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.
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.