Speciality
Spotlight

 




 

Urology


 

 




 Renal Transplant

    

  • TH Mathew, for the Tricontinental Mycophenolate Mofetil Renal Transplantation Study group (Queen Elizabeth Hosp, Woodville, South Australia):
    A blinded, long-term, randomized multicenter study of mycophenolate mofetil in cadaveric renal transplantation. Transplantation 65: 1450-1454, 1998.

         


    The effect of the new immunosuppressant drug mycophenolate mofetil (MMF) on acute renal allograft rejection was investigated in a prospective randomized, double-blind clinical trial at 21 transplant centres in Australia, Europe and Canada.

        


    MMF treated patients had a higher incidence of gastrointestinal, hematologic, infection, and malignant events.

        


    Whereas, MMF significantly reduced rejection episodes within the first 6 months, it did not improve survival at 3 years.

        


  • A Zaidi, M Schmoeckel, F Bhatti, et al (Univ of Cambridge, England; Imutran Ltd, Cambridge, England; Papworth Hosp., Cambridge, England):
    Life supporting pig-to-primate renal xenotransplatnation using genetically modified donors. Transplantation 65: 1584 – 1590, 1998.

         


    In this pig-to-primate transplant model, xenograft kidneys from human decay-accelerating factor transgenic pigs show prolonged survival. The experience includes no episodes of hyperacute rejection of transgenic kidneys which may also be protected against acute vascular rejection. The findings also demonstrate the basic physiologic compatibility between a pig and a non-human primate.

      

  • Barry
    D Kahan for the Rapamune US Study.




    Efficacy of sirolimus compared with
    azathioprine for reduction of acute renal allograft
    rejection: a randomized multicentre study.


    The
    Lancet, vol.356, July 15, 2000, PG.194-201

      

    Acute
    rejection episodes are an important clinical challenge
    in renal transplantation. Despite
    use of multidrug immunosuppressive regimens, 20-40% of
    recipients have these events, which increase health
    care costs and are an important risk factor for
    chronic allograft failure.

     

    Members of Rapamune US study group did a prospective
    multicentre, randomized double blind trial to
    investigate the impact of addition of sirolimus (rapamycin),
    compared with azathioprine to a ciclosporin and
    prednisone regimen. Sirolimus was used in the dose of 2mg or 5mg daily. 
    A total of 719 patients were studied.




      

    The rate of efficacy failure at 6 months was lower in
    the 2 sirolimus (rapamycin) groups than in the
    azathioprine group. Patients
    on sirolimus showed a delay in the time to first acute
    rejection episode, and decreased frequency of moderate
    and severe histological grades of rejection episodes
    compared with azathioprine group.
    Rates of infection and malignant disorders were
    similar in all groups.

     

    Interpretation of the study is that use of sirolimus
    reduced occurrence and severity of biopsy confirmed
    acute rejection episodes with no increase in
    complications. Further
    studies are needed to establish optimum doses for the
    combined regimen.




      

    Editors’ commentary:


     

     

    Kahan and colleagues found that patients with
    renal transplants on rapamycin plus ciclosporin had
    fewer episodes of acute rejection than did those on
    azathioprine and ciclosporin. However, impaired
    renal function, raised blood pressure, and
    hyperlipidaemia were commoner among patients in the
    rapamycin than in the azathioprine group. Each
    of these variables may reduce long-term survival of
    graft or patient. The
    increased susceptibility to nephrotoxicity and
    hypertension in the rapamycin groups seem to be due to
    a poorly understood interaction between rapamycin and
    ciclosporin that intensified the action of ciclosporin. This
    interaction also raises the possibility that some of
    the efficacy of rapamycin in the study may be
    attributable to enhancement of the effect of
    ciclosporin.




      

    Although Kahan and co-workers’ study shows the
    efficacy of the combination, the prevalence of the
    side-effects suggests that their protocol is not the
    best way of using rapamycin. A
    reduction in the dose of ciclosporin may help but the
    efficacy of this change would require evaluation.

  • Chin
    JL, Kloth D, Pautler SE, et al [ Univ of Western
    Ontario, London, Canada ]

    Renal Auto transplantation for the Loin Pain-Hematurla
    Syndrome : Long Term Follow-up of 26 cases


    J Urol 160: 1232-1236, 1998



    Introduction : – Patients with the loin pain-hematuria
    syndrome experience intractable flank and loin pain
    and have microscopic gross hematuria



    Diagnosis of this rare entity is by exclusion of
    urological and nephrological disease. Renal auto
    transplantation has provided pain relief in several
    small series with relatively short follow-up.



    Method – 22 of referred patient underwent 26 renal
    autotransplants for pain control.



    Results – 18 of 26 auto transplantation were
    classified as long term successes. These patients had
    pain relief and were able to return to their normal
    activities. One immediate technique failure needed
    post transplant nephrectomy. Another patient needed
    nephrectomy for post  transplant ishemia at 2
    months.



    Pain recurred in 6 patient within 1 year. 3 of these
    needed nephrectomy. 3 needed analgesia.



    Conclusion The result of the study atleast to
    success of renal autotransplantation in controlling
    the patient’s symptoms and preserving the renal units.



         

 



 

  

Speciality Spotlight

 

 
Urology
 

 

 Renal Transplant
    

  • TH Mathew, for the Tricontinental Mycophenolate Mofetil Renal Transplantation Study group (Queen Elizabeth Hosp, Woodville, South Australia): A blinded, long-term, randomized multicenter study of mycophenolate mofetil in cadaveric renal transplantation. Transplantation 65: 1450-1454, 1998.
         
    The effect of the new immunosuppressant drug mycophenolate mofetil (MMF) on acute renal allograft rejection was investigated in a prospective randomized, double-blind clinical trial at 21 transplant centres in Australia, Europe and Canada.
        
    MMF treated patients had a higher incidence of gastrointestinal, hematologic, infection, and malignant events.
        
    Whereas, MMF significantly reduced rejection episodes within the first 6 months, it did not improve survival at 3 years.
        

  • A Zaidi, M Schmoeckel, F Bhatti, et al (Univ of Cambridge, England; Imutran Ltd, Cambridge, England; Papworth Hosp., Cambridge, England): Life supporting pig-to-primate renal xenotransplatnation using genetically modified donors. Transplantation 65: 1584 – 1590, 1998.
         
    In this pig-to-primate transplant model, xenograft kidneys from human decay-accelerating factor transgenic pigs show prolonged survival. The experience includes no episodes of hyperacute rejection of transgenic kidneys which may also be protected against acute vascular rejection. The findings also demonstrate the basic physiologic compatibility between a pig and a non-human primate.
      

  • Barry D Kahan for the Rapamune US Study.


    Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomized multicentre study.
    The Lancet, vol.356, July 15, 2000, PG.194-201
      
    Acute rejection episodes are an important clinical challenge in renal transplantation. Despite use of multidrug immunosuppressive regimens, 20-40% of recipients have these events, which increase health care costs and are an important risk factor for chronic allograft failure.
     
    Members of Rapamune US study group did a prospective multicentre, randomized double blind trial to investigate the impact of addition of sirolimus (rapamycin), compared with azathioprine to a ciclosporin and prednisone regimen. Sirolimus was used in the dose of 2mg or 5mg daily.  A total of 719 patients were studied.


      
    The rate of efficacy failure at 6 months was lower in the 2 sirolimus (rapamycin) groups than in the azathioprine group. Patients on sirolimus showed a delay in the time to first acute rejection episode, and decreased frequency of moderate and severe histological grades of rejection episodes compared with azathioprine group. Rates of infection and malignant disorders were similar in all groups.
     
    Interpretation of the study is that use of sirolimus reduced occurrence and severity of biopsy confirmed acute rejection episodes with no increase in complications. Further studies are needed to establish optimum doses for the combined regimen.


      
    Editors’ commentary:

     

     
    Kahan and colleagues found that patients with renal transplants on rapamycin plus ciclosporin had fewer episodes of acute rejection than did those on azathioprine and ciclosporin. However, impaired renal function, raised blood pressure, and hyperlipidaemia were commoner among patients in the rapamycin than in the azathioprine group. Each of these variables may reduce long-term survival of graft or patient. The increased susceptibility to nephrotoxicity and hypertension in the rapamycin groups seem to be due to a poorly understood interaction between rapamycin and ciclosporin that intensified the action of ciclosporin. This interaction also raises the possibility that some of the efficacy of rapamycin in the study may be attributable to enhancement of the effect of ciclosporin.


      
    Although Kahan and co-workers’ study shows the efficacy of the combination, the prevalence of the side-effects suggests that their protocol is not the best way of using rapamycin. A reduction in the dose of ciclosporin may help but the efficacy of this change would require evaluation.

  • Chin JL, Kloth D, Pautler SE, et al [ Univ of Western Ontario, London, Canada ]
    Renal Auto transplantation for the Loin Pain-Hematurla Syndrome : Long Term Follow-up of 26 cases
    J Urol 160: 1232-1236, 1998

    Introduction : – Patients with the loin pain-hematuria syndrome experience intractable flank and loin pain and have microscopic gross hematuria

    Diagnosis of this rare entity is by exclusion of urological and nephrological disease. Renal auto transplantation has provided pain relief in several small series with relatively short follow-up.

    Method – 22 of referred patient underwent 26 renal autotransplants for pain control.

    Results – 18 of 26 auto transplantation were classified as long term successes. These patients had pain relief and were able to return to their normal activities. One immediate technique failure needed post transplant nephrectomy. Another patient needed nephrectomy for post  transplant ishemia at 2 months.

    Pain recurred in 6 patient within 1 year. 3 of these needed nephrectomy. 3 needed analgesia.

    Conclusion The result of the study atleast to success of renal autotransplantation in controlling the patient’s symptoms and preserving the renal units.

         

 

 

By |2022-07-20T16:42:34+00:00July 20, 2022|Uncategorized|Comments Off on Renal Transplant

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