Lebanese and 52 Bahraini Arabs. Subjects of both sexes were unrelated and HLA-DRB1 and DQB1 genes were genotyped using the polymerase chain reaction-sequence specific primer (PCR-SSP) technique. Analysis of the HLA-DRB1 alleles showed that the DRB1*040101 and DRB1*110101 alleles were more common among Lebanese, whereas DRB1*030101, DRB1*130701/1327, and DRB1*160101 alleles were more common among Bahrainis. Similarly, of the 7 HLA-DQB1 alleles analyzed, the presence of DQB1*0201 was higher among Bahrainis, whereas DQB1*030101 was higher among Lebanese. The DRB1*160101-DQB1*050101 (23.08%) and DRB1*030101-DQB1*0201 (21.15%) haplotypes were more frequent among Bahrainis, while the DRB1*110101-DQB1*030101 (56.67%), DRB1*040101-DQB1*0302 (28.89%) and DRB1*040101/DQB1*030101 (25.56%) haplotypes were more frequent in Lebanese subjects. Our results underline significant differences between these two populations in HLA class II distribution, and provide basic information for further studies of MHC heterogeneity among Arab-speaking countries, and as a reference for further anthropologic studies.

Inhibition of cytokine production and cytokine-stimulated T-cell activation by FK506 (tacrolimus)1.

Insofar as it exerted its immunosuppressive effect by inhibiting cytokine expression, we assessed the effect of FK506 (Tacrolimus) on cytokine-stimulated T-cell activation. Human T cells, treated with FK506, or controls were stimulated with the mitogens PHA + PMA, Con A, and the "CD3-bypass" stimulation regimen, PMA + ionomycin. T-cell proliferation was quantitated by measuring the uptake of tritiated thymidine, and mRNA expression was assessed by RT-PCR. FK506, in a concentration-dependent fashion, inhibited T-cell proliferation and steady-state mRNA expression of IL-2 and IL-7; half-maximal suppression was obtained at 10(-7) to 5 x 10(-8) M. We tested whether FK506 antiproliferative effect could be overcome with exogenously reconstituted rIL-2 and/or rIL-7. Neither rIL-2 nor rlL-7, individually in conjunction with suboptimal concentrations of PHA or Con A, or in combination without any costimulus, was capable of abrogating FK506 antiproliferative effect, indicating that FK506 also acted by inhibiting cytokine-stimulated T-cell activation. To confirm this, T cells were treated with FK506 and stimulated by rIL-2 and rIL-7, individually in conjunction with suboptimal concentration of PHA and Con A. In addition, T cells were stimulated with rIL-2 and rIL-7 without any costimuli. FK506 inhibited T-cell activation stimulated by rIL-2 and by rIL-7, individually and in combination. This confirms that, in exerting its antiproliferative effect, FK506 acts at two levels, by inhibiting cytokine availability and by suppressing cytokine effect on target cells, and explains the beneficial effect of FK506 in attenuating ongoing immune responses.