RESUMO
AIMS: Effect of early steroid withdrawal protocol using basiliximab in kidney transplantation (KTx) on the clinical outcomes was investigated as compared with triple regimen. METHODS: Kidney transplant patients in group 1 (n = 62) were treated with 8 mg/kg of cyclosporine (CsA), 2000 mg of MMF, two bolus IV injections of 20 mg of basiliximab and 500 mg of methylprednisolone (MP) rapidly tapered and withdrawn at 14 postoperative days (POD). Group 2 (n = 56) was treated with same dose of CsA and MMF, and 250 mg of MP tapered and continued. Acute rejection (AR) episodes were treated with MP pulse therapy followed by muromonab CD3 (OKT3) in case of steroid-resistant rejection. RESULTS: In 46 of 62 cases (74.2%) in group 1, steroid was successfully withdrawn at 13.7 +/- 1.7 POD. Graft survival at 3, 6, and 12 months in group 1 was 100%, 100%, and 98.4% (one death with functioning graft), and 100%, 98.2%, and 96.4% in group 2, respectively. The incidence of AR was 12.9% for group 1 and 42.9% for group 2, among which 21 cases in group 2 were treated with ALG or OKT3; no patient needed ALG or OKT3 in group 1. Fifteen cases in group 1 and 13 cases in group 2 developed CMV antigenemia, among which febrile episode was exhibited in 3 cases (4.8%) in group 1 and 5 cases (8.9%) in group 2. CONCLUSIONS: Early steroid withdrawal protocol using basiliximab is promising for reducing the incidence of AR (especially steroid-resistant rejection), CMV diseases, and steroid-related complications.
Assuntos
Corticosteroides/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Proteínas Recombinantes de Fusão/uso terapêutico , Corticosteroides/administração & dosagem , Adulto , Basiliximab , Cadáver , Calcineurina/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Falência Renal Crônica/cirurgia , Doadores Vivos , Masculino , Muromonab-CD3/uso terapêutico , Ácido Micofenólico/uso terapêutico , Doadores de Tecidos , Resultado do TratamentoAssuntos
Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Proteínas Recombinantes de Fusão/uso terapêutico , Corticosteroides/administração & dosagem , Basiliximab , Cadáver , Infecções por Citomegalovirus/epidemiologia , Citotoxicidade Imunológica/efeitos dos fármacos , Citotoxicidade Imunológica/imunologia , Esquema de Medicação , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/imunologia , Teste de Histocompatibilidade , Humanos , Falência Renal Crônica/cirurgia , Doadores Vivos , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Doadores de TecidosAssuntos
Encefalopatias/induzido quimicamente , Doenças Desmielinizantes/induzido quimicamente , Imunossupressores/efeitos adversos , Transplante de Fígado/imunologia , Tacrolimo/efeitos adversos , Adulto , Azatioprina/uso terapêutico , Encefalopatias/diagnóstico , Encefalopatias/diagnóstico por imagem , Ciclosporina/uso terapêutico , Doenças Desmielinizantes/diagnóstico , Doenças Desmielinizantes/diagnóstico por imagem , Quimioterapia Combinada , Família , Feminino , Humanos , Imunossupressores/uso terapêutico , Doadores Vivos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Síndrome , Tomografia Computadorizada por Raios XAssuntos
Ciclosporinas/toxicidade , Ilhotas Pancreáticas/patologia , Manose/análogos & derivados , para-Aminobenzoatos , Ácido 4-Aminobenzoico/farmacologia , Animais , Imunofluorescência , Ilhotas Pancreáticas/efeitos dos fármacos , Ilhotas Pancreáticas/ultraestrutura , Manose/farmacologia , Ratos , Ratos Endogâmicos , Valores de ReferênciaAssuntos
Ácido 4-Aminobenzoico/farmacologia , Aminobenzoatos/farmacologia , Ciclosporinas/farmacologia , Rim/fisiologia , Manose/análogos & derivados , Prostaglandinas/metabolismo , Circulação Renal/efeitos dos fármacos , Animais , Ciclosporinas/farmacocinética , Ciclosporinas/toxicidade , Rim/efeitos dos fármacos , Rim/patologia , Masculino , Manose/farmacologia , Ratos , Ratos Endogâmicos , Valores de Referência , Distribuição Tecidual , para-AminobenzoatosAssuntos
Ácido 4-Aminobenzoico/uso terapêutico , Aminobenzoatos/uso terapêutico , Ciclosporinas/toxicidade , Ilhotas Pancreáticas/efeitos dos fármacos , Manose/análogos & derivados , Animais , Peso Corporal/efeitos dos fármacos , Ciclosporinas/análise , Ciclosporinas/farmacocinética , Teste de Tolerância a Glucose , Insulina/sangue , Ilhotas Pancreáticas/patologia , Ilhotas Pancreáticas/ultraestrutura , Masculino , Manose/uso terapêutico , Extratos Pancreáticos/análise , Prostaglandinas/análise , Ratos , Ratos Endogâmicos , Distribuição Tecidual , para-AminobenzoatosRESUMO
Change in the electrical charge of leukocyte surface membranes during hemodialysis (HD) using a cellulose membrane was studied by examining adsorbability of leukocytes taken from patients undergoing HD to cation and anion exchange resins. Leukocytes of HD patients were well adsorbed to both anion and cation exchange resins, whereas normal leukocytes were only minimally adsorbed to a cation exchange resin, suggesting that the surface membranes of normal leukocytes were charged electronegatively. Adsorbability to anion exchange resin by patients' leukocytes taken from the venous limb of the HD circuit line 15 minutes after starting HD was significantly decreased when using a cellulosic membrane. This suggests that the decrease in electronegative leukocyte surface membrane charge, which may facilitate the attachment of leukocytes to electronegatively charged endothelial cell membranes, is the factor leading to leukopenia. Adsorbability to anion exchange resin by normal leukocytes incubated with plasma taken from HD patients 10 to 60 minutes after starting HD was increased, suggesting an increase in electronegatively charged substances in patients' plasma; these recombine with leukocyte surface membranes thereby increasing the electronegative charges of the leukocyte surface membranes and enabling subsequent release of leukocytes from endothelial cells, consistent with the transient nature of the leukopenia.
Assuntos
Resinas de Troca Aniônica , Resinas de Troca Iônica , Leucócitos/fisiologia , Leucopenia/fisiopatologia , Diálise Renal , Adsorção , Resinas de Troca de Cátion , Membrana Celular/fisiologia , Eletrofisiologia , Humanos , Leucopenia/etiologia , Membranas Artificiais , Diálise Renal/efeitos adversosRESUMO
Forty-eight hour hypothermic continuous perfusion preservation was attempted using a perfusion technique with an artificial blood substitute, a pyridoxylated hemoglobin-polyoxyethylene conjugated solution (stabilized hemoglobin, PHP). After preservation each of the 10 canine livers was orthotopically transplanted. Postoperative graft function was estimated by parameters such as activated clotting time (ACT), bile excretion, consciousness level, survival period, histologic findings, and adenosine triphosphoric acid (ATP) content of the perfused liver. Four of ten livers displayed good function, with bile excreted immediately after revascularization, and animal survival for over 24 hr. Cellular structure of the liver was well maintained, although atrophy of the hepatocytes and swelling of the mitochondria were seen. PHP solution is therefore considered suitable as a perfusate for long-term liver preservation.