Days Of Induction Therapy Research Articles

LIVING UNRELATED DONORS IN KIDNEY TRANSPLANTS: BETTER LONG-TERM RESULTS THAN NON-HLA IDENTICAL LIVING RELATED DONORS?

431 Given the severe organ shortage and the documented superior results with living vs. cadaver donor kidney transplants, we have adopted a very aggressive policy for the use of living donors. Currently, we make thorough attempts to locate a living related (LRD) or living unrelated (LURD) donor before proceeding with a cadaver transplant. We compared the results of our LURD vs. LRD transplants to determine if there was any significant difference in outcome. Between 1/1/84 and 6/30/98, 711 adult kidney transplants with non-HLA identical living donors were performed. Of these, 595 were with LRDs and 116 with LURDs. Immunosuppression for both groups was cyclosporine-based, though LURD recipients received 5 to 7 days of induction therapy (ALG or ATG) while LRD recipients did not. Demographic characteristics are shown in the table. LURD recipients tended to be older, to have inferior matching, and to have older donors vs. LRD (all factors potentially associated with decreased graft survival). Short-term results, including initial graft function and incidence of acute rejection, were no different between the two groups. LURD recipients had a slightly higher incidence of CMV disease (p=ns). We found no difference in patient and graft survival rates. However, the incidence of biopsy-proven chronic rejection (CR) was significantly lower in LURD recipients (p=0.05) (graph). The exact reason for this is unknown; one possibility is that LURD recipients may have better compliance rates vs. LRD recipients (12 of the 595 LRD grafts have been lost after recipients discontinued immunosuppression vs. 2 of LURD grafts). (Figure)TableFigureConclusion: Although LURD transplants have poorer matching and older donor age, patient and graft survival rates are equivalent to non-HLA identical LRD transplants. The incidence of biopsy-proven CR is lower in LURD transplants. Given this finding and the superior results of living donor vs. cadaver transplants, a thorough search should be made for a living donor (LRD or LURD) before placing a potential recipient on the cadaver waiting list.

A prospective randomized trial comparing the efficacy of tacrolimus versus cyclosporine in black recipients of primary cadaveric renal transplants

BACKGROUND: We performed a prospective randomized trial to compare the efficacy and safety of tacrolimus (FK506) versus cyclosporine (CSA) in black primary cadaveric renal transplant (CRT) recipients. METHODS: Between December 1994 and February 1997, 35 black primary CRT recipients were enrolled in this trial. All patients received 7 days of induction therapy with OKT3. Fourteen patients received FK506 and prednisone only. Twenty-one patients received CSA, azathioprine, and prednisone. The two groups were comparable in terms of age, gender, plasma renin activity, human leukocyte antigen mismatches, and cause of renal failure. RESULTS: Patient and graft survival were 12 of 14 (86%) for the FK506 group and 20 of 21 (95%) for the CSA group ( P = 0.71). Three patients died owing to cardiac events with functioning grafts. Acute rejection was 2 of 14 (14%) for the FK506 and 8 of 21 (38%) for the CSA group ( P = 0.25). Two other patients on CSA were converted to FK506 as rescue for OKT3-resistant rejection. Mean serum cholesterol at 1 year was 198 ± 45 mg/dL for the FK506 group and 244 ± 49 mg/dL for the CSA group ( P = 0.03). Mean serum creatinine at 1 year was 1.39 ± 0.38 mg/dL for the FK506 group and 1.94 ± 0.64 mg/dL for the CSA group ( P = 0.02). CONCLUSION: Patient and graft survival were similar in both groups at 1 year posttransplant. Although statistically not significant, the incidence of acute rejection was lower in the FK506 group. Furthermore, FK506-treated patients had significantly lower serum creatinine and cholesterol levels at 1 year posttransplant.

Initial Electroencephalographic Findings in Children with Acute Lymphoblastic Leukaemia

Electroencephalography (EEG) was performed on 66 children with acute lymphoblastic leukaemia, 45 before treatment and 21 during the first 5 days of chemotherapy. The patients, aged 7 months to 16 years, 33 boys and 33 girls, had been admitted to the Department of Paediatrics, University of Oulu, between March 1976 and January 1987. The EEG findings were compared with those in 66 age and sex-matched control children chosen at random from the local population. The patients had significantly more frequent and more severe disturbances in background activity (p less than 0.001) than the controls and increased slow waves in the occipital (p less than 0.001) and temporal regions (p less than 0.01). The patients who had received chemotherapy before the EEG recording had EEG disturbances significantly more frequently than the other patients (p less than 0.01), but the latter still had EEG abnormalities significantly more frequently than their matched controls, although they did not have severe changes (grade 3). The results suggest that chemotherapy increases EEG changes during the early days of induction therapy and possibly induces long-term disturbances in brain function. The associations between EEG changes and clinical findings were also analysed and the results show that a long duration of leukaemic symptoms or an aggressive disease may lead to EEG abnormalities.