Survival Rate Of Transplant Patients Research Articles

Experimental study of renal toxicity of cyclosporine and the ameliorative effect of N-acetylecysteine in albino rat

Introduction: Cyclosporine A (CsA) is considered powerful immunosuppressive drug which has improved the quality of life and survival rate of transplant patients and also used in autoimmune diseases. However, its use is limited by many side effects mainly nephrotoxicity. NAC is an antioxidant found to reduce CsA toxicity. Aim of the work: The study aims to determine the effect of exposure to cyclosporine on the kidney and to investigate the protective role of NAC. Methods: the study conducted on 50 adult male albino rats for 4 weeks, divided into 5 groups, group A the negative control group, group B the olive oil group (0.5 ml/d orally), group C the cyclosporine group (25mg/kg/d orally), group D the NAC group (600mg/kg/d orally) and group E the cyclosporine+NAC group. At the end of the study the evaluation was done by biochemical analysis and histopathology. Results: cyclosporine significantly affects the kidney by morphological changes in the form of dilatation of urinary space with congestion and lobulation of glomerullar capillaries in the renal corpusle. Proximal convoluted tubules showed degeneration of their cells with irregularity and destruction of brush border. Degeneration of distal convoluted tubules with exfoliation of some cells inside the lumen and the peritubular capillaries were congested and extravasated. Also cyclosporine affects the kidney by increasing serum urea and creatinine levels, while coadministration of NAC with cyclosporine attenuate its effects. Conclusion: cyclosporine causes renal injury through oxidative stress and NAC as an antioxidant attenuates but not fully protect against cyclosporine induced injuries.

Lung bioengineering: advances and challenges in lung decellularization and recellularization.

Bioengineering the lung based on its natural extracellular matrix (ECM) offers novel opportunities to overcome the shortage of donors, to reduce chronic allograft rejections, and to improve the median survival rate of transplanted patients. During the last decade, lung tissue engineering has advanced rapidly to combine scaffolds, cells, and biologically active molecules into functional tissues to restore or improve the lung's main function, gas exchange. This review will inspect the current progress in lung bioengineering using decellularized and recellularized lung scaffolds and highlight future challenges in the field. Lung decellularization and recellularization protocols have provided researchers with tools to progress toward functional lung tissue engineering. However, there is continuous evolution and refinement particularly for optimization of lung recellularization. These further the possibility of developing a transplantable bioartificial lung. Bioengineering the lung using recellularized scaffolds could offer a curative option for patients with end-stage organ failure but its accomplishment remains unclear in the short-term. However, the state-of-the-art of techniques described in this review will increase our knowledge of the lung ECM and of chemical and mechanical cues which drive cell repopulation to improve the advances in lung regeneration and lung tissue engineering.

Influence of Proton Pump Inhibitors on Mycophenolic Acid Pharmacokinetics in Patients With Renal Transplantation and the Relationship With Cytochrome 2C19 Gene Polymorphism

BackgroundMost patients have serious digestive complications after renal transplantation. Therefore, it is important to protect gastrointestinal function to improve the survival rate of transplant patients. Proton pump inhibitors (PPIs) such as lansoprazole and rabeprazole are widely administered to renal transplant patients with mycophenolic acid (MPA) in the perioperative period. PPIs are metabolized by cytochrome (CYP) 2C19 enzymes. Mycophenolate sodium (MYF) and mycophenolate mofetil (MMF) have been used in immunosuppression. Clinically relevant drug-drug interactions have been described between immunosuppressive drugs. In the present study, we investigated the drug interaction between MPA and lansoparazole or rabeprazole and the impact of CYP2C19 polymorphisms on these drug interactions after renal transplantation. Materials and MethodsA total of 125 renal transplant patients taking MPA derivatives between 2012 and 2016 were included in this study. The 125 patients were divided into 6 groups: MMF/tacrolimus/steroid together with lansoprazole or rabeprazole; MYF/tacrolimus/steroid together with lansoprazole or rabeprazole and without PPI. The single nucleotide polymorphisms of CYP2C19 were determined by the polymerase chain reaction-restriction fragment length polymorphism. Plasma concentrations of MPA were measured by cloned enzyme donor immunoassay. Clinical parameters such as incidence of delayed graft function and acute rejection, the rate of change of serum creatinine, toxicity, and gastrointestinal adverse effects were analyzed retrospectively. ResultsThe mean concentrations of MPA in the MYF group were higher than those in the MMF group. The mean dose-adjusted blood concentration of MPA coadministered with lansoprazole was lower than that of MPA with rabeprazole or without PPI in MMF and MYF groups (P < .05). In patients with the CYP2C19*2/*2 genotype, the mean concentrations of MMF with lansoprazole were significantly lower than those with rabeprazole with MMF or without PPI (P < .05). Gastrointestinal side effects were significantly higher in MMF with lansoprazole group than in MYF with lansoprazole group (P < .05). However, no differences were found according to genotype distribution in all groups (P > .05). ConclusionPolymorphisms in CYP2C19 are related to the metabolic oxidation of drugs to varying degrees. Both genetic and clinical factors in pharmacokinetics may help to make further progress toward individualized therapy to yield maximum efficacy with minimal side effects.

Effect of cyclosporine A on the structure of adult albino rat testis and the role of lycopene supplementation

IntroductionCyclosporine A (CsA) has improved the quality of life and survival rate of transplant patients. However, the oxidative stress induced by CsA limits its use as it causes side effects in different organs. Lycopene is an antioxidant found in tomatoes, water melon, and pink guava.Aim of the

Immunsuppression nach Nierentransplantation – Calcineurininhibitoren sind die Basis der aktuellen Therapie

During the past few decades, renal transplantation became the therapy of choice for patients with terminal renal insufficiency. The success of this procedure is based on the continuous advance of immunosuppressives. A milestone of this progress has been the introduction of calcineurin inhibitors which have significantly increased the survival rate of transplant patients by the calcineurin inhibitors' capacity to considerably reduce rejection. Hence, they form the basis of present therapy regimes after renal transplantations. Numerous clinical studies have been aiming at comparing the effectivity of calcineurin inhibitors as immunosuppressives after renal transplantations. Overall, both agents are comparable regarding their effectivity, but they show a different profile of adverse reactions. Current research efforts focus on dose-reduced or calcineurin-inhibitor-free therapy regimes in order to optimize long-term transplant survival.

Liver transplantation in 48 patients with fulminant hepatic failure

Fulminant hepatic failure (FHF) is the most dramatic hepatic disease and is associated with high mortality. Urgent liver transplantation (LT) is the treatment of choice for these patients. From January 2002 to November 2008, 86 patients presented to the hospital with FHF. All patients met the King's College criteria at the time of listing for urgent LT. Drug hepatotoxicity was the most common etiology, affecting 37% of the patients. Methyldopa was the most frequent agent. Thirty-five percent of the patients had cryptogenic FHF, and 14% due to acute hepatitis B virus infection. From 86 patients with FHF, 48 were submitted to LT (36 women and 12 men). During this period there were 181 patients submitted to nonurgent LT. The mean time interval between listing and LT was 2.2 days. MELD scores ranged between 26 and 61 by the time of LT (mean, 41). Patients' median age was 37 years (range, 16 to 70). According to the Briceno score, 75% of hepatic grafts were retrieved from extended criteria donors. Donors were 40 years old or more in 54% of the cases (mean age of 41 years). The 1-year patient actuarial survival rate of transplanted patients with FHF was 57.1% and the 3-year actuarial survival rate was 54.1%. Forty-two percent of the patients died early after the transplant. The main cause of early mortality was sepsis/multisystem organ failure, and late mortality was related to immunosuppressive therapy noncompliance. The mean patient follow-up was 16 months (range, 0 to 57). Another 36 patients with FHF referred to us died while awaiting LT. Only one patient survived without LT. In conclusion, despite the high mortality rate, urgent LT is still the best therapy for patients with FHF.

Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

We investigated the survival rate of Danish diabetic patients with end-stage renal disease (ESRD) between 1990 and 2005 and evaluated possible predictors of survival rate. Data were obtained from the Danish National Register on Dialysis and Transplantation and from the Scandiatransplant database. Survival rates in different patient groups and association with age, sex, calendar time, waiting-list status and renal transplantation were evaluated using a multivariate Cox regression model. During the study period 8,421 patients (13% type 1 diabetic, 9% type 2 diabetic and 78% non-diabetic) started renal replacement therapy. The overall survival rate improved by 15% per five calendar years (hazard ratio [HR]=0.85, 95% CI: 0.81-0.88). The percentage of patients within each group who received renal transplantation was: type 1 diabetic: 26%, type 2 diabetic: 5%, non-diabetic: 24%. The survival rate of transplanted patients with diabetes mellitus (types 1 and 2) compared with non-diabetic patients at 1 year was: 95 vs 93%, at 5 years: 80 vs 85% and at 10 years: 52 vs 71%. Among diabetic patients survival rate was better in transplanted than in waiting-list patients (HR = 0.21, 95% CI 0.13-0.34), whereas the survival rate in waiting-list patients seemed to be superior to the survival rate among non-transplantation candidates (HR = 0.75, 95% CI 0.53-0.1.02, p = 0.07). The survival rate of diabetic patients with ESRD has improved during the last 15 years. Although some selection bias may exist, significantly improved survival rate was observed among transplanted patients compared with dialysis patients on the waiting-list for transplantation. Renal transplantation should therefore be offered to diabetic patients with ESRD whenever possible.

Medical perspectives of adults and embryonic stem cells

In the last 30 years, allogeneic bone marrow transplantation has become the treatment of choice for many hematologic malignancies or inherited disorders and a number of changes have been registered in terms of long-term survival rate of transplanted patients as well as of available sources of hematopoietic stem cell (HSC). In parallel to the publication of better results in HSC transplantation, several recent discoveries have opened a scientific and ethical debate on the therapeutical potential of stem cells isolated from adult or embryonic tissues. One of the major discoveries in this field is the capacity of bone marrow-derived stem cells to treat a genetic liver disease in a mouse model, thus justifying the concept of transdifferentiation of adult stem cell and raising hopes on its possible therapeutical applications. We have tried here to summarise the advances in this field and to discuss the limits of these biological data.

Predictive value of thallium stress testing for coronary and cardiovascular events in uremic diabetic patients before renal transplantation

Coronary artery disease and the ability of noninvasive exercise perfusion imaging with thalium-201 to predict future coronary and cardiovascular events was prospectively evaluated in a group of 85 insulin-dependent diabetic renal transplantation candidates. Sixty patients received renal allografts (36 living related donors, 24 cadaver donors) after a thallium stress test; the actuarial 2 year patient survival rate after transplantation was 84 percent. Twenty-five patients remained on dialysis, and the 2 year actuarial survival rate from onset of dialysis was 41 percent, significantly lower than the actuarial survival rate of transplanted patients (p < 0.01). Thirteen transplanted patients had positive thallium stress test results, and 6 (46 percent) had cardiovascular events (two fatal). In contrast, of 47 transplant patients with negative thallium stress test results, only 13 (28 percent) had cardiovascular events (four fatal). Five patients treated by hemodialysis only had positive test results and three (60 percent) had cardiovascular events (two fatal), whereas of 20 hemodialysis patients with negative test results, 9 (45 percent) suffered cardiovascular events (four fatal). In this study, cardiovascular events included arrhythmia, stroke, and pulmonary embolism. Within the total group, 4 of 18 patients (22 percent) with a positive test result (22 percent) had a fatal myocardial infarction, whereas only 3 of 67 patients (4 percent) with a negative result had a fatal myocardial infarction (p < 0.05). In comparison, 24 of 85 patients had a history or electrocardiographic evidence of preexisting cardiovascular disease, and 13 (54 percent) had subsequent cardiovascular events (5 of 11 patients with positive test results and 8 of 13 patients with negative results). In summary, renal transplant candidates with positive thallium stress test results appear to be at increased risk compared with those with negative results for the development of fatal myocardial infarction, but thallium stress testing is no more predictive for future coronary and cardiovascular events than is a history or an abnormal electrocardiogram.